Nancy Altman: Hi everybody.
Nancy Altman: Thank you.
Nancy Altman: We just ended one meeting. So we're waiting, everyone will join us soon.
Kim Hildred: Hey this is Kim Hildred, chair of the Board. I just wanted to welcome everyone. And just let you know we're just waiting for people to continue to sign up and we plan to get started in one
Kim Hildred: So this is your five minute will for a break or whatever you need.
Bob Joondeph: Correct.
Taramattie Doucette: I am. It's nice to see you.
Taramattie Doucette: It's nice. I never see you
Linda Landry: Nice to see you too. It's nice to put a face with
David, are you on
David Lescarini: I'm on
David Lescarini: Would you mind giving me the last story of your
Phone number so I can just rename you
Emma Tatem: On zoom
David Lescarini: Sure, um,
David Lescarini: Let me find which one about
David Lescarini: Sorry about that. Okay.
Emma Tatem: I got you.
Emma Tatem: You look like you're
689878
David Lescarini: Huh. Okay.
David Lescarini: The 253215878
Kim Hildred: I think the numbers don't translate directly, Emma.
Emma Tatem: Okay, okay. Yeah.
Kim Hildred: To use the highlighted box. I think it's the right way to go.
Emma Tatem: Great things
Rachel Emmons: And this is Rachel, I'm on as well. I don't know if you can tell which number I am
Rachel Emmons: Yet
Rachel Emmons: I got you. Good.
Kim Hildred: I'm gonna get started. This is Kim hildreth I've just turned off my video because I'm having some internet issues. So I hope everyone can hear me.
Kim Hildred: So good afternoon. And thank you for attending this important discussion on dedicated accounts for children receiving SSI this roundtable continues the boards work on dedicated accounts which we first examined in depth in our 29th.
Kim Hildred: Can you not hear me.
Emma Tatem: You're fine.
Mary O'Connell: Okay, you can do
Kim Hildred: Okay i don't i'm sorry i
Thought I heard another voice.
Kim Hildred: So anyway, the roundtable continues the boards work on dedicated counts, which we first examined in depth in our 2019 SSI statement included in the Social Security's annual report to the President and the Congress on the SSI program.
Kim Hildred: While the board did not make a recommendation related to dedicated accounts at that time we committed to continuing our research on into this issue. And that's why we're here today. So today we are so pleased to be joined by a group of several experts on dedicated accounts, who will
Kim Hildred: Discuss the purpose oversight administration challenges and range of policy options regarding dedicated accounts and our discussion today will inform the board as we decide on our next steps in this important policy area. So before we begin the discussion. I want to
Kim Hildred: Go, my fellow moderator Nancy Altman from the board who will be moderating this afternoon session, but
Kim Hildred: I never play an active role. The second session, but will play an
Kim Hildred: active role in this one I'm short and I'd like to introduce our speakers and panel members there are joined by Joanne Barnhart former commissioner of social security.
Kim Hildred: Gregory Bruce sick, who's the vice president of the National Council of Social Security Management associations. He is the district manager of Bellingham, Washington Field Office at social security.
Kim Hildred: On terror net T to set is the project director for the children's disability project Greater Boston Legal Services Rachel Adams is the Washington representative for the National Council of Social Security Management associations.
Kim Hildred: Danielle Flint is a parent representative paint he have a child with a dedicated account.
Kim Hildred: James client San Francisco audit Division Director of the Office of the Inspector General with Social Security Linda Landry is the senior attorney with a disability law center Massachusetts Protection and Advocacy database.
Kim Hildred: It lists greenie is president of a district manager McMinnville, Tennessee field office at social security.
Kim Hildred: And Mary O'Connell, professor of metadata Northeastern University School of Law retired. So again, we are so thankful for all of your time and participation and this important discussion and I wanted to just cover a few housekeeping items before we begin,
The roundtable is being recorded.
Kim Hildred: With live
Kim Hildred: Closed captioning and to turn on your captioning. Please select the CC icon in the bottom right hand corner of your zoom menu and choose Show subtitle
Kim Hildred: The agenda and participant BIOS can be found on our website, the recording of the event and complete Supplementary. Supplementary materials will be posted on our website. Following the roundtable attendees are muted, time permitting questions from the audience will be addressed or
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Kim Hildred: So we're going to be this first part of the discussion is the legislative purpose and oversight.
Kim Hildred: Dedicated accounts. So to kick us off. Professor Mary O'Connell from Northeastern University School of Law will present on the legislative history of dedicated accounts and their challenges as outlined in her law review or so, Mary, take it away.
Mary O'Connell: Thank you very much. Thank you for having me. When you write about something as small and narrow as this, you don't get invited to a lot of parties. So I'm actually delighted to
Mary O'Connell: Have a chance to speak to people who are interested in this piece of the law as I am.
Mary O'Connell: What I'm going to do is ask you to buckle your seatbelts and come with me from a trip. That's going to start in 1972 and ended 1996 1996 is the year that Congress created the mandatory dedicated account 1972 is the year that Congress added SSI the Supplemental Security Income program.
To the
Mary O'Connell: Programs that are available to Americans.
Mary O'Connell: So I in doing this work and it the full article is 76 pages long with 600 footnotes. So I spent a lot of time on this, but I
Mary O'Connell: Think what I saw were
Jo Anne Barnhart: A number of different threads.
Mary O'Connell: Coming in at different points in the time span that I'm going to be talking about
Jo Anne Barnhart: All of which
Mary O'Connell: Affected Congress's perception of children with disabilities and all of which affected Congress's perception that the dedicated account would be
Mary O'Connell: A positive addition SSI. So I'm going to take us back.
Mary O'Connell: To 1972
Mary O'Connell: And to President Richard Nixon.
Mary O'Connell: Who is actually working on
Mary O'Connell: My house is really close to the
Mary O'Connell: Street and when anybody backs up
Jo Anne Barnhart: I get to hear the
Mary O'Connell: Backup signal, but I think
Mary O'Connell: It's turned off now. So Nixon and Daniel Patrick Moynahan unlikely friends were very enthused about the possibility of expanding benefits for Americans.
Mary O'Connell: In, in particular, this 1972 statute, which created the Supplemental Security Income, the SSI system also created the cola for people who are retired or
Mary O'Connell: Survivors of retirees the cola is the cost of living adjustment. So if you're old like me and you are actually collecting Social Security retirement benefits you get a little notice at the end of every year, telling you that your benefits have been adjusted
Mary O'Connell: Very much really awkward to match the cost of living, this was important because Congress really didn't want to have to fight about adjusting Social Security retirement benefits every year.
Mary O'Connell: So the coal was enacted in the same bill that created SSI and in addition to the color. There was a sudden bump up and benefits for retirees and survivors by 20%
Mary O'Connell: And I have a feeling that was backfilling through the years of the cola hadn't been in effect.
Mary O'Connell: There was also a real interest by the Congress in people with disabilities and people who were elderly
Mary O'Connell: And in both cases, this was SSI and it was limited to people who have very limited resources and very low incomes. Now there are some exceptions on the resources you can own a house.
Mary O'Connell: Or you can own a car, but if you have money in the bank, you're not going to wind up on SSI. So this program for very people with very limited assets have very limited incomes was also going to be only for elderly people.
Mary O'Connell: Or four people with disabilities at the same time that Congress had all of those things out in front of it, there was a great deal of interest in something that it's called us that the Family Assistance Program and it never got an active if he had he
Mary O'Connell: Would have provided
Mary O'Connell: A federal benefits every month to every family in the United States that include a child under 18 that might sound strange to us today, but in fact a lot of European countries have a program like that. So here we are with all of these things out on the table.
Mary O'Connell: And there was real discussion about the fact I think it was probably the most controversial piece, but as that's getting
Mary O'Connell: Discussed and as the Social Security Supplemental Security Income, the SSI benefits are being discussed and idea emerges that may be SSI onto apply not just to adults.
Mary O'Connell: But to children, obviously not the old age program, but to children who had a disability.
Mary O'Connell: That was controversial and then bring it up again later in a slightly different context. But the ultimate resolution was by the by the chairs of the two powerful congressional committees Wilbur Mills.
Mary O'Connell: On the Ways and Means and Russell on inside finance, but they would go with adding children to the disability category, but they would not approve the fact
Mary O'Connell: And that's what emerged from these discussions and that was what was signed into law by Richard Nixon in 1972
Mary O'Connell: Almost immediately, there were some big surprises when Congress was getting information on starting a disability program and an old age program for people with very limited incomes and assets.
Mary O'Connell: They were told that about two thirds of the people on those roles with the elderly and one third would have disabilities and at the very beginning that turned out to be true.
Mary O'Connell: The program was enacted in 1972 it took until 1974 to begin the rollout, which was a mess. But that's a different story by 1978
Mary O'Connell: Two thirds of the people on the roles were people with disabilities and one third or elderly and four fifths of the applications in 1978
Mary O'Connell: Were by people with disabilities. So what Congress thought of as a program to help those people who got late, you know, a little late life and have very limited assets income.
Mary O'Connell: But also to help people with disabilities really became a disabilities program. The reason this is significant is that disability programs are much more expensive to administer
Mary O'Connell: And they're very likely it is very likely that a person with a disability will stay on the roles longer
Mary O'Connell: Than a person who doesn't go on the roles until she's at least 65 years old. So Congress had given birth to a much more expensive and complicated program.
Mary O'Connell: Than it had any reason to believe probably part of what people hadn't focused on was the D institutionalization of people with mental disabilities that actually began in the 1950s.
Mary O'Connell: In 1955 there were half a million people living in institutions for the mentally disabled. They spent their lives there.
Mary O'Connell: By 1994 there were only 72,000 people in such institutions, there have been a massive, massive change much better use of
Mary O'Connell: Medications and just a sea change in society where people with mental disabilities tended to stay with their families and stay in their homes.
Mary O'Connell: Of course, when they lived in the institutions, although there were lots of horror stories told about the institutions, the States which ran them paid for their key.
Mary O'Connell: Now that they were back with their families or back in society in some way.
Mary O'Connell: So money was going to have to come to support these people, and I don't think from all of the research that I've done that Congress had any real understanding that that's what they were facing when they created the statute in 1972 so let's go on to
Mary O'Connell: The period after we're going to move through Richard Nixon. We don't even have to think about Gerald Ford
Mary O'Connell: But by the time we get towards the end of the Carter administration, the SSI rules have grown dramatically, and there's a lot of concern about how costly SSI has become
Mary O'Connell: And so, towards the end of his term in office, President Carter signed a statute, which created the continuing disability review the cdr.
Mary O'Connell: And all that said was, after three years, you should have to you a person collecting SSI because you're disabled, you should have to do something to show that your disability is continuing and that's all
Mary O'Connell: Well, Carter leaves office Ronald Reagan takes office and i'm not blaming Reagan, but there's really a change in how Americans are seeing the world government.
Mary O'Connell: I mean, Reagan famously said, don't ask the government to solve your problems. The Government is the problem.
Mary O'Connell: You don't have to believe that but you can see why a sudden escalation or continuing escalation in the SSI roles which are very expensive would be a cause for concern.
Mary O'Connell: What the Reagan administration decided to do with these seemingly innocuous CD, ours is really ramp them up do many, many more of them.
Mary O'Connell: And try to cherry pick the cases where people might have recovered from their disability. So to throw some numbers at you and I do love numbers, but I think all of this information is available from
Mary O'Connell: The people at the advisory board in 1975 and 76 about 22% of people who went through a CDR had their benefits terminated the rest continued
Mary O'Connell: By 1978 to 1985 it was 46 it was twice as many people were being cut from the roles in those days, if you were cut from the roles because of a CDR you lost your benefits immediately.
Mary O'Connell: You had a right to appeal, but during the appeals process, you would not be getting any money. Obviously, if this is the money you're using to survive, you're in big trouble. And that was actually what was happening.
Mary O'Connell: Doctors were calling congress people screaming at them that their patients were at risk. There was a big, big push back to this sudden acceleration in the CD ours.
Mary O'Connell: And in fact, it turns out that the success rate on appeals was 69% so people were getting thrown off waiting struggling and then getting put back on. So, um,
Mary O'Connell: Congress decided it better do something and the Social Security Administration was feeling absolutely swamp. There were 23,690 separate lawsuits filed and Social Security income cases in 1993 alone.
Mary O'Connell: And the SSA last 18 class action lawsuits in that period. So Congress responds with a new statute.
Mary O'Connell: The statute is colloquially known as Deborah, it doesn't actually have an E in it. It's the disability Reform Act of 1984
Mary O'Connell: And it changes the rules for stopping someone's disability benefits the SSA must know demonstrate medical improvement on the part of the beneficiary.
Mary O'Connell: Or that a clearly erroneous initial decision is being reversed. Those are fairly high standards and the the
Mary O'Connell: Number of people getting cut to CD ours began to decrease and to stabilize that problem seems to be over. One of the reasons I'm so interested in Deborah is Deborah had what I call a sleeper.
Mary O'Connell: The Congress noticed as it was working on Deborah in 1984 that the mental health listings, don't talk about listings in a second. The mental health listings hadn't been updated since the social security.
Mary O'Connell: SSI was rolled out 10 years prior. And so it's simply said to ssA oh and by the way, while you're at it, please update your mental health listings. Okay, all right, two huge huge
Mary O'Connell: Complications directly relevant to the children's program and to ultimately our dedicated account come from this CVR debacle that we just talked about.
Mary O'Connell: One is the one of those class action lawsuits as a case called Sullivan versus assembly.
Mary O'Connell: And the assembly case was brought by advocates in the Philadelphia Legal Services office. I mean another
Mary O'Connell: Another unexpected consequence of the CD ours was a lot of lawyers learned an awful lot about SSI in a very short period of time in order to be able to help these people who had been removed from the rules.
Mary O'Connell: One group. The people in Philadelphia kind of looked at the statute and said, Wait a minute, something's wrong here.
Mary O'Connell: The statute said basically in the children's program, which is a very brief part of the 1972 statute basically says treat children like adults in terms of assessing their disability.
Mary O'Connell: And it turned out the children were not being assessed exactly the same way adults were
Mary O'Connell: And the folks at Philadelphia legal services setting. This is a problem. This is disadvantaged children. So let me talk a little bit about the disability process, and particularly about the listings. Okay.
Mary O'Connell: So if a person in your family had a disability. And you thought that they were should be entitled to SSI and remember they have to have very limited assets and very low incomes. But if they do.
Mary O'Connell: Then the next step you first establish the low income and the low assets with the Social Security Administration is established, you get handed over
Mary O'Connell: To a partner organization usually referred to as Disability Determination services ds.
Mary O'Connell: They're run by the state. So there's slight differences among them, but they will be the organization that will determine whether the person actually has a disability, which is covered
Mary O'Connell: By SSI, they start with something called the listings, which is part of the Code of Federal Regulations and they will say if you have any of these things, then you are a person with a disability.
Mary O'Connell: If you don't have a disability that's on the listings. It doesn't necessarily mean you won't get benefits because there's this and there's no longer true for children but bear with me.
Mary O'Connell: There's a concept called comparable severity. If you have something not on the listings
Mary O'Connell: But something that has severity comparable to things on the listings, then you would also be entitled to benefits. Okay. At the time of sadly that's as far as the child would go
Mary O'Connell: If a child did not have a disability on the listings or what of comparable severity, the child application will be denied.
Mary O'Connell: But for adult. There was a third bite at the apple
Mary O'Connell: For an adult. The DDS could say, Okay, you don't have something on the listings. You don't have something of comparable severity, you clearly do have a disability, but is there work that you can do, despite your disability but, given your work experience and
Mary O'Connell: Your education and sometimes the answer to that was no. Of those adults could be placed on the roles. There was no comparable assessment of what a child could do
Mary O'Connell: Now, the Social Security office, but that doesn't make any sense. Children don't work and what we're assessing with adults is their capacity to work.
Mary O'Connell: But the people who brought the assembly case didn't agree they agreed that there should be some kind of functional analysis of the child so that even a tribe like Brian's Emily, who had not did not meet the listings
Mary O'Connell: And did not have something of comparable severity should be able to be assessed to see how severe his limitations really were and how much that was going to affect his life.
Mary O'Connell: Well, the assembly lawsuit was filed in January, and I'm sorry. In July 1983
Mary O'Connell: Into the very long time to get through the courts because that's not really too surprising.
Mary O'Connell: There were lots of attempts to negotiate with the Social Security Administration to see if they could come up with something. But finally, the case went all the way to the Supreme Court of the United States, and it was decided in Brian's at least favor on
Mary O'Connell: February 20 1990 the assembly assembly lawsuit was filed in 83 and it was a class action and the members of the class were children who had been denied benefits on or after
Mary O'Connell: January 1 1980 it takes 10 years for this thing to get through the courts, the assembly class included 450 2000 children.
Mary O'Connell: These were kids who had been denied benefits under interpretation of the law by the SSA that the Supreme Court had just held was erroneous.
Mary O'Connell: Every one of those children got a notice saying if you would like to have your claim rededicated please let us know and 320 2000 children said yes. So there was an enormous amount of reeducation
Mary O'Connell: And though it was slightly less than 50% of children who were found to be entitled to benefits when the new rules were applied, it's still absolutely exploded the rules. Now I'll tell you why I wanted to talk about Deborah and the sleeper provision.
Mary O'Connell: Deborah was told, update the mental Deborah told the Social Security Administration to update the mental health listings, both for children and for adults.
Mary O'Connell: The thing that happened in between the initial listings in 1972 74 and the updating, which is post, sadly, is that the mental health profession had issued a new volume of the DSM.
Mary O'Connell: DSM is the Diagnostic and Statistical Manual and it is where everyone in the mental health profession goes for information. It is absolutely there. I hate to use the word Bible but it's the book that they use.
Mary O'Connell: To understand mental health conditions symptoms treatments, etc, etc. In between the creation of SSI and the decision in suddenly
Mary O'Connell: The DSM had gone from DSM two second edition to DSM three that may not sound like a big deal. It's a big deal.
Mary O'Connell: DSM three is prescribed and this is in the medical mental health literature as, quote, a variable veritable paradigm shift in psychiatry.
