VERA INSTITITUE OF JUSTICE 
END ABUSE OF PEOPLE WITH DISABILITIES WEBINAR SERIES 
5/15/18 
1:30-3:30 P.M. EST 


>> LENI DWORKIS: Good afternoon, everyone. 
Thank you for joining our webinar today. 
I'm Leni Dworkis with the Center for Victimization and Safety at the Vera Institute of 
Justice. 
I would like to welcome you to today's webinar where we will discuss connecting 
survivors with disabilities with public benefits. 
We are pleased to bring you this as part of our End Abuse of People with Disabilities 
webinar series. 
We have just a few quick logistical items to go over before we begin today. 

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following the webinar. Let's begin. 

Advocates working with domestic violence and sexual assault programs connect 
survivors with benefits such as welfare and affordable housing to bridge the gap from 
living with an abusing to living on their own. There are additional services a survivor 
might need assistance accessing, federal disability benefits and supportive housing. 
This webinar will provide information to domestic violence and sexual assault providers 
how to connect survivors with disabilities to these additional necessary resources. 
Our presenter is Ashley Brompton. 
Ashley joined the Center on Victimization and Safety as a Program Associate in 
November 2016. 
She brings passion and knowledge about individuals with disabilities, particularly 
intellectual and developmental disabilities, and criminal justice. 
At Vera, Ashley provides technical assistance to victim service providers and disability 
service providers around the country that are starting to improve service to survivors of 
domestic and/or sexual violence who have disabilities and Deaf survivors. She 
coordinates Vera's national outreach, the End Abuse of People with Disabilities webinar 
series and monthly newsletter. 
Prior to joining the Vera Institute of Justice, she was the Criminal Justice Fellow at the 
Arc's National Center of Criminal Justice and Disability where she advocated on behalf 
of individuals with intellectual or developmental disabilities who are involved in the 
criminal justice system as victims of crime or suspect offenders. 


Ashley also advocated on behalf of people with disabilities in the criminal court and 
mental health diversion court in North Carolina. 
Ashley has a juris doctorate from Wake Forest University School of Law and Bachelor's 
Degree in political science from Florida Gulf Coast University. She is licensed to 
practice law in Florida. With that I will turn the presentation over to you, Ashley. 

>> ASHLEY BROMPTON: Great! Thanks, Leni. So, there is --it seems like we might 
be having a technical difficulty. I'm not entirely sure. I'm going to go ahead and get 
started and hopefully my Vera colleagues with work on all that stuff in the background. 

Okay. So today we are going to talk about some benefits that survivors with disabilities 
might need to be connected to in order to safely and hopefully leave their abusers. So 
with that, before we even get started, I have to do the "this is not legal add vice" 
disclaimer. Nothing in this presentation is design to constitute legal advice, any 
scenarios and examples that I talk about are for illustrative purposes only. For legal 
advice or guidance on a particular situation, please contact one of the resources that I'm 
going to talk about at the end of this webinar. And for more information on any of the 
benefits discussed in this presentation specifically, you can always reach out to the 
administering agency of that particular benefit. 

Before I go ahead and get started and talk about the objectives of the webinar, I did 
want to let you know that apparently Adobe Connect is having --doing an emergency 
update to their system right now, and what that means is that we might be experiencing 
some technical difficulties throughout the webinar, and we apologize in advance. And 
we'll try to do as many work-arounds as much as we can to make it as smooth as 
possible for you all, but we just want to let you know. 

Okay. So today our objectives, we will identify the unique elements of domestic 
violence and sexual assault of people with disabilities that may lead to the need of 
additional supports. We will particularly focus on domestic violence because that is 
where you will see a lot of the dynamics that we're talking about and the supports 
needed. The types of supports that people with disabilities might be connected to, how 
to connect survivors to those supports and to apply for and maintain those supports. 
This is a lot of information that we're going to be talking about. 

Okay. So why do survivors with disabilities need additional supports? 

So everyone on this phone call, or most people on this phone call, are probably steeped 
in an understanding of the dynamics of domestic violence. Power and control, coercion, 
et cetera. We all know about that. Anything to all of those tactics of abuse, there are 
additional tactics of abuse that people with disabilities face specifically. Abusers know 
how to take advantage of a vulnerability or a perceived vulnerability and it is apparently 
when you look at some of these that it is clear that their disability has part of a 
connection to the type of abuse that is used. 


So, for example, becoming a relied upon or primary caregiver before beginning the 
abuse. So many people with disabilities have other caregivers, for instance, maybe 
personal care attendants that are hired out from an outside agency or friends or support 
system that way. So one tactic is becoming a relied upon a primary caregiver before 
beginning the abuse, kind of eliminating the access that other folks have to the person. 
And what this also means is that the person can't just leave. They rely upon a caregiver 
for daily care, maybe for dressing, showering, toileting, etc., so leaving is not as easy as 
--not that it's ever easy, but it's even more difficult. Becoming a legal guardian. So, 
people with disabilities oftentimes, especially if they have a psychiatric disability or 
intellectual/developmental disability can sometimes be ordered by the court to have a 
legal guardian, and this is a person who basically has substitute decision making 
powers over the individual, and that gives the person a lot of power. They decide -they 
can decide everything from medical care to living situations, to who the person is 
able to access, to transportation, everything. Service provision, basically anything you 
can think of depending on the type of guardianship can be determined by a guardian, 
which gives a person extreme amounts of control over the individual. 

Another tactic is using transportation options for --many communities, rural or smaller 
communities there may only be one accessible transportation route, and that route is 
easily found, right? And so unlike in maybe other places or for other people who don't 
have a disability who could maybe just take a different route to work, a person with a 
disability might not be able to do that if there's only one accessible transportation route, 
which makes it much easier for their abuser to follow them. 

Another tactic is severing relationships with other caregivers and fostering isolation. I 
already mentioned a little of this, but saying to the person "well, you don't need them to 
come by anymore and help you with that, I'll help you with that," and just completing a 
sense of complete and total reliance on the abuser and not giving the person with a 
disability the opportunity to not only report the abuse, but have --be able to rely on 
other people. 

And then refusing necessary medical care. If the abuser has control over the individual 
with the disability, they might be able to refuse to take the person to a doctor, for 
example, or refuse to refill the person's medication or something like that. Which can 
lead not only to more power and control but to serious medical consequences. Huh-oh, 
we're going backwards. 

