Transition Care: The Basics Transition care is defined as the care of individuals as they move from childhood into adulthood and occurs in multiple settings; for example, from Transition from pediatric to adult school to work and from pediatric to adult healthcare. The overall goal care is a process of transition is to improve a persons success in multiple facets of life such as and oftentimes working, living independently, and community living1. Transitioning is an includes a team of providers active process that focuses on the medical, psychosocial, and including: educational/vocational needs of adolescents and may involve multiple parties • Patient - including physicians, caregivers, the school system and possibly the legal • Family system2. It also involves giving the teen increased responsibilities in • School decision making, self-care and medical management. system • Physician • Social Transition medicine is the deliberate, coordinated process of moving a worker patient from pediatric-oriented health care to adult-oriented health care with • Legal the goal of optimizing the young adult’s ability to assume adult roles and system function3 Transition involves Medical transition involves multiple steps including: coordinated • Transfer of care from pediatric physicians to adult providers planning for changes in • Access to continuous health insurance coverage various areas • Acquisition of knowledge and skills to manage medical conditions including living, vocation and • Connecting to appropriate adult community resources health care. Transitioning is oftentimes difficult and medical conditions can make it even harder, but well-planned health transition facilitates transition in other areas like work, community, and school). Transition is an individualized process and occurs as different rate for every individual and family. Because of this, it is never to early to start thinking about the transition from the pediatric to the adult arenas21 http://www.illinoisworknet.com/vos_portal/Disabilities/en/Home/Youth/2 Transition from child-centered to adult health-care systems for adolescent with chronic conditions. A position paper ofthe Society for Adolescent Medicine. J Adolesc Health. 1993; 14:570-576.3 A Consensus Statement On Health Care Transitions For Young Adults With Special Health Care Needs. AmericanAcademy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society ofInternal Medicine, 2002.
Transition Care: Portable Medical Documents A portable medicalA portable medical document is a summary of a patient’s medical document is anhistory and may include medications, allergies, past hospitalizations, abbreviated record thatsurgeries, laboratory tests and radiology studies. It is important to will help a new physicianknow about your medical problems – especially if you are about to get to know you and yourtransition to a new physician. A portable medical document is a medical problems.document that you can carry with you to physicians’ visits as well asto ER visits or hospital stays. Your portable medical record may be Helpful examples can beon paper or electronic. It will help a new provider learn about you found in the followingand your medical conditions efficiently. websites:What are the parts of a portable medical document? • Basic information: 1. Name, date of birth, address, phone number. Free online records: 2. Guardian, emergency contact. http://www.google.com/int 3. Primary care physician, address, phone number. l/en-US/health/about/ 4. Insurance. Includes insurance type and policy number http://www.healthvault.co m/personal/index.aspx • Health conditions: 1. Name of your conditions and brief summary of your conditions. 2. Health care providers who help to care for these Online examples: conditions – for example, a cardiologist may help care http://www.syntiro.org/hrt for a heart problem. w/tools/pdfs/HRTW- 3. Past hospitalizations and surgeries. TOOL-Template-Portable- 4. Current medication list Medical-Summary-July- Includes medication name, dosage and how 2007.pdf often medication is taken throughout the day. May include past medications and why you http://www.medicalhomein stopped them fo.org/for_families/care_no 5. Current allergies. tebook/care_notebook.aspx 6. Immunization history. 7. Recent laboratory values. http://www.syntiro.org/hrt 8. Recent imaging studies. w/tools/pdfs/CP6SHC_Tra nsition_Summary.pdf • Services: 1. Assessment of cognitive and physical disabilities. 2. Services (for example, PT/OT) and where you are receiving them. • Transition specific issues: as you get closer to adulthood, you will want to identify adult health care providers. If you have identified them, you should include them in your portable medical summary
• Your medical summary may also include hospital discharge summaries, surgical reports, consult evaluations (for example, most recent PT evaluation, cardiology evaluation) as well as laboratory and imaging tests.