Mary O'Connell: It really gone and DSM to from sounding kind of like 40 and there was a lot of discussion of neuroses and interpersonal conflict.
Mary O'Connell: To sounding my word for is going to be very, very medicalized DSM three, we're now up to DSM five but DSM three is very medical it gives very detailed descriptions of various mental disorders. It talks about tests that can be used to identify what a problem might be
Mary O'Connell: It has things like likely age of onset for particular disability. So very, very medical
Mary O'Connell: Another important thing
Mary O'Connell: DSM to
Mary O'Connell: The old one had 182 categories of mental
Mary O'Connell: Disorder. That may sound like a lot, but DSM three had 265 so it's about a 40 it's more than 40% increase. It's just a different worldview by the mental health profession of mental health. So when we get to the
Mary O'Connell: Children's listings right which have to be for SSI, which have to be updated. Now they have to be updated to match DSM three
Mary O'Connell: And so it probably won't surprise you that there were four categories of mental health issues in the
Mary O'Connell: Original listings and it the almost tripled went up to 11 so there's much much more recognition of the possibility that children might be disabled because of mental rather than physical disorders and these two things happen within two months of each other. Right. The the
Mary O'Connell: The have to get my brother. The, the changes that had to be made because of the sibling.
Mary O'Connell: And the updating of the mental health disorders, the change that had to be made because of 70 was to do something to look at a child's functioning.
Mary O'Connell: As the statute looked at the functioning of an adult. And so what the Social Security Administration created was the individualized functional assessment, the IFA that's going to blow up to, but we will go on.
Mary O'Connell: Alright, so that's the statute that we have an effect post, sadly, we've got this new world of very expanded mental health diagnoses and in January of 1994 we're going to bring in the media.
Mary O'Connell: We're already 1994 1996 I let you go. So we were looking at the media and a some very not flattering depictions of the children's SSI program that were published in 1994
Mary O'Connell: The Washington Post very reputable newspaper began a series of articles in January and their basic theme is that there are some federal programs that are wreaking havoc with the federal budget, the first ones they talked about
Mary O'Connell: The first one they talked about was Medicaid, but on February 4 1994
Mary O'Connell: To journalists, you may have heard of Bob Woodward and Benjamin wiser published an article in the post. And I'm going to read you the title of it.
Mary O'Connell: Costs solar for children's disability program how 26 words cost the taxpayers billions in new entitlement payments. The 26 words I wanted you to hear because we'll get back to in a minute.
Mary O'Connell: This article has three pieces and I'm going to spend some time on it because it gets terribly important.
Mary O'Connell: The first piece was an extensive interview conducted with a doctor. Nora cook Porter. She was a pediatrician and she had worked with DSS in Pennsylvania.
Mary O'Connell: She was actually being moved from her job. When she reached out to Bob Woodward, but she was very concerned about the DSS
Mary O'Connell: DDS role and the children's SSI program. She told Woodward and wiser that most of the children getting benefits did not in fact have a disability.
Mary O'Connell: I'll quote from her. She said, children who curse teachers fight with classmates perform poorly in school are rebellious are being diagnosed with behavioral disorders and given SSI benefits that was what she said to them,
Mary O'Connell: She also claimed that many others working in DD DDS share her ideas and there were also reports that when the parents would get the checks.
Mary O'Connell: Because their children were getting benefits they wouldn't spend them on the children, they would spend them to buy cars and take vacations.
Mary O'Connell: So that was the first piece of the article. The middle piece of the article actually goes back to 1972 and the drafting of the statute.
Mary O'Connell: And they interviewed a gentleman who was a staffer and he W Social Security was part of health, education and welfare for a while.
Mary O'Connell: And this man, his name is Thomas Joe very interesting guy. He actually was a person with disabilities himself, he was blind, and he had drafted the children's program section.
Mary O'Connell: Most of which is covered in just 26 words. It basically says, oh, and by the way, treat children as you're going to treat adults. Under this new disability program.
Mary O'Connell: He agreed with Woodward and wiser that he was just trying to sneak this thing through the bill was 697 pages long.
Mary O'Connell: And he claims that no public hearings were ever held on the children's program.
Mary O'Connell: That's not correct. There were no public hearings in the house, apparently, because Wilbur Mills hated public hearings and he held us up with them as possible, but there were public hearings in the Senate.
Mary O'Connell: And it's very, very clear that the two chairs bills and long disagreed about the children's disability program Mills was all in favor of it. He said, these families need more and their children will have a better future. If we give them more
Mary O'Connell: Long's position was they need health insurance, but they get that under Medicaid
Mary O'Connell: But finally, they agreed and I told you this before they agreed that they would not pass fact the Family Assistance Program, but they would
Mary O'Connell: Add children with disabilities to SSI. So I think Mr. Joe was maybe slightly overstating his role in all of this, but Woodward and wiser, like the idea and notice this is their title.
Mary O'Connell: That 26 words are costing the taxpayers millions last story. And this is the one most relevant to the dedicated account they interviewed a woman named Beverly Smith.
Mary O'Connell: Her 11 year old son was one of those me plaintiffs he's described in their article as hyper active and was found to be entitled to benefits on the reeducation posters up okay if you apply for SSI benefits and you are approved. You don't necessarily get your money right away.
Mary O'Connell: And if there are back payments due because of various delays, you are entitled to get those back payments with assembly. Some of these kids should have been adjudicated as having a disability.
Mary O'Connell: 10 years before they actually saw any money. Remember that class went on for a very long time. So Mrs. Smith actually got a check for $13,000 for her son.
Mary O'Connell: And if that weren't complicated enough if that $13,000 sat in the bank for six months. Her son would lose its benefits because you would go over the assets ceiling.
Mary O'Connell: So under the statute. She had six months to spend down that amount or her son could lose his benefits. It's a little more complicated than that but not a lot more complicated.
Mary O'Connell: So when we're in wiser spend a lot of this article describing her spending spree.
Mary O'Connell: Forgive me for throwing in something personal engendered but only a man who would have thought that all of these things were a mistake, but going on.
Mary O'Connell: Miss Smith did, in fact, own a house. She worked part time as a custodian in a bank and $13,000 was one and a half times your annual income.
Mary O'Connell: Her house had a leaky roof, which she had been able to repair, but she didn't have the money.
Mary O'Connell: And the roof leak was so bad that it actually what it out some of the floors, she took the $13,000 got a roof repaired and her floors repaired. She had some money left after that.
Mary O'Connell: One of the things for son like to do was start fires and he had done that more than once. And so she had a new stove put in with all kinds of safety features to try to make it safer for her son who was so attracted by fire.
Mary O'Connell: She did buy some things that I guess you could say are spending spree. But this is the one that I think it is gendered she bought a washer and dryer.
Mary O'Connell: She'd never had them. She had to go on the bus with her hyperactive son to the laundromat, and she thought, you know, a washer and dryer might really improve everybody's quality of life.
Mary O'Connell: She did buy a used car and TV and she bought her son a computer is first computer and as other people on this call my this
Mary O'Connell: Zoom might be able to tell you. Doctors will specifically recommend computers for some kids with attention deficit hyperactivity disorder it somehow helps them to focus and helps them to learn. So that was the spending spree, but the
Mary O'Connell: The article was not meant to Patti Smith on the head for what a good job. She did spending down or monies or some didn't lose benefits.
Mary O'Connell: Instead of Woodward and wiser in the article quoting a psychologist who sometimes worked with DDS who said, parents are receiving a cash award for having achieved the problem.
Mary O'Connell: And copies of this article were distributed to every member of Congress, not by the Washington Post by but some folks in the House members of ours who really were.
Mary O'Connell: Felt very vindicated that this was what others were seeing in the SSI children's program. Okay, so that's February in October.
Mary O'Connell: We have another big media piece. This is on ABC primetime live and the segment was called Crazy chicks.
Mary O'Connell: It was hosted by Chris Wallace Diane Sawyer and Sam Donaldson, again, journalists, everybody's heard of
Mary O'Connell: The same pediatrician or a reporter was extensively interviewed by Chris Wallace.
Mary O'Connell: And she this time she comes up with a number. She tells him that fewer than 30% of the children on SSI deserve their benefits.
Mary O'Connell: She also says that the benefits are so generous that if you have several children with disabilities and a family. They family could quote by a Mercedes.
Mary O'Connell: The remainder of the interviews all take place in Arizona. I'm sorry, Arkansas. And it turns out that the
Mary O'Connell: There was a state legislator arm and so was very interested in this program and very concerned by this program tried to get the Arkansas legislature interested in it, but they weren't
Mary O'Connell: But when he went to the Arkansas democrat Gazette. There were some reporters there who were interested they made some inquiries.
Mary O'Connell: And while chris wallace and Diane Sawyer and Sam Donaldson kind of followed up on that, and a number of teachers and school counselor said they did think that parents were coaching their children.
Mary O'Connell: To act as if they had a disability, so that the family could get a benefit and they were telling their children that they needed crazy chicks, which is where the name
Mary O'Connell: For this came from. Interestingly, when they interviewed people in disability termination services actively at work in Arkansas.
Mary O'Connell: More than one said it doesn't happen in this office because we're really careful. But we know what happens someplace else. So this was crazy checks.
Mary O'Connell: And crazy checks was aired before all of the members of Congress who wanted to come and see it. So those two pieces, both coming out in 1994 were very important in painting SSI kids in a pretty bad light. Okay.
Mary O'Connell: We can go off to Congress, we can finish 1994 and get ourselves to 1995 to 1996 so in
Mary O'Connell: 1992 I just backed up a little bit. Bill Clinton had been elected president. And one of the things he pledged to do was end welfare as we know
Mary O'Connell: By welfare human a of DC wasn't talking about SSI. But what just happened with this bad publicity in 1994 is some of the antagonism, and there was a lot of social antagonism towards the FTC program. Some of that's now catching the kids on SSI.
Mary O'Connell: Bill Clinton was not talking about SSI when he promised to end well for as he as we know it, but he was talking about changing benefit structures because they were too costly and maybe they were even encouraging.
Mary O'Connell: negative behaviors. All right. At the time that Clinton was elected the Republicans were in the minority in the house, but they were very, very focused on welfare reform and they were working hard on it.
Mary O'Connell: In fact, in 1994 and the next midterm election Newt Gingrich, who was then in the minority party in the house and bunch of other Republicans in the House and candidates for the house introduces the Contract with America.
Mary O'Connell: They promised voters that if they, the Republicans took over the house, they would balance the federal budget. I think in 10 years
Mary O'Connell: Right, a large tax cut that would benefit. Lots of folks and they were going to pay for these things by stopping the waste in welfare.
Mary O'Connell: They didn't again specifically talk about SSI. But if you think about this as a train the caboose on this train the
Mary O'Connell: Lead of this train is the FTC the caboose is kind of SSI. So that was 19 September 1994 Gingrich and the Contract with America October is when crazy checks errors and in November. THE REPUBLICANS TOOK CONTROL THE HOUSE AND in January when the new Congress was sworn in.
Mary O'Connell: Newt Gingrich had become the Speaker of the House and the republicans go right to work on trying to find ways to cut benefits so they can deliver on their balanced budget and their problem of a tax cut.
Mary O'Connell: So they did a number of things. This is going to lead us right into the dedicated account. I promise it's going to take a lot of different pieces of legislation. I don't think
Mary O'Connell: I'm going to go through them all. I think I can make it a little shorter than that. But here's what happened.
Mary O'Connell: The first piece of legislation that the republicans are working on would have made drastic cuts to SSI. Basically, there would have been no more cash benefits.
Mary O'Connell: Except for children who are living in institutions or would have to be placed in an institution, if their family lost their benefits for all other children.
Mary O'Connell: cash benefits are over what Congress was going to do instead is give some money to the states and it was going to be about a 25% cut
Mary O'Connell: In what was being expended at that point in the existing program, but the states could apply to get some money.
Mary O'Connell: 75% of what they would have been coming from the fence before
Mary O'Connell: And they would have a lot of leeway. They could basically design any sort of program. They wanted what children would qualify for benefits. What kind of benefits would be available, but there was one rule.
Mary O'Connell: No State could give a cash payment to a family on behalf of a child with a disability. So this was pretty draconian
Mary O'Connell: I'm going to skip a little bit and merge a little bit, but the basic answer is Bill Clinton veto this bill.
Mary O'Connell: It has other lots of other provisions, I just want to stick with SSI when he vetoed the bill.
Mary O'Connell: He, he looks like 82 points that he made on why the bill was not going to ever get his signature.
Mary O'Connell: But he mentioned specifically the damage to children with disabilities.
Mary O'Connell: And at the same time that this was going on the Urban Institute was working hard to get some data on how these various bills might actually affect children.
Mary O'Connell: And one line of theirs really stood out in the public's mind and that was that 2 million American children would fall below the poverty line.
Mary O'Connell: If what the House wanted to do the Congress actually wanted to do with cutting SSI and FTC
Mary O'Connell: Okay, I'm going to leave the house. I'm going to go set it. I'm going to introduce you to the man who wrote the provision that became the dedicated account, this must mean we're going to get there. Sunday.
Mary O'Connell: The man was center rubber Dole was also pursuing a disability, and he had been worried. Since Zeb Lee came down about the large back payments. He knew they just weren't going to look good.
Mary O'Connell: And he had a suggestion and actually wrote a bill which would have allowed a parent getting one of these back payments to create a trust and any money in that trust would not be subject to the spin them requirement. So it would remove the problem that
Mary O'Connell: Beverly Smith and faced with get rid of this money now your son loses its benefits.
Mary O'Connell: However, as he staff research this, they found that the cost of the trust. You've got to get a private attorney to write it a private attorney to administer it. It was just cost prohibitive. Most of these families would not be able to afford it.
Mary O'Connell: So he gave up that piece, but he never really gave up the notion that some way for a parent to elect elect to put money aside.
Mary O'Connell: Would be beneficial and would really make this a better program. So, as the House Republicans are back working on a newly revised version of their bill since Clinton vetoed the first one.
Mary O'Connell: Dole is trying to figure out what he could do to create something that would be like a trust, but not a trust and he comes up with a good idea.
Mary O'Connell: When a child gets a disability payment. It's deposited into your bank account, WHICH IS PERSONAL REPRESENTATIVE virtually always as parent opens for him dolson idea if the parent elects if
Mary O'Connell: She can open to savings accounts and we will take the back payments and put them in this special dedicated savings account.
Mary O'Connell: The dedicated savings account won't cost the mother anything. It just goes into a bank account and the protections that a trustee might
Mary O'Connell: You know, a supply. If this were private trust can be covered by legislation so don't came up with just a few things that this money could be used for education and job skills training.
Mary O'Connell: special equipment or housing modifications specifically related to and required by the nature of the child's disability. Sorry, that was Roberto's language or appropriate Therapy and Rehabilitation
Mary O'Connell: The really important thing about Robert dole's ideas not only that's probably a good idea, but it was completely voluntary.
Mary O'Connell: The goal here was to empower the parent. So suppose you had a child who had a brain injury at birth.
Mary O'Connell: And it might take a long time to understand how much function, the child might have lost from that brain injury.
Mary O'Connell: And maybe the child for whatever reason has a hold up in payments and winds up with a large back payment, the parents might say, you know,
Mary O'Connell: We'd like to wait and see what kind of accommodations, a little one is going to need
Mary O'Connell: But if we don't spend the money and we lose the benefits on the Medicaid. That's not going to work for us. So don't would have empowered parents in that position or other similar positions.
Mary O'Connell: To elect to have this back payment put in this dedicated savings account know costs incurred some limitations on you. Some pretty severe limitations on us, but no parent had to opt for it. Okay.
Mary O'Connell: Back to the house. We're almost there The houses seem that maybe President Clinton isn't too keen on
Mary O'Connell: Having large numbers of children lose their SSI benefits so it stays with its two tiered idea.
Mary O'Connell: It still says that only children who are in institutions are at risk of institutionalization are going to get full benefits, but all of the other children will get 75% and it will still come as a cash benefit.
Mary O'Connell: But he didn't like that either. So this bill also is going to get vetoed ultimately and this is sort of funny, especially if you spent like a year reading through all of this.
Mary O'Connell: The Senate, the House basically on the SSI provisions still remember the NGO was trained as a FTC, they are trying to get rid of a FTC
Mary O'Connell: And to change it into just what they were talking about for SSI, that is rather than a benefit to each individual above a bucket of money for a state, not an open bucket.
Mary O'Connell: And the state gets to decide exactly how it is going to deal with poor children or deal with children with disabilities. So they get off that train they stay on it for a sec. But they get off it for SSI.
Mary O'Connell: And they just cut dramatically, the number of the benefit rules that doesn't work, they go back and they say maybe bob dole had a good idea.
Mary O'Connell: So they go to a bunch of things that were in bob dole's plan like let's eliminate the individualized functional assessment, the IFA and there is a
Mary O'Connell: Obviously the inspector general report about coaching in which they say we don't really know if there's any company out there, but we think the IFA is a big mistake.
Mary O'Connell: And if you want to reduce the number of children on SSI, get rid of the IFA and have another means for deciding if a child is entitled to benefits that was Bob Dole's idea.
Mary O'Connell: Get rid of the IFA and instead create a definition of disability that is unique for children don't try to make the children mimic the adult standard. So I'll just read you briefly what he said.
Mary O'Connell: Under models proposal, a child must show a medically determined physical or mental impairment
Mary O'Connell: Which results in marked and severe functional limitations and can be expected to last at least 12 months that replaced the IFA the CDR process was kept but it was kind of cleaned up in dullsville and then he creates this optional dedicated savings account when the
Mary O'Connell: House rather desperate for a victory at this point and seeing the Clinton is not real keen on cutting benefits to children with disabilities.
Mary O'Connell: Basically adopts dullsville it's fairly toothless and a lot of ways. It probably does something positive and getting rid of the IFA
Mary O'Connell: But in the conference committee. So when there are conflicting pieces of legislation on the same topic.
Mary O'Connell: One in the house. And one of the Senate of conference committee is named with members from both the House and the Senate.