I don't know what happened there. Apologies. 

Okay. So when talking about the unique dynamics of abuse of people with disabilities, 
again, we already talked about some of this. People with disabilities who experience 
domestic violence face a variety of unique circumstances that make it even more 
difficult to leave their abuser. A lot of times they are worried about everything from not 
just the typical "how am I going to afford my rent, how am I going to make sure that I'm 
able to keep my medical insurance," but now they're thinking of "how am I going to get 
dressed in the morning? How am I going to... 


I don't know what is going on with the slides. 

How am I going to get to my doctors? Who is going to help me figure out my 
medication and help me do my medications every week? 

So there's a lot of things that can come up. Or if the person is a legal guardian, how do 
I change that person to that person is no longer a legal guardian and what if we go to a 
courtroom and it's a he said/she said situation and the Court doesn't believe me and lets 
them continue to be my guardian? What if I'm getting life-sustaining treatment? For 
example, what if a person is getting dialysis and... I'm sorry, these are... the slides are 
doing something funky. 

What if a person is getting dialysis and paid for by their spouse's insurance and if they 
lose their insurance they won't be able to get dialysis, which is a life-sustaining 
treatment. So we're thinking about complex medical conditions, sometimes where -without 
the abuser's insurance or abuser's ability to help them access healthcare, they 
could literally die just because of that. 

So that's kind of another layer of what you see when you see survivors coming in for 
services, another level of anxiety and another need that they need. 

So, because survivors with disabilities rely on their abuser for so many of these daily 
living things that we already talked about, leaving the situation --so finally making that 
difficult decision to leave their abuser, could mean losing not just their spouse, maybe 
the father of their child or the mother of their child or their parents, not just losing that 
relationship but also losing all of these things that are really vital to being able to live 
independently on their own in the community. Which then makes them fear the idea 
that they may get institutionalized, if not one --if they cannot get help in the community, 
their options are limited living in the community. 

So, helping a survivor to leave, helping a survivor to safety plan, helping a survivor 
move forward in the process, may be replacing some of the supports the abuser 
provided, and luckily there are supports out there for folks that you can connect them to 
in order to help them not only financially but with some programmatic supports, that will 
really help them to be able to fill those gaps and not have to be afraid of losing their 
abuser because they will lose all of these other services that the abuser provides 
besides the relationship that they have, or whatever the relationship may be. 

So, what are the supports? How do we get them for survivors? 

So the first thing I wanted to do, and hopefully this will work, because right now we are 
having technical difficulties. So I apologize if me moving this chat box over doesn't 
work. I don't think it's going to. 


But, what services or financial supports are you aware of for people with disabilities? I 
don't know if the chat box is going to be able to be pulled over, so maybe just take a 
minute to think about, what do you know of for people with disabilities that either maybe 
your local community provides or your state or even the federal government, but 
specific to people with disabilities and what they need. And then we'll talk through some 
of the things that we know about that can be really helpful for folks. 

I'm going to attempt... I don't think this is going to work... attempt to move over the chat 
box. Nope, that's not going to work. Apologies about that. But what services or 
financial supports are you aware of for people with disabilities? 

It looks like maybe we're moving --yay! Here we go. 

The chat box has arrived. If you can type in there and talk about what you know about. 
I kind of want to gauge what the audience knows already when it comes to services that 
are specific to people with disabilities. 

Okay, we have a couple people typing. So, yeah, SSI, supplemental security insurance, 
we'll talk about that. Again, another SSI. In home supportive services, we're going to 
talk about that as well. That's a big one when looking at services that are not... 

[ audio interference ] 

>> I think there is someone not mute. I hear something in the background. 

So, yeah, state coalition, adult protective services, Medicaid, meta-transit, Medicare. 
Yeah, all of these are great and we're going to talk about a lot of those and I know a few 
are still typing, but I'll keep monitoring that. I can still see what y'all are typing in there. 
Home and Community Based Services waivers, all of those are great. What we're 
going to talk about today are a few federal and state services. Obviously, every state 
has additional services, every community has additional services, and unfortunately 
because of the great variety amongst the states we can't talk about every state, but 
what we can do is talk about some federal stuff and then some of the state stuff that is 
in every state, although it might be administered in a slightly different way. 

So we will talk about Social Security disability insurance, which is SSDI. Supplemental 
security income, which is SSI. Federal supported housing... 

[ audio interference ] 


>> ASHLEY BROMPTON: So I'm hearing someone --sounds like someone... [ audio 
interference owe interference ]... 

>> ASHLEY BROMPTON: I'm not sure what that noise is, but it's... 

So I'm going to talk over it and hope that they're able to get that resolved. So we're also 
going to talk about some state programs, Medicaid being the big one that I'm sure most 
of you are already familiar with. And then long-term supports and services, which are 
provided through Medicaid that are kind of a different process. 

So the first one is Social Security disability insurance. As a reminder, we're really 
talking specifically about programs that are for people with disabilities and deaf people. 

Excuse me. 

And what that means is that there are a lot of programs that you all are probably familiar 
with such as CHIP and SNAP and things like that that we're not going to talk about 
today because they're not specific to people with disabilities. So just keep that in mind 
as you're thinking about what we're covering. 

So Social Security Disability Insurance is funded by payroll taxes. It's the tax that is 
taken out of every paycheck. And once you have a sufficient working history, if at some 
point during that time you acquire a disability, you can withdraw from that account even 
if you're under the age of 65 and that is Social Security Disability Insurance. To qualify 
for Social Security Disability Insurance you have to have a qualifying disability. So this 
doesn't just mean that you have a disability. It's more complicated. It doesn't mean you 
just have a health problem. You have to meet the Social Security Administration's 
definition of a disability. So inability to engage in substantial gainful activity because of 
a medically determinable, physical or mental impairment, which can be expected to 
either result in death or which has lasted or can be expected to last for at least 12 
months. So that's a pretty specific definition. It means that you have to have a disability 
that is medically determinable, which means it has to be able to be recorded in medical 
records. And that is expected to lead to either death or is expected to lead to a period 
of disability that is at least one year long. 


You also have to be under 65 for obvious reasons. If you're over 65 you can just get 
your retirement benefits. It's the same account. The only difference is when you get 
SSDI, you get them earlier because of your disability. You have to have a sufficient 
work history. So if you haven't worked or didn't work enough, you will not have enough 
work credit, which means you will not qualify for SSDI. That's not to say you cannot get 
another type of disability program, but not SSDI. 

