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Long Covid Disability Revives Push to End 24-Month Medicare Wait

Feb. 3, 2022, 8:33 PM

Congress needs to make it easier for people who are disabled by long-term Covid-19 conditions to access Medicare benefits, advocates and medical doctors told lawmakers at a hearing Thursday.

Anyone eligible for Social Security Disability Insurance (SSDI) is also eligible for Medicare, but those who get approved for SSDI have to wait a mandated 24 months before they can get those health benefits.

That waiting period can be harmful to people suffering from a chronic illness, including the constellation of physical, neurological, and psychological conditions known as long Covid, which lasts for months after an initial Covid-19 infection, one doctor said.

Patients who’ve had to wait two years for Medicare coverage are getting worse, not better, Monica Verduzco-Gutierrez, chair of the Rehabilitation Medicine Department at the University of Texas Health San Antonio Long School of Medicine, told members of the House Ways and Means Subcommittee on Health.

“Ones with severe brain injuries, their muscles shorten and painfully twist in, and their families cannot care for them at home,” she said, adding that Congress has the ability now to support them.

Legislation Introduced

Just before the hearing on health equity gaps facing people with disabilities and chronic conditions, subcommittee chair Rep. Lloyd Doggett (D-Texas) and Sen. Bob Casey (D-Pa.) reintroduced legislation along with Rep. Brian Fitzpatrick (R-Pa.) to end that 24-month delay.

The Stop the Wait Act was first introduced in 2019 but never passed. The legislation directs the Social Security Administration (SSA) to phase out its five-month waiting period for SSDI benefits once someone is approved, and it amends the Social Security Act to give those who are uninsured or unable to afford health insurance immediate access to Medicare coverage.

“This arbitrary wait was no doubt established to contain cost, but it really only shifts the costs to the vulnerable,” Doggett said during the hearing.

Liza Fisher, of Houston, said her family was forced to dip into their retirement savings to pay for her medical care while she was waiting for her Medicare benefits to kick in. Fisher, who has long Covid, was approved for SSDI in June 2021.

“I talked to a social worker and found out that the waiting period wasn’t 24 months from when you are considered disabled, but it’s 24 months from when you were approved for disability,” she said. “So, that added an additional five months.”

VIDEO: The scale and newness of the Covid-19 pandemic presents new questions about what treatments insurers will cover and who, ultimately, will pay for what could be years of medical care.

Ongoing Issue

But even getting Social Security disability benefits can be difficult. A SSA report for 2019 found that 66% of claims for Social Security disability benefits were denied between 2009 and 2018. Bloomberg Law talked to several people with long Covid, who were struggling to get disability benefits through either the federal government or a private insurer.

To qualify for Social Security disability insurance, a condition must meet the agency’s definition of a disability and has to have lasted, or be expected to last, for a year or result in death. That can be hard to prove when some of long Covid’s most debilitating symptoms don’t show up on tests.

To contact the reporter on this story: Lydia Wheeler in Washington at lwheeler@bloomberglaw.com

To contact the editor responsible for this story: Brent Bierman at bbierman@bloomberglaw.com

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