By Michael Couture, Esq.
Multiple Sclerosis (commonly referred to as MS) is a disease where the body’s own immune system attacks the nervous system. This damage to the nervous system causes an array of symptoms, such as numbness, blindness, coordination problems, and even paralysis. MS can also have psychological effects, such as depression, mood swings, and irritability. The symptoms vary with each individual suffering from MS.
Multiple Sclerosis can be a frightening prognosis for several reasons, none more important than the health of the individual with MS. Additional causes for concern are maintaining job security and health care. It is important for a recently diagnosed individual to maintain employment, remain insured, and to continue to provide for his or her family for as long as possible. Thankfully, the government has passed legislation that protects and provides for the disabled, such as the Americans with Disabilities Act (ADA), Social Security, Medicare, and Medicaid.
Anyone with MS should understand whether they are protected under the ADA, and if so, know their rights and obligations regarding their current employment. The ADA specifically addresses several disability/employment issues, such as when to disclose the disability to the employer, what information must be disclosed to the employer, confidentiality between the employer and the disabled employee, and the employer’s duty to accommodate individuals with the disability. One thing to remember is that an employer cannot discriminate against an employee with a disability under the ADA so long as that disability does not impair the employee’s capacity to perform his or her specific work related functions.
If an individual with MS is unemployed, the individual may be eligible for SSDI or SSI under the Social Security Administration (SSA). SSDI provides a monthly benefit for the disabled with a work history, whereas SSI provides a monthly benefit for the disabled without a work history. SSDI is an insurance program, and there is no asset limitation on those seeking SSDI eligibility. SSI, however, is a needs-based program, and it has strict financial limitations for those seeking eligibility. Regardless of the program, the individual must demonstrate a disability to the Administration that prevents him or her from maintaining substantial gainful activity (SGA). MS is listed as a recognized impairment in the SSA, but applicants with MS must still demonstrate that the symptoms of their MS prevent them from SGA.
Some individuals with MS suffer from “flares,” which are periodic outbreaks of symptoms. Because of these flares, it may be challenging to prove a disability because an individual may appear healthy at times, such as in front of a physician or a judge, when in reality, the disease has severely reduced the individual’s functional capacity. Unfortunately many applicants are denied their first time applying for either SSDI or SSI. Careful preparation, such as thorough documentation of symptoms and obtaining a physician who understands MS and its effects on one’s ability to maintain employment, can achieve beneficial results with the SSA.
Another crucial issue with those suffering from MS is obtaining and maintaining health insurance. If an individual with MS loses his or her employment and health insurance, Medicare coverage may be an option. Medicare is a federal public health insurance plan for seniors and the disabled. An individual is automatically enrolled in Medicare if they are under sixty-five and are receiving SS benefits for twenty-four months or they receive SS benefits when they reach age sixty-five.
Medicare is broken down into parts A, B, C, and D. Medicare can provide an array of services, such as services that are medically necessary for treatment and rehabilitation of an illness. Physical therapy and home health benefits also fall under Medicare. Prescription drugs are also covered with co-pays and deductibles under Medicare Part D. Nursing home care, however, is not covered unless it falls under Medicare’s 100 days of rehabilitation in a skilled nursing facility.
Medicaid is another insurance program that may provide additional services with those with MS. However, Medicaid is a welfare program and is only available to those who meet its strict financial guidelines. It is important to note that those receiving SSI automatically receive Medicaid in many states, including Massachusetts. Medicaid covers many services that Medicare does not, such as long-term care in a skilled nursing facility.
Eligibility for and retention of government benefits can be a complex task, and lack of proper analysis and legal representation may jeopardize eligibility, causing delay or denial of benefits. The Attorneys at Moschella & Winston specialize in the field of public benefits and entitlement programs. We can assist with the intricate planning, application, and appeal procedures necessary to receive government benefits. Please contact info@moschellawinston.com or call (617) 776-3300 for an initial consultation.
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Moschella & Winston has specialized in legal planning and protection for individuals and families for over 30 years, and our attorneys are experts in elder, disability and special needs law. Please contact us at info@moschellawinston.com or (617) 776-3300.