Mary O'Connell: And they sit down and figure out how to make a unified bill that they think both houses of Congress can pass. So here comes the new bill and the House and Senate are a little bit different. The Senate still has bob dole's
Mary O'Connell: Optional dedicated account, but the conference committee, my view was just trying to salvage something that looked like it was restricted creates a mandatory dedicated account.
Mary O'Connell: So if you are going to get a back payment more than four times the federal benefits right so more than four months in back payments, you have to open a dedicated account.
Mary O'Connell: You have to deposit that money into the dedicated account and they increase the number of uses for the dedicated account but not by awful lot. I know they'll be much more discussion of this later, but they there are
Mary O'Connell: Only the following things that if that money can be spent for education, job skills training personal needs assistance special equipment.
Mary O'Connell: Housing modification medical treatment therapy or rehabilitation and then there's a piece of the Emma says, or any other item or service, the Commissioner deems to be appropriate.
Mary O'Connell: Provided it benefits such individual and in some cases is related to the impairment of such individual that's the mandatory dedicated account.
Mary O'Connell: It came out of the conference committee, they don't explain in the conference committee report why they were doing it, but they definitely take bob dole's idea. And here's the good things about it. It's free.
Mary O'Connell: And it protects the money from pushing the child of benefits because he has too many assets, but it's very, very, very restrictive and what this bill is now done and this bill becomes law is create the dedicated account.
Mary O'Connell: Whether the parent wants it or not. If it is just four times the benefits that have been backed up. It's not an enormous amount of money.
Mary O'Connell: I tried not to have too many pieces of paper in front of me as I did this. But when the Social Security advisory board wrote it statement on the dedicated account.
Mary O'Connell: In 2019 it said that at that time you would be required to open a dedicated account if you were if the child was old $4,626 in back payments. That's not nothing
Mary O'Connell: But it's not a lot. The other thing I will mention, and then I'm going to stop talking. Is that in this very same bill that creates the mandatory dedicated account and gets rid of the IFA and does some other things which owns SSI, the
Mary O'Connell: Senate. The deep sorry that Congress said that, if any, any adult or child is old, more than a certain number of back payments.
Mary O'Connell: They get them in installments. And that didn't used to be true. Miss Smith, that the whole $13,000 at once. Now most large back payments come in three installments.
Mary O'Connell: Some people think, Well, why didn't they put two and two together and say, Why do you need a dedicated account if we're never going to have these huge back payments again.
Mary O'Connell: But they were under a lot of pressure to finish this bill. And again, I would urge you, this lesson, I'm going to say to remember that driving the train.
Mary O'Connell: Is a FTC not SSI. SSI is the caboose. It basically did pretty well when you figure out what it was up against with the first round where everybody's gonna lose the benefits, but he does.
Mary O'Connell: With this mandatory dedicated
Mary O'Connell: Account which other people are going to talk about, but I don't favor. I'm done.
Kim Hildred: Well, thank you so much, Mary. That was a very comprehensive and we really do appreciate it.
Kim Hildred: I think what we're gonna do is we're going to move to James client because we're under some type time frames time limitations, but we'll get to questions after gym.
Kim Hildred: So hold on to your thoughts. For those of you have questions, so
Kim Hildred: What I'd like to do now is turn the program over to Jim Kline from us from Social Security's Office of Inspector General.
Kim Hildred: And he's going to be presenting on the Office of Inspector General's audit and oversight work on dedicated account, including its most recent September 2019 report. So Jim, you want to take it away.
James Klein: I do. Good morning, everyone. At least, good morning for me and good afternoon. I think most folks on the call.
James Klein: appreciate the invitation to participate in the discussion about dedicated accounts for SSI recipients
James Klein: And what I'm going to do today is I'm going to provide you with a summary of the results of to Office of Inspector General audits concerning dedicated accounts and leave the audit focused on SSH policies, procedures, and practices when dedicated account requirements apply
James Klein: And I am also going to respond to some questions that you submitted concerning these reports. And lastly, I believe, you do have copies of the reports today.
James Klein: So as Kim mentioned, I'm going to talk about a September 2019 report on dedicated account underpayments payable to children receiving SSI and this was actually an audit that would they follow up to a November 2010 report.
James Klein: On the same topic. And then the second report. I'm going to talk about briefly is an August 2007 record on SSH monitoring of dedicated accounts for SSI recipients
James Klein: So let me jump into the sep tember 2019 report for this audit we determined whether SSA had adequate controls to ensure it paid dedicated account underpayments to children receiving SSI.
James Klein: And just a little bit of background. Our, our audit focused on SSI recipients with underpayments that required dedicated account that SSA had not made any payments.
James Klein: And that is the red pay basically had not established the account.
James Klein: So therefore, our audit by design was focused on a population that was more likely to be problematic.
James Klein: We did not review dedicated account that rep pays had established and that SSA issued some or all of the underpayments
James Klein: For example, our audit did not include a review of approximately 42,000 recipients could have to say was making installment payments to a dedicated account.
James Klein: When our audit did look at was a population of approximately 21,500 recipients. Again, who's dedicated accounts and not been established, and so they may know payments and from that 21,500 we reviewed a random sample of 100 recipients review.
James Klein: And our findings.
James Klein: What we found is for the 100 recipients in our sample SSA had not paid 65 recipients dedicated account underpayments totaling 360 $3,000 on average about 50 $600 a person
James Klein: And actually will, will we looked at this a little bit further. As it turns out, eight of the 65 did not even meet the requirement to establish a dedicated account.
James Klein: When we project those results to sample results to our population we estimated that as a and not paid approximately $78 million to 14,000 SSI recipients
James Klein: What I want to do now is go over a little bit of the characteristics of the types of pays for the 65 recipients in our audit and when I wrote that your
James Klein: Statement own dedicated account. I think the percentages are really close to what you disclosing in that report as well.
James Klein: So for the 65 recipients
James Klein: Five or or had organizational rep pays or 8%
James Klein: For have a relative that will pay 6% for had a grandparent, who is a representative at number 6% and 12
James Klein: With father was a rep pay 18% and 14 the monitor was representative pay. So basically 92% of the pays were relative or closer to the to the child recipient.
James Klein: And we did also a little bit of work on to follow up on our 2010 on it, we reviewed a random sample of 13 recipients from that audit and we found the next phase doing not paid dedicated account underpayments the team of the recipients 60%
James Klein: So what I'd like to do is get a little bit into the reasons we failed. Why so say had not paid dedicated account on the payments.
James Klein: And of the 6529 page simply did not comply with requirements to establish some dedicated account.
James Klein: And you know that's that's a challenge and in got some information progressive say on this, which might give some insight on why this was occurring.
James Klein: SSI indicated that parents have SSI disabled children.
James Klein: May be encountering difficulty in opening bank accounts, they were stating that some banks refuse to open the account with the pain because the pain is poor right at risk.
James Klein: And when a paid does not basically comply with the requirements. So as a policy really leave their employees to looking for alternative pay
James Klein: However, as a good tell us that removal pay in these situations with not always in the best interest of the child. Generally, and as our stats show
James Klein: Almost always, these are paid in parents living with the channel and is in the best interest and in the best position to know up and attend to the child's needs. So therefore SSA would keep these on and they would remain as the preferred pay
James Klein: I think in the end. These 29 cases like this will will will get resolved, but some obviously are still falling through the fact
James Klein: Another 21 there was instances which assets. A employee simply did not do required follow up on their system diaries or alerts.
James Klein: There were 11 instances in which there was no evidence that systems on diaries and alerts were even really generated are produced to ensure that SSA employees. Following up on these accounts.
James Klein: And then lastly, we identified four instances in which there was no evidence that has the same form the pace of the existence of dedicated fund and the need to establish and dedicated account.
James Klein: We may pre recommendations to SSA in this report and basically the first two dealt with.
James Klein: Taking corrective actions on the sample cases that we identified and also taking corrective action on the larger populations larger population that is our recipients with unpaid dedicated counts.
James Klein: And then we had three or third recommendation that dealt with improving controls to ensure a timely paid dedicated account underpayments such as establishing management reports, ensuring that it retains diaries and or adding automation, which is, which was discussed in in our report.
James Klein: As soon as he agreed with all three of those recommendation and this is back in September of 2019
James Klein: So you had a number of questions related to the 2019 report. First question dealt with.
James Klein: You stated, the report included a subset of cases, President both the 2010 and 2019 samples within property without underpayments what factors have limited SSA in establishing adequate controls to resolve these protracted issues over the years.
James Klein: And, you know, you're correct in our 2010 report, we did have a recommendation that absolutely needed to improve controls.
James Klein: To ensure that it was properly paying dedicated funds in May of 2013 so say reported that it says to apply modernization efforts would address our recommendation.
James Klein: SSI also stated that it would be part of a multi year effort for SSI modernization starting in fiscal year 2013 and going through fiscal year 2017
James Klein: We did see that that's what they did implement some system changes to address or to address our recommendation for example, one of the issues are dealt with certain alerts and diaries.
James Klein: Or recipients with dedicated funds on prior and weren't and previous as if I records they did make a change for that. However,
James Klein: Or 29 keen on it found that the system changes with just not enough and they did not fully address the conditions we identified in our 2010 report.
James Klein: So, which leads us to the next question. And what does that say doing now in response to our 2019 report.
James Klein: You asked what I would actually has a taken in response to Oh geez recommendations included in 2019 report, and do they sufficiently address the issues raised in court. And I'll say, to a large extent the jury's out on that.
James Klein: So say reported that it took corrective action on all of our sample cases identified in the 2019 audit. I say also reported that is
James Klein: That it is continuing to identify the remaining population that's upon recipients with unpaid dedicated account under payments for those are basically addressing our first two recommendations.
James Klein: concerning our third recommendation with respect to improving controls to ensure SSH. Finally, a dedicated account manager payments.
James Klein: SSA reported that it's still evaluating enhancements required to implement this recommendation and if determining whether whether they are feasible. So, and that was information we got from us as a within the last few weeks, so
James Klein: It's still an open issue.
James Klein: You had a question asking whether we have conducted a follow up analysis of these issues during the pandemic and we have not. And at this point, we do not have anything planned at this time.
James Klein: You had a question. How is that all has the pandemic influence the administrative challenges outlined in the
James Klein: Report.
James Klein: I'm sure it has had an impact. I don't know that I can quantify that impact, but I think it is a couple things that I'd like to know.
James Klein: Of importance as to say has made no policy changes concerning dedicated account funds during the pandemic.
James Klein: And in fact, as they instructed its employees to follow existing dedicated account instructions during the pandemic and that is any requests for you so dedicated funds.
James Klein: During coven 19 or the establishment of dedicated accounts must still meet policy criteria for the use of funds and establishment of accounts.
James Klein: You had a question whether SSH it modernization plan adequately addresses the systems issues such as like a diary alerts for as Danny underpayments highlighted 2019 report and you're asking, are other changes necessary to ensure, as they have adequate controls and, if so,
James Klein: What they what
James Klein: They are and what should what would be needed to do so.
James Klein: We looked at SSL is it plan. It does not specifically address this issue and identify their report.
James Klein: However, as I mentioned previously SSH just informed us within the last few weeks that it is still evaluating our recommended enhancements to determine whether they are feasible. So again, it's still an unanswered question this point.
James Klein: So the next report, I want to talk about briefly is an August 2000 report on SSH monitoring a dedicated accounts for SSI recipients and this report is a bit dated, but it generated a question from the board. So I want to just kind of briefly go over what we found in this audit.
James Klein: For this audit we determine whether SSA complied with its policies and procedures regarding the touring of dedicated accounts for SSI recipients
James Klein: And for the audit we identified a population of proximity 17,000 recipients with dedicated account balances and then from that population we selected a random sample 305 recipients for review.
James Klein: Our overall findings were that SSA was unable to provide accounting forms for more than half 154 of the 305 samples recipients, but we couldn't even determine whether and that's that's a good enough provided evidence that they had sufficiently monitor those funds.
James Klein: For the hundred and 51 recipients that access a was able to provide accounting forums 31 had questionable and incomplete responses and SSA policy require that its employees follow up to resolve and base 31 instances the employees did not do the required follow up actions.
James Klein: The questions that came from the board on this report really dealt with question of the prevalence of misuse or fraud related to dedicated account.
And
James Klein: I guess the best information I can tell you a really the best I can maybe point you to is I think SSA is in the best position to give you perhaps information or data related to misuse or potentially fraud for dedicated funds.
James Klein: As you know, as to say it's required to report to congress annually on the results of it cyber who's a rep at and during these reviews as a contractor now is required to examine it pays us have dedicated funds.
James Klein: I reviewed essays most recent report to Congress and found that it did not include any information on those dedicated funds. However, the data behind this report may have some information.
James Klein: Concerning me since we're dedicated funds.
James Klein: And then SSA also might collect data.
James Klein: When it detects misuse of dedicated funds doing it periodically determinations for SSI recipients
James Klein: That's another possible source from data on this us
James Klein: And certainly should we do future audit work concerning dedicated accounts we we would, you know, this is something we would certainly consider looking into and would collaborate with our ops investigation to see what information they may have related to fraud related to dedicated account.
James Klein: So with that, that's kind of my brief summary of those two reports and I can take questions now. But it sounds like can you want to defer questions to maybe a little bit later.
James Klein: Nope, you're not off the hook yet.
Kim Hildred: We're gonna that's a couple of questions now, and we're supposed to break to do a break at 230. So I think we've got some time for some questions as moderator. I'm going to take us my
Kim Hildred: moderating title to go ahead and just ask a couple of questions. First, before I turn it over to our board members.
Kim Hildred: So actually the first question I'd like to ask a direct my question to is Mary and that is
Kim Hildred: This is a very broad question, but I think it's just it fits the ticket. And that is, are the accounts are dedicated account serving their intended purpose as laid out in the legislation.
Kim Hildred: No. Actually, you're right.
Kim Hildred: Sorry, no.
Mary O'Connell: But and and what are the things I think that Commissioner Varner may want to
Mary O'Connell: Talk about but administrate these things isn't free she estimated 120 plus $5 million a year to have dedicated accounts.
Mary O'Connell: And I provided to the board a short synopsis of a bunch of studies.
Mary O'Connell: very much focused on questions about coaching with the kids being taught to be a badly, so they could get crazy checks.
Mary O'Connell: And no one is ever able to document it. Now, as they say, it's hard to document coaching if parents are having secret conversations with their kid. It's going to be out of earshot to everybody else. But part of what
Mary O'Connell: seems so strange to me is that, you know, the these kids are getting benefits. After going through several levels of examination and several people who have no particular incentive
Mary O'Connell: To do find that a fraudulent case should go forward are finding in the trans favor or they don't get a dedicated account and nothing happens. I think I can say that a little bit better. So give me one more shot at it.
Mary O'Connell: This is not as though somebody gets to apply for something and they don't have to establish any proof.
Mary O'Connell: They do so in order for children to be coached on to benefits, who don't really have a disability. You don't only need to assume that parents are
Mary O'Connell: You know, being fraudulent, you have to assume that none of the monitoring is working. So if it's in the initial situation, you have to assume that DDS didn't do a good job and let a kid on who really doesn't belong there.
Mary O'Connell: And in terms of the dedicated account if we're if we don't think the parent was committing fraud and getting the child on the on the benefits. I'm not sure why they would be committing fraud later on.
Mary O'Connell: And and again I have. I've submitted already to you set of reports somebody the oag but also by the National Institutes of medicine and the National Institute of social insurance in which they say this has really been overblown.
Kim Hildred: And then could you also just briefly talk about your, your understanding of the statute, and whether SSA, you know, obviously, changing the law, it's hard for all kinds of reasons that have nothing to do with the policy itself. Oftentimes,
Kim Hildred: And I'm wondering, you know, based on your experience is there more that SSA could be doing under the statute, either through regulation or procedures to make the process easier for parents.
Mary O'Connell: You know, it may be that a tyrant yourself or Linda Landry would be better to respond to that because we're now getting down to the very
Mary O'Connell: Procedural level. I think this is true that the requirement that a spouse who is a representative payee make a
Mary O'Connell: Report on a regular basis about the use of funds, I believe that's been waived. And so one of the things that I don't know as much about as I should, is how much of the reporting that's required.
Mary O'Connell: Could be done away with, because it's very, very burdensome for the parent
Mary O'Connell: And for the people working Social Security. I will give you one anecdote, but it comes from a person that I had a fellowship
Mary O'Connell: At Greater Boston Legal Services for two years I worked very closely with her and in all of that time she only had one client who had automated banking.
Mary O'Connell: And that's when you think about very poor people. That's not unusual. So keeping records can be very hard, especially if you're talking about very, very poor families. They have to move more often.
Mary O'Connell: Than other people and so keeping records and showing that you're doing the right thing.
Mary O'Connell: I think it'd be hard for me. But for somebody who doesn't have automated Becky for somebody who has several moves, sometimes in the course of a few years.
Mary O'Connell: I feel like this idea came in at the last minute and it sounded good to Congress because it looked like we're being a little tougher on them. And remember, this is a period of awful media coverage.
Mary O'Connell: And nobody sat and thought about because there wasn't time, how is this actually going to be implemented, who's going to watch over this. How do we make sure that only these categories of expenditures are being made. So I think
Mary O'Connell: It's not very workable and the thing that puzzles me terribly is once they decided they Congress to do installment payments.
Mary O'Connell: Why do you also need a dedicated account if the amount of money that's coming into a parent's hands and anytime is relatively small. I don't think you need to worry about the shopping sprees that that so upset.
Mary O'Connell: We're in wiser.
Kim Hildred: Great, thank you. And Jim. I just wanted to ask you a little bit. I know you just talked about it briefly, but I'd like to see if you have any other thoughts.
Kim Hildred: You know, we, you know, in as SSA reviews parents and read pay ease spending have dedicated accounts, they talk about misuse and they talk about Miss application.
Kim Hildred: And then there's also this more global term out there, as you well know, known called frauds and I'm just wondering, have you is this.
Kim Hildred: This big has seen any complaints about through their hotline.
Kim Hildred: Or just any from any other outside sources I, in my experience, at least, you know, usually if there's if there's some blatant you know problem with a particular policy people will go ahead and report it.
