social security: starting%20a%20soar%20project%204 18 07

8/14/2019 Social Security: Starting%20a%20SOAR%20Project%204 18 07

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Starting A SOARStarting A SOAR

Project – A Tool ToProject – A Tool To

ReduceReduce

HomelessnessHomelessness

…For…For State or Local AgencyState or Local AgencyAdministratorsAdministrators

Revised 4/18/07Revised 4/18/07



SSI and SSDISSI and SSDI

SSI: Supplemental Security Income;SSI: Supplemental Security Income;federal benefit rate is $623 per month infederal benefit rate is $623 per month in2007; provides Medicaid in most states2007; provides Medicaid in most states

SSDI: Social Security Disability Insurance;SSDI: Social Security Disability Insurance;amount of benefit dependent on earningsamount of benefit dependent on earningsput into SSA system; Medicare providedput into SSA system; Medicare providedafter two years of eligibility in mostafter two years of eligibility in most

instancesinstances The disability determination process for The disability determination process for

both programs is the same; when oneboth programs is the same; when oneapplies for SSI, they are usually review byapplies for SSI, they are usually review by

SSA for their eligibility for SSDI as well.SSA for their eligibility for SSDI as well.



Why is Access to SSI andWhy is Access to SSI and

SSDI Important for HomelessSSDI Important for Homeless

Recipients?Recipients?

SSA disability benefits can provideSSA disability benefits can provide

access to:access to:HousingHousing

IncomeIncomeHealth insuranceHealth insurance



SSDISSDI

Important for State andImportant for State and

Localities?Localities? Homeless people are frequent users of Homeless people are frequent users of

expensive uncompensated health care.expensive uncompensated health care.

Providers can recoup the cost of Providers can recoup the cost of uncompensated health expenses fromuncompensated health expenses from

Medicaid for up to 3 months prior toMedicaid for up to 3 months prior to

date of SSI application.date of SSI application. States that fund health care for lowStates that fund health care for low

income and/or disabled persons canincome and/or disabled persons can

save state dollars once Medicaid issave state dollars once Medicaid is



SSDISSDI

Important for State andImportant for State and

Localities?Localities? States and localities can recoup fromStates and localities can recoup from

SSA the cost of public generalSSA the cost of public general

assistance provided to homelessassistance provided to homelessapplicants during the SSI/SSDIapplicants during the SSI/SSDI

determination period.determination period.

SSI, SSDI and Medicaid bring federalSSI, SSDI and Medicaid bring federal

dollars into states, localities anddollars into states, localities and

community programs.community programs.



The ProblemThe Problem

The SSI application process is The SSI application process is

difficult for people who aredifficult for people who are

homeless, many of whom havehomeless, many of whom have

mental illnesses and co-occurringmental illnesses and co-occurring

substance use disorderssubstance use disorders

Only about 10-15 percent of thoseOnly about 10-15 percent of thosewho apply are typically approved onwho apply are typically approved on

initial applicationinitial application

Appeals take years and manyAppeals take years and many



Why Is Access To SSI SoWhy Is Access To SSI So

Difficult?Difficult? People who are homeless need assistancePeople who are homeless need assistanceto apply for SSIto apply for SSI

They need adequate assessment and They need adequate assessment and

documentation of how their disablingdocumentation of how their disablingconditions limit their ability to workconditions limit their ability to work

Providers who assist SSI applicants needProviders who assist SSI applicants needstaff who understand the disabilitystaff who understand the disability

determination process and who have timedetermination process and who have timeto assist in all aspects of developing theto assist in all aspects of developing theapplicationapplication

Relationships with SSA, the state DisabilityRelationships with SSA, the state Disability

Determination Service (DDS), communityDetermination Service (DDS), communitymedical providers and others are essentialmedical providers and others are essential



What We Know IsWhat We Know Is

Possible…Possible…

Approval rates of 65-95%Approval rates of 65-95%on initial applicationon initial application

for homeless applicantsfor homeless applicants



SOAR Technical AssistanceSOAR Technical Assistance

InitiativeInitiative SOAR stands for “SSI/SSDI Outreach,SOAR stands for “SSI/SSDI Outreach,