And so you're not able to participate in substantial gainful activity. So substantial gainful 
activity is any activity where you earn over 1,180 per month. So if you work and make 
over $1,180 per month, you are presumed to be participating in substantial gainful 
activity and able to qualify for Social Security Disability Insurance. If you are blind that 
number is 1,970, so it's a little higher, but those are the requirements. So it's pretty 
strict and they take very strict interpretation of what all of these requirements are. 

After two years on Social Security Disability a person automatically qualifies for 
Medicaid --or Medicare, excuse me. Just a quick note on Medicare, we'll talk about it in 
a minute, but there are some limitations to what Medicare covers when it comes to 
disability. So we'll talk a little bit about that and we'll talk a little bit about people who 
qualify for Medicare and Medicaid and how to make that work. 

So a big thing to note here is there is a five-month waiting period. And that's after they 
have determined that the person has a disability. So depending on how smooth the 
process is, the application process and the review process, it could take anywhere from 
a few months to a few years to determine that a person has a disability, and if it is 
determined that they have a disability, then you have to wait another five months before 
you even start receiving the benefits. So, it's a really long process and so you would 
have to think of something that you could do in the interim to fill that gap while you were 
waiting in a crisis situation. 

Another thing to note about SSDI is that it doesn't have an income requirement as far as 
you can make the $1,180 per month. You can also make any unearned income, things 
like passive income. So rental properties that you might own or if you have stocks and 
bonds that you get dividends out of, those are unearned income and don't count for 
purposes of Social Security Disability Insurance, and neither does your spouse's 
income, which is something that we'll talk about when we talk about supplemental 
security in the next slide. 

So Supplemental Security Insurance is what we typically hear in our everyday 
vernacular as welfare. Disability welfare funded by general taxes. So it doesn't depend 
on anything but having a qualifying disability and having low income and low assets. So 
it's completely need-based. The definition of disability is the same. However, you also 
have to have less than $2,000 in assets or if it's a couple, $3,000. And a very limited 
income. 

So what does this mean for someone who maybe has just left their spouse and 
separated but still legally married? If you are separated, your spouse's income likely will 


not matter as long as you're maintaining a separate household and you're not holding 
yourself out to be married. However, if a survivor goes back to their spouse, they will -the 
spouse's income will begin to count, which could mean they lose the benefits from 
SSI. So that's definitely something that you want to inform people of when you're 
talking about this with them. 

As far as the assets go, you can have a main primary residence. In some states it's 
called a homestead residence that is not counted as an asset. Typically vehicles --it 
depends, sometimes they are counted and sometimes they're not counted. We'll talk a 
little bit in a couple slides about what happens when you try to apply for SSI for a child, 
and what that looks like, because that is very different as far as the definition of 
disability as well as the income calculations. But it's important to note that this program, 
you really have to be indigent, basically, to qualify for it. 

If you get SSI you automatically receive Medicaid in your state. And SSI does not have 
the same waiting period, so while you may wait to get a determination, your benefits will 
start the first full month after that determination. So there's a lot less of a waiting game 
type thing. 

So, a scenario that we're going to talk about. These scenarios are designed to talk 
about some of the complexities in thinking this through. So let's talk about this one. 
Marie and her son Luke are living in transitional housing and receiving other services 
from the organization as well. Luke is ten years old and has Down Syndrome. Marie 
works full time at a medical office with a salary of $50,000 per year. So what, if any, of 
the two financial benefits that we already talked about does Luke likely qualify for? 

So, for children, the rules are slightly different. You have --for SSI for children, you 
have to meet the definition of disability for children, which is different. For children they 
have to have a medically determinable physical or mental impairment that results in 
severe and marked functional limitations. And has last or expected to last at least one 
year. So it's a slightly different standard that involves a functioning, a level of 
functioning or lack thereof that needs to be evaluated. So this is an additional process 
that is often --school records are used to determine this. Oftentimes developmental 
pediatricians are used to help determine this. But it is a slightly different standard for 
SSI for children. The other consideration --that's the first one. Does Luke meet the 
definition of disability? He likely does, because Down Syndrome is considered one of 
the lists of disabilities that is basically automatically accepted. The other question, 
though, is Marie's income. Does Marie's income impact her ability to get her son on 
SSI? And the answer is yes, it does. For children, their parents’ income does come 
into play. It's part of the calculation. A percentage of their parents' income will be 
deemed as their income and therefore could disqualify them from SSI. 

However, the Social Security Administration may still pay a limited benefit. It may be 
$30 and provide them with Medicaid services, which you'll also see later can also mean 
that they can get home and community based services and long term supports and 


services in their home, which is a lot of the reason why people apply for SSI for their 
children. 

So then would there be any changes to his benefits if Marie was permanently injured 
and had to go on SSDI? And the answer to that, again, is yes. So the Social Security 
Disability Insurance program has something called a disabled child --a child of a 
disabled adult. So what that means is a child whose parent is either retired or on SSDI, 
and they can claim benefits under their parents' work history. What they need to do is 
have been declared disabled by the Social Security Administration before age 22, and 
their parent has to be --also has a disability and have a sufficient work history. And 
what will happen then in that situation is that Luke and Marie will both get SSDI 
payments, however they will only get payments up to the maximum family benefit. And 
I know this is very confusing. I've included some resources in files for download pod 
that go through things, and I have some other resources available. It's a lot of 
technicality and a lot of "if then" things, which is why we can't say an absolute to 
anything, but if a parent qualifies for SSDI and therefore they have no substantial gainful 
activity, they could qualify. They could both qualify, both get SSDI, both eventually get 
Medicare. They would only be able to get up to the maximum federal benefit amount as 
a family. 

So scenario 2... crystal is a 30-year-old with autism spectrum disorder. She and her 65year-
old mother recently arrived seeking shelter and services. Crystal has never 
worked and chooses not to live alone. Her mother receives Social Security retiree 
benefits and had a long career as teacher. What, if any, financial benefits does Crystal 
likely qualify for? 

So in this case, first we look at Social Security Disability Insurance, SSDI. Crystal may 
qualify. However, she was not declared by the Social Security Administration to be 
disabled before age 22, so even though her mother has sufficient work history and she 
has a disability that likely qualifies as a qualifying disability, she probably would not be 
able to get services because she was not declared disabled before age 22. 