James Klein: Yeah.
James Klein: And I've were concerning positions for sure.
James Klein: So I could follow up with our hotline to see if they have seen anything
James Klein: Personally, I'd be a little surprised, but, you know, again, I'm not in a great position to know with certainty, whether that is problematic.
Kim Hildred: And then maybe you could provide just a little bit of insight for us as we as we think about all of these issues going forward.
Kim Hildred: You know, one of the things the board consistently talks to SSH bad is collecting data collecting the right data ahead of time.
Kim Hildred: You know as their when they set up new programs to make sure they're collecting the right data so that they can monitor how policy is actually being implemented and what needs to change.
Kim Hildred: You talked a lot about controls and could you talk a little bit about the process that SSA uses
Kim Hildred: And I don't know if that's through a systems group or what have you, in terms of priorities for what system changes are going to get made, and whether that you know controls versus certain data point collections and how that works in terms of establishing priorities.
James Klein: Yeah, I know, I know security does have the group that does prioritize it projects.
James Klein: You know, I, we have a separate dedicated systems team that might be in a position to address that, you know, looking at this, again, that's my personal opinion.
James Klein: You know it's it's a vulnerable population. It's important population. It's not huge in the SSA world. So it might not always meet that
James Klein: Cut off point. Whereas, what's a determining, you know, which, what are our priority projects you know this recent audit will talk about 14,000 recipients $70 million. That's a lot of money to those people
James Klein: I'm just not sure if it's
James Klein: You know where it fits in. So it's a threshold for it priorities. And I also think
James Klein: And again, I'm giving my personal opinion, the systems can do so much. And at some point, an employee needs to do the right thing.
James Klein: And managers need to oversee their employees to make sure they're doing the right thing. And I think that may be applicable with with this issue. And what we found in 2019
James Klein: Sure, sure.
Kim Hildred: Alright, so we can open it up to first maybe board members for any questions the board members may have
Jagadeesh Gokhale: So I have a question about one of the
Jagadeesh Gokhale: Issues, or comments that presenter made about the types of expenses, they are allowed under current law.
Jagadeesh Gokhale: For spending two dedicated accounts and the comment was that these allowances for spending items are very restricted. So, are there particular ways in which those
Jagadeesh Gokhale: Conditions would be expanded.
Jagadeesh Gokhale: Or should be expanded in your view,
Jo Anne Barnhart: Questions directed to me.
Jagadeesh Gokhale: Yes, yes.
Mary O'Connell: Okay. Um, well, okay.
Mary O'Connell: If the if the statutes going to be changed, of course.
Mary O'Connell: Congress is going to have to change.
Jagadeesh Gokhale: Your view about how
Jagadeesh Gokhale: And what directions. What particular additional items should be included in that list.
Mary O'Connell: Um, I guess I would well
Mary O'Connell: The problem with education is that most of these kids go to public school, the public. The problem with talking about medical care is most of them. Fortunately, are on Medicaid. So I guess I'd need to think a little bit more about
Mary O'Connell: What is it that should be in this restricted fund but easier for the child to use. I mean, honestly.
Mary O'Connell: Some of the stories that I tell them the long version of my paper. There was a mother who brought a child to
Mary O'Connell: That a birth injury home, he's this tiny little baby the mothers barely able to pay her rent and she can spend money in his dedicated account on education will use an infant job skills special equipment which you really needed. I mean, I don't mean to sound.
Mary O'Connell: Silly here, but she needed infant formula. She needed diapers. She had to take him to many, many medical appointments, but she wasn't allowed to use that money.
Mary O'Connell: To transport herself. She didn't have a car to transport herself to medical appointments all over the place.
Mary O'Connell: It was Boston in the winter and she wanted to buy him a SNOW SUIT. So she had all of these expenses and none of them could be touched, because they're not in the restricted categories.
Mary O'Connell: So I think what I'm really saying to you is, any idea of restricted categories.
Mary O'Connell: If there's not, the option as Senator Dole would have had it for a parent to say yes, this is a good idea for me or this isn't we're just going to miss so many people. One of the things from last year's
Mary O'Connell: Board program statement was that there are over pages on 26% of dedicated accounts never get touched
Mary O'Connell: It isn't that the parent wouldn't like some money. It's that their life and what this money is available for just don't mesh it all.
Mary O'Connell: And I think that is again part of this like the Congress didn't think about this, Senator Dole slide when an optional count Congress just made it mandatory and didn't think it through.
Kim Hildred: And driving. I just wanted that the second panel, we actually ask the panelists to submit their suggestions for expansion, so we'll be talking about that.
Kim Hildred: In addition, we'll be talking about that piece again.
Kim Hildred: Sure. And I just wanted to. I saw Joanne's name pop up real quick. Then I just I know she's in a car traveling over the mountains and I just wanted to share Joanne. Was there something you wanted to say.
Nancy Altman: Okay, I'm going to
Kim Hildred: ALWAYS KNOW NANCY. Yeah, it looks like Julia was muted. So
Nancy Altman: So enjoy
Nancy Altman: If you can hear us. Keep your hands on the wheel. If you're talking
Nancy Altman: We don't
Nancy Altman: We don't you hear me.
Jo Anne Barnhart: I hadn't muted because I'm going 80 miles an hour at one, it's kind of noisy in the car. So I was listening to the wonderful speakers. Thank you both for your presentations. I had a question where I'm really exhibiting my ignorance here.
Jo Anne Barnhart: As far as expenditures under dedicated account, do they have to be current or prospective expenditures, or are they allowed to pay for things that have already
Jo Anne Barnhart: Been paid for by the parent. What brings this to mind for me, particularly now is given co but it's likely this year, created a situation where parents may have had to spend money on things for their children. Maybe under the allowable reason
Jo Anne Barnhart: Before the child was deemed eligible
Jo Anne Barnhart: And as a result, now are in debt or can afford to get their roof fixed or whatever. So can you back pay the parents for things that they spent as long as they can provide documentation.
Jo Anne Barnhart: I would think so. And again,
Mary O'Connell: There may be that the people who do this every day, rather than writing articles about I could give you what absolute
Mary O'Connell: Answer.
Jo Anne Barnhart: I know, parents,
Mary O'Connell: Were many parents worry a lot
Jo Anne Barnhart: About misusing funds.
Mary O'Connell: Because if they misuse funds they have to pay it back.
Mary O'Connell: out of their own pocket and sometimes they just can't think of a way to do that.
Kim Hildred: Hmm, do you know the answer to that question.
Kim Hildred: I don't, but I
James Klein: Do know
James Klein: Not for other senses outside of dedicated funds. I know there is
James Klein: Provisions, in essence, a policy that allows reimbursement to the paid for previously and current expenses, but that's more general not not specifically dedicated account. I don't know whether that a policy that policy applies to dedicated dedicated funds as well. Okay.
Kim Hildred: Or David
Jo Anne Barnhart: And Kim. I had one other question, which really was kind of a, an add on to what you asked, and that is, I heard what the first two areas of allowable expenditures are education and medical. What was the third, and is there any flexibility there in a house. I can interpret that
Mary O'Connell: I'm looking for my notes so I don't get this wrong, because there are different versions of it.
Jo Anne Barnhart: Education or job skills training.
Mary O'Connell: Personal needs assistance special equipment housing modification medical treatment therapy or rehabilitation or any other item or service that the Commissioner deems to be appropriate. And then there's some some limitations on that.
Jo Anne Barnhart: Yeah, yeah, that's the huge flexibility there any, any other one that
Jo Anne Barnhart: That seems to leave it wide open for a rule or regulation condition the condition, but that's just, that's how I would interpret it said someone raises issues, focus on dedicated account. So when I was there. So that's, that was my question. Thank you. Thank you. That's
Jo Anne Barnhart: Great I pair. Other questions from board.
Members.
David Lescarini: This is David, I didn't, I didn't do the star six. Can you hear me now hear you now. Okay, so back to that that question about perspective or retroactive.
David Lescarini: There, there is sort of a catch all where it talks about emergency exceptions, we can determine that emergency situations if there's an unavailable.
David Lescarini: If the core the unavailability of a dedicated account funds would cause problems with basic living expenses or may result in the child becoming homeless or malnourished and we can approve defines so that could apply in that situation.
Mary O'Connell: Great.
David Lescarini: Thank you.
Mary O'Connell: We've actually heard that there are some SSA offices where you have to
Mary O'Connell: Have an eviction notice in your hand to have funds released for paying rent, because that's not normally covered so good, but maybe not so good.
Kim Hildred: Okay, are there other questions.
Kim Hildred: Yeah, Kim.
Nancy Altman: Kim. I have a question for Mary
Nancy Altman: First of all, I found that history.
Nancy Altman: really informative. So thank you for, for all that detail on it. I'm intrigued that I know that both Democratic and Republican administrations called for just eliminating
Nancy Altman: Dedicated accounts and you indicated that was that you were interested in jag and escape one alternative which is just make the funds more available.
Nancy Altman: What do you think of keeping the dedicated accounts for making a voluntary, the way that and maybe making them less restrictive as well as an alternative
And I think
Nancy Altman: I guess the question is, is there a reason to keep them.
Nancy Altman: If they were voluntary or is it just it's it takes too much administrative costs and time and it's just
Mary O'Connell: Not worth it. Um, I guess. I don't know about the administrative
Mary O'Connell: Costs in time. The only figure I have and I'm sure she's correct is can be sure
Mary O'Connell: To set cost $5 million as currently set up. I think Senator Dole had a really good idea. And you know, when I think about that child who came home from the hospital and it was just so unclear how profound his disability was going to be
Mary O'Connell: To to you might want to put money aside if his mother had been a little bit wealthier maybe would own the house and your child wasn't going to be able to walk. What you don't know yet.
Mary O'Connell: You would want to make housing modifications, but because you have to spend on policy, you couldn't maybe wait and see how the child develop
Mary O'Connell: It's not necessarily a bad idea. I wonder how much it would cost, but I do think you know this this dedicated account came along, mandatory dedicated account.
Mary O'Connell: At a time when there was very bad publicity about SSI which none of the of the deep studies later really very much supported
Mary O'Connell: And when Congress kind of quickly said, oh, we like this ideal and separate account. Let's just make it mandatory I I don't mean to say that I would want to do Congress's work.
Mary O'Connell: They had a lot of work to get done. But I don't think a great deal of thought was put into this and if if that if it were to be made optional that would have to go back to funders. Right.
Mary O'Connell: So if we're going back to Congress. I guess I would rather just say, do we really need this at all, especially because we now have installment payments.
Mary O'Connell: There are a whole lot easier for SSH to manage the monitoring a dedicated account. And if you wanted to create a statute where if you are owed up to X dollars you get
Mary O'Connell: Three installments. But if it's this much has to be six installments.
Mary O'Connell: The installment payments. I like a lot. And they seem to me like they once it was set up, they would be
Mary O'Connell: easy for us to say
Kim Hildred: To administer
Kim Hildred: Thank you.
Bob Joondeph: Kim. I just had a quick. This isn't so much a question is that maybe send me questions on it. Is that going back over the history. I was a legal aid lawyer in the early 80s.
Mary O'Connell: Or laugh.
Bob Joondeph: Many people were thrown off of SSI and watching a large portion population were to disorganized frankly to even reapply and what happened at the same time that had federal support for housing so dramatically reduce
Bob Joondeph: In my mind at least, brings us to today, in many ways, and so this seems for me very topical going through the history. I
Bob Joondeph: I, I was interested in one of the comments online, which is about April accounts and it seems like there is somewhat of a parallel in terms of
Bob Joondeph: Creating voluntary accounts for people to put money that then then can be available for cost but less thing I was going to mention, and maybe you can comment on it is that I saw something very similar
Bob Joondeph: In terms of reaction publicity happened in the area of respite services for kids with intellectual developmental disabilities, where there was a great crest.
Bob Joondeph: Coverage of families that were taking vacations, who had
Bob Joondeph: The enormous burden or at least
Bob Joondeph: Challenge of
Bob Joondeph: Taking care of kids with severe disabilities and having an opportunity to take a break from that and have some help.
Bob Joondeph: Allow them to fulfill the service that traditionally, as you pointed out, used to be provided by state institutions and when
Bob Joondeph: Those institutions and parents, step up, of course, you know,
Bob Joondeph: I thought it was a reasonable policy option to give them a break in terms of providing that and so I see real parallels in those areas so
Bob Joondeph: I guess my question is, is, has there been a major publicity effort in order to bring those sorts of perceptions forward and experiences or right, since it seems like Congress reacted very much to publicity about fraud and abuse.
Bob Joondeph: Is that something that advocates can consider in terms of
Bob Joondeph: At least maybe getting regulations to change administrative policies to change and you know getting Congress to move is something I can contemplate, but I just wonder if anything of that sort of tapping
Mary O'Connell: I know nothing about that. I think it's a wonderful idea of the Institute of Medicine, which was the last group to evaluate the program and see whether they thought that they were
Mary O'Connell: Done with that the issue here was, was there overdiagnosis of mental disabilities and children applying for SSI wasn't way out of, out of sorts, with the overall diagnosis in the general population.
Mary O'Connell: And they said no. And they said, very, very clearly that poverty is itself a pre existing condition.
Mary O'Connell: That if you are growing up in poverty, the likelihood that you're going to suffer any of them range disabilities is high, whether we're, you know,
Mary O'Connell: The middle class family that's doing okay. They may have a disabled child too, but the likelihood is very, very different. I
Mary O'Connell: I'm, I'm a scholar i right sort of long, boring treatises, you don't want me up there guy, you know, telling the public think about this differently, but I think you're exactly right. That if more of the stories.
Mary O'Connell: Of how kids are helped by this program and the things that they can do and you know we've all seen this, those of us who were a little bit older, not to make any assumptions about you, sir.
Mary O'Connell: But the, the, the people who would have spent their life in an institution, if they weren't born in 1950
Mary O'Connell: Now have jobs. I mean, there are lots of things they can't do, but they're, you know, bringing the shopping carts back in the parking lot there bagging groceries and they have a meaningful and productive life. And maybe if we could do more with that it would be great.
Kim Hildred: I'd like to just mention and Bob, you just mentioned it briefly that the attendee question about why do dedicated account continued to be necessary in light of later legislation.
Kim Hildred: Specifically the able X allows for savings which do not affect most means
Kim Hildred: Tested benefits up to 100,000 disregarded by SSI program additional the allowable expenditures from a dedicated account or allowable is qualified disability expense.
Kim Hildred: Expenses under able and finally the state able program share data under a data exchange program with us to say a certain account information is visible at SSA
Kim Hildred: It's a very, very good question. I find
Kim Hildred: Sometimes we're Congress may not necessarily give
Kim Hildred: One. They're focused on a particular issue. They may not give the global attention to other conflicting policies at that time because they're focusing on the matters at hand. That's not to say that they might not catch up eventually.
Kim Hildred: Or, you know, use it to justify changes later. So, but it's a great point. So thank you for that. It is now 230 and this is actually our time to take a brief break of 15 minutes
Kim Hildred: I want to, before we go though again thank Mary and Jim great presentations. Great information. Thank you so, so much. I hope you're going to be staying with us.
Kim Hildred: For the second panel because I know we'll have some great discussion then so if everyone will just enjoy their break and we'll see you back here at 245
Kim Hildred: Thank you.
Nancy Altman: That may be our cue to start, but I'll give it one more minutes to 44
Nancy Altman: And I see we have
Nancy Altman: We're very grateful for the advisory board to have so many people who are
Nancy Altman: You're participating in this roundtable so
Nancy Altman: Let me welcome everyone back. Thank you so much. I'm Nancy Altman a board member and I'll be moderating this next session of the roundtable
Nancy Altman: I want to start by thanking cam and also married and Jim for providing such a really helpful overview
Nancy Altman: In this part will now hear from people who are really on the ground. We're extremely fortunate to have so many important perspectives on this issue, we're going to hear from apparent web P, we're going to hear from
Nancy Altman: People in the US has a who are actually engaged in the administration of this including former Commissioner Barnhart. And then we also have on the round table.
Nancy Altman: To lawyers who were are assisting people who are navigating this. So let me start we are grateful to start with.
Nancy Altman: Daniel Flint, who's a licensed clinical social worker and apparent representative P managing a dedicated account on behalf of her channel Danielle. Thank you so much for joining us and for your willingness to share your experience.
Danielle Flint: My pleasure.
Nancy Altman: We're really we really are so grateful we are hoping you can describe for us your experience really so because we've been at this high level. And we really like to hear
Nancy Altman: How it how it really works. And then touches touch you know you may talk on what's been difficult. Anything you think that you think it would be useful for us to hear. So let me with that and turn it over to you. And thank you so much.
Nancy Altman: You're on mute. I think you're muted.
Danielle Flint: And done that I've done in the forest. Let's do one of them to make sure that that was that wasn't an issue. Okay, so let me go back.
Danielle Flint: Okay. So good afternoon. My name is Danielle Flint. I am a mother of four children, two of which are currently receiving Social Security benefits. My daughter and my son both qualify for SSI.
Danielle Flint: Under the sickle cell disease criteria and both of my children require dedicated accounts to be set up upon approval of benefit.
Danielle Flint: Sickle Cell Disease is a potential life threatening inherited blood disorder that comes with many different symptoms. This disease is typically diagnose that birth.
Danielle Flint: Patients with sickle cell have Miss shaped red blood cells, which are the cells that transport oxygen.
Danielle Flint: So patients also who have sickle cell have a dysfunctional spleen and the spleen is the Oregon that fights invading germs in the body.
Danielle Flint: And it controls the level of blood cells, white, red, and platelets and it fills out the filters the blood and removes any old and damaged red blood cells.
Danielle Flint: This is why patients are prone to infections pain crisis are common.
Danielle Flint: Are also very common where there's blockage due to the misshapen cells interfering with blood flow and oxygen to important parts of the body.
Danielle Flint: This pain is described by my children as knife like stabs which are managed by morphine and stronger narcotics, either through IV or at home administration.