For more information: http://www.ssa.gov/ssi/ For more information: http://www.ssa.gov/ssi/ http://www.ssa.gov/dibplan/indexTransition Income Supports: http://www.ssa.gov/dibplan/index.htmSSI and SSDI 1-800-772-1213Supplemental Security Income (SSI) and Social Security Disability 1-800-772-1213 SSA office Locate localIncome (SSDI) provide income to disabled persons who meet theSocial Security definition of disability and income requirements. Locate local SSAto Apply: Three Ways officeBoth use the same definition of disability, but the amount of For SSDI Adults only, apply onlinebenefit paid is different. SSDI is based upon payroll taxes if a Three Ways to Apply: atperson has a strong work history; SSI is based upon a fixed For SSDI Adults only, apply online https://s044a90.ssa.gov/apps6z/amount if a person is low income or lacks a strong work history. at https://s044a90.ssa.gov/apps6z/ISBA/WHO does this apply to? Call the toll free number for either • Childhood SSI/SSDI recipients an in office appointment or a Call thetelephone appointment toll free number for either • Adults with disabilities (18yo and over) who did not an in 1-800-772-1213 or or a office appointment • receive childhood SSI due to family income levels telephone appointment TTY 1-800-325-0778 • Individuals who were found disabled before age 22 and 1-800-772-1213 or TTYLocate local SSA office. See 1-800-325-0778 became eligible to receive SSDI benefits due to a parent’s disability, retirement for which they are office locator at local SSA office. See Locate https://s044a90.ssa.gov/apps6z/ receiving SSA retirement benefits or death office locator at https://s044a90.ssa.gov/apps6z/FOLOAfter Age 18 Before applying, consider obtainingChildren already receiving SSI or SSDI will have a review the following documents:(“Redtermination”) when he or she turns age 18. They will use Before Copies of consider obtaining applying, IEPsthe adult disability rules to decide whether they meet disability the following documents: School reportsand income requirements as an adult. Because of the different Copies of IEPs support from vocational Letters ofdefinitions of disability for children and adults, a child receiving School coordinators, teachers physicians reports Letters of support from vocationalbenefits is not guaranteed to continue receive benefits as an coordinators, teachers physiciansadult. Remember: first applications areIf an individual was not eligible for SSI before his or her 18th often denied. It is important tobirthday because parent’s income being too high, he or she may Remember: first applications are follow up on the SSA appealbecome eligible for SSI at age 18 and should apply as an adult. often process. It is important to denied. follow up on the SSA appealWhen children are evaluated for a disability, SSA compares how process. receive a denial of the initial If youthat child is developing compared to their peers. However, application, appeal the decision withinwhen an individual turns 18 year old, SSA considers whether or If you60 days a denial of the initialonline or receive by filing and appealnot an individual can enter the work force in a substantial application, appeal the decision recipients, by phone. For childhood withinmanner without needing special accommodations. If SSA finds 60 days by filing and10 days online or appeal within appeal to continue receiving SSI checks. by phone. For childhood recipients,that someone’s impairments prevent them from substantial appeal within 10 days to continuegainful activity (i.e. earning more than $1010 per month in receiving SSI checks.2012), then the individual will be found disabled as an adult.SSA has a specific listing that defines what is “disabled” for mostillnesses and conditions, and requires you to show functionallimitations to your ability to work.
Social Security Disability Insurance (SSDI): SSDI is available only to adults who have held a job in thepast, or who are eligible to collect disability benefits under a parent’s past work record. If the adultdoes not have a work history but one parent does, the individual may be eligible for SSDI if: 1. The individual’s disability is documented as having begun before the age of 22 AND 2. The parent is 1) Retired, 2) Disabled themselves, or 3)Deceased Childhood Disability Beneficiary (CDB) = a disabled adult receiving SSI can move to receiving SSDI, which is a better benefit.Health Insurance Impact • After receiving SSDI for 24 months, adult child also becomes eligible for Medicare (better than Medicaid eligibility under SSI) New income from SSDI is exempt for Medicaid asset requirementsThese benefits are also payable to an adult who received dependents benefits on a parent’s SocialSecurity earnings record prior to age 18, if he or she is disabled at age 18. The disability decision usingthe disability rules for adults. SSDI continues as long as the individual remains disabled. Your child doesnot need to have worked to get these benefits.Supplemental Security Income (SSI):If a disabled adult does not receive benefits under SSDI, they should consider eligibility for theSupplemental Security Income (SSI). SSI is a federal income supplement program designed to helpelderly (age greater than 65), blind or disable people who have limited income or