MPLC
What are the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks?
The social determinants of health
What is the name of the process by which an individual must get approval from their Medicaid plan before accessing medical equipment, specific services, medication, or an out of network provider?
prior authorization
You work at a candy factory. Your boss makes you separate skittles by color, so you get angry and cuss him out. This is not the sweet job you dreamed of. Your mean boss later fires you and you apply for unemployment compensation benefits. Will your claim be approved?
No, your claim will be denied because you were fired for just cause.
What is one of the main differences between SSI and SSDI?
SSI is for people who have very little work history, and SSDI is for people who have a significant amount of work history
Your client’s child is sick. The client needs ingredients from the grocery store to make her famous chicken noodle soup and does not want to leave the child alone. The client gives her neighbor the EBT card and asks the neighbor to pick up the ingredients. Is this fraud?
No! You can authorize another person to pick up food for your household.
What partnership helps patients who are facing eviction or have other apartment/rental related problems, helps patients with questions about divorce, custody, child support, or grandparent rights, will help patients with questions about eligibility for public benefits (food stamps, cash assistance, medical insurance), and helps patients with questions about guardianship, powers of attorney, health care directives?
The medical legal partnership
What is the class of individuals that has a broader coverage standard through Medicaid, which can make it easier to obtain prior authorization?
Children
It’s Monday and after a long weekend, you decide you just cannot work another day, so you quit your job. You then apply for unemployment compensation benefits. Will your claim be approved?
No, your claim will be denied because you did not have just cause to quit.
What is the definition of the word “disabled” for both SSI and SSDI benefits?
You have a medically proven impairment or combination of impairments that are likely to result in death or that prevent you from being substantially and gainfully employed for one year or longer
Your client speaks only Spanish. However, they receive a notice in English. What should the client do?
Contact the office and request a translated notice. It is required by law for an agency to translate notices.
What percentage of a person’s health is determined by social factors including: income and health insurance, housing and utilities, education and employment, legal status, & personal and family stability?
70%? (NOTE: there are many stats out there on this- so 70% seems like a good avg)
What are two statutory reasons for a denial of durable medical equipment?
The item is not the lowest cost alternative and the item is for comfort and convenience.
You’ve been approved for unemployment compensation and are receiving benefit payments. After careful consideration you decide, this is the life! You plan to spend your days reading novels and eating chocolate cake. Can you collect benefits forever?
Sadly, no. Traditional unemployment benefits only last for 26 weeks.
What do money in the bank, a house that you own but do not live in, and a life insurance policy with a cash surrender value have in common?
Things that are considered available resources for people receiving SSI benefits?
A client is a refugee and wants to apply for public benefits. However, they are not yet citizens. How do you advise them?
Tell them they could be eligible for public benefits for the first 5-7 years while in the USA. After that time, they must become citizens to keep the benefits.
What is the name of the plan that a school and parent works to create to support a student who has special needs in the classroom?
An IEP (Individualized Education Program)
What are people found to have current needs under the developmental disability needs assessment process are placed on?
a waiting list
You suffer a tragic papercut while working as a legal document sorter and are forced to take Family Medical Leave. You apply for unemployment compensation benefits. Will your claim be approved?
No, your claim will be denied because you are not unemployed
What should I do if I’m receiving SSI benefits and I inherit a $200,000 house from my mother who just passed away?
Report the inheritance to the Social Security Administration and put the house up for sale for the fair market value
When the PHE ends, so will the public benefit protections/expansions many of our clients have enjoyed for the last two years. What are two (2) public benefits that will be affected?
(2 out of these) The expansion for SNAP benefits allotment will end. Medicaid will be able to kick people from the program again. Medicare programs will end free COVID testing. ETC.
What percentage of children are more likely to exit foster care when their parents with a Substance Abuse Disorder (SUD) have legal representation?
11%
Developmental Disability Waiver services may be denied if what types of services are meeting the needs of the client?
what are alternative services?
You are still receiving vacation pay from your job but decide to apply for unemployment benefits, so you will have enough money to go on a real vacation. Will your claim by approved?
No, your claim will be denied if you are still receiving vacation or even sick pay from your employer.
What is the best thing to do if I’m receiving SSI and I’m getting divorced?
Make sure I have an ABLE or LAWO attorney representing me, because they can make sure I get the best deal I can while considering the benefits I’m receiving
With the public health emergency ending, Medicaid will resume pre-pandemic operations. Unfortunately, this means people may be disenrolled from the program if they are ineligible. How should you prepare your client for the possible change?