Danielle Flint: My children have experienced a range of complications from this disease. Both have faced the future syndrome, which is a life threatening pneumonia.
Danielle Flint: And one of the leading causes of death in patients with sickle cell disease. Some patients like my son will require blood transfusions and treatments during crisis.
Danielle Flint: And during one crisis, my son face it resulted in the removal of his spleen, as it was life threatening. And he was only four years old when that happened,
Danielle Flint: Since there is a six year age difference between my two children, and a seven year difference in their application date. I'll give you a little background on my daughter's experience for being approved for SSI first
Danielle Flint: As I mentioned during infancy. My daughter was hospitalized frequently frequently
Danielle Flint: And after returning from maternity leave and depleting my set time I was terminated from my employer. When my daughter was five months old.
Danielle Flint: With no income and nowhere to turn I contacted the social worker for Boston Children's Hospital and she urged me to apply for Social Security benefits.
Danielle Flint: And in the past, we had discussed this with the chief of hematology, who happens to be my daughter's doctor and he felt strongly that my daughter qualified and met the criteria under SSI. However, at the time of discussion my household income would make us an eligible
Danielle Flint: In September 2008 I applied for benefits, on behalf of my daughter. A few months later we received our first denial, stating that my daughter did not meet the criteria for benefits.
Danielle Flint: I called the social worker again for some guidance and the hematology team encouraged me to appeal.
Danielle Flint: And so I did three months later, after doing so I received a second denial letter.
Danielle Flint: At that time I was employed as a family case manager for Head Start and would often refer families to greater Boston Legal Services for a range of matters.
Danielle Flint: I decided I'd call g BLS and complete an intake and this is when my daughter became a client of the children's disability project in January 2010 my case was assigned to Tara Matty to say
Danielle Flint: We had our first hearing in March 2010 a week shy for my daughter second birthday months later, the appeal was denied.
Danielle Flint: Really and throughout the years we faced multiple appeals, including federal court, the case was ultimately remanded and a final hearing to place in October 2015
Danielle Flint: The following month, a decision was made in favor of my daughter and the benefits would go retroactive from the date of application.
Danielle Flint: In December 2015 a dedicated account was set up for my daughter. It took several months to finalize the correct correct retroactive amount, but ultimately, my daughter ended up with a large retroactive award that was released in mid 2016
Danielle Flint: And although a seven year battle for approval sounds well summarize, there was many times I wanted to give up and Tara and the project did not allow me to do so.
Danielle Flint: I felt very depleted and defeated and Tara once turned to me after one of our elevator rides down and one of our heritage and told me worry about being a mom and I'll handle the last stuff.
Danielle Flint: It's something I'll never forget. And I remember a dark time when I stood bedside from my daughter in the ICU machines beeping all around. And I felt like a complete failure.
Danielle Flint: I was earning minimum wage lacked higher education and no cure for this monster that was robbing my daughter of her childhood.
Danielle Flint: All along being told that I could receive some financial support from a program that was designed for family like mine.
Danielle Flint: But then being told on the other end by the administration that my child isn't that sick.
Danielle Flint: I was stuck in this tug of war with Social Security for medical team would provide extensive evidence of eligibility, but every two to three years of medical experts sat across Tara and I and minimize her illness and the denial will follow.
Danielle Flint: And though the seven year appeal ended in victory. The challenges of Social Security. We're not over a dedicated account that was setup for my daughter has been a struggle to access
Danielle Flint: Fortunately, with the dedication of my daughter's legal representatives and the hematology team, we were able to have funds approved for the purchase of a vehicle.
Danielle Flint: That would be used to transport, my daughter to and from routine medical appointments and school the cars also used to get her to and from
Danielle Flint: The hospital a timely manner to bring her for medical intervention and avoid being transported without me by ambulance, which has happened in the past when she was a preschooler
Danielle Flint: Since the approval of the vehicle purchase in 2016 I have yet to successfully received an approval to use the dedicated account funds to purchase any other qualifying expense for her.
Danielle Flint: My son's benefit stories, a little bit different. And he also required an account has application experience was different. As I mentioned,
Danielle Flint: And his experience medical challenges were early on by decided to hold off applying and wait to see how my daughter's case would play out.
Danielle Flint: When he was 12 months old. I applied, since there was enough evidence for an approval and though his case was more medically complex than my daughter. He was also initially denied benefits.
Danielle Flint: I requested an appeal and he was awarded benefits. After the first appeal due to the time it took for approval, he required a dedicated account in which eventually funds were released
Danielle Flint: Through the years to hematology team has provided numerous supporting letters for purchases on behalf of both children.
Danielle Flint: Each request has was met with an additional barrier requesting more despite how compelling the supporting documents were
Danielle Flint: It was a time when my washer and dryer stop working. And I requested funds to purchase a new set to keep my daughter's clothes clean and have access to a dryer to heat up blankets. When the aches from the pain crisis was unbearable.
Danielle Flint: That was denied during the time that she had a frequent hospitalizations her doctor suggested getting her an iPad to keep her up with school and access apps that he would recommend that was denied.
Danielle Flint: For physician also felt it was imperative that she get enrolled in an extra curricular activity that she enjoyed
Danielle Flint: And embrace her abilities and not focused on her disabilities and provided social interaction as this disease is very isolating that was denied.
Danielle Flint: After my daughter was denied so many qualifying expenses. I stopped pursuing music
Danielle Flint: By 2017 my son had his funds on touch for two years and that that time he was four and very excited to return to preschool.
Danielle Flint: In the fall, unfortunately, two months before his first day of school, he became severely ill and was hospital as needed to have a spleen removed.
Danielle Flint: And unpredictable recovery with many variables. By the time he was ready to go back to school. It was October, and luckily his school held his placement, but I could no longer afford the tuition.
Danielle Flint: After being out of work for three months. I assumed with this dedicated account being a smaller amount
Danielle Flint: It'd be easier to access because it was clearly an educational expense and the only way I could return back to the workforce.
Danielle Flint: I requested his funds, this time in person, and though I know the decision cannot be made on the spot. I wanted to provide the representative any additional information to expedite the process.
Danielle Flint: I ended up with an incredibly unprofessional claims representative who simply did not seem to understand the rules governing dedicated accounts.
Danielle Flint: The rules that clear this expenses from my son's tuition which falls under education and school
Danielle Flint: Instead, the representative question my integrity and challenged the request them out, stating that this doesn't sound right. Do they know you're receiving public benefits.
Danielle Flint: They should be giving you free or reduced childcare I explained that this was already a reduced rate and that this preschool was not an easy program that accepted vouchers, the rep asked proof of this.
Danielle Flint: I went back to the preschool what notes tuition in hand to get asked for another favor and the director wrote another detail letter verifying that what I had already stated
Danielle Flint: During my next conversation and following the receipt of the second letter the rep started to question why I wasn't receiving child support from the absent father
Danielle Flint: I felt a little than angry to be treated in this manner and can only wonder how many other vulnerable parents have have faced this kind of treatment.
Danielle Flint: What was the most violating was that this employee called my son school without my permission to ask for the questions.
Danielle Flint: My family's privacy was completely violated and I was humiliated when I had to explain to the school staff. Why this rep was calling to speak to the director
Danielle Flint: After this occurred, I contacted G BLS to share my horrific experience and we ultimately spoke to a supervisor who followed through.
Danielle Flint: With the approval to use the funds for my son suicide and after already being enrolled for six months. This depleted his account, and though it was then it was close.
Danielle Flint: This process was almost not worth the humiliation. So fast forward three years and covert hits, I received a call from Terra just checking in.
Danielle Flint: As shared how tight things were financially. How was working from home and balanced in the demands of at home learning for for children, my household cause had increased and my hours reduced
Danielle Flint: And named off a list of needs that I knew were qualifiers to use for my daughter's dedicated account. But I also know from past experience, it would be impossible to access without legal help
Danielle Flint: To are provided the manpower, I would need alarming enough, even with legal help supporting documents and in the middle of a global pandemic all the requests were denied and required more proof.
Danielle Flint: Each request I made was directly in accordance with the guidelines of usage for dedicated accounts and professionally outlined.
Danielle Flint: I'm sure with more time and legal assistance we can get this approved, but this is unnecessary.
Danielle Flint: So remember back in 2008 when I told you I applied for Social Security for on behalf of my daughter. It wasn't the only application I completed.
Danielle Flint: Inspired by my daughter's journey and the professionals that stood by him by me I enrolled in college and in May 2015 five months prior to our final hearing. I graduated with my master's degree in social work.
Danielle Flint: And obtain my LCS W. I'm currently a candidate for my independent license pending an exam and I currently work for early intervention and as a childhood social worker and help families like mine.
Danielle Flint: So here's my advice on how to improve the use of dedicated accounts eliminate them. They're not necessary parents know what their children need and how to best support them.
Danielle Flint: As I tell my parents. I work with you are the expert in your child's life.
Danielle Flint: So much is left in the discretion of the representative and this is a problem claim representatives who don't understand the rules or have strong opinions about
Danielle Flint: Who should receive SSI create huge obstacles and barriers to accessing the dedicated account funds.
Danielle Flint: In my case, the administration failed my child from the start and the lack of knowledge caused the need for the dedicated accounts in the first place. Why fam why punish a family twice.
Danielle Flint: It would be ideal to be to be able to access these funds without any barriers or hurls especially during this pandemic.
Danielle Flint: For example, during this pandemic. I've had to buy additional cleaning products hand sanitizer laundry detergent and mass
Danielle Flint: The cost of food and utilities have increased which are all basic needs that exceed my wages and the supplement income, I received from SSI from my kids.
Danielle Flint: As I look at my accounts, trying to figure out how to pay the next bill there's a large amount of money that I cannot access
Danielle Flint: Yes, I can apply for government help. But why take from another family that can use it when I have an account does designated for these expenses.
Danielle Flint: During this time, SSH should just wave the rules for accessing any dedicated account funds so low income families like mine can meet the needs of their disabled children without hesitation or punishment.
Danielle Flint: This code world is not new to a family like my during this pandemic, the world has faced job loss struggles to meet basic needs risk of homelessness isolation and depression.
Danielle Flint: I repeat, this is not new to a family with a child who is disabled. However, there's no current stigma around job loss struggles or accessing public benefits like unemployment.
Danielle Flint: So please keep in mind when dealing with a family of a disabled child. We live in a constant pandemic. But typically, the world is just not that understanding. Thank you for your time.
Nancy Altman: Well, Daniel. That was you're bringing me to tears that was very, very powerful and
Nancy Altman: Now fortunately most of the people who work at the Social Security Administration are very dedicated Mr also boxed in by these rules. I'm sorry you had that experience. But let's now hear from one of those dedicated employees.
Nancy Altman: David less greenie is President of the National Council of Social Security Management associations, he's going to start us off.
Nancy Altman: By providing on the ground, as I say, concrete, look at the at the field at the, the issue of dedicated accounts from the perspective of the field office that are getting these requests.
Nancy Altman: And then after his remarks, we will open it up more generally. So David, the floor is yours.
Nancy Altman: David, are you muted or
David Lescarini: I was muted. Can you hear me now, Nancy. We can hear you.
David Lescarini: Perfectly. Okay, thank you. Thank you. Thank you for letting me be here today. And I just want to express
David Lescarini: My sympathy for what the previous speaker had to go to. I'm sorry you had that bad experience that you had with your local office and I hope that
David Lescarini: I hope that they have resolved resolve the issues. I'm going to try today to give a perspective of from a workload perspective of what happens in the field office.
David Lescarini: Most dedicated account situations occur when a child is first approved for disability benefits.
David Lescarini: Though some do occur while processing read determinations medical cessation appeals that do not have benefit continuation or verification of household income that results in an underpayment to the child.
David Lescarini: And all of these instances the underpayment which is defined as the past big benefit must be paid into a dedicated account if the total underpayment amount exceeds six times the federal benefit rate or FDR
David Lescarini: This year the FDR is $783 in 2021 it will be $794 at this point the representative pay. He is required to establish a dedicated account.
David Lescarini: And provide the field office, the name and address of the financial institution, the routing and account number, the account title.
David Lescarini: The type of account and the amount of money deposited into the account if any this account cannot be the same account used for the monthly benefit.
David Lescarini: The field office must then have the page sign and date and SSA 552 dedicated account, use of funds statement which must then be uploaded to the electronic folder.
David Lescarini: Because the dedicated account information is not captured within the SSI program itself. The information provided by the pay. He must be loaded in remark in the remarks field.
David Lescarini: And
David Lescarini: A report of contact must be made concerning the information at that point the technician must use the automated one time payment process HTTP.
David Lescarini: To pay funds to the dedicated account. This is a manual process that involves one employee loading the payment information for each month and a second employee of equal or greater.
David Lescarini: pay grade reviewing and approving the input, because any underpayment over three times the FDR must be paid in installments six months apart but no more than three installments.
David Lescarini: Dedicated account benefits are subject to this provision when an underpayment is subject installments. The system uses what we call diaries to work Field Office technicians when subsequent installments are needed.
David Lescarini: In addition, field office managers can maintain a manual list of these cases as an additional control in case the system should not operate as intended, and set the diaries correctly.
David Lescarini: Once a dedicated account is established and payments are made to the account to pay. He is limited as to what the funds can be used for. And I know it's been mentioned several times, but I'd like to cover him again.
David Lescarini: They can be used for medical treatment education and job skills training. In addition, as it relates to the child and child's impairment, the money can be used for personal needs assistance special equipment.
David Lescarini: Housing modification therapy rehabilitation or other items and services that SSI determines appropriate. In addition, there is the emergency exception that I mentioned earlier in the in the first hour
David Lescarini: If the pay. He wants to spend money from the dedicated account and they are unsure if it falls into one of the allowable categories.
David Lescarini: Or if I have another name that is not explicitly listed as an allowable expense. Then I are supposed to contact the field office and ask for permission. Prior to spending the money.
David Lescarini: Because each expenditure request as you make fo staff must consider all request carefully and ensure that the pay. He has the opportunity
David Lescarini: To explain the connection between the expenditure and the child's impairment fo staff misuse their best judgment to decide on a case by case basis whether the expenditure relates to results from or would improve the child's condition.
David Lescarini: I must take the following steps during the determination process. I have to once again manually put remarks or report of contact.
David Lescarini: remind the payee of record keeping responsibilities and the annual accounting and provide the payee with a notice whether it was approved or not. Plus appeal rights. Now, look at this. Notice is a manual. Notice
David Lescarini: The system cannot automate such notices our policy manual does have many examples that employees can refer to as to what can and cannot be approved, but it is not an exhaustive list and discretion lies with the deciding employee.
David Lescarini: As mentioned previously, we require pay to keep records and receipts of all deposits to and expenditures from the dedicated account.
David Lescarini: And in addition to pay you must submit an annual accounting report form 1633 representative pay. He reported benefits and dedicated account.
David Lescarini: Or the use of benefits and the activity of funds and the dedicated account. This is a three page form with five pages of instructions on how to complete the form
David Lescarini: Ages. One and two are for accounting for the monthly benefits if required, and Page three is for accounting for the dedicated account benefits.
David Lescarini: Question seven on the form asked the following. Did you take any money out of the deck dedicated account during the report period.
David Lescarini: And where these purchases for medical treatment or education or job skills training if the pay answer's no to this.
David Lescarini: Second question there and partly in the field office will have to determine if the expenditures were allowable.
David Lescarini: It to pay ask for permission. Prior to spending the money then documentation should be in the electronic record if prior permission was not asked
David Lescarini: Field Office staff have to determine after the fact that the expenditures were allowable.
David Lescarini: If the employee determines that the expenditure was not allowable than the employee must conducting investigations determine if Miss application or misuse applies and these are two different concepts.
David Lescarini: The use of funds from a dedicated account for an expanse not authorized is considered a miss application of funds.
David Lescarini: When the expenditure is done knowingly and when the pay. He knew that the expense was unauthorized but the benefits, but the expenditure was used for the child.
David Lescarini: In that case, will pay. He is responsible for returning that money to the dedicated account.
David Lescarini: Misuse applies when a representative pay. He received payment for the use and benefit of another person and convert such payment to use other than for the use and benefit of the of the other person. In this case, the child so there's there's a difference there.
David Lescarini: This is a brief overview of the dedicated account workload process in the field.
David Lescarini: I'd like to end with some issues that often arise as well as the impact of the pandemic on the process.
David Lescarini: First many financial institutions are not familiar with a dedicated account comes up, which can lead to difficulties prepay ease and establishing such account.
David Lescarini: It is not uncommon for banks to suggest that one account is good for both the back pay and the monthly benefits.
David Lescarini: Which is true for individuals who do not need a dedicated account. This leads to banks contact in the field office for clarification or re contact by the payee on the issue.
David Lescarini: Some individuals have difficulties in getting bank accounts because of past issues with local banks and direct express accounts are not an acceptable type of account.
David Lescarini: This is particularly noticeable in Rural. Rural communities that are underserved in regards to the availability of financial institutions.
David Lescarini: Dedicated account processes and added burden on the payee and takes away their discretion and using the funds for emergency situations.
David Lescarini: field offices. It is a labor intensive process in developing request for expenditures and for accounting for such benefits. Also, even when a child turns AJ team if they are still entitled SSI benefits the dedicated account stays in place. And even if they are now their own tiny
David Lescarini: They must abide by the dedicated account rules. Lastly, the pandemic has made it more difficult to administer the dedicated Account Program, David, the need for all these forms.
David Lescarini: Expenditure such as expenditure request before and 5552 at the beginning, it has to be signed. So the pandemic has made it more difficult because we're having these the mail.
David Lescarini: For pretty much everything and individuals may not have access to fax machines that we could use
David Lescarini: That is not call me up and
David Lescarini: Be happy to answer any questions.
Nancy Altman: Well, thank you so much. Let me just ask you one question. And then I'm going to ask questions of the panelists who haven't spoken yet. And then we're going to really open it up for sort of a round robin and as Kevin
Nancy Altman: said at the beginning, we're very fortunate to be joined by
Nancy Altman: Two other managers and field offices to other colleagues of David. So Greg, and Rachel. So all of you should feel free to jump in. Um, can you talk a little bit about the pre coven and postcode and
Nancy Altman: Wish you were part of a freak overt and covert period and in the ability to review these accounts and also
Nancy Altman: The former Commissioner Joanne Barnhart in the first panel also talked about that there might be some fair amount of discretion on the part of the
Nancy Altman: Commissioner, even without but legislation to change things from your perspective as the ones who really have to implement this policy.
