Treatment Considerations for Maine’s Indigent Claimants Suffering from a Mental Health Disability

Many of Maine’s disabled are suffering from severe mental health problems that impact their ability not only to work but also to seek out the types of treatment they need so as to appropriately treat their mental health illness.  For those who are longer term disabled from working as a result of their disabling condition, it becomes necessary to seek benefits from the Social Security Administration in the form of Social Security disability income benefits and/or Supplement Security Income.  Unfortunately, many individuals do not understand that in order to prove entitlement to Social Security benefits it is necessary to prove 1) that they remain totally disabled from a “severe medically determinable impairment” that causes them to be 2) unable to undertake gainful employment “despite prescribed treatment.”  And thus, it’s important to understand from an initial standpoint that one can not meet these 2 requirements without appropriate medical care.   Many are left not knowing what options remain available to them.

The State of Maine’s medicaid program, called Mainecare, has undergone changes in recent years that has made it much more difficult to qualify for benefits as an indigent disabled individual.  The medicaid program is designed to provide health insurance to those who fall within the poverty guidelines, and who are found to meet the equivalent of Social Security’s disability rules.   While many disability claimants used to be able to qualify for Mainecare as they were pursuing an application for Social Security disability, claimants now find that they are rejected routinely their Mainecare applications once it’s been determined that their Social Security disability claim has been denied.  Many who pursue a Mainecare application do not understand that from the beginning they need to make sure their application falls under the “disabled status” category for Mainecare: notwithstanding this fact, it’s quite common for the State of Maine to deny the application if in fact their federal Social Security/SSI claim has been denied.  It is important to understand that one does have the right to appeal that denial, and to provide evidence to the State of Maine as to how this determination was made in error: additional evidence can be provided from one’s treatment providers to establish that the disability criteria is met.

Unfortunately, finding the treatment providers who will help establish that criteria may be difficult if treatment has yet to be established.  Many times, primary care physicians have  been providing the treatment in the interim and may prove a valuable resource in helping to support their patients in establishing both treatment and, ultimately, assisting with supporting either a Mainecare claim or a Social Security claim.   There are a number of other options available to establish treatment, even if you remain without insurance.  There are a number of mental health clinics throughout the state of Maine that offer sliding scale counseling and psychiatric care assistance.  For example, Maine Behavioral Healthcare, provides mental health care for patients residing in the following counties:  Androscoggin, Cumberland, Franklin, Kennebec, Knox, Lincoln, Oxford, Sagadahoc, Waldo and York counties.  They have a network of over 30 clinical programs, coordinating doctors and hospitals at 30 different locations so as to provide mental health care throughout the State of Maine.  Chances are that there is a clinic or hospital close to you that participates in this program that is designed to work with patients, even if they are without resources or insurance to pay for their care, to ensure that Maine’s disabled are assisted with their mental  health needs.  Services are noted to be available for adults, children, adolescents, and includes crisis intervention.

Without treatment in place, as far as the Social Security process is concerned, it’s as if you are a tree in the forest, with nobody around: you will not make a sound.   It is impossible to show that one continues to suffer from a severe medically determinable impairment unless and until there is a mental health professional treating  for such an issue and objectively documenting such problems in their notes.   While the Social Security Administration may send you for an evaluation with one of their doctors, it is important to understand that this process is normally undertaken when there is insufficient evidence available from one’s own treatment providers.   While these evaluations may be helpful in providing a snapshot of one’s diagnosed conditions and how they remain impacted in terms of their ability to function, they are no substitute for showing a longitudinal history of one’s mental health impairments and how they have impacted an individual over what needs to be shown as at least a year or longer.  It’s also important to understand that the Social Security rulings and regulations do not allow for diagnoses to be established through nurse practitioners or physician’s assistants, which many times one is relegated to seeing.  However, such providers may be helpful in establishing a record of how you remain impacted in your ability to function over the long term, and then one of Social Security’s doctors or even one’s own primary care physician can be helpful in establishing the necessary diagnosis that will serve as one’s “severe medically determinable impairment.”

Understanding the importance of ongoing treatment, and the importance of such treatment with the right types of providers, is essential for both one’s personal well being and for the successful resolution, ultimately, of one’s Social Security disability.  An experienced Maine Social Security lawyer, such as Attorney Russell Goldsmith, can help provide you with the guidance you need.  Should you or a loved one find yourself lost as to how to receive the benefits you need as a result of severe mental health problems, contact the Law Offices of Russell J. Goldsmith at 1-800-773-8622.


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