Bring Badly Needed Federal Dollars Into Rural Communities

1
Bring Badly Needed Federal Dollars Into Rural
Communities

• Creating a Rural Federal Disability Benefits
  Specialist Program
• SSD/SSI advocacy A very big missing piece in
  social service work

2
Rural Oregon Benefits Pilot

• Project Background and Funding
• Made possible through Community Service Block
  Grant funds (CSBG), and
• American Recovery and Reinvestment Act of 2009
  (ARRA)

3
Community Services Block Grants

• CSBG is a federal, anti-poverty block grant which
  funds the operations of a state-administered
  network of local agencies
•   This CSBG network consists of
• Over 1,100 agencies deliver programs and services
  to low-income Americans
• 96 percent of the nation's counties

4
Community Service Block Grants

• Oregon Housing and Community Services office
  administers these federal funds (OHCS)
• CSBG provides
• Core funding to local agencies to reduce poverty
• Revitalize low-income communities, and
• Empower low-income families to become
  self- sufficient.

5
Community Service Block Grants

• CSBG funds are used to provide services for
• Employment
• Education
• Better use of available income
• Housing
• Nutrition
• Emergency services
• Health

6
The CSBG Network

• Most agencies are Community Action Agencies
• Oregon has 17 CAAs and
• Statewide farm-worker organization
• Community representation and accountability are
  hallmarks of the CSBG network
• Agencies governed by tri-partite boards
• Boards consists of
• elected public officials
• low-income community representatives, and
• appointed leaders from the private sector

7
ARRA Funds Allocations

• In addition to regular CSBG funding, Oregon
  received an additional 7.9 million in CSBG/ARRA
  monies
• 99 of ARRA funds went to eligible entities
• 1 of CSBG/ARRA was earmarked for
• benefits enrollment coordination activities
  relating to the identification and enrollment of
  eligible individuals in Federal, State and local
  benefits programs

8
The Benefits Project Timeline

• April 26, 2010 Disability Benefits Training
  Consulting LLC (DBTC) was invited to OHCS to
  present an overview of benefits work for the
  disabled homeless and indigent
• OHCS staff felt this was a perfect fit for the
  ARRA funding
• The project came together very rapidly

9
Timeline Cont.d

• OHCS invites CAAs to participate in pilot
  project One stipulation
• Benefits Specialist position must be a
  full-time, dedicated to the pilot program
• May 17, 2010 OHCS issues RFP
• May 28, 2010 RFP awarded to DBTC
• June 1, 2010 Four CAAs are chosen for the
  pilot
• June 4, 2010 Contract signed with DBTC

10

• June 7, 2010 September 20, 2010
• Six day on-site trainings SSI Boot Camp
• Visited seven separate towns
• Training included six months of follow-up
  technical assistance to each agency
• Pilot completed March 31, 2011
• OHCS extended DBTCs contract for 12 months to
• Develop a statewide peer group
• Continue to collect data

11
Future Plans

• Involve the HUD Continuum of Care coalitions for
  housing for the homeless
• Continue to add benefits to rural 10 year plans
  to end homelessness
• Collect statistical data with the use of HMIS
• Develop working relationships with the SSA

12
Pilot Project Results

• Total of Referrals from 5 sites 93
• Cases accepted for representation 48
• Not accepted for representation 31
• Decisions still pending for repg 14
• Cases Allowed 8

13
Coos/Curry Counties, Coos Bay, Oregon
14
Lane County Eugene Springfield , Oregon
15
Klamath/Lake Counties Klamath Falls, Oregon
16
DBTCs SSI BOOT CAMP
17
Douglas/Josephine Counties, Canyonville, Oregon
18
UCANs SSI BOOT CAMP
19
Lets take a break
20
My Message in a Nut Shell

• HUGE missing piece in social services its
  foundational to self sufficiency for a person
  with severe disabilities
• You already navigate so many other complex DHS
  systems WHY NOT LEARN THIS ONE TOO?
• This work should NOT default to attorneys as it
  is not in their financial interest to be
  proactive
• The learning is in the doing!