Nancy Altman: What, what kinds of changes if you, you know, if you will, the world, what would you, what would you recommend. So that's, that's a lot. But if I can just get your initial thoughts.
Nancy Altman: That would be great.
David Lescarini: Okay, I'll try my best. I'll say before the pandemic, one of the things
David Lescarini: And this is just anecdotally, from my experience in as the office manager. A lot of times when someone has a request for an expenditure out of a dedicated account.
David Lescarini: You know, it's an immediate need they're going to come into the office, they're going to discuss it with the technician and
David Lescarini: You can oftentimes make a decision at that point and say, well, you know, I think we can approve this. Just give me the receipts, you know,
David Lescarini: Give me an estimate of how much it's going to be. And you can go ahead and release the money. So it can be a pretty quick decision right now we're in a situation where
David Lescarini: All of this is having to be done by mail for the most part, unless somebody has access to a fax machine. So you're talking about someone having to call our office.
David Lescarini: Talk to the customer service rep who answers the phones. They're going to have to hand that case off to a claim specialist who can actually approve.
David Lescarini: The expenditure, but they're going to have to have something in writing before they can approve the expenditure.
David Lescarini: So it has prolong the process as far as what we would like to see I can say that next month as an organization had advocated for the elimination of the dedicated account provisions we advocated for eliminating the accounting for parents.
David Lescarini: That are paid for children and for spouses and that was nice to see that happen. But we would also advocate and have advocated or the elimination of the dedicated account provisions themselves.
Nancy Altman: Thank you. And let me now bring in
Nancy Altman: Joanne, if it's if it's safe for you. I know I will do that.
Nancy Altman: But to because that's really a I think David presented a sort of a good jumping off point that the
Nancy Altman: That there's an, I should say. I hope you don't mind me revealing this that Joe and I go way back. We actually worked on the whole together in the 70s and
Nancy Altman: So we, we all and Kim's worked there for many years. So we all know how hard it is to get legislation through Congress. But this is one where you've got both Democratic and Republican administrations that have
Nancy Altman: advocated for
Nancy Altman: Limited eliminating dedicated accounts. Do you have any sense or from your years of testifying on this working on this, whether there's a hang up with it or
Nancy Altman: Because if you think it could just be slipped into something or it's too low priority in any way and then please any other state. Any other comment, you want to make
Nancy Altman: Before I turn on to the other panelists who have not yet spoken.
Nancy Altman: And Joanne. I think you're on mute, if you if you heard that question.
Nancy Altman: Can anyone. Is there a way to tell if Joanne's muted or
Emma Tatem: Appears
She is muted.
Nancy Altman: Can you unmute her or if not, we'll move
That the host can unmute her
Emma Tatem: Show. Hello.
Nancy Altman: We, you know what, what the two of you figure that out. Why don't already move on because we're also, as I say, very
David Lescarini: fortunate to have
Nancy Altman: Two.
Nancy Altman: attorneys who work on these issues, Tara. Does that and Linda Landry and I assumed here that was
Nancy Altman: You that Danielle was referring to. And I love that advice to
Nancy Altman: You know that you'd worried about the legal link so
Nancy Altman: Let me ask you, as both of you.
Nancy Altman: If there
Nancy Altman: I get the same kind of question what you've seen on on the ground and pre coven and coven and any other kind of comments, you want to make about this issue of dedicated accounts that you think it's important for all of us to know
Taramattie Doucette: First of all, thank you all for having
Taramattie Doucette: insurance, disability project for having me participate in this Roundtable. This is a dream come true for me that I get to talk about this issue in my agency Greater Boston Legal Services.
Taramattie Doucette: I am known as the person who's pushing that rock up a hill and I'm so glad to hear so many people say it should be eliminated. Professor Mary O'Connell was my professor
Taramattie Doucette: at Northeastern University School of Law. In fact, we had a name of a couple of fellows a fellowship after her, and we've had a couple of fellows, they have they worked on the article with Miri
Taramattie Doucette: Danielle's experience. I just want to make a couple of comments, Danielle planes experience and thank you for your kind comments, Danielle.
Taramattie Doucette: About the representative
Taramattie Doucette: About the claims representative, that wasn't
Jo Anne Barnhart: There are some claims representative who are like that, but there are many, many very high and good claims representative who wanted to help because I know we have the next people. They are so staff this, I want you to know that. And we are
Jo Anne Barnhart: Closely with our local field offices and we know it's hard work and we do know that the so understaffed. We get that you'd walk into an office and it would be
Jo Anne Barnhart: jam packed and you go up to the window and they would be was hoping to understand that and then levels it later on to tell you this. Linda host our
Jo Anne Barnhart: National
Jo Anne Barnhart: Coalition. So she gets all the problems that we can count for a couple of things. We called it
Jo Anne Barnhart: While you know I appreciate the report of the process what our experience on the ground.
Jo Anne Barnhart: It's very, very difficult.
Jo Anne Barnhart: Why does it take a lawyer.
Jo Anne Barnhart: To go before the Social Security Administration to get somebody on
Jo Anne Barnhart: A computer or for tuition.
Jo Anne Barnhart: Or medical expense paid that shouldn't happen and that's kind of a consistent problem and we see unlike Daniel mentioned
Jo Anne Barnhart: After we got her the first item which you advocated for
Jo Anne Barnhart: Just kind of went away and I called him back.
Jo Anne Barnhart: And he or she was just like, I have all of these expenses and I can't use this money. I mean, the washer and dryer think she should have been allowed to use her money right clean and easy to back up a little bit about the disability project. I know that I'm
Jo Anne Barnhart: Am I had gone to our side, you know, social advisory board staff went to our side, the children's disability project, you look at our materials we invest how we got involved. We got invited. We decided to create
Jo Anne Barnhart: The saving and spending warp tour guide families because there was nothing out there.
Jo Anne Barnhart: Really in the in the in language and in a kind of developed in a way that people could really
Jo Anne Barnhart: Understand
Taramattie Doucette: You know, how do you, how do you navigate this dedicated account. What are the do's and don'ts, how we, I was looking at it I printed out some of what we
Taramattie Doucette: Say this is what is a dedicated account to do's and don'ts of a dedicated account, keeping back benefits separate. This is what you have to do you um can I put my funds into a dedicated account.
Taramattie Doucette: How to get them written for a special purchase and there's this is what you do, you need to
Taramattie Doucette: Know the cost. You need to get a doctor's letter or it's all in here, how to keep track of your spending. So we decided to do that. And we thought that would have a big impact.
Taramattie Doucette: And this is pre recorded post covert, it's the same issue for us. It's not being covered
Taramattie Doucette: One quick thing I want to because I heard this in this application term come up so often in this the conversations and we do not. But the difference with misuse and this application. I have never seen a misused.
Taramattie Doucette: allegation. I have seen one misapplication allegation, and I took it all the way up to before the administrative law judge and because of a court order.
Taramattie Doucette: The monies were released. And I want to just briefly talk about the story and I call the client Deidre not do it very quickly.
Taramattie Doucette: So this story is about Deidre a 20 to 22 year old girl receipt young woman who received SSI as a child, but later when she graduated high school SSA would not really dedicated account for college tuition.
Taramattie Doucette: Dishes impairments was depression a topic dermatitis psoriasis obesity and she has a learning disability in March 2008
Taramattie Doucette: Brenda Deidre his mother applied for SSI, the application with us was denied twice and then in 2010 she came to CDP for legal help
Taramattie Doucette: She was, she was 13 years old when I represented and we won and then mom went away. Then it was, you know, Detroit graduated high school
Taramattie Doucette: And when her claim was finally probably I should step back and see when the claim was process. She was old 31 months of
Taramattie Doucette: retroactive benefits that was slated to go to a dedicated account.
Taramattie Doucette: So, Brenda was teachers representative paid and you take your clients as you get them Brenda has her own impairments. She has
Taramattie Doucette: Disabilities of her own. And she had a long work history, despite with disabilities. Despite her impairments until she had a serious injury and she could no longer work. So she was on so
Taramattie Doucette: As Dr. To have a learning disability. The mom. So this is, and she wasn't able to navigate her child account. So then six years later in 2016 because I'm not thinking about Deidre and Brenda anymore. I'm moving on to my other cases, I am representing Danielle now right so
Taramattie Doucette: Brenda contacted a CDP because in that six year span only one installment was speeding. It was for $2,113 and 20 cents.
Taramattie Doucette: And guess what she used it because she followed it, she thought she was following the rules. He was spending it on a child.
Taramattie Doucette: And then Social Security said, hey, we're not, we can't put any more money that because you miss apply that we're hitting you with Miss application. And we're not going to pay any more installments and that was that. So by that point.
Taramattie Doucette: Deidre wanted to go to college, you wanted to go to community college you wanted to enroll in class. There's no money. So she went to social security.
Taramattie Doucette: To for tuition for money to pay tuition and that's how she found out that you know they had this miss application.
Taramattie Doucette: I'm not going to go into all these details, but this case involved this mom who had a very limited income came back to Social Security $50 because as the Social Security reps here know that
Taramattie Doucette: When you if you are charged with this application, there's a plan to pay back and she thought I am paying back $50 it is going back to my daughter's dedicated account. I will do better next time I will follow exactly what they say.
Taramattie Doucette: She didn't realize that $50 that she was paying back that she could barely afford was going back to the US Treasury. It was gone forever. She didn't know that she cried when I explained that to her.
Taramattie Doucette: She had paid that until he couldn't pay it anymore. Well, the first visit to Social Security. This is where I have to say I met a very nice.
Taramattie Doucette: Brilliant claims rep, who knew the rules and
Taramattie Doucette: She released pot of money. And it was the first installment, and we were able to pay tuition and books she happened to
Taramattie Doucette: You then she got pregnant. And she went, and this is real life. I'm telling you, on the ground, it's our turn to tell on the ground. She so I need to tell underground. It is my life.
Taramattie Doucette: She got pregnant, she went on maternity leave, guess what it was time for now for teacher to pay for the next part of a tuition. We went back to social security.
Taramattie Doucette: That rep said no, I still see that misapplication. You're not getting any more money I'm I'm embellishing okay just for to make it not so dry and I'm so
Taramattie Doucette: Not you're not getting any money you're denied. No. So what happened is that I took this to the lodge and here's what the judge ruled
Taramattie Doucette: He was like, overwhelmingly in support of a believe this claiming because he saw all of their receipts and all of that. And he wrote an expedited decision and Mary I also sent him your article after the fact.
Taramattie Doucette: And because I was so thrilled with his decision. He wrote
Taramattie Doucette: I find that Brenda's mental and educational limitations support her testimony that she did not knowingly violate the rules regarding the appropriate expenditure of funds from this account.
Taramattie Doucette: Furthermore, Brenda statements, indicating that she always attempted to comply with SSA rules and regulations.
Taramattie Doucette: are supported by the fact that she consistently provided receipts for our expenditures associated with this account, including receipts dating back to 2011 and 2012 remember when we're in 2018 when we're having this this hearing.
Taramattie Doucette: Up Brendan may not have fully comprehended the minutiae of every portion of the regulatory framework of dedicated accounts, but the record certainly indicates that she consistently made good faith efforts to
Taramattie Doucette: Ben funds this account on her daughter's behalf. The record as a whole, supports the conclusion that she did not miss apply to Clemens dedicated account out funds.
Taramattie Doucette: Because she spent the funds on allowable expenses, including educational and employment related expenses and just judge actually put the the here treatments that the mom useless because of the
Taramattie Doucette: Psoriasis and they actually put the foods that she was a purchasing the special foods for to help control her obesity and he put that in the decision and we got an expedited decision and disease. So I just had to share that
Taramattie Doucette: I think having someone be having someone blocked from the education chart, a young woman with a disability who started this process at age 13 and then
Taramattie Doucette: as as as others mentioned to became her own cave and she became an adult, she became my own rep representative P and still that money was on lockdown. She could not
Taramattie Doucette: Access it and how sad for her. She was blocked from her education, I am pleased to say that we started this journey, a while ago in 2019 the last payment was me and she's all done with her dedicated account. So that's my story.
Nancy Altman: I'll care that that was very again. We wanted to hear on the ground and we are definitely are. And I see that Joanne was
Nancy Altman: unmuted, and nails muted. Again, but I don't know me if you can unmute her Joanne, because we'd like to bring you into this conversation as well.
Emma Tatem: unmute and I believe she has to press star.
Nancy Altman: Six.
Jo Anne Barnhart: I think she did you hear me now.
Jo Anne Barnhart: Can you hear me now.
Jo Anne Barnhart: Yeah, we can. Right, right. I can hear you before, Nancy. Thank you so much for trying to bring me in earlier, but I could not unmute
Jo Anne Barnhart: Okay, so I want to thank all three presenters for their comments extremely helpful and really wonderfully different perspectives and insights provided. I did want to ask some administrative type questions of David, because you know when we talked about
Jo Anne Barnhart: Whether or not dedicated accounts even make sense fiscally speaking day it's David correct
David Lescarini: Yes. Yes, he did. Yes.
Jo Anne Barnhart: Okay, so my question, I have a couple of questions.
David Lescarini: If I am a
Jo Anne Barnhart: parent who is calling in to inquire about expenditures, or to get approval for expenditures on a dedicated account, am I calling the 800 number or am I calling a specific person.
David Lescarini: Well, you could be calling either, but it's really when someone does an update on somebody, record the perks.
David Lescarini: When somebody gets approved or redetermination the technician is supposed to inform the individual, you know, here's, here's my name. Here's my
David Lescarini: Here's the phone number. Here's the extension and I should be telling them, contact me if you have a question concerning you know expenditures for the dedicated account. Does that always have a reason is that
Jo Anne Barnhart: The reason I asked that is because I know the tremendous strain the 800 number is under and the waiting times and so forth. And I also know from my own experience.
Jo Anne Barnhart: Visiting district offices and talking with claims reps that they're often totally backed up in terms of voicemails too. So the first thing is
Jo Anne Barnhart: My question would relate related to specifically how timely or response. Does the parent or the person who is responsible for administering the dedicated account, your how timely, it can they expect action.
Jo Anne Barnhart: I don't expect you to answer that. I just raised that
Jo Anne Barnhart: As more of a general concern given the agency workloads and the claims wrapped workloads and backlog of voicemails typically speaking on the question is that, let me
Nancy Altman: Open it up speakers, we have to others.
Nancy Altman: For managers to if any of them because I think that is a really important question about the timeliness.
Nancy Altman: Of the that's part of the problem with the
Nancy Altman: Need for approval. So the either the others.
Nancy Altman: And Rachel grade.
Nancy Altman: Have anything
Nancy Altman: You want to add on that before joining guns to our next question.
David Lescarini: And see, this is David Greg had to drop off. He had another
David Lescarini: Engagement in
David Lescarini: Yeah. Rachel is actually our Washington
David Lescarini: Rap. So she's not a field office manager. Okay.
Nancy Altman: Thank you for that clarification.
Nancy Altman: Julian back to you.
Jo Anne Barnhart: Okay, so. My second question is this, the people who handle the issue of the dedicated account. Is it a specified workforce within the district office.
Jo Anne Barnhart: Or is it just sort of if you have happened to be the claims are up to was assigned that particular beneficiary that you handle that, generally what I'm saying. David Wright, I would say in
David Lescarini: General, it's probably going to be the same claims records per claim specialist that handled the original dedicated account though my experience, I've worked primarily in rural offices.
David Lescarini: And that's been my experience. I can't really speak for a large metropolitan office with with, you know, 50 or 60 clients specialist. They may have somebody dedicated
David Lescarini: That I'm not sure I can't speak them. Yeah, so
Jo Anne Barnhart: So the point. The point I'm raising there is. If it's handled by the claims reps, generally speaking, and I have tremendous respect for the claims or UPS. I've seen the palms. Believe me, tremendous respect and seeing them in action.
Jo Anne Barnhart: But it is a very specialized area that requires discretion and judgment at a certain amount of knowledge. And so I do think that that is something that contributes to perhaps
Jo Anne Barnhart: misapplication of the way that the the rules and the regulations read and result in the situation as noted by our parents who unfortunately I apologize, but I couldn't hear your name with the road noise.
Jo Anne Barnhart: But your story was incredibly compelling and and I'm very sorry you had to go through it, too. And I just want to reiterate with Nancy said, which is, in my experience,
Jo Anne Barnhart: 99.9% of the Social Security employees are incredibly dedicated and wanting to do the same thing. The right thing and I'm really sorry.
Jo Anne Barnhart: That you got one who, for whatever reason wasn't able to live up to that. So Nancy, I'll turn it over and let someone else go I'm, I'm just trying to help.
Jo Anne Barnhart: Build a case from an administrative side for why perhaps the dedicated accounts end up being not not don't make financial sense you know from the standard way to budgetary concerns which were one of the things that brought them into existence to begin with. So that's it for me.
Nancy Altman: That was
Very, very
Nancy Altman: Helpful. And it's really we are really so fortunate
Jo Anne Barnhart: To have
Nancy Altman: So much expertise and so much
Nancy Altman: Firsthand
Nancy Altman: Experience on this issue and we really talking in two levels. One is
Nancy Altman: That you know what we could do if we could
Nancy Altman: Have legislative change. But also, are there things we can do short of legislation or before
Nancy Altman: Legislation to improve so
Nancy Altman: They say
Jo Anne Barnhart: Even if
Nancy Altman: Danielle, you would have a greater claims rep, it still would have had
Jo Anne Barnhart: Problems. I mean, it's
Jo Anne Barnhart: It's money than someone else's
Jo Anne Barnhart: You know, was his
Jo Anne Barnhart: Report to
Nancy Altman: So with that, let me
Nancy Altman: Start by asking
Nancy Altman: Start with
Nancy Altman: People on the panel who may have comments or
Nancy Altman: Questions for each other or
Nancy Altman: Have some conversation among
Nancy Altman: Yourselves and then we'll go to
Jo Anne Barnhart: Board members for questions.