Access and Recovery”Access and Recovery”

Strategy to help States andStrategy to help States andcommunities increase access to SSIcommunities increase access to SSI

and SSDI for people who areand SSDI for people who are

homeless through training, technicalhomeless through training, technicalassistance and strategic planningassistance and strategic planning

Includes use of SAMHSA’sIncludes use of SAMHSA’s SteppingStepping

Stones to Recovery Stones to Recovery trainingtraining



SOAR StatesSOAR States ArizonaArizona ColoradoColorado ConnecticutConnecticut District of ColumbiaDistrict of Columbia

FloridaFlorida GeorgiaGeorgia HawaiiHawaii IndianaIndiana

KentuckyKentucky Los Angeles County*Los Angeles County* MarylandMaryland MassachusettsMassachusetts MichiganMichigan

MinnesotaMinnesota MontanaMontana NevadaNevada New JerseyNew Jersey

North CarolinaNorth Carolina OhioOhio OklahomaOklahoma OregonOregon

PennsylvaniaPennsylvania Tennessee Tennessee UtahUtah VirginiaVirginia WashingtonWashington

St i St tt t t



Stepping Stones totepp ng tones toRecovery Recovery TrainingTraining

CurriculumCurriculum Based on success of University of MarylandBased on success of University of Maryland

Medical System Baltimore SSI OutreachMedical System Baltimore SSI Outreach

ProjectProject Over a 10 year period, achieved successOver a 10 year period, achieved success

rate on application of 96% for those projectrate on application of 96% for those project

staff believed to be eligiblestaff believed to be eligible Comprehensive approach to individual’sComprehensive approach to individual’s

needs with income as the “hook”needs with income as the “hook”

Engagement, relationship, assessment areEngagement, relationship, assessment are



How Is This ModelHow Is This Model

Different?Different? Case managers actively assistCase managers actively assist

applicantsapplicants

Step-by-step explanation of SSIStep-by-step explanation of SSIapplication and disabilityapplication and disabilitydetermination processdetermination process

Focuses on the initial application –Focuses on the initial application –

“Get it right the first time!”“Get it right the first time!” Avoids appeals whenever possibleAvoids appeals whenever possible Focuses on documenting theFocuses on documenting the

disabilitydisability



What Does It Take?What Does It Take? Ensure adequate staffingEnsure adequate staffing Use the SOAR Critical ComponentsUse the SOAR Critical Components ((

www.prainc.com/SOAR/about/CriticalComponentsChawww.prainc.com/SOAR/about/CriticalComponentsCha))

Focus on the initial applicationFocus on the initial application Become an applicant’s representative (SSA FormBecome an applicant’s representative (SSA Form1696)1696)

Work closely with community medical providersWork closely with community medical providers Reach out to hospital and clinic medical recordsReach out to hospital and clinic medical records

departmentsdepartments Reduce the need for consultative examsReduce the need for consultative exams Develop medical summary reports signed by aDevelop medical summary reports signed by a

physician or psychologistphysician or psychologist

Provide training and quality controlProvide training and quality control

Collaborate with SSA and DDSCollaborate with SSA and DDS

http://www.prainc.com/SOAR/about/CriticalComponentsChart.pdf





How Do You Make ThisHow Do You Make This

Happen?Happen? Reallocate existing resources. Try it on aReallocate existing resources. Try it on a

small scale.small scale.

Serving people who have an income and healthServing people who have an income and health

insurance makes it easier and quicker to accessinsurance makes it easier and quicker to accesshousing, treatment, and other supportivehousing, treatment, and other supportive

services.services.

Being able to get people on SSI and/or SSDIBeing able to get people on SSI and/or SSDI

and Medicaid in 90 days or less frees upand Medicaid in 90 days or less frees upresources to assist other individuals.resources to assist other individuals.

Time spent up front on assessment and Time spent up front on assessment and

benefits acquisition can be an effective way tobenefits acquisition can be an effective way to

engage people who are homeless for longengage people who are homeless for long



How Do You Make ThisHow Do You Make This

Happen?Happen?1.1. Look for partners that stand toLook for partners that stand to

