Issue-specific fact sheets for transition age youth with chronic health needs. Provides overview information on legal and medical issues related to transition.

4. Transition Care: The Basics
Transition care is defined as the care of individuals as they move from
childhood into adulthood and occurs in multiple settings; for example, from Transition from
pediatric to adult
school to work and from pediatric to adult healthcare. The overall goal
care is a process
of transition is to improve a person's success in multiple facets of life such as and oftentimes
working, living independently, and community living1. Transitioning is an includes a team
of providers
active process that focuses on the medical, psychosocial, and
including:
educational/vocational needs of adolescents and may involve multiple parties • Patient
- including physicians, caregivers, the school system and possibly the legal • Family
system2. It also involves giving the teen increased responsibilities in • School
decision making, self-care and medical management. system
• Physician
• Social
Transition medicine is the deliberate, coordinated process of moving a
worker
patient from pediatric-oriented health care to adult-oriented health care with • Legal
the goal of optimizing the young adult’s ability to assume adult roles and system
function3
Transition
involves
Medical transition involves multiple steps including: coordinated
• Transfer of care from pediatric physicians to adult providers planning for
changes in
• Access to continuous health insurance coverage
various areas
• Acquisition of knowledge and skills to manage medical conditions including living,
vocation and
• Connecting to appropriate adult community resources
health care.
Transitioning is oftentimes difficult and medical conditions can make it even
harder, but well-planned health transition facilitates transition in other areas
like work, community, and school). Transition is an individualized process
and occurs as different rate for every individual and family. Because of this,
it is never to early to start thinking about the transition from the pediatric to
the adult arenas2
1
http://www.illinoisworknet.com/vos_portal/Disabilities/en/Home/Youth/
2
Transition from child-centered to adult health-care systems for adolescent with chronic conditions. A position paper of
the Society for Adolescent Medicine. J Adolesc Health. 1993; 14:570-576.
3
A Consensus Statement On Health Care Transitions For Young Adults With Special Health Care Needs. American
Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of
Internal Medicine, 2002.

5. Transition Care: Portable Medical
Documents
A portable medical
A portable medical document is a summary of a patient’s medical
document is an
history and may include medications, allergies, past hospitalizations,
abbreviated record that
surgeries, laboratory tests and radiology studies. It is important to
will help a new physician
know about your medical problems – especially if you are about to
get to know you and your
transition to a new physician. A portable medical document is a
medical problems.
document that you can carry with you to physicians’ visits as well as
to ER visits or hospital stays. Your portable medical record may be
Helpful examples can be
on paper or electronic. It will help a new provider learn about you
found in the following
and your medical conditions efficiently.
websites:
What are the parts of a portable medical document?
• Basic information:
1. Name, date of birth, address, phone number. Free online records:
2. Guardian, emergency contact. http://www.google.com/int
3. Primary care physician, address, phone number. l/en-US/health/about/
4. Insurance.
 Includes insurance type and policy number http://www.healthvault.co
m/personal/index.aspx
• Health conditions:
1. Name of your conditions and brief summary of your
conditions.
2. Health care providers who help to care for these Online examples:
conditions – for example, a cardiologist may help care http://www.syntiro.org/hrt
for a heart problem. w/tools/pdfs/HRTW-
3. Past hospitalizations and surgeries. TOOL-Template-Portable-
4. Current medication list Medical-Summary-July-
 Includes medication name, dosage and how 2007.pdf
often medication is taken throughout the day.
 May include past medications and why you http://www.medicalhomein
stopped them fo.org/for_families/care_no
5. Current allergies. tebook/care_notebook.aspx
6. Immunization history.
7. Recent laboratory values. http://www.syntiro.org/hrt
8. Recent imaging studies. w/tools/pdfs/CP6SHC_Tra
nsition_Summary.pdf
• Services:
1. Assessment of cognitive and physical disabilities.
2. Services (for example, PT/OT) and where you are
receiving them.
• Transition specific issues: as you get closer to adulthood, you
will want to identify adult health care providers. If you have
identified them, you should include them in your portable
medical summary

6. • Your medical summary may also include hospital discharge summaries, surgical reports, consult
evaluations (for example, most recent PT evaluation, cardiology evaluation) as well as laboratory
and imaging tests.