Jo Anne Barnhart: And conclude
Nancy Altman: With the
Nancy Altman: Questions and others who are. And again, thank you.
Jo Anne Barnhart: I can see
Nancy Altman: Thank you. And let me repeat that if you have
Questions.
Jo Anne Barnhart: Please.
Nancy Altman: Put them in the chat.
Nancy Altman: Right. Emma, or they can
Nancy Altman: Email
Nancy Altman: The events.
Nancy Altman: So without so if you're thinking of questions, send them on to Emma's is we'll, we'll catch them as soon as they come in. But let me start
Nancy Altman: Linda you if you've got want to add something and people from the morning panel, anyone who wants to either make comment, ask a question or somebody else make a comment to someone else.
Linda Landry: I'd like to make a couple of points. Nancy, if I may. Thank you.
Linda Landry: And thank you for putting whatever put this panel together. It's been a great experience. And it's, it's so needed
Linda Landry: And I wanted to thank Commissioner Barnhart for her remarks as well you know be even before coven
Linda Landry: local offices have been understaffed. And I don't think the the dedicated account workload has been a priority workload.
Linda Landry: Claims reps to do a difficult job they do what they're they handle the priorities that they're supposed to be handling a dedicated accounts are really, relatively speaking, a small portion of the job but a very important part of the job.
Linda Landry: Which is we've heard requires a lot of knowledge and and and discretion and
Linda Landry: I think that's possibly why
Linda Landry: Tara and I and a lot of other advocates and and
Linda Landry: Kim Arnie diet, Danielle. Sorry. Danielle. I wanted to rename you Kim, you remind me of a camera. I used to know anyway.
Linda Landry: Have have seen such you know trouble getting perfectly approvable expenses approved and by the way.
Linda Landry: When I speak to parents who parent pay ease who are setting up a dedicated account I have yet to hear one who understood the difference between how they can manage the the the pay the rapid pay Reese responsibilities for the monthly expenses versus the dedicated account.
Linda Landry: You know, what does it mean something that benefits your child, you know what, what does education expense mean people have their own ideas about this and there's really
Linda Landry: They often don't have the time to talk to somebody long enough to get a full explanation.
Linda Landry: And I, and also I also tell them you know even if you think it's perfectly allowable. It's always best to get permission ahead of time because the next person who looks at it might have a different
Linda Landry: Different idea. And if you have it in writing that it's allowed you're good for the next time it's looked at, because it's, you know, annually these expenses good get allowed. I mean get reviewed so
Linda Landry: So what do we really think should happen. I mean, I think that in the covert emergency the short staffing and all the problems you've heard are really magnified. You know, people need the money.
Linda Landry: To have a healthy life for their children and they really can't get access. Now it's even worse, even though they have a greater need for the funds and we would like to see some emergency proclamation
Linda Landry: to suspend the use of the dedicated account rules. During this emergency and not penalize folks for using benefits.
Linda Landry: As long as they've benefited their, their children.
Linda Landry: At the very least, however, what we'd like to see is that SSA explain train claims reps to use maximum flexibility with the existing
Linda Landry: Dedicated account.
Linda Landry: Provisions what what things can be spent on and also work to
Linda Landry: Add more explanation.
Linda Landry: More examples that are more inclusive and you'll see some of those in the materials that that Tara has provided along with some of the other case examples and
Linda Landry: By the way, I wanted to ask if someone could put in the chat, where you find those materials, they're a little hard to find. I think they're available as resources to people who are watching
Emma Tatem: Yes, I will send the link again.
Linda Landry: Thank you, Emma.
Thank you.
Linda Landry: So, and you'll see there are a number of number of in those materials the materials that terrorists sent in. There are a number of ideas for expanding examples so that
Linda Landry: Claims reps feel comfortable saying yes, perhaps sooner. You know, one of them is an education expense all children need computers these days to go to school, especially, especially children who are now unable to go to school.
Linda Landry: Some school systems have supplied computers to children, but not all of them have and so children who have special needs, who are at home and don't have access to a computer.
Linda Landry: Are really missing out. And, you know, frankly, I think all kids need to succeed in school to have a computer to do research, especially now with the libraries being closed and everything so there there are a number of examples there that we would like to see
Linda Landry: Available to families during the CO but but also also after and that's a change in the palms, which doesn't really require
Linda Landry: A huge lift. I think there is that other more discretionary provision that is in the statute that says any other item or service, the Commissioner determines to be appropriate, provided that such expense is related to the impairment
Linda Landry: Of the child. So there's a there is a huge other category that I think could be flushed out more. So that claims reps would be comfortable, you know, allowing more different kinds of expenses more quickly.
Linda Landry: I think that that's probably where the emergency exclusion came from the emergency exemption exemption for a shelter and food items if the child is likely to become homeless or or malnourished is not in the statute. So that must have been something that
Linda Landry: That was that came in, under this this other discretionary function. In addition, the statute gives the Commissioner great discretion on systems of accountability.
Linda Landry: For dedicated accounts. It just says the Commissioners shall establish a system for accountability and monitoring. It doesn't say what has to be, again, we'd rather see the dedicated account go but understand that that will take some time and that there are other mitigating measures.
Linda Landry: That can be can be taken.
Linda Landry: In addition, I think, you know, if I don't think dedicated accounts were ever needed except perhaps politically, I think we got them because there was a misunderstanding of the SSI program. There's a misunderstanding about mental health.
Linda Landry: You know, I think people thought that SSI for kids should be for kids with the kinds of disabilities, you can see
Linda Landry: I remember one of those programs from 1995 watching. There was a picture of a child riding a bicycle and the child was alleged to be receiving SSI and the context was how can a child who can ride a bicycle be disabled.
Linda Landry: And so I think this is where a lot of the essentially discrimination comes from. And I think, you know, at the time the dedicated account was established.
Linda Landry: installment payments were established and installment payment then allowed for an initial payment of 12 times the maximum benefit payable.
Linda Landry: And another one in that same amount. And then the third for the rest of it. Now the installment payment requirement. Since 2005 is only allowing three times the maximum benefit payable.
Linda Landry: Which is you know a lot less money. So there's a lot less need for a dedicated account. I actually don't like installment payments.
Linda Landry: I think they're also expensive for Social Security to to manage that. If you need more money than what's in the first installment, you have to come forward and make a hardship agreement hardship.
Linda Landry: Proof and show that you need the money for some important purpose, which is again more work for claims reps, but it is perhaps the lesser of two evils. If we have to have either dedicated accounts or installment payments. I'm not sure why we need both.
Linda Landry: And they're also also able accounts now available to families, it would be great if families had the option of, you know, not putting money in a dedicated account but putting it in an ABLE account.
Linda Landry: That is can be more broadly used and they can also use able accounts to teach a child with a disability, how to manage their own money, much more easily with an ABLE account so
Linda Landry: I think I've rambled on long enough, but
Nancy Altman: That that was very helpful. And there was there was a lot in that
Linda Landry: I no
Nancy Altman: No, no, that was very useful. Let me first say, I thank you for thanking
Nancy Altman: Us for having us. Thanks. Really go we have an really fantastic staff. As you can tell, and they
Nancy Altman: Claire Diane and Emma and all the rest of the staff have been terrific. And I think you raised an important point to about
Nancy Altman: What are sometimes called invisible disabilities.
Nancy Altman: Or Can people really have to be educated about it and you also have a lot of interesting thoughts about
Nancy Altman: Discretion and maybe being able to use naval account and although i think i'm not sure the law can be stretched quite that far. But let me open it up to other everyone else who's
Nancy Altman: On the panel. If you have questions for each other comments to each other. Anything you, you know, you sound at this point that you're all agreeing. Are there areas of disagreement.
Nancy Altman: David, I'd be curious if you had thoughts about enjoy and as well if you're able to as your as you're able to have
Nancy Altman: Some of the suggestions. Linda had and so forth. So let me this Roundtable. Let me open it up to anyone that wants to speak just jump in and then we'll turn to start turning to questions.
Taramattie Doucette: Me. I go, just very briefly, for coming. Thank you.
Taramattie Doucette: Before coming to the meeting. I just did a quick run because you know I'm at home at in my dining room, my little spot during the zoom did a quick run and the numbers that we had since we started the project we had
Taramattie Doucette: The number of children we represented we represented well over 700 kids and I tried to do a little breakdown on the percentages.
Taramattie Doucette: And I found that 75% children I represented, or we represented in CDP we're children of color and it was even split between blacks and Hispanics and I say that
Taramattie Doucette: I say that because this is called with 19 and I need to make this comment because we can't look at social security in isolation. We have to look at what's happening around us and who is suffering.
Taramattie Doucette: And everyone looking to meet your eyes open a newspaper. It's all about black and brown people what's happening to people of color.
Taramattie Doucette: You know the panic had a pandemic has had devastating effects on communities of color and we know it's because of the inequities economic you know inequities health inequities.
Taramattie Doucette: Education in equities and I'll add another one internet and Wi Fi in equities the broadband in equities. I read something about that.
Taramattie Doucette: So all of that affecting the people I serve the poorest of the poor and the most vulnerable children with disabilities.
Taramattie Doucette: And you heard from Danielle and her struggles you know she couldn't get that wash and dry in all the hand sanitizer, and the things that she wants to buy
Taramattie Doucette: Buying that's that's eating up her budget so immediately what's needed
Taramattie Doucette: During this pandemic. It's for Social Security to, I want to say live to rule suspend the rules when we wrote to our the Massachusetts a congressional delegation. We actually were saying, Can we have a moratorium, just like the basically the housing moratorium something
Taramattie Doucette: People with a representative case can actually say what they want from all used to money and provider receipts and say, here are the receipts. This is what I used it for, and this is how, and this is why how I used it to help my child.
Taramattie Doucette: And get it approved. And that's, I felt like those numbers were very important for me to just to
Taramattie Doucette: Just to tell you about because of our location where my office is located. We serve the greater Boston area my torch Dorchester Roxbury Chelsea. And every time I open up your buddies. The communities that hit the hardest.
Taramattie Doucette: And I want to help the clients I serve and I'll say one last thing. When I took on the class.
Taramattie Doucette: Action lawsuit again at this I never thought we could do this massive case.
Taramattie Doucette: I'll tell you something. We said about the change the culture of the MBT and I think we can change a culture of the Social Security Administration. I'll tell you why why I say that. So, Linda, you talk to the non APAC the kids with non parents disabilities.
Taramattie Doucette: You know, make, I think, changing the culture. What I'm. What I mean is,
Taramattie Doucette: To be more receptive of families with children with disabilities and to
Taramattie Doucette: Trust that the as Danielle said a mom knows what's best for her child don't come and say negative because you know all the stories from the media in the past, don't have that in your background move forward.
Taramattie Doucette: Think about families as moms. These days, these moms know what to get for their family for their kids trust the mom. So it's kind of changing that culture, a little bit is something I would love to see, that's my comment.
Nancy Altman: Well, and thank you for bringing that perspective. I mean, we are at a moment in our nation's history really talking about systemic racism and
Nancy Altman: Racial Justice and some of what Mary was talking about with the attacks on welfare have those undercurrents as well. So let me at this point, open it up to board members if I've got a few questions as well but
Nancy Altman: camera died, be sure, Bob, do you feel free to jump in and either make comments are these questions or post questions either the whole group or the individuals.
Nancy Altman: We bring everyone else into this conversation because I think this is an extremely
Nancy Altman: educational content conversation for all of us and and the ideas to get different not necessarily points of view but but different angles on this because
Nancy Altman: perspectives that way.
Nancy Altman: So,
Kim. Go ahead.
Kim Hildred: I'm happy to to start out at least I have two questions. One is for David. And David. I'm wondering
Kim Hildred: I think I'm right about this that SSH put out
Kim Hildred: I don't know if it was an emergency message or instructions to the field kind of reminding them of the flexibility that they have to allow distributions from dedicated accounts that made the overall criteria. A. Do you recall when that message went out and have you seen
Kim Hildred: You know, a little bit of a different approach for by the field to go ahead and respond to those requests.
David Lescarini: So off the top of my head. I do not remember when that came out and but
David Lescarini: As far as if I have I seen the change
David Lescarini: In my experience, there's always been a lot of flexibility and approving expenditures from the account. So I was actually pretty shocked when I heard the experience that the prior speaker went through.
Nancy Altman: Okay and Kim, if I can.
Kim Hildred: David, if I can follow up.
Nancy Altman: Call it that the fact that the field offices now have to be closed and you're working remotely for, you know, obviously, for
Nancy Altman: Safety
David Lescarini: Yes. Now that would have an impact because of the fact that, you know, I think one of the questions earlier was the timeliness that you, that was asked, and
David Lescarini: Obviously, it's a lot more timely when you're open to the public and the person can come in, see somebody that day and at least have a good idea as to whether or not
David Lescarini: Their, their expenditures going to be approved, whereas right now. You know when you're having to conduct everything by mail I would assume that they're going to be longer delays in getting a pretty bold in the past.
Nancy Altman: And Terry and Linda, you, you are on the ground with that or are you seeing that as well, that it's harder because the offices are closed or not. Do you see the difference or no.
Linda Landry: Um, I think the message came out in June, I can answer that question.
David Lescarini: And
Linda Landry: We were glad to see the message or we didn't see it. It was not made public, but we were told what was in it and
Linda Landry: But it i think it's it's really, it really wasn't enough. It was it. It still leaves.
Linda Landry: Too many questions about what's approvable or not, you know, what does maximum flexibility mean it means something to everybody else and your. It doesn't mean to deviate from the covetable expenses listed in the palms. It just means to be, I think, flexible with them, or at least
Linda Landry: That seems like a likely interpretation, Tara. Have you seen any difference in responsiveness. When you have had had to contact local offices about the
Linda Landry: Dedicated account spending.
Taramattie Doucette: We just
Kim Hildred: Since June.
Taramattie Doucette: Since June. Well, Danielle, we put in for the last
Taramattie Doucette: Couple of things for Danielle.
Taramattie Doucette: In June in depth.
Taramattie Doucette: And actually we did this in
Taramattie Doucette: August and actually they did respond back and say they needed more information. And I don't know if it's because we were using the faxes and everybody's at home, but that one we did get and the other
Taramattie Doucette: Chris, I should i do I call it quick. The client who received a notice to quit.
Taramattie Doucette: He was about to be evicted.
Taramattie Doucette: He came in in March.
Taramattie Doucette: That's one of the office shut down. But I took his file home and that regional office help so and I was able to like by August. That was resolved from March to August
Taramattie Doucette: He was allowed to use that bit of a dedicated account funded regional helped with that, you know, and I don't know if he could response on this was to me because I'm pushing it.
Taramattie Doucette: And if you're asking, Danielle responsiveness to her may be, that's a different story responsiveness to me means you have a lawyer calling regional calling everybody calling the manager emailing right so that's the difference that sticks.
Linda Landry: But, and I think that's, that's an important point, too, because not everyone
Linda Landry: Represents people
Linda Landry: Whether it's child disability eligibility or whether it is not all lawyers do this. In fact, most I think do not. And so there's very little representation to people either on SSI claims for children. Generally, or for
Linda Landry: On dedicated accounts very specifically
Linda Landry: You know, I know, I know the Tyra Tyra doesn't and a few others do at the legal services, programs in Massachusetts. I know Community legal aid in Philadelphia, doesn't there are probably others. But the point is, I don't think it's widespread grip available representation
Nancy Altman: And people don't don't often don't notice that they should seek representation
Linda Landry: That's true, true.
Nancy Altman: And I see Bob is I take it you're unmuted. And you're visible. So
Nancy Altman: I assume that means you have a comment or question.
Bob Joondeph: very perceptive of you, Nancy. First of all, I just want to say that this is an absolutely fantastic discussion and
Bob Joondeph: The amount of expertise and experience it. Our staff have brought forward and all of you brought forward are stunning really, it's great.
Bob Joondeph: But I'm going to come at a slightly different angle. Because one of the things that our advisory board has also been looking at is, is the represented P system and how that's administered by social security and one of the questions that's come up there.
Bob Joondeph: Is whether it's social security really is the best place to be making decisions about individuals who have in their, in their lives in terms of what what their
Bob Joondeph: mental capacity of their cognitive capacity is what are the circumstances in life. Who are the people who care about them. How are they, how are they doing in terms of using their money wisely or or legally and and one of the questions that has come up there is whether
Bob Joondeph: Social Security and the federal agency is really the best place.
Bob Joondeph: To staff to to make those sorts of calls in people's lives or whether that would be something that would be better done locally. Perhaps it's true at the state level or the locality level. And so I'm completely convinced that
Bob Joondeph: That
Bob Joondeph: President system that we have here is not
Bob Joondeph: Made or effective but if if it works, has remained in place. Could it be done better by someone else, rather than social security claim representative
Nancy Altman: Anyone to feel free to jump in if you have a thought or response.
Mary O'Connell: I'm just gonna say something to Bob. But that assumes who's holding the money.
Mary O'Connell: Because right now, it's social security that that has the strings to hold them on. I mean, I understand the money's in the bank somewhere. But if you're envisioning this
Mary O'Connell: More local group of people, maybe more oriented towards understanding disability because there's so much that claims weapon Social Security has to deal with.
Mary O'Connell: Are you going to move money somewhere or release Social Security's obligations, we're seeing that the money only goes according to the
Kim Hildred: Statutory categories.
Bob Joondeph: But what are the in the representative pay area where things
Kim Hildred: Were
Bob Joondeph: Loved about is the fact that in actually sort of many of the same types of administrative hiccups that we hear about you hear, hear we hear about over there as well in terms of
Bob Joondeph: The
Bob Joondeph: The claim rep is just is, you know, works for an agency that's very, very effective and moving an enormous amount of money.
Bob Joondeph: Every year in getting it to the right place. But in terms of really assessing individual needs.
