Insights

Disability is a lengthy and arduous process; waiting on a case to be determined by the Social Security Administration (SSA) for disability can be a daunting experience. Claimants are commonly faced with medical issues, mounting medical bills, and little to no income. Sixty-seven percent of applications are denied after the initial claim; reconsiderations are denied at an even higher rate of 87%. Of the denials, a significant number of cases appeal and are reviewed by the Appeals Council for an Administrative Law Judge decision. This process takes at least 18 months, sometimes even extending to 24-36 months.

Curbing previous abuse of Social Security Disability, lowered need-based thresholds under expanded Medicaid, and historic-low unemployment have all contributed to lower SSA Disability Approvals. As such, their contribution to many providers’ revenue cycles has materially diminished. And, while still meaningful in non-expansion states as well as those that receive disproportionate share payments, the impact of lowered SSA Disability payments, which historically have been at least three times greater than that of a standard Medicaid reimbursement, are negatively hitting many providers’ bottom lines.

Increasingly, providers are challenged in their pursuit of Disability reimbursement and many simply no longer pursue them. While the challenges are clear and undeniable, many techniques can be employed to reduce the negative impacts of these convoluted processes. In parallel to a Disability determination, those in non-expansion states can pursue SSI in parallel to SSDI as they wait through this process. However, if the SSA denies an SSDI claim before the state determines Medicaid eligibility, the state is highly likely to deny the Medicaid application.



If you are a health care provider who is experiencing any of these challenges, Aspirion has a dedicated, experienced disability department staffed with caseworkers who know how to identify and work with patients who are potentially eligible for SSI and SSDI. Contact us today to see how we can help improve your bottom line by assisting this challenged patient population.