For SSI, however, the standard is different, right? So all they need is disability and low 
income and assets. So because Crystal is 30 years old, she is considered independent 
for purposes of SSI. Her mother's income does not count towards her income. So no 
matter what her mother --the fact her mother gets Social Security does not impact 
Crystal's income. So Crystal does not work, has never worked, and so she would likely 
qualify for SSI and then medication --Medicaid, excuse me, as long as her disability 
meets the definition of disability. 

So, those are just a couple of examples. Again, it really is kind of working through each 
of the issues that could come up, like talking about, okay, this is SSI, this is 
requirements for SSI, disability plus a lack of assets and income. What is required for 
SSDI? Disability plus a work history, plus a lack of gainful activity. 

And then obviously the different exceptions for children of disabled adults or retirees. 


So, how do you apply for SSI or SSDI? It's all done on the Social Security 
Administration's website. The only exception to that is if it is a child of a disabled adult. 
If it's a child of a disabled adult, then you have to file a paper form also found on the 
website, but it's not an online application process, so it's a little more tedious. Based 
upon a lot of research that has been done on this on rates of success, rates of success 
are very low, especially for SSDI. It's always helpful to have a lawyer, an attorney, 
walking you through the process, whether that is a legal aid attorney, a private attorney 
who is working on contingency, or a protection and advocacy attorney, which we'll talk a 
little bit about later on, to assist in the process and advocate making sure that you get 
all the correct medical records, all of the school records, if applicable, and that you're 
able to make a strong case for why the person needs SSI or SSDI. This is not a fast 
process. This is something where it's going to take a long time, most likely, to actually 
see the benefits come to the individual. This is not something where a person in crisis 
can get this the next week. This is something more of a long-term plan while someone 
is transitioning, that you can start working on. But there will need to be stop-gaps or 
something to kind of meet immediate short-term needs. 

The other considerations for SSI and SSDI is representative payees. So when a person 
has a cognitive disability, intellectual disability or they have schizophrenia or even 
sometimes in cases where people have autism, it is highly likely that the Social Security 
administration will require that that person have a representative payee, which is a 
person who is financially responsible for the individual's check. 

So, the individual will get a check. It will be written to the representative payee and go 
into a bank account that the representative payee has access to and then the 
representative payee will be responsible for paying for that person's living expenses and 
medical expenses out of that check money. 

What does that mean? That means you really need to be thinking about who that 
representative payee would be. Typically it's someone who is very much relied upon. 
It's someone who is, you know, a family member or a friend, or if it's an elderly person, 
maybe an adult child. But it can also be a court-appointed person. So if a person has a 
legal guardian, they're often also the person's representative payee. And if a person 
gets services from a service organization, that organization might be a representative 
payee. So it's a variety of different people. What this means that if a person is going to 
get a representative payee, it's important that you talk through what that means with the 
person, and also who they trust to be responsible for their financial health and their 
financial resources while they are receiving benefits. So that's a brief overview. 
Unfortunately we don't have a ton of time to talk about SSI and SSDI. If you have 
questions about SSI and SSDI, put them in the Q&A box. I'm trying to make sure I have 
time for questions at the end so I can get to those. Right now we're going to move on 
housing. It's a quick overview because it's not different than any other housing you help 
someone connect to. What is different is the supportive part of it, which is actually not a 
housing program. It's actually considered a home and community based services 
program. So we'll talk about that in a different place. HUD, the Department of Housing 


and Urban Development has a specific program for people with disabilities, and it's 
Section 811. And it's the only HUD program that is dedicated to producing affordable 
accessible housing for non-elderly very low income people with significant disabilities. 
So this is a program that you can specifically help a person apply for if they have a 
disability, but they are not elderly, and it's often easier to get for a person with a 
significant disability because of some of the logistical requirements, but a lot is the same 
as Section 8. 

Just like for anything else you talk to HUD. Go through HUD or local housing advocates 
in your community. The income limitations and calculations are similar to other HUD 
programs. There's really not a ton of difference. So what I'm --why I'm talking about 
this is because it is a specific disability program. However, it kind of runs parallel to 
regular Section 8 housing and does not typically have any real substantive application 
differences other than you're applying in a different location. 

So then we're going to talk about Medicare. So if a person is on Social Security 
Disability Insurance, like I said, they will automatically be enrolled in Medicare two years 
from the date that they were declared to be disabled by the Social Security 
administration. If a person is declared disabled, when they are 22, and they start 
getting benefits, when they are 24 they will qualify for Medicare even though they are 
not 65, they will qualify for Medicare. What does that mean? They will get a Medicare 
card in the mail. They will have part A coverage for free. They'll have part B coverage 
that they have to pay for. So there are a few options, if you have to --if they have to 
pay for part B and then if they need a supplement or a Medicare advantage plan. Most 
states have income assistance programs for people on SSDI that need help paying for 
med care. Additionally a lot of people are dual qualifiers, which means they qualify for 
Medicare and Medicaid, so sometimes Medicare will cover some of those costs. 

The thing to know about Medicare is that it has very limited coverage for people who 
have disabilities. It does not provide a lot of funding for just disability services. So longterm 
supports and services, coverage is limited. For example, home health services are 
only covered for beneficiaries homebound. So when we talk about these supports and 
services in the community is that the goal is to integrate people into the community as 
much as possible. That means paying for a helper, as is often referred to, to go to the 
movies with a person or go grocery shopping with a person 

A lot of that is funded by Medicaid and by home and community based service labors. 
Medicare will not pay for that kind of coverage. They will pay for home health 
healthcare services. They will not pay for case management. They're not paying for 
transportation. All of those things are things that someone would have to get through 
Medicaid. Which, again, is a lot of the reason why people who qualify for Medicare also 
apply for Medicaid in their state so they can get those services. 

Personal care services are not covered at all under Medicare. They are completely 
unfunded under Medicare, which means that a person who needs personal care 
services, even if they're on SSDI, even if they are on Medicare, still would not be able to 


necessarily provide those services unless they're paying out of pocket, which they 
probably can't do if they're on SSDI because they're only receiving that $1,100 a month 
or so. 