Bob Joondeph: And capabilities and and effective this that's a bit removed so
Bob Joondeph: Obviously if if there was some other entity that was performing this task, they would have to be a con it have to be set up a contractual or or
Bob Joondeph: System in which certain responsibilities are delegated and so forth. So I don't know about the particular is and how it would work here, and I'm not really suggesting that we should continue
Bob Joondeph: System, the way we have it now, but I do want I do wonder, because I hear echoes from the other work that we've done as to whether
Bob Joondeph: This federal agency that is very, very effective and doing one thing where they're given the task of doing something else that requires much more individual contact and assessment.
Bob Joondeph: If that's really their strong suit. And if there might be a better way to do it.
Nancy Altman: Well, and I think, actually, this exchange really
Nancy Altman: brings up another issue and something I'd like to ask a question about that.
Nancy Altman: The, you know, part of what is going on. There's a lot of pressure from lots of different places for the search screen administration.
Nancy Altman: And what of course it's Congress and as Mary said, you know, they see stories in the paper or they hear from constituents that there's all this kind of fraud going on and they say a skirt administration. What are you doing,
Nancy Altman: And if it is an interesting question. If you, if you, if they were just really just paying out the money to the address and someone else was in charge of the recipe, whether Congress would would shift its focus or still
Nancy Altman: Bring its guns towards the administration, so it's it's complicated.
Nancy Altman: And that really another
Nancy Altman: Piece of this, we haven't
Nancy Altman: Talked about, because we were very
Nancy Altman: Focused on and as I love Mary comment that you know in LA you focus on something very narrow and you know get invited to all the parties, but it's a very
Nancy Altman: You become the, the world's expert on it. So we appreciate the work you've done on it, David. Um, and this is really a question for Linda Daniel and
Nancy Altman: Daniel, you're free to jump in, but it's really a question for Tara and Linda and David and that is how high a priority is it in your work world. I mean, how many of these
Nancy Altman: How much of
Nancy Altman: In David in in your office is this, and it really adds to Joanne's is that
Nancy Altman: It's really anybody because it because there isn't just enough of that for someone to specialize in it. And the same thing with Linda. Linda made the point that
Nancy Altman: There aren't that many who represented in this issue earlier. But is that because there just isn't that much work. People coming in or
Nancy Altman: Another reason. So David, why don't we start with you and give us a feel for
Nancy Altman: How often these claims come in when they come in, how much time has expanded, whether it's one claims rapper, whether it's sometimes has to be looked at by a supervisor, you know, sort of, sort of, someone will, you know, Daniel walks in the door.
Nancy Altman: And says, you know, my I need the money for tuition for my child, what would be the next maybe that's too easy one, but one that's more you know that's maybe greater the area. How would you
Kim Hildred: Well,
David Lescarini: I'll try to, I'll try to paint a picture here.
David Lescarini: Pre coated. Let's say someone walks in and
David Lescarini: You know they they talk with the customer service representative about what they need and they referred to the claim specialist that worked on the case.
David Lescarini: And, you know, at that point, they're going to give a media service as far as getting an idea of whether it's going to be approved or not.
David Lescarini: On on the downside with that immediacy, though, is there is not a control for this workload in place, meaning that at the point that customer
David Lescarini: Brings us to produce, we need the documentation, you know, an estimate of how much money they need
David Lescarini: receipts that sort of thing. There's not a centralized control. So it's really all in the control of that claim specialist
David Lescarini: So how quickly that workload gets work is going to be left up to that claim specialist
David Lescarini: So that's, that's a little bit of a could be a really big positive, it could be a downside, depending on how the claims represent the claim specialist prioritises that workload.
David Lescarini: One positive thing about the current coven situation, even though we are having to do everything by mail. We do have a control in place. We have a
David Lescarini: Everything that is being mailed in or faxed goes into a program we call work track, and for the most part it's really all management that is
David Lescarini: Scanning for the most part it's management scanning the documents in or at the very least profiling it meaning assigning it to an employee. So you do have a control with the current environment and can monitor these requests, so that they could get can get down then
David Lescarini: You know, timely or everybody's don't my
David Lescarini: Expectations of that of the office. So it can be balanced with the other workloads. So there's pros and cons to both
Nancy Altman: And
Nancy Altman: Are there is no way to sort of get special attention. I mean, I was struck, I guess, Tara was talking about a client of hers that was facing eviction and then I would think that would be one where you know you drop everything to focus on that. But how
Nancy Altman: Is there a way to jump the killer. Is it really pretty much, you know, it's the fairness is to just do it in the order that it comes
David Lescarini: Well, no. I mean, things like that, you know, I would treat that like you would any type of dire need situation like what we have to make a determination whether
David Lescarini: We can, you know, test somebody to check in office, for example, because they missed their check and they need. They need to pay their rent. I mean marinade situation should always jump to the before Friday.
David Lescarini: Individuals that we have coated is deceased donor records and they're not deceased. I mean, those people need immediate attention so we can get them back and pay. So, you know, I would treat things like that in the same fashion.
Kim Hildred: Nancy, I had a question for Joanne.
Sure.
David Lescarini: So Joanne. I hope you
Kim Hildred: You can hear me. And you're available. You have service.
Kim Hildred: But
Nancy Altman: Joanne, if you can, you'll have to unmute so you can start doing that now. Go ahead.
Nancy Altman: So my question for Joanne is
Kim Hildred: I'm wondering, especially since you given your experiences, Commissioner.
Kim Hildred: And I, I want all of our attendees and our panelists to understand that as as as an advisory board, we're exploring all of these issues and and you know sometimes what we have to do is think about
Kim Hildred: You know, okay, is it say there is not going to be legislation or up until legislation is going to happen or or whatever, the possibilities are we try to really flesh out all kinds of different ideas as much as we can.
Kim Hildred: And so I'm curious, Joanne in terms of especially now that you know given coven and the fact that the field is at home. And there's a lot more flexibility, relatively speaking, in terms of automation moving workloads, etc.
Kim Hildred: Do you think there would come a time where you know there could be some specialization on some of these complicated workloads that not everyone has the skill for
Kim Hildred: But who could be available to assist with just these kinds of workloads to get them processed or is your view that operations will always say, you know, kind of maintain what seems to be their position of. No, no, no, we need the workers and let
Kim Hildred: Us decide how to use
Jo Anne Barnhart: It or, you know, then that and that's the rub. Kim, you just identified it because I went through this and we were working visual disability claims and
Jo Anne Barnhart: CD ours and things like that, making those choices in tight budget times when I was, Commissioner, and I think there's always the possibility
Jo Anne Barnhart: Particularly with the electronic nature of the system. Now that and the fat and and you've got the added the added sort of throw to that.
Jo Anne Barnhart: With it with the covert environments. There's always the possibility of specializing workflow.
Jo Anne Barnhart: The problem is determining how many workers, you need and then you're taking them off the front lines and exactly the point you made operations will say,
Jo Anne Barnhart: We need every single claim strap you know that we have, but there's definitely that possibility. But that would require quantifying how many of these requests come in every month.
Jo Anne Barnhart: And, you know, then someone doing a workload assessment of what that workload involves, you know,
Jo Anne Barnhart: I could not hear who the person was then asked the question about maybe SSA wasn't the right place to be making these kinds of decisions.
Jo Anne Barnhart: And a going trying to come at it from a more fundamental perspective mine, my perspective on this whole thing is even more fundamental. I have never been a fan of policies that do what I call keeping the whole school after class because someone talked
Jo Anne Barnhart: And I think so often so often.
Jo Anne Barnhart: You know, a concern for somebody who might do the wrong thing puts congress in the position of keeping the whole school after class.
Jo Anne Barnhart: And I think anytime that that an administrator can use flexibility when warranted to adjust for that. And that's one of the reasons I had focused on
Jo Anne Barnhart: The administrative costs. I think the work big done has done is helpful if there's some way to say, look, there really aren't that many cases of this application going on.
Jo Anne Barnhart: And other words and miss that. When I say Miss application. I mean, things that are good for the child in the best interest of the child. And when you read that list of items. That's really what it is.
Jo Anne Barnhart: That's what they're all geared toward and if there's a way to quantify that the work that the it did and the problems that they found and how that relates to the entire workload.
Jo Anne Barnhart: If there are ways to quantify the amount of time it takes for these claims reps and the map, what it does in terms of lag time.
Jo Anne Barnhart: For people getting a timely response, the parents getting a timely response because you can, you know, the US and the answer you notice to SSH.
Jo Anne Barnhart: You know, sort of catchphrase is get the right checks to the right person in a timely fashion and. And when you think about it, that's really what the dedicated accounts are all about making the right decision.
Jo Anne Barnhart: You know, at the right time to make sure that the family gets the money when they need it or gets the use the money when they need to, so I i think
Jo Anne Barnhart: If I were the commissioner. Now, what I would appreciate is something from the board that says, look, we're in this unique time and Cove, it is
Jo Anne Barnhart: demands more flexibility. People are hurting, more than ever, families with disabled children, maybe making other sacrifices in their family and going into debt in order to provide the services and things their children need now so they really need this, and the Commissioner has this flexibility.
Jo Anne Barnhart: And and I was not aware of the directive, they use, you mentioned Kim that came out in June, but if there was a way to flush that out some as was suggested
Jo Anne Barnhart: I think that would be a really good recommendation to make to the Commissioner.
Jo Anne Barnhart: And and if there's a way to quantify again the potential is there and sort of the law of diminishing returns you know we're keeping the whole school after class that Coca Cola guys after school.
Jo Anne Barnhart: Because somebody talked and what is it costing you know what is the diminishing return on this based on claims reps being taken out offline basically to handle these kinds of discretionary situations and not even being able to do at the time, like that.
Kim Hildred: Yeah.
Nancy Altman: Got it. Thank you.
Nancy Altman: And Joe, am I love that I'm
Nancy Altman: I'm gonna steal that.
Nancy Altman: Is such a good image that one person talks a little
Nancy Altman: Everyone has
Mrs recess.
Nancy Altman: And
Nancy Altman: In some ways that's that's obviously a good last word.
Jo Anne Barnhart: Just
Jo Anne Barnhart: We're getting
Nancy Altman: We got about
Nancy Altman: Five more minutes.
Nancy Altman: Before we start to wrap up. So
Again,
Nancy Altman: Now I see Jagdish is
Nancy Altman: Visible and unmuted. So I
Nancy Altman: Turned the floor to you. I assume that was
Jo Anne Barnhart: So well. Thank you, Nancy.
Jagadeesh Gokhale: I must say the session.
Jagadeesh Gokhale: Was educational in one dimension.
Jagadeesh Gokhale: But not necessarily in all the dimensions it needed to be educational
Jagadeesh Gokhale: In the sense that it pulls at your heartstrings because of the very sad cases that were described
Jagadeesh Gokhale: But I did not really feed my brain a whole lot with the kind of information. I generally ask for which is really data on called the entire adjudication of dedicated account is working.
Jagadeesh Gokhale: But having said that, well,
Jagadeesh Gokhale: former Commissioner Joanne Barnhart was speaking I had an idea which
Jagadeesh Gokhale: I wanted to kind of run by you. I haven't made up my mind about it, but this is one possibility to consider, which is currently the legislation described describes the types of expenditures that are permitted
Jagadeesh Gokhale: With some flexibility on extenuating circumstances expenditure needs that
Jagadeesh Gokhale: May be allowed.
Jagadeesh Gokhale: Because of the discretion allowed into the law.
Jagadeesh Gokhale: But
Jo Anne Barnhart: An alternative approach.
Jagadeesh Gokhale: Would be to specify spending that is not a law like you cannot go and you cannot go into a casino with this money. You cannot go into a
Jagadeesh Gokhale: Balloon to take a balloon ride.
Jagadeesh Gokhale: You cannot, you know, all of those things that seemed like frivolous consumption of
Jagadeesh Gokhale: You know consumption that need frown.
Upon
Jagadeesh Gokhale: You know, society as a whole, might have a consensus about certain expenditures
Jagadeesh Gokhale: That these accounts should not be spent on and
Jagadeesh Gokhale: Then anything else that doesn't fall into these categories may be allowed under the discretion and choice by the representative fees, whatever the arm that's an alternative approach and the way to do that. I mean, I
Jagadeesh Gokhale: Know the loss of government agencies that track hundreds and hundreds of items of consumption and spending.
Jagadeesh Gokhale: I mean, we have the entire bureau of labor.
Jagadeesh Gokhale: Statistics that compiles statistics.
Jagadeesh Gokhale: On inflation and they sample and track.
Jagadeesh Gokhale: You know, hundreds of different commodities and items that are transacted and markets to get a sense of how how high inflation is in the economy. There we have
Jagadeesh Gokhale: Surveys, like the consumer expenditure survey that also surveys house was on their spending habits and again includes hundreds and hundreds of items. It will take someone less than a couple of days. And as I say to go through these lists of possible
Jagadeesh Gokhale: Spending to kind of your mark or
Jagadeesh Gokhale: Horse classify items that should be
Prohibited
Jagadeesh Gokhale: For spending two dedicated accounts and then leave the rest of
Jagadeesh Gokhale: Possible spending.
Jagadeesh Gokhale: at the discretion of parents if they want to spend on anything that's not in the list of prohibited items and that's fine.
Jagadeesh Gokhale: That would I think ease the burden for even administration, because then
Jagadeesh Gokhale: There would be an issue about monitoring because there has to be some way of reporting whether someone is
Jagadeesh Gokhale: Not spending on the items that are prohibited, but maybe that could be worked out. That's the one thing that's keeping me from deciding whether this is a good idea.
Jagadeesh Gokhale: But maybe it could be considered
Jagadeesh Gokhale: More in a little more detail.
Jo Anne Barnhart: Can I say, Can I say something, there is a great idea. I think the problem is that would require a statutory change because
Jo Anne Barnhart: Again, I'm riding in the car. But the way that that flexibility provision is written, is the Commissioner can allow other things. It doesn't say the Commissioner can disallow which would, therefore, I think.
Jo Anne Barnhart: Legal Counsel would probably say doesn't allow you to come up with a list of things that you can't do that rather a description of things that are allowable.
Jo Anne Barnhart: I mean, I love your approach. And I just think it would require a change in the law, which is something that's going to be extremely difficult to get
Jagadeesh Gokhale: Right. I mean, the idea
Jagadeesh Gokhale: Here i mean the the driving motivation for for this debate is to eliminate dedicated accounts as a policy recommendation which would also require a change in the
Jagadeesh Gokhale: Law, but
Jagadeesh Gokhale: You know, next to that is an alternative approach to how to specify the life you know if
Jagadeesh Gokhale: Getting rid of dedicated accounts is not
Jagadeesh Gokhale: Feasible or there's not enough.
Jagadeesh Gokhale: Support, then maybe this is a fallback option. Anyway, these are just some random thoughts that occurred.
Jo Anne Barnhart: In my head.
Jagadeesh Gokhale: Just now.
Thank you very much.
Jo Anne Barnhart: Any, any last comments.
Nancy Altman: Before we start to wrap up.
Nancy Altman: Well, let me say I think we've reached agreement on one point and that is that the current system does not appear to be working well, but it's
Nancy Altman: You know, it's really been useful to have these all of these perspectives.
Nancy Altman: You know, the people who are the customers as the first 30 minutes duration.
Nancy Altman: Dave David and Greg and Rachel who are Joanne, you know, the three who are currently on the front line and Joanne.
Nancy Altman: In the
Nancy Altman: As when she was commissioner in is still very involved as you see her, she's on our call today. And so there may be disagreement and Jagdish raise some about different approaches. I think, you know,
Nancy Altman: which way to go, but I think that there, as they say, there does appear to be agreement that the current system is costing the government too much money administration and there's not enough pay off.
Nancy Altman: For what it is and
Nancy Altman: You know, I think there was a
Nancy Altman: I would guess a plurality and maybe even a majority, although we're not taking votes on just eliminating them. But then we're suggestions as well. There's also the issue of what can be done legislatively and what can be done.
Nancy Altman: Across the
Nancy Altman: Can be done regular
Nancy Altman: Regulatory way and you can hear from Joanne's remarks why she was such a fantastic, Commissioner, because she was dedicated to what loss that but she was creative as well. So let me
Nancy Altman: Really thank all of the people who are part of this Roundtable.
Nancy Altman: Thank you for participating today, but really thank you much more for
Nancy Altman: For all the work, it's such important work that you do and Danielle, you get a really a special thank you because I think you know the other of the rest of us were talking about
Nancy Altman: Slightly higher terms, this is your life that you were talking about it. We really appreciate so much and I think I speak for all of us. When I congratulate you on that you've, you've been licensed for you're about to take the licensing exam, we're
Nancy Altman: We see your middle to get respond. But in any case, we we applaud you and wish you well.
Nancy Altman: The good news is that this, I believe, Claire, correct me if I'm wrong, but I believe this whole session has been recorded, so if there are any
Nancy Altman: Who would like to either hear parts of it again, or have other colleagues who might want to
Nancy Altman: Hear it it's
Nancy Altman: It will be
Nancy Altman: Put online. I'm not quite sure when we have a lot of really good information that we've
Nancy Altman: That I see with Emma put in the the chat for all the various information that was given, and someone just actually put up a chat that I didn't see but
Nancy Altman: Then, but I really want to thank first one I want to thank Kim, who is my co moderator and Jagdish and Bob for your excellent thoughts and questions and participation and again right really deep thanks goes to the staff who work so hard.
Nancy Altman: Putting this putting this all together. So Kevin, if you have any last words, you'd like to say, and then I think we're on to Thanksgiving.
Kim Hildred: Think we are. Thank you, Nancy to all well said well put. Thank you all. We really, really appreciate it. Thank you to Emma and the staff are all of their hard work as well and
Kim Hildred: And as he points out, we'll get some information up on line and the discussion certainly will be continued. So thank you all very, very much best message for a safe and happy holiday season. So thank you all.
Nancy Altman: With that, we conclude the program. Thank you again for to be continued. We're ending the program, but we're not ending the discussion and we are
Nancy Altman: You know, our primary focus is social security, but we also are very concerned about the SSI as SSI program. And so we are going to be doing more and calling on all of you again we and we thank you again for all of your time.