resources. It providesmonies to help meet basic needs for food, clothing and shelter. SSI eligibility has two types ofrequirements: 1) category, and 2) income. For adult SSI, the SSA looks at the student’s disability,income, and assets at age 18 or older.2011 SSI Amount = $698/month • Payment can vary based on living arrangements & other factors • Patients nor guaranteed to always receive the full amountIn Illinois: if you qualify for SSI, you probably also for Medicaid • Illinois Medicaid is NOT automatic àMUST apply separately • Children can be insured under IL All Kids until age 19 if they meet income requirements • Not all All Kids participants will qualify for Adult Medicaid.SSI Income: less than $1000, assets under $2000The income requirement for SSI eligibility states that the student cannot earn more than $1000 ofincome per month. Additionally, the student cannot have assets (savings and checking accounts,retirement accounts, stocks, bonds) over a specific amount in any given month to be eligible for SSI. If
single, the individual’s countable assets must be $2,000 or less. If married, the individual’s assetscombined with his/her spouse’s assets must be equal to or less than $3,000
SSI DISABILTY DETERMINATION Child Disability Standard Adult Disability StandardINCOME: INCOME:Under 18 years old, parents incomes and Over 18 year old, do not look at parents’ income orassets count assets (< $2000) unless the child lives with parents. If so, some of parents’ support paid for housing and feeing the child will count toward in kind support and reduce the child’s SSI check.DISABILITY: DISABILITY:Impairment(s) must cause “marked and A severe impairment or combination of impairmentssevere functional limitations” and last at least that prevent engaging in substantial gainful activity12 months – compared with functionality of (SGA), lasting for a continuous period of not less thanpeers 12 months or resulting in death. Must lack Residual Functional Capacity (RFC) to perform any jobs that exist in substantial numbers in the national or local economy. EXCEPTIONS Can reduce assets contributing to SGA if: • Impairment-related work expenses, or • The work is “subsidized” (i.e. employee is being paid more than the work is worth) SSI vs. SSDISupplemental Security Income (SSI) Social Security Disability Insurance (SSDI)• Strict income and resource limits • Based on work record (average $1,000)• No work history required • Unearned income is not counted with no• $698 maximum– 2012 Federal Benefit Rate asset limits• Often also qualifies for Medicaid (but • Benefit amount depends on work record separate application) • May qualify for Medicare (usually better coverage than Medicaid)
Young adults are the highestTransition Planning – Insurance: uninsured group in the US. Medicaid/Medicare Because of this, it is importantAs adolescents transition into adulthood – insurance plans change. to know your insurance optionsYoung adult patients are the highest uninsured group in the US. There and to apply for insurance in aare multiple insurances choices which makes insurance difficult to timely manner.understand. Because of this, it is important to start learning aboutinsurance options early. You can ask your health care provider for helpwith this issue. Children with public aid are not Is there a difference between Medicaid and Medicare? Yes! guaranteed adult Medicaid due to different eligibilityMedicaid requirements. It is important toMedicaid is a state insurance that provides coverage for children, adults know the differences inwith disability and low-income elderly. Medicaid covers certain medical eligibility and to remember toservices, prescriptions and medical equipment. apply for adult public aidChildren’s Medicaid around age 17.States must cover children’s who meet the state’s income requirementsfrom birth until their 19th birthday. Programs also provide coverage topregnant women. People who can help with insurance issues include:Adult MedicaidEligibility for adult Medicaid varies by state. In many states, adults must • Your school/IEP teamfound disabled by Social Security first in order to qualify for Medicaid. • Your medical teamRecipients must also meet their state’s income level requirements to • A hospital social workerqualify.MedicareMedicare is a federal health insurance program that is available to retiredcitizens as well as people with disabilities, provided they are eligible forsocial security disability insurance (SSDI). Medicare covers certainhealth services but does not cover prescription drugs. Medicare is nottypically appliciable to young adults, but may be during the transitionprocess if he or she works, or his or her parents become disabled.Medicare is available to people who are older than 65 who receive SSAretirement or SSI. It is also available to people of any age with certainmedical conditions like ALS or end-stage kidney disease requiringdialysis.High Risk Pools and CHIP Programs:As a part of national health care reform, most states now havetransitional insurance buy-in programs for individuals with pre-existingconditions (the “High Risk Pool”). These plans are not consideredpublic aid and have premiums and out-of-pocket costs that beneficiariesmust pay. CHIP programs are state insurance programs that do not