So what do people do in this situation? So Medicaid. So I'm sure you're familiar with 
Medicaid in traditional medical insurance/medical care coverage, but Medicaid also 
provides a whole host of other services specific to people with disabilities. So Medicaid 
is the service that, for example, pays for elderly people who are put into nursing homes, 
pay for the nursing home. They are the organization that pays for home and community 
based services for people with disabilities. They provide transportation. They are the 
funders of day programs for folks, for vocational rehab, occupational therapy, physical 
therapy. All of that is funded by the Medicaid program in your state. So Medicaid pays 
for institutional care. I was designed to pay for institutional care, nursing homes and 
care facilities. It used to be that a person with a disability would go into an institution 
and Medicaid would cover their healthcare and support services within the institution 
that they lived in. Starting a couple of decades ago, there's been a large movement 
towards deinstitutionalization, bringing people back into the community, integrating 
people into the community. And with that we've seen changes to the Medicaid system 
and that includes the idea of Medicaid dollars being used to pay for in-home support as 
opposed to only paying for supports in an institutional setting. 

For many years Medicaid was biased towards institutional care. So even though it paid 
for supports in the community, it was much easier and much more streamlined to get 
funding for institutional care than it was to get any sort of funding for community-based 
services. 

This has changed --the Affordable Care Act, for example, has really expanded 
Medicaid and the eligibility of folks to get community-based services. Although there 
are a lot of exceptions that we're going to talk about and a lot of discretion within the 
state. 

And the benefits vary depending on the state as well. So I'm not going to be able to talk 
specifically about your state. What I can do is provide some general information about 
the types of things that your state will consider when they're talking about long-term 
supports and services, and what that means. And then connect you to some resources. 

So Long Term Supports and Services, they mean exactly what they say. They are longterm 
care. So anything that is considered long-term care is a Long Term Supports and 
Services. So whether that is someone who needs supports through every phase of 
their life for the rest of their life because they have a permanent disability or if that's an 
older person who needs to be in a nursing home or an Alzheimer's facility, for example, 
or that is a person who wants to get nursing care in their home so they don't have to go 
into a facility, all of that is considered long-term care. And it goes beyond healthcare. It 
goes into basically any service that is provided in the community. 


So it includes institutional care. It includes home and community based services. 
Services are usually person-driven. So typically in many states you'll see that the 
person with the disability is able to hire, for example, their own personal care attendant. 
So they are able to choose who they want to help them. They are also able to direct 
which services they need. Usually there will be an intake process where there is a 
conversation about what they want. Do you want to be able to get a job? If so, let's talk 
about job coaches. Let's talk about rehabilitation specialists or vocational rehab. Do 
you want to take public transportation by yourself? Let's talk about a rehab specialist 
that can help you learn public transportation and how to navigate it. 

So it's very much designed... in an ideal world it's very much designed to be responsive 
to the person's needs and desires. 

And it's kind of a coordinated response. Usually there's a case management service. 
So you have one person who is coordinating the different care providers that one 
person will have. And it's funded by Medicaid. So it's available to people who require 
an institutional level of care. So it's really available to people who would otherwise be in 
an institution. 

So what this means, it's called --the program I'm specifically talking about is called the 
Medicaid Waiver Program, because what it means is that the state has to waive the 
funds they would get to put this person in a facility and then they can use those funds to 
pay for in-home services. 

So they have to first qualify for being in a facility in order to qualify for these resources. 
So it does take a significant level of disability and a significant need in order to qualify 
for these services. It depends on the states. Many states have different waiver 
programs depending on the type of disability or the type of support that a person wants 
or needs. 

For example, some states have a waiver program that is specific for people with 
intellectual/developmental disabilities and then they also have a separate waiver 
program for people with mental health disabilities. And then maybe they have a 
separate waiver program for people with physical disabilities. Other states might only 
have a waiver program for people with intellectual and developmental disabilities. It is 
completely kind of discretionary, up to them, how they kind of run those programs in a 
lot of ways. 

So some other things about this, states are allowed to cap the number of people who 
participate in these waiver programs. Which means you get wait lists. You get people 
being denied services that they need because states are at or over capacity. 

It also means that states are allowed to maintain wait lists. There is another program 
that states also administer that provide similar services that we're not going to talk about 
today, where they're not allowed to have wait lists. Most states don't have it as a 


program, but states have programs where they're allowed to maintain wait lists. And 
those wait lists you'll see vary significantly in length and duration of time waiting. 

The other thing states can do is they can limit the services in geographic areas. Which 
means if the services are only provided in a certain region of the state, that means that 
a person who needs the services either needs to move to that portion of the state or not 
get services. They're allowed to do that as well. Although I would say that's much less 
common. The most common limitations we see are only having programs for certain 
types of disabilities and having maximum capacity limitations. 

So what types of Long Term Supports and Services are included in this type of thing? 
Assistance with activities of daily living, such as personal care attendants. When I say 
personal care attendants, I mean not only people who come to help with showering and 
toileting and cooking and cleaning and those type of things, but also people who come 
into the home to go with you to the grocery store or go with you to the movies or maybe 
you need to go buy a dress and they help you go buy a dress, and this is sort of like a 
companion program. They do that as well. Obviously, that's not the only thing that they 
do, but that is one of the things that is funded. 

They also fund case management, which I already talked about. They fund medication 
management. So if someone needs assistance making sure either compliance with 
medication, where they just don't comply with their medication program, or if they need 
assistance in just, like, for instance maybe setting up a pill box for them to make sure 
that they're taking all of their medication every day. It will fund someone to come out 
and do that. 

Adult day programs, it funds those. It funds occupational physical and speech therapy, 
which is something that is very important, especially when talking about children with 
disabilities. 

It funds supported employment services and vocational rehab and job training for 
people with disabilities, which is a very important service as well as we're trying to get 
people with disabilities into the workforce. 

So the limitations on what it funds, it only funds things that are integrated in the 
community. 

So, for example, Medicaid would not fund a group home if that group home was 
completely segregated from the community and the people that lived in that group home 
were not able to make their own autonomous decisions about their treatment plans and 
their providers of services. 

Medicaid would fund someone who lives by himself in an apartment who has a job 
coach and a personal care attendant and a nurse case manager who comes in and 
helps with medication management and a transportation --who needs transportation 
assistance, Medicaid would fund all that, but it only funds services when the person is in 


the community. And meaningfully in the community. And so the thing to know about 
this is literally almost anything you can imagine is a service that a Home and 
Community Based Services program or some other Long Term Supports and Services 
program that a state might administer covers and pays for. The hardest part is really 
connecting to those services and getting those services despite wait lists, despite 
challenging logistical hoops that you have to fly through to get to them. 