21
Social Security Disability (SSD) and Supplemental
Security Income (SSI)

• THE BASICS, THE PROCESS

22
What is Social Security Disability?
FICA taxes

• Social Security Trust Fund
• Retirement Benefits
• Survivors Benefits
• Disability insurance (SSD)
• Medical insurance component
• Medicare

23
What is Supplemental Security Income?
Federal General Funds

• Absolute basic needs
• Food
• Shelter (SSI) 674/mth
• Clothing
• Must not have any assets equaling over 2000/mth.
• Exemptions House, Car, Household items
• Medical insurance component
• Medicaid

24
Levels of Administrative Review

• Initial Handout (C)
• Reconsideration
• Hearings
• Appeals
• Federal District Court
• US Ninth Circuit Court of Appeals
• US Supreme Court
• Continuing Disability Review

25
Common Misconceptions

• Decision is all or nothing, not disabled or
  disabled, no partial disability
• My medical records will show I am disabled
• My doctor will make sure I get disability
• Ill need to hire an attorney to get benefits
• It will take years to get my benefits
• I cant be working when I apply
• Lack of support and preparation result in denials

26
What Most People Dont Know

• In order to be eligible for benefits
• One has to be severely disabled with a diagnosis
• The conditions have to prevent work for 12
  consecutive months or are expected to end in
  death
• Your medical records dont even begin to tell
  the whole story of how poorly you function during
  the day, let alone in a work setting
• You have prove that you cannot sustain a job,
  making 1000.00/mo. for any real length of time

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Again, far too few know how to effectively help
the severely disabled through this system

• When thinking about budget shortfalls and new
  revenue streams, dont forget about SSD/SSI,
  Medicare and Medicaid
• 100 of these federal dollars go directly back
  into your community

28
The Community Connection Stakeholders
Disabled citizen becomes a consumer
All SSA/DDS Offices
Families of the disabled
All Medical Providers
Dept. of Corrections Jails
SSI/SSD Benefits Assistance
Child Support
Mental Health Providers
TANF
A D Treatment Centers
State Medicaid Programs
Legal Aids
Housing Programs
29
Benefits Program Development

• Why a Benefits Specialist?
• Critical components for success
• Relationships with Social Security Administration
• General Assistance/Presumptive Medicaid Programs
• Possible funding streams
• Training and program set up costs
• Successful programs

30
Why a Benefits Specialist vs. a Case Manager?

• Two thirds of disability applicants nationawide
  are denied
• 25 of the claims awarded for severe mental
  illness
• This model creates
• Focused program separate from normal case
  management
• Badly needed outreach to rural areas
• Dramatically improves opportunities for
  comprehensive healthcare and housing
• Very concrete and positive ripple effect on the
  local community as a whole

31
Critical Components for Success

• Very organized, proactive benefits specialist
  with good writing skills
• Trained benefits specialist in SSAs disability
  eligibility criteria
• Focused and manageable caseload sizes (15 - 20
  pre-application cases at one time)
• Ample funds for psychological evaluations and
  subcontracted psychologists who can provide
  diagnostic evaluations
• Comprehensive functional documentation and lay
  evidence
• Good relationship with local Social Security
  Administration offices
• Good relationship with local treatment providers
• A partnership with a local FQHC is a very big
  plus!
• Understanding of General Assistance Programs or
  Presumptive Medicaid applications.

32
Benefits Specialist Job DescriptionMuch more
like paralegal work

• Sign on as the official representative
• Investigate all evidence sources
• Collect and review all evidence
• Interview the claimant for their history and
  functional information
• Research SSAs eligibility criteria
• Write a comprehensive narrative report for each
  client
• File the application with SSA and monitor it
  closely
• File all appeals timely
• Track all referral and case progress data

33
Why train benefits specialists?

• This is a whole different niche than case
  management
• Engagement with severely disabled people
  experiencing homelessness, or in psychiatric
  wards, or those who are incarcerated takes longer
• This section of administrative law allows for
  lay representatives, or non-attorney
  representatives
• They know their clients better than other
  one-time service professionals such as attorneys
• Need to have outreach capabilities
• Most don't charge fees for their assistance
• Time spent may be billable as case management

34
What comprehensive training should provide

• Thorough, on-site training
• Office, files and forms set-up
• On-line application training
• Research tools
• Referral and case data tracking system
• Medical records request tracking
• On-going, case specific technical assistance
• Contact list of pertinent local agencies

