SSI/SSDI Outreach, Access and Recovery

www.TheNationalCouncil.org

SSI/SSDI Outreach, Access

and Recovery

Increasing access to Social Security disability

benefits for people who are homeless or at risk

for homelessness

Deborah Dennis and Kristin Lupfer

Policy Research Associates, Inc.


Poll Questions

> Do you know if there is a SOAR project in

your community?

> Have you or has anyone from your agency

been to a SOAR training?


SOAR Technical Assistance Initiative

> SOAR: SSI/SSDI Outreach, Access and Recovery

> Sponsored by SAMHSA in collaboration with SSA

> No direct funding to states

> 50 states currently participate

> Helps States and communities increase access to SSI/SSDI through:

• Collaboration and strategic planning

• Training

• Technical assistance


Why is SSI/SSDI Important?

SSA disability benefits can provide access to:

• Income

• Housing

• Health insurance

• Treatment

• Other supportive services


Myths About SSI and SSDI

> Everybody is denied the first time

> You will be denied 3 times before you are approved

> You need an attorney to be approved

> You can’t get benefits if you use alcohol or other drugs

> If you go to work, you’ll lose your health insurance and your benefit check


SSI and SSDI: The Basics

> SSI: Supplemental Security Income; needs based, federal benefit rate is $698 per month in 2012; provides Medicaid in most states

> SSDI: Social Security Disability Insurance; amount depends on earnings put into SSA system; Medicare generally provided after 2 years of eligibility

> The disability determination process for both programs is the same


The Problem

> Only about 10-15 percent of homeless adults

are approved on initial application

> Only about 32 percent of all applicants are

approved on initial application

> Appeals can take a year or longer

> Many people give up and do not appeal


What We Know Is Possible

> As of June 2011, 44 states reported outcomes:

• More than 10,000 individuals were approved for SSI/SSDI

on initial application

• 71 percent approval rate

• In an average of 101 days

> In 2010 alone, SSI/SSDI brought at least $85 million

into the state and local economies of these states

> An average of $10,700 in Medicaid reimbursement

per person approved, as a result of SOAR


Uses SAMHSA’s Stepping Stones to Recovery Training Curriculum

> Based on success of University of Maryland Medical

System SSI Outreach Project in Baltimore

> Achieved 96% approval rate for those assessed to

be likely eligible

> Comprehensive approach to individual’s needs with

income as the “hook”

> Engagement, relationship, and assessment are

integral parts of project and curriculum


How Is This Model Different?

> Case managers actively assist applicants and develop evidence

> Focuses on the initial application – “Get it right the first time!”

> Avoids appeals and consultative exams whenever possible

> Focuses on documenting the disability


Poll Questions

> Does your organization serve people who are

homeless or at-risk for homelessness?

> Are you a Medicaid provider?


Why Is Access to SSI and SSDI

Important for States and Localities? > People experiencing homelessness are frequent users of

expensive uncompensated health care

> Providers can recoup cost of this care from Medicaid for up to 90 days retroactive to date of SSI eligibility

> States that fund health care for low income and/or disabled persons can save state dollars once Medicaid is approved

> States and localities can recoup from SSA the cost of public assistance provided during the application process

> SSI, SSDI and Medicaid bring federal dollars into states, localities and community programs


Benefits for Healthcare Providers

> Recovery of costs for uncompensated care

> Results in newly insured patients who were previously

uninsured

> Non-profit organizations fulfill “community benefits” requirements

> Reduces public health care costs by providing ongoing

treatment and services

> Helps to reduce homelessness


SOAR Across Michigan

> Implemented State-wide in 2005

> Added as requirement in CMHC PATH

provider contracts

> As of April 2012, 1,818 persons (homeless or

at risk) have been approved for SSI/SSDI

> Collectively case managers have an approval

rate of 67% including initial applications and

appeals


Park Center in Nashville, TN > Nashville’s 10-year plan funds 3 positions in

community mental health center

> Since May 2006, 96% of 329 applications approved in an average of 65 days

> Works closely with medical records staff of local primary care clinics and hospitals

> Outreach ensures contact with applicants

> Treatment provided in agency where SSI project is housed


Central City Concern in Portland, OR

> Integrated primary and behavioral health care; strongly linked to provision of housing

> Approval rate of 91% for 270 applications in average of 50 days

> $539,000 of past medical bills reimbursable through Medicaid for 37 applicants

> Funding from local hospital, foundation, City of Portland and Portland Housing Authority


North Carolina

> Funded by the State, SOAR coordination is

provided by the North Carolina Coalition to End

Homelessness

> Focus on helping localities develop and sustain

benefits specialist positions

> 17 FTEs in 10 communities/regions

> In 3 years 79% of 316 applications were

approved in an average of 106 days


Grady Memorial Hospital and First Step in Atlanta, GA

> Grady refers individuals who are homeless and uninsured to First Step for assistance with benefits

> First Step works with Grady to bill for Medicaid or Medicare

> From 2007- 2010, First Step had more than 300 approvals with an 86% approval rate

> Outcomes from the first 9 months of this collaboration:

• Grady Memorial Hospital recovered ~$600,000 in expenses previously written off as bad debt

• Grady shares a percentage of their recovery with First Step to support their outreach efforts


Collaborations with Corrections > NY’s Sing Sing prison & NYC community service agency

• Same staff does pre-release applications and follows folks in community

• 85% of 183 pre-release SSI applications approved in 85 days on average

> Miami / Dade jail diversion program

• SOAR is cornerstone of behavioral health court program

• 77% of 673 applications approved in average of 68 days

• Housing and treatment are provided upon release based on strong likelihood of SSI approval

• Recidivism one year prior to and one year after SSI approval went from 77% to 22%


Affordable Care Act and SOAR

> Affordable Care Act brings expanded access

to Medicaid

> SSI/SSDI remain as crucial income supports

> SOAR providers can continue their work and

help with outreach for the Medicaid

Expansion population


Until 2014 – What SOAR Can Do

> Although many of the individuals you currently serve will be eligible for Medicaid on 1/1/14, SOAR and SSI outreach is important now!

• There are still 1.5 years until 2014 – getting people SSI and Medicaid remains critical

• The Medicaid program that currently exists may provide more benefits, especially in mental health, than the “new” “Essential Health Benefits” Medicaid that your State may adopt


2014 and Beyond > In January 2014, individuals will not automatically be

enrolled – they will still have to apply for Medicaid

> SOAR case managers will be especially poised to help individuals who are homeless to enroll

> Look at ways current systems can be modified to address Medicaid expansion efforts

> The Affordable Care Act only provides access to Medicaid

> Income supports, such as SSI and SSDI are critical for safe and stable housing, which in turn lead to better health outcomes


Get Involved with the ACA

> SOAR Case Managers can improve client health outcomes and be a part of Health Homes

> CMHCs can and should be key players in community SOAR efforts and ACA implementation

> Every State is in a different place – find out what your State Medicaid agency is doing on ACA implementation

> Talk to your State legislators and Medicaid agency staff about how SOAR can be a partner in health care reform efforts

> The national SAMHSA SOAR TA Center is prepared to help address the expanding need


Get Involved with SOAR

www.prainc.com/soar

• Find your state lead

• Find local trainings

• Attend a planning

meeting

http://www.prainc.com/soar


For More Information

Presented by:

Deborah Dennis and Kristin Lupfer

SAMHSA’s SOAR Technical Assistance Center

Policy Research Associates, Inc.

Delmar, NY

www.prainc.com/soar

518-439-7415

[email protected]



Documents

SSI/SSDI Outreach, Access and Recovery