So a little bit more about Home and Community Based Services. Almost every state 
has a wait list. Some states have a very short wait list of maybe three months. Other 
states have wait lists. States like Texas and Florida have wait lists up to ten years 
depending on which waiver program you're applying for. Ten years is a very long time 
for a person with a disability who needs these services to wait. 

There are exceptions to that. They give priority to people in crisis. So crisis is if a 
person is homeless, a danger to theirselves or others or if they're living with a person, a 
caregiver, who is either unable to give care or a danger to the person. So an abusive 
partner who is providing their services right now, and they are in a life-threatening 
situation and they need to be able to get out. That might qualify as a crisis. 

What that really means is that you have to be able to navigate the system and know 
how to alert the system that this is a crisis situation, so that a person is not put at the 
bottom of the wait list. And, unfortunately, that is not necessarily something I can tell 
you today because it's different in every single state. 

What I would recommend is getting to know the administering agency in your state. 
Typically it's the department of disability services or the agency for people with 
disabilities or something along those lines, and I also, when we talk about resources, 
we'll have a directory of those. But getting to know them and kind of getting to know 
what their process is and knowing the regulations in your states is extremely important 
to be able to navigate when a person in a crisis situation needs these services. So if a 
person is living with an abusive partner, and without that abusive partner they cannot 
get the transportation that they need, they cannot pick up their own medication, they 
cannot cook for themselves or clean for themselves, and you don't really know what to 
do, contacting that agency and talking about waiver services might be a good option to 
help that person as quickly as possible. 

A lot of local disability agencies can help with that. They are all very well-connected to 
the system, the Medicaid system and the Medicaid waiver system and other types of 
Long Term Supports and Services programs in your state. They are probably funded by 
them. If they have any type of supportive housing, it's funded through Medicaid. A lot 
of times you'll see that disability organizations will have supportive housing where they 
have maybe three people with disabilities in an apartment and then a live-in habilitation 
specialist. That is funded by Medicaid. And those are the type of things when a person 
is in crisis you can try to connect them to as a priority 1 situation. 


They also have --some states have different levels of priority depending on the severity. 
For instance, the number-one is if someone is in --at risk of bodily harm. So, I think 
that that is --you can make that argument for someone who is leaving a domestic 
violence situation or is currently in a domestic violence situation, that they are at risk for 
bodily harm if they stay with their caregiver. 

There are other levels for homelessness or living in a homeless shelter, for children who 
are either don't have someone to take care of them or living in an abusive environment. 
There is a lot of ways that you can argue a priority or a crisis situation. But they really 
have to know the system, but knowing the system and how to advocate in this system 
requires building relationships with these agencies. Early on before you need services 
from them. 

Just so you know, Medicaid, 46% of Medicaid services is used in Home and Community 
Based Services. So that means that almost half of everything that Medicaid pays for -so 
think of the scope of Medicaid just health insurance and how much they pay for 
health insurance and health coverage. Despite how much they pay for that, almost half 
of their spending is really on Long Term Supports and Services. So it's a huge amount 
of money and what it really means is that the federal government subsidizes. So 
instead of matching Medicaid's output like they do for a lot of other programs, for the 
Home and Community Based Services program, the state gets a subsidy in order to 
provide the services. They're spending 46% of their budget plus the additional subsidy 
they get from the government. 

So, I think that that is a very, very, very brief overview of Home and Community Based 
Services. Again, the key takeaway is get to know these service providers and 
administering agencies. Find out what the application process looks like in your state. 
Talk to disability organizations, and have those relationships built so that when 
someone comes in, that you are able to quickly respond to the situation. 

So, here is another scenario. Mike has been homeless since leaving his abusive 
partner. He has an intellectual disability. He does not know how to take public 
transportation, manage his medication or manage his finances. What services and/or 
financial supports may Mike qualify for? 

So there's a lot here. He has an intellectual disability. We don't know if he works or not. 
If he works, he probably doesn't make more than the amount that he's allowed to make 
via the Social Security Administration. So he likely qualifies for SSI. So SSI would then 
mean that he's connected to Medicaid insurance and healthcare. And then, because he 
is homeless, you're dealing with housing. You have a couple options. You can try to 
get him in Section 811 of federal housing, or you can work to find him housing through a 
disability organization or through Medicaid waiver services. Note that even if a person 
is on Medicaid already has Medicaid or is applying for Medicaid, they are not 
automatically given a waiver. They're not automatically applying for a waiver. It is an 
affirmative process. You have to fill out an additional application and go through 
additional paperwork and red tape before they're able to even be put on the wait list. 


And then if it's a crisis situation, there's usually additional paperwork on top of that that 
they have to fill out in order to qualify as a crisis. And usually it requires meeting with a 
case worker and a variety of difficult sort of conversations that a person, maybe Mike, 
who has an intellectual disability doesn't know how to navigate the system and doesn't 
know what to say to the person at the Agency for Persons with Disabilities, if you're in 
Florida, for example, and doesn't know what to say to convey he is in a crisis situation. 
That is where an advocate at your organization would step in and be able to walk him 
along, or at least connect him to an advocate at a disability organization who is maybe 
more familiar with the process of applying for waiver services, and then create that 
smooth transition to working with that advocate. 

So, he would qualify for things like independent living skills, habilitation services, 
medication and case management. He would also probably need a representative 
payee, depending on the severity of his intellectual disability. So another thing we 
would need to have a conversation with him about is, who can you trust to take care of 
your finances? Obviously not his partner. So who is that person that you can trust with 
your finances? That would be another conversation that you would need to have. So, 
applying for Long Term Supports and Services, the process is difficult. The process is 
not easy to navigate. People with disabilities themselves almost never even know that 
this service exists. They usually apply for it on behalf of the person by either a parent or 
a guardian or a disability service provider who knows about these services because this 
is what they do and this is what they understand. 

Doctors will sometimes help and say, hey, this service exists. But they don't know how 
to navigate the system either. Depending on the state of residency, the application 
could be quick. It could take a very long time. You could be on a wait list. And be on a 
wait list for years. Or you could be on a wait list and taken off a wait list very quickly. 
The other thing to keep in mind, if a person is going to move states, the wait lists are 
state dependent. The applications are state dependent. If you have a survivor who is 
currently living in Texas but is planning on moving to Oklahoma, across the state line, to 
go live with their family members, for example, that would mean that they would then 
have to --the Texas wait list would be void when they moved to Oklahoma. They would 
have to start the entire process over again. So, that would really mean that letting them 
know that --if they know they're moving, they're able to plan for that, maybe connecting 
them to an advocate in the state that they're moving to, but it's important to realize that 
this is all state dependent. It does not carry over. And if they're going from a state with 
a very long wait list to a state with a very short wait list, that might be great for them. 
But if they are going from a state where they are on a short wait list and going to, for 
example, Florida where the wait is ten years, that might be a significant factor for them. 

Another factor is if they're already receiving state-based benefits. So Medicaid, Long 
Term Supports and Services, a waiver, that is not transferred to the next state. If they 
are crossing state lines they have to reapply for everything. 

Social Security Disability and supplemental security, those cross over, those are federal 
programs. If a state office has a supplement to those programs, then the state 


supplement won't cross over, but they will at least still have those benefits even if they 
move states. 

And, again, remember this is usually a different application than Medicaid itself. So 
finding someone at the office, the Medicaid office or whoever administers your disability 
services is going to be difficult. You need to make sure someone who is familiar with 
the program, familiar with the requirements of the program and knows how to connect 
you to it. I have personally heard experiences of people who have applied for Medicaid 
and asked the person that they talked to that is helping them apply, am I also applying 
for these services, and they've been told "yes" when in fact they're not. Not necessarily 
out of any sort of ill will, but just because people do not know what they're talking about 
when they say, "am I applying for services?" They don't know what that means 
because they don't work in that area. Sometimes it's even a completely different 
administering agency, in fact it usually is a completely different administering agency. 
So just needing to make sure that you're communicating that and you try to really try to 
figure out the net of that system before you enter a crisis situation or have someone 
come in who is in a crisis situation. Another scenario. Marissa and her four-year-old 
son, math chew, are receiving services from your organization. Matthew has cerebral 
palsy and uses a wheelchair. Before Marissa's divorce she was able to pay out of 
pocket for a personal care attendant for Matthew while she worked at her full-time job 
where she makes $60,000 a year. Since she left her husband she's been on leave but 
now has to return to work. How can you help ensure Matthew gets the services he 
needs while Marissa works? 

So the first consideration is financial services. Matthew would not qualify for Social 
Security Disability Insurance because his mother is not disabled. And he may not 
qualify for Supplemental Security Insurance because his mother makes $60,000 a year. 
The other thing to keep in note is his father's income may count toward the total 
parental income as well. So he might not qualify for either federal disability benefit. 
However, he may still qualify for Medicaid and for Home and Community Based 
Services. So he may still qualify for a day program that is funded through Medicaid. He 
may still qualify for a personal care attendant to assist him if his mother has to work odd 
hours and cannot help him bathe, he might still qualify for habilitation services, physical, 
occupational therapy. He might still qualify for all of those even though he doesn't 
qualify for either of the federal disability programs. 

So, applying for Long Term Supports and Services through Medicaid is something that 
he would need to do even if he doesn't necessarily need Medicaid for health benefits 
because if his mother has a full-time job making $60,000 a year she likely has health 
insurance, although I will say nowadays that is not a given. But he can still receive 
other services if he applies through the Medicaid waiver system in his state. Again, that 
would be state dependent. And typically people who have developmental and 
intellectual disabilities, there is a program for them in every state. Not every state has 
waiver programs for people with mental health disabilities and not every state has 
programs for people with physical disabilities, but intellectual developmental disabilities 
is pretty standard. That's the most likely to have a waiver program for people with those 


types of disabilities. And cerebral palsy is a developmental disability that also affects 
physical aspects of your life, so he would still probably be able to get waiver services. 
So that would mean that you would need to walk Marissa and Matthew through the 
process of applying for those services. 

So, another scenario. Janet has just left her husband after 20 years of marriage. She 
is blind. She has several other health conditions and cannot work. She has not yet 
initiated divorce proceedings. She and her husband share a savings account but Janet 
does not know how to access the money or how much money is in the account. What, 
if any, benefits could Janet qualify for? 

So Janet has no work history. If she cannot work. I'm assuming she has never been 
able to work. That is an assumption I'm making. That may not be the case. If she has 
a work history, that would be something to look into. So we're looking at Supplemental 
Security Insurance, SSI, because she does not have a work history, in my assumption. 

So what does that mean? She has to have a disability. So she's blind. So there are 
special provisions for people who are blind. They typically are automatically considered 
to have a qualifying disability. And, for example, in SSDI, they're actually able to earn 
more per month and still qualify than other types of disabilities. 

So she likely has a disability under SSA regulations. She doesn't have a work history. 
We don't know what her assets are or what her income is. She has zero income from 
work but does she have other residual unearned income such as stocks and bonds? 
Does she have --maybe she is listed as an owner on rental property that the couple 
owned jointly all of that will count as assets and income for her. This joint account they 
have, this joint savings account, if her name is on that account, it is considered an asset 
by the Social Security Administration, even if she has no way to access it. If her name 
is on the account. If the account is in her husband's name and she is no longer living 
with her husband and she's not --she's not holding herself out to still be married to him, 
she is planning on a divorce, and it's only in his name, it would not count against her. It 
would not count as income for her determination. So it really is very fact-dependent. 
It's about thinking about specific --the specifics of an individual case, which is why I'm 
going to talk a little bit about some resources that are available from people who can 
actually walk you through specific cases. Because I can give you general information, 
but because everything is so case-dependent, talking to a person about actual cases 
and connecting a person to an attorney or a benefits advocate is really the best option 
that you have. 

So, I just have another chat, and I think Adobe may be cooperating a little bit better now 
for us to be able to bring the chat box out. I'm not entirely sure though. No promises. 
But just think for a couple minutes about what challenges you foresee in your 
organization in connecting survivors with disabilities to the supports that we talked about 
today. Does any of this seem particularly difficult or challenging for you given either 
your resources or educational --I'm sorry, not educational --training and sort of 
experience? And what maybe could you do to mitigate some of that challenge? 


So, I see a few people are typing. So we'll give everyone --so, yeah, rural program, it's 
very difficult for a rural program. What I would suggest is having a really close 
relationship with your statewide administrators of these programs, because you may not 
have local disability providers, but the statewide may be able to provide you with 
someone that is close to you that may be able to provide information for you. 