35
Building rapport with local SSA offices and DDS

• Introduce the program in person
• Ask if the office would be willing to flag
  program cases in their computer
• Ask for a liaison to rapidly process program
  applications to DDS
• Ask DDS if they would be willing to provide a
  homeless liaison as well

36
General Assistance Presumptive Medicaid
Applications

• Some states can grant Medicaid before an SSI
  award
• Complete documentation and forms to the local
  Seniors People with Disabilities offices at the
  time of application
• Time limit for this decision is 90 days
• If Presumptive Medicaid is granted first the
  claimant will have insurance during the SSI
  application (If SSA denies first denial may be
  binding on Presumptive Medicaid
• In Oregon SPD is very responsive to this model.
  They want to help! And our help helps them!

37
Basic Funding for one FTE

• One Benefits Specialist _at_ 30,000 - 36,000/yr
  Paralegal wage range
• Plus administrative and fringe expenses
• One FTE should be able to win 30 to 35 severely
  disabled clients per year once fully trained
• Training expenses (trainers time and per diem)
• A rolling or ongoing case load may climb to 15
  to 20 in active, pre-application development and
  15 to 20 cases waiting for decisions at any given
  time

38
Important additional funds to consider

• Recommend ample funds for psychological
  evaluations should range from 600.00 to 800.00
  each
• Recommend negotiating with local psychologists
  for half of their retail price (above)
• Experience shows 75 of the mentally ill
  applicants will need a current psychological
  evaluation to bolster their chances of an award
  of the benefits

39
Program Funding Ideas

• For mental health clients this type of benefits
  case management is billable to Medicaid
• Grants from local hospital foundations
• Local Housing Authorities
• Veterans assistance programs
• PATH programs
• Cities' or Counties' (investment in 10 year
  homelessness plans)
• Multiple agencies participating/sharing the cost
  of one FTE
• Grants from pharmaceutical companies (creates
  paying customers that no longer need prescription
  assistance programs)
• Medicaid revenue will begin to increase as a
  result of this work for many sites
• Fee generating case work

40
Portland, Ore. program stats from 3/1/08 to
3/31/10

• Approximate preparation time for a complete
  application to be submitted to SSA is 2 months
• 968 referrals reviewed face to face records
  review
• 377 cases enrolled into program in 25 months
• 61 claim applications in development stage
• 248 claims filed on-line with SSA
• 205 claims awarded benefits, 25 were in appeal
• 90 allowance rate
• Average time for decision after submission to SSA
  46, (shortest 1 day)

41
What made the Portland, Ore. project work so well?

• Portland added benefits to their 10 year plan to
  end homelessness
• Seed money from City of Portland Housing Bureau
• Two grants from hospitals
• Congressional communication with SSA
• Cooperation from local SSA field offices and DDS
• Money for psych evaluations
• Manager legally trained in SSI/SSD process
• Many referral sources throughout the city

42
Expected ResultsIn creating a model similar to
Portland's the goals should be

• Cooperative relationships with SSA, DDS and DHS
• 66 or greater success rate at the initials
  levels
• 30 to 35 allowances per year per benefits
  specialist once fully trained

43
Some other successful models

• B.A.R.T., Denver, Colorado
• S.M.A.R.T., Sacramento, California
• Legal Aid Society of Hawaii
• Miami/Monroe, Florida
• Atlanta, Georgia
• Albuquerque, New Mexico
• Boston, Massachusetts
• Philadelphia, Pennsylvania
• Nashville, Tennessee

44
The Klamath Falls, Oregon Project
45
Our Service Area

• Klamath County, OR
• Area of 6,136 sq mi 600 sq miles larger than
  Connecticut
• County population 63,775 fewer than Kennewick,
  WA
• 15 unemployment rate
• 20 poverty rate

• Lake County, OR
• Area of 8,358 sq mi the size of Connecticut
  AND Delaware
• County population 7,442 about the same
  population as Chehalis, WA
• 14 unemployment rate
• 18 poverty rate

