Accessing Mainstream Services: SSI and SSDI

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Accessing Mainstream ServicesSSI and SSDI

• Yvonne M. Perret, MA, MSW, LCSW-C
• Houston, Texas
• February 1, 2008

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Social Security Administration (SSA) SSI and
SSDI

• Two disability programs SSI and SSDI
• Strict definition of disability
• Both have similar process
• Processing of non-medical or non-disability
  information at SSA
• Processing of medical information to determine
  disability

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SSAs Definition of Disability

• Impairment must affect a persons ability to do
  significant work
• Significant work called substantial gainful
  activity
• Defined as an amount of gross earnings/month
• 2008 940/month.

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Disability Criteria for SSA

• Medically Determinable Physical or Mental
  Impairment lllness(es) must meet DDS criteria
  supporting information must be documented in
  medical records
• Duration Impairment tied to illness(es) must
  have lasted OR be expected to last 12 months or
  more OR result in death
• Functional Information Applicant must
  demonstrate significant functional impairment
  related to the illness(es)

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Areas of Functional Information

• Marked restrictions in activities of daily living
• Marked restrictions in social functioning
• Marked restrictions in concentration,
  persis-tence and pace in the completion of tasks
• Repeated episodes of decompensation each of
  extended duration

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Addressing Homelessness Among
People with Disabilities

• SSI and SSDI can be critical steps towards ending
  homelessness for people with disabilities
• Providing access to needed treatment and housing

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The Problem

• The SSI application process is very difficult for
  people who are homeless, many of whom have mental
  illnesses and co-occurring substance use
  disorders
• Only about 10-15 percent of those who apply are
  typically approved on initial application
• Appeals take years and many potentially eligible
  people give up and do not appeal

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Why Is Access To SSI So Difficult?

• People who are homeless need assistance to apply
• They need adequate assessment and documentation
  of how their disabling conditions limit their
  ability to work
• Providers who assist SSI applicants need staff
  who understand the disability determination
  process and who have time to assist in all
  aspects of developing the application
• Relationships with SSA, DDS, community medical
  providers and others are essential to changing
  the outcomes of SSI/SSDI applications

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What We Know Is Possible

• Approval rates of 60-95
• on initial application
• for homeless applicants

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SSI/SSDI Outreach, Access and Recovery(SOAR)

• Has just come to Texas!
• Is now in 34 states
• Has brought about, in cooperation with states,
  approval rates ON APPLICATION averaging 62 in
  87 days!!
• Incorporates critical components we know bring
  success

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SOAR Technical Assistance Initiative

• Works as a strategy to help States increase
  access to mainstream benefits for people who are
  homeless through training, technical assistance
  and strategic planning
• Includes use of SAMHSAs Stepping Stones to
  Recovery training curriculum

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Stepping Stones to Recovery Training Curriculum

• Based on success of University of Maryland
  Medical System Baltimore SSI Outreach Project
• Achieved success rate on application of 96 for
  those deemed likely eligible
• Comprehensive approach to individuals needs with
  income as the hook
• Engagement, relationship, and assessment are
  integral parts of project and curriculum

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How Is This Model Different?

• Collaboration and strategic planning among key
  stakeholders is critical
• Case managers actively assist applicants and
  develop evidence
• Step-by-step explanation of SSI application and
  disability determination process
• Train-the-trainer program allows for expansion
  and sustainability

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How Is This Model Different?

• Focuses on documenting disability for the initial
  applicationGet it right the first time!
• Avoids appeals
• Provides follow-up observation, TA, and feedback
  for States initial training and ongoing TA for
  action plan implementation
• Tracks outcomes to document success and help
  access additional resources
• Incorporates critical components for success

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Component for Success 1 Trained Case Managers
and Other Outreach Staff

• Agencies doing work on SSI with people who are
  homeless must have outreach capacity
• People who are homeless cannot be adequately
  served on an in-office basis
• Staff must have time to work on all aspects of
  application process, including clinical
  development, to be successful
• Designated staff is often helpful to develop
  expertise. Sustainability must be considered

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Component for Success 2Ongoing communication
and contact with the applicant

• Technical denials by SSA are largely due to an
  applicants inability to follow up
• Staff can use technology to stay in touch with
  SSA, e.g., e-mail
• Staff who assist must be skilled in engagement,
  maintaining contact, and assisting in beginning
  recovery, e.g., through Stepping Stones to
  Recovery curriculum
• Staff who are hired need to be reviewed for
  interpersonal skills rather than content skills

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Component for Success 3Serve as Applicants
Representative

• Using the SSA-1696 to be the representative is
  invaluable
• Becoming representative allows case manager to
• Receive all correspondence from SSA/DDS
• Receive award letters, copies of appointments
• Receive CDs of all information in the persons
  record that SSA has in case an appeal is needed
• Poses no liability on a case manager or his/her
  agency can be submitted at any time in the
  process

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Component for Success 4Obtaining medical
information

• Complete medical information is critical to the
  disability determination process
• An active role for case managers in this process
  eliminates a great deal of waiting for
  information and helps to avoid CEs
• Procedures with providers need to be developed
  before SSI effort is implemented
• Case manager submits medical summary report
  co-signed by applicants physician/psychologist

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Component for Success 5Collaboration with
physicians and psychologists for evaluations

• Obtain needed assessments prior to submission of
  complete package of medical information
• Make least use of most expensive staff
• Prepare for diagnostic evaluations by using
  program staff to conduct thorough clinical
  assessments
• Avoids Consultative Exams (CEs)

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Component for Success 5 (cont)Collaboration
with physicians and psychologists for evaluations

• Negotiate with health care providers to conduct
  one pro bono evaluation/year for SSI applicants
• Provide training for psychiatrists/ psychologists
  on their role in disability documentation
• Use psychiatry residents, psychology PhD
  candidates to conduct assessments and provide
  mental status exams within past 90 days

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Component for Success 6Submit information
electronically

• Provide hardware and training to do applications
  (SSDI and i3368) on-line
• Electronic submission quickly establishes
  protective filing date
• Speeds up the application process

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Component for Success 7Collaboration with SSA
and DDS

• Establish collaborations with SSA offices, both
  on regional and local levels Ask for designated
  staff and appointments to apply
• Develop a partnership with the DDS Professional
  (PRO) or Medical Relations Officer (MRO) Ask for
  designated staff
• Flag applications at both DDS and SSA (can be
  done electronically)

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Component for Success 8Quality review and
tracking

• Provide for quality review of each others
  application submissions for completeness and
  accuracy
• Track your success rates to advocate for
  additional resources

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SUCCESS CAN HAPPEN

• Apply above critical components
• Work with community and state leadership to
  obtain support of your efforts
• Focus on the importance for people you serve
• Pursue recovery, including employment

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Contact Information

• Yvonne Perret, National SOAR TA Team
• Advocacy and Training Center, Cumberland, MD
• 301-777-7987
• yvonne.perret_at_gmail.com
• Deborah Dennis, National SOAR Project Director
• Policy Research Associates, Inc., Delmar, NY
• 518-439-7415, ext. 238
• ddennis_at_prainc.com