7. For more information:
http://www.ssa.gov/ssi/
For more information:
http://www.ssa.gov/ssi/
http://www.ssa.gov/dibplan/index
Transition Income Supports:
http://www.ssa.gov/dibplan/index.htm
SSI and SSDI 1-800-772-1213
Supplemental Security Income (SSI) and Social Security Disability 1-800-772-1213 SSA office
Locate local
Income (SSDI) provide income to disabled persons who meet the
Social Security definition of disability and income requirements. Locate local SSAto Apply:
Three Ways office
Both use the same definition of disability, but the amount of For SSDI Adults only, apply online
benefit paid is different. SSDI is based upon payroll taxes if a Three Ways to Apply:
at
person has a strong work history; SSI is based upon a fixed For SSDI Adults only, apply online
https://s044a90.ssa.gov/apps6z/
amount if a person is low income or lacks a strong work history. at
https://s044a90.ssa.gov/apps6z/ISBA/
WHO does this apply to? Call the toll free number for either
• Childhood SSI/SSDI recipients an in office appointment or a
Call thetelephone appointment
toll free number for either
• Adults with disabilities (18yo and over) who did not an in 1-800-772-1213 or or a
office appointment
• receive childhood SSI due to family income levels telephone appointment
TTY 1-800-325-0778
• Individuals who were found disabled before age 22 and 1-800-772-1213 or
TTYLocate local SSA office. See
1-800-325-0778
became eligible to receive SSDI benefits due to a
parent’s disability, retirement for which they are office locator at
local SSA office. See
Locate https://s044a90.ssa.gov/apps6z/
receiving SSA retirement benefits or death office locator at
https://s044a90.ssa.gov/apps6z/FOLO
After Age 18 Before applying, consider obtaining
Children already receiving SSI or SSDI will have a review the following documents:
(“Redtermination”) when he or she turns age 18. They will use Before Copies of consider obtaining
applying, IEPs
the adult disability rules to decide whether they meet disability the following documents:
School reports
and income requirements as an adult. Because of the different Copies of IEPs support from vocational
Letters of
definitions of disability for children and adults, a child receiving School coordinators, teachers physicians
reports
Letters of support from vocational
benefits is not guaranteed to continue receive benefits as an
coordinators, teachers physicians
adult.
Remember: first applications are
If an individual was not eligible for SSI before his or her 18th
often denied. It is important to
birthday because parent’s income being too high, he or she may Remember: first applications are
follow up on the SSA appeal
become eligible for SSI at age 18 and should apply as an adult. often process. It is important to
denied.
follow up on the SSA appeal
When children are evaluated for a disability, SSA compares how process. receive a denial of the initial
If you
that child is developing compared to their peers. However, application, appeal the decision within
when an individual turns 18 year old, SSA considers whether or If you60 days a denial of the initialonline or
receive by filing and appeal
not an individual can enter the work force in a substantial application, appeal the decision recipients,
by phone. For childhood within
manner without needing special accommodations. If SSA finds 60 days by filing and10 days online or
appeal within appeal to continue
receiving SSI checks.
by phone. For childhood recipients,
that someone’s impairments prevent them from substantial
appeal within 10 days to continue
gainful activity (i.e. earning more than $1010 per month in receiving SSI checks.
2012), then the individual will be found disabled as an adult.
SSA has a specific listing that defines what is “disabled” for most
illnesses and conditions, and requires you to show functional
limitations to your ability to work.

8. Social Security Disability Insurance (SSDI): SSDI is available only to adults who have held a job in the
past, or who are eligible to collect disability benefits under a parent’s past work record. If the adult
does not have a work history but one parent does, the individual may be eligible for SSDI if:
1. The individual’s disability is documented as having begun before the age of 22
AND
2. The parent is 1) Retired, 2) Disabled themselves, or 3)Deceased
Childhood Disability Beneficiary (CDB) =
a disabled adult receiving SSI can move to receiving SSDI, which is a better benefit.
Health Insurance Impact
• After receiving SSDI for 24 months, adult child also becomes eligible for Medicare (better than
Medicaid eligibility under SSI)
 New income from SSDI is exempt for Medicaid asset requirements
These benefits are also payable to an adult who received dependents benefits on a parent’s Social
Security earnings record prior to age 18, if he or she is disabled at age 18. The disability decision using
the disability rules for adults. SSDI continues as long as the individual remains disabled. Your child does
not need to have worked to get these benefits.
Supplemental Security Income (SSI):
If a disabled adult does not receive benefits under SSDI, they should consider eligibility for the
Supplemental Security Income (SSI). SSI is a federal income supplement program designed to help
elderly (age greater than 65), blind or disable people who have limited income or resources. It provides
monies to help meet basic needs for food, clothing and shelter. SSI eligibility has two types of
requirements: 1) category, and 2) income. For adult SSI, the SSA looks at the student’s disability,
income, and assets at age 18 or older.
2011 SSI Amount = $698/month
• Payment can vary based on living arrangements & other factors
• Patients nor guaranteed to always receive the full amount
In Illinois: if you qualify for SSI, you probably also for Medicaid
• Illinois Medicaid is NOT automatic àMUST apply separately
• Children can be insured under IL All Kids until age 19 if they meet income requirements
• Not all All Kids participants will qualify for Adult Medicaid.
SSI Income: less than $1000, assets under $2000
The income requirement for SSI eligibility states that the student cannot earn more than $1000 of
income per month. Additionally, the student cannot have assets (savings and checking accounts,
retirement accounts, stocks, bonds) over a specific amount in any given month to be eligible for SSI. If