46
Starting The Program

• June 2010 KLCAS picked for Benefits Specialist
  Pilot
• August 2010 - hired as Benefits Specialist
• SSI Boot Camp included me, a new Program
  Manager, and one other back up person
• Intensive immersion into SSD/SSI rules,
  procedures, jargon and methodology
• Significant portion of SSI Boot Camp spent
  introducing program to community through outreach
• Introduced ourselves to local SSA employee
• Introductory luncheon held for potential referral
  sources. Over 30 community partners, including
  local hospital social workers

47
Outreach to the Community

• Our message to the community is this
• There is Federal money (SSI/SSDI) available to
  take care of severely disabled homeless and low
  income individuals. That is where the burden for
  their care should fall, not on limited local
  resources. By simply taking the time to help
  them obtain what they are entitled to, they can
  become contributing members of their community!
  Helping us help them is an investment in the
  community!
• Every person awarded SSI/SSDI qualifies for
  Medicaid/Medicare, easing the burden on local
  providers
• Disabled homeless qualify for HUD have money to
  pay rent
• Back awards and monthly awards are spent in the
  community
• Benefits Specialist Programs help
  stabilize/reduce homelessness
• Individuals now have means to treat drug/alcohol
  addictions

48
Our community really Got It

• Medical community very receptive with prompt,
  free medical records
• DHSs Seniors and People with Disabilities is a
  huge resource
• Numerous referral sources
• Homeless mission is our biggest referrer
• Mental Health has come to see us as a resource
  they can use to reduce their work load
• Developmental Disability Services
• Local doctors starting to refer clients who they
  have diagnosed with disabling diseases
• Our programs at KLCAS (energy assistance and
  homeless prevention) screen clients for the
  program
• Vocational Rehab, our local VA, City Council
  persons, DHS, and others have all contributed

49
Social Security Medford District OfficeThey have
become our biggest fan!

• The Medford district office handles the largest
  territory in Oregon, covering four very large
  counties
• Small Klamath Falls field office only takes
  incoming forms and makes appointments for the
  Medford office
• After several requests obtained a face-to-face
  meeting with Medford district office
• Very rapidly embraced our program and appointed a
  point person for us
• Point person was the on-line application
  specialist
• Agreed to file all applications and appeals
  on-line

50
KLCASs Commitment The Difference Between
Failure and Success

• Our Director, Donna Bowman, and Program Manager,
  Rob Petchell are proactive and community oriented
  and look for underserved niches in social
  services
• The KLCAS vision is to offer a wide variety of
  programs to the homeless and lower income in a
  service center type environment
• The Benefits Specialist program was sought
  because it complimented existing programs and
  because there is a high need not because it was
  an easy revenue stream to obtain

51
KLCASs Commitment The Difference Between
Failure and Success

• Funding is currently an ongoing problem but KLCAS
  is committed to the program and has sought
  innovative ways to ensure the program continues
• Organizational Representative Payee Program
  Social Security allows Rep Payees to collect a
  nominal fee for money management services. In
  Klamath Falls there was no Organizational Payee
  service able to fill another need while
  supplementing funding for the Benefits Specialist
  Program.
• Supportive Services for Veteran Families All of
  the services we offer at KLCAS, including the
  Benefits Specialist Program, are sought after by
  the VA for their Veteran Families. We are
  currently seeking a 600,000 grant from the VA
  that will allow part of the Benefits Specialists
  time to be charged to that grant.
• We hope to establish a success rate that will
  convince our community partners to invest real
  dollars in our program.

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Presenters Contact Information

• Lynn Adams, CSBG Program Analyst
• State of Oregon, Housing Community Services
• 725 Summer St. NE Suite B, Salem OR 97301-1266
• [phone]
• lynn.d.adams_at_hcs.state.or.us
• Mellani Calvin, Program Director
• Disability Benefits Training Consulting, LLC
• 1336 E. Burnside St., Ste. 130
• Portland OR 97214
• Phn 503-888-2690, Fax [phone]
• disabilitybenefitstraining_at_hevanet.com
• www.DisabilityBenefitsTraining.com
• Walter Davis, Homeless Benefits Specialist
• Klamath-Lake Community Action Services
• 1803 Main St. Klamath Falls, OR 97601
• [phone]
• wdavis_at_klcas.org