Required documentation. That is definitely, if someone is leaving an abusive situation, 
they might not have the required documents that they need. Maybe they don't have 
their birth certificate, they don't have their Social Security card, let alone other medical 
records and things of that nature. So it's definitely difficult to connect people to these 
services without having that required documentation. Just like you do with disabilities 
you can help them get a new birth certificate and new Social Security card and things of 
that nature, but it does mean that there are delays. And, yeah, we didn't talk about 
emergency services. Emergency services specific to people with disabilities are really 
limited to getting people crisis services through the waiver system. There are domestic 
violence shelters that are accessible to people with disabilities. They are truly 
accessible shelters or temporary housing, it's hard to find, but if you are an advocate 
and connecting someone to shelters, don't be afraid to advocate on behalf of your client 
for accessible services. And saying you know, they are entitled under the Americans 
with Disabilities Act to have a sign language interpreter here. You need to provide it. A 
lot of times that is the only way they're going to get these services, if they or you are 
advocating on their behalf. 

Let's see what else we have here. These are really good challenges that --really they 
face everyone. A lot of people in rural communities... the good thing about --not the 
good thing about the protection and advocacy system is that attorneys in the protection 
and advocacy system, which we'll talk about when we talk about resources, they're 
based all over the state and they have a really good connection statewide. So being in 
a more rural area may not be as big of an issue as you think when dealing with 
statewide resources and with technology. But bringing people to those resources is 
difficult, yes. 

Let's see. The clients don't have money for attorneys, don't have pro bono available. 
The good thing about protection and advocacy services is they are funded by the 
federal government, so they provide services to people with disabilities free of charge, 
so that means that even if someone does not have any assets whatsoever, they can still 
receive legal services when it comes to getting benefits. Protection and advocacy 
agencies, many of them also have advocates that are not attorneys to help people apply 
for these benefits as well, as well as many legal aid organizations also have those type 
of things. 

Let's see if there's anything else. Having more resources available, having accessible 
resources, these are things that we see basically with all --with all organizations really, 
and it's something that it involves a lot of planning and thinking about, but there are a lot 
of things you can do with very little resources. You can create in a Word document a 


directory of the names of the agencies or a contact person at the agencies, things like 
that that are very helpful. 

I see something, maintaining confidentiality with so many connections needed. 
Informed consent is a very touchy subject when it comes to people with disability. 
When it comes to consent, when talking about this type of thing, it's important to talk to 
the person, not their guardian. A lot of times their legal guardian may be their abuser. 
It's a touchy subject. What it just means is having very thoughtful conversations with 
the client every step of the way, explaining what you're doing, having releases that are 
in plain language that are easy to understand, training your advocates on conveying 
that information in a way that is accessible for people with disabilities. 

Yeah, I mean, a lot of this is resource-based. Legal aid not having enough resources. 
A lot --there is someone on here who made the comment that most Social Security and 
SSI attorneys basically work on a contingency, which means they don't get paid unless 
the person gets benefits and then they get a portion of the benefits that the person 
would get. Typically that is an appeal process. So if a person is denied benefits they 
can hire an attorney without having to pay that attorney and then when they win, the 
attorney will take their price out of whatever the lump settlement is. 

So that's just some of the challenges. You all have brought up really good challenges. I 
think there's a lot of thinking that can be done around how to overcome some of these 
challenges. I think that the biggest thing is just forging these connections between 
yourselves and disability organizations and between yourselves and administering 
agencies, especially at the state level. I think that that is really the key to figuring all this 
out. It's a complete spiderweb of services and organizations and navigating that is very 
difficult. And having those connections will make sure you're not missing anything. 
We're going to talk about resources. We have a couple minutes left and I'm hoping to 
have a couple minutes for questions, so hoping to get through the resources quickly. 
The first is the Protection and Advocacy Agency, there is one in every single state, it's 
federal mandate, funded by the federal government to provide advocacy services, legal 
and otherwise, to people with disabilities. If you click the link in the PowerPoint it will 
take you to the National Disability Rights Network, which is the national network of 
protection and advocacy agencies. There will be a map on there and you click on your 
state. You can find your P&A. They will all have the ability at the very least to connect 
you to an advocate in receiving benefits. If they don't have anyone on staff. This is a 
priority area of all the P&Asand so it's something that they definitely work on. 

They also --the other good thing about P&Asis that they have expertise in abuse and 
neglect. Maybe they don't understand domestic violence but they understand the risk 
that people with disabilities face and why it's important to help them immediately and 
quickly, especially in crisis situations. So that's helpful. 

The other resource is, again, the State Disability Agency. They often administer a lot of 
services. So, for example, waiver services are administered by the states via these 
agencies. For example, in Florida it's called the Agency for Persons with Disabilities. In 


Virginia it's called disability services agency. And in D.C. it's called the Department on 
Disability Services. And, again, I sent you a link to the directory right in the PowerPoint. 
And there are --they also list out a lot of the requirements for waiver services and what 
the application looked like and all of that in their website. 

And then there are a lot of disability advocacy organizations. The Arc of the United 
States and their chapter network, they have 600 plus chapters across the country, 
including in many rural areas that can provide information. Another good one that is not 
in here is your local Independent Living Center. They usually have habilitation 
specialists on staff funded by Medicaid and work with people every day in getting 
benefits and managing benefits that they need. So they are a great resource as well. 
And if you have questions and want to talk about other resources or resources in your 
state, you can contact me. My contact information is available here. I saved one 
question, so I'm going to go ahead and answer it real quickly. You mentioned finding 
support people, particularly for control of finances. If a survivor doesn't have a support 
system in place and doesn't have anyone to appropriately manage finances, what 
recommendations would you give that person? So they have a few options. If they are 
getting connected to services through a disability service provider, that disability service 
provider is probably certified to be a representative payee for the people that they serve. 
They could have --that would probably be the best option. Another option is a court 
can always assign someone. There are people quote/unquote professional 
representative payees, who just do this for people. 

What I would say about that is you have to be very careful about who you are selecting 
because there is a lot of opportunity for financial misuse of people's money and identity 
and so you really want to vet whoever is going to be that person. 

And unfortunately it looks like we're out of time, so I'm going to go ahead and pass it 
back to Leni. Thank you all so much. 

>> LENI DWORKIS: Thank you so much, Ashley. 
And I would like to thank all of you for participating in today's webinar. 
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Thanks again and have a good afternoon!