9. single, the individual’s countable assets must be $2,000 or less. If married, the individual’s assets
combined with his/her spouse’s assets must be equal to or less than $3,000

10. SSI DISABILTY DETERMINATION
Child Disability Standard Adult Disability Standard
INCOME: INCOME:
Under 18 years old, parents incomes and Over 18 year old, do not look at parents’ income or
assets count assets (< $2000) unless the child lives with parents. If
so, some of parents’ support paid for housing and
feeing the child will count toward in kind support and
reduce the child’s SSI check.
DISABILITY: DISABILITY:
Impairment(s) must cause “marked and A severe impairment or combination of impairments
severe functional limitations” and last at least that prevent engaging in substantial gainful activity
12 months – compared with functionality of (SGA), lasting for a continuous period of not less than
peers 12 months or resulting in death.
Must lack Residual Functional Capacity (RFC) to
perform any jobs that exist in substantial numbers in
the national or local economy.
EXCEPTIONS  Can reduce assets contributing to SGA
if:
• Impairment-related work expenses, or
• The work is “subsidized” (i.e. employee is
being paid more than the work is worth)
SSI vs. SSDI
Supplemental Security Income (SSI) Social Security Disability Insurance (SSDI)
• Strict income and resource limits • Based on work record (average $1,000)
• No work history required • Unearned income is not counted with no
• $698 maximum– 2012 Federal Benefit Rate asset limits
• Often also qualifies for Medicaid (but • Benefit amount depends on work record
separate application) • May qualify for Medicare (usually better
coverage than Medicaid)

11. Young adults are the highest
Transition Planning – Insurance: uninsured group in the US.
Medicaid/Medicare Because of this, it is important
As adolescents transition into adulthood – insurance plans change. to know your insurance options
Young adult patients are the highest uninsured group in the US. There and to apply for insurance in a
are multiple insurances choices which makes insurance difficult to timely manner.
understand. Because of this, it is important to start learning about
insurance options early. You can ask your health care provider for help
with this issue. Children with public aid are not
Is there a difference between Medicaid and Medicare? Yes! guaranteed adult Medicaid due
to different eligibility
Medicaid requirements. It is important to
Medicaid is a state insurance that provides coverage for children, adults know the differences in
with disability and low-income elderly. Medicaid covers certain medical eligibility and to remember to
services, prescriptions and medical equipment. apply for adult public aid
Children’s Medicaid around age 17.
States must cover children’s who meet the state’s income requirements
from birth until their 19th birthday. Programs also provide coverage to
pregnant women. People who can help with
insurance issues include:
Adult Medicaid
Eligibility for adult Medicaid varies by state. In many states, adults must
• Your school/IEP team
found disabled by Social Security first in order to qualify for Medicaid. • Your medical team
Recipients must also meet their state’s income level requirements to • A hospital social worker
qualify.
Medicare
Medicare is a federal health insurance program that is available to retired
citizens as well as people with disabilities, provided they are eligible for
social security disability insurance (SSDI). Medicare covers certain
health services but does not cover prescription drugs. Medicare is not
typically appliciable to young adults, but may be during the transition
process if he or she works, or his or her parents become disabled.
Medicare is available to people who are older than 65 who receive SSA
retirement or SSI. It is also available to people of any age with certain
medical conditions like ALS or end-stage kidney disease requiring
dialysis.
High Risk Pools and CHIP Programs:
As a part of national health care reform, most states now have
transitional insurance buy-in programs for individuals with pre-existing
conditions (the “High Risk Pool”). These plans are not considered
public aid and have premiums and out-of-pocket costs that beneficiaries
must pay. CHIP programs are state insurance programs that do not