People With Addicition And Alcoholism-Related Disabilities Lose Benefits

Persons with disabilities contributed to in a material way by drug addiction and/or alcoholism (DA&A) lost Title 11 and SSI payments and Medicare and Medicaid eligibility under the Contract with America Advancement Act of 1996.

The standard for determining whether DA&A “materially contributes” to a disability has been around since 1994. Under the standard, DA&A is material if

  1. 1.The only impairment is a substance abuse disorder,
  2. 2.The individual’s other impairment(s) is (are) by itself (themselves) not disabling,
  3. 3.The other impairment(s) is disabling only because it is exacerbated by DA&A. For example, if the evidence shows that, after a drug free period of at least one month, the other impairment would not be disabling, DA&A is material.

Simply put, would the person’s current physical and mental limitations still be disabling if the person stopped using drugs or alcohol?

To make this determination, the Social Security Administration (SSA) will be looking for medical evidence from treating physicians considering the person’s capacity to engage in substantial gainful activity if they stop using drugs and alcohol.

What if prior drug use or alcoholism caused the disabling impairment? Would the persons with such impairments still be eligible for benefits? Yes. The cause of the impairment is irrelevant as long as the impairment is still disabling after the drug/alcohol use has stopped.

Note that the person does not need to stop taking drugs or consuming alcohol in order for the determination to be made of whether the DA&A contributes materially to the person’s disability.

Also, if it is determined that the DA&A condition does not contribute materially to a person’s disabled condition, the person will not be required to receive drug/alcohol treatment in order to continue receiving benefits. (under the former law, people with DA&A disabilities would have their benefits suspended for failure to comply with treatment.)

As of August 1996, the SSA sent out 200,000 notices of termination of benefits nationally, effective January 1, 1997. Over 43% of those receiving notices appealed. For these appeals, doctors will he asked to verify whether DA&A is present; and, if so, whether it contributes materially to the disability or whether there is an impairment present which would be disabling regardless of the person’s drug or alcohol use.

This article was prepared by Robert F. Webber