Accessing Public Benefits: SSI and SSDI

Yvonne M. Perret, MA, MSW, LCSW-CAdvocacy and Training Center

National Alliance to End Homelessness Conference

July 19, 2006

Mental Illness and Co-Occurring Disorders in Homeless Population

In 2000, the Urban Institute estimated that 1% of the population are likely to experience homelessness at least 1/year

Estimates of adults with mental illness in the homeless population vary from 25%-60% (National Health Care for the Homeless Council, Community Action Network)

Approximately half of those with mental illness also have a substance use disorder

Ongoing physical health problems, including infectious diseases, are common and debilitating

What are SSI/SSDI?

Supplemental Security Income (SSI): Income benefit, with set Federal Benefit Rate, available to low-income individuals who are blind, or who have a disability or who are 65 or older. Maximum benefit: 2006-$603

Social Security Disability Insurance (SSDI): Disability benefit whose amount is based on earnings put into the Social Security System. Has a family benefit as well.

Current Reality…

Only 11% of homeless population currently receiving SSI/SSDI

Many more are estimated to be eligible

Getting this Benefit is Difficult in the Best of Circumstances…

Nationally, 37% of SSA disability applications are approved upon initial submission

This is an aggregate numberNot broken down by housing status Increases to 52% after appeals

What We Know is Possible…

Approval rates on initial application

of 60-95% can be achieved

for people who are homeless

Components of Successful Work

Focus on recoverySuccessful engagement and relationship

buildingAttention to all needs of individual Skilled development and understanding

of SSI/SSDI applications/medical evidence

Addressing co-occurring disorders

Benefits and Recovery

What does recovery from homelessness involve? A holistic approach to work with homeless individuals and encompasses:Life stability: Housing, treatment and

supportive servicesEmploymentOngoing human relationshipsSuccessful community livingHope for reaching life goals

Without income, recovery is extraordinarily difficult.

Successful Engagement

Characteristics:RespectSafe environmentPromises kept Listening, clarifying, and believingAddressing of basic needsAssurance of future contact

Obstacles to Engagement

Obstacles/problems to address:Trauma of homeless experiencePast experience of disrespectHistory of receiving poor servicesSymptoms of mental illnessMistrust and disconnectionPractical issues (e.g., transportation)

Making Characteristics Come to Life

Respect: Ask how individual prefers to be addressedAddress basic needs; bring, when possible,

food drink, clothingProvide choice and be clear what can do

Safe environment:Meet where individual choices; outreach Inquire about comfort; explain purposeProvide personal space

Making Characteristics Come to Life

Promises Kept Rule of practice: Under-promise and over-deliver—

offer only what you can provide If you don’t know an answer, say so and offer to

find out. Don’t fake it!

Listening, Clarifying, and Believing Homeless people often don’t feel heard Clarify any questions using clear language Don’t refute someone’s perception of experience

Making Characteristics Come to Life

Addressing of basic needsEnsure the person is warm/cool enough,

can get food, clothing, etc.Ask for housing wishes and work on

referralsAssurance of future contact

At first meeting, find out how to contactBe clear about next steps and follow themKeep appointments

SSI/SSDI Eligibility Criteria

Non-medical: Different for SSI and SSDIMore detailed for SSI as is needs-basedCleared by SSAMust be cleared for application to proceed

Medical: Exactly the same for bothDisability Determination Services (DDS):

State agencyMakes disability determination for SSA

Medical Criteria for Eligibility for SSI/SSDI

(1) Individual must have medically determinable physical or mental impairment;

(2) Impairment must result in death or have lasted or be expected to last 12 months or more

(3) Impairment must cause functional limitations that keep the individual from working Substantial Gainful Activity (SGA) (2006: defined as $860/mo. gross earnings)

Functional Areas

Activities of Daily Living: Washing, dressing, bathing, using transportation, budgeting, housekeeping, using a phone, etc.

Social Functioning: Ability to communicate clearly with others; also ability to tolerate being around and interacting with other people on a consistent basis

Functional Areas (continued)

Ability to maintain pace and persistence in the completion of tasks: Cognitive functions such as concentration, memory, following directions, focus, repeated ability to do

Periods of decompensation of extended duration: Must have lasted at least 2 weeks or more 3 or more times in the last year

Eligibility for SSI/SSDI

After meeting non-medical criteria, individual must:Meet diagnostic and durational criteriaShow “marked” functional impairment in at

least two of the four functional areas “Marked” defined as more than “moderate”

To determine eligibility, DDS follows a sequential evaluation

Importance of Sequential Evaluation

Includes 5 stepsEligibility possible at 3rd and 5th stepsNeed to understand “medical listings”At 4th and 5th step, prior work and

residual functional capacity (RFC) considered

Person can be denied if can do work that “exists in national or regional economy”

Current Consideration of Substance Use

1996: Legal change; prior to this, if material, ok

If substance use deemed “material,” can be denied

Determining material: If a person were to be clean and sober,

would he or she still be disabled by another illness or impairment?

If the answer is yes, the person more likely would be approved

If no, the person would be denied.

Deciding “Material” Requires Comprehensive Evaluations

Evaluations Must be longitudinal Must be comprehensive and address

all relevant information Should be done with use of open

ended questions whenever possible Must understand early and ongoing context

of substance use

Comprehensive Evaluations

Must consider:Trauma history: Discipline, “brain hurt”Educational and other learning difficultiesContext of substance use—its purpose for

individualEmployment: Duration, relationships, tasks,

why left

For more information…

CONTACT:

Yvonne M. PerretExecutive Director

Advocacy and Training Center1116 Bedford St.

Cumberland, MD 21502Yvonne.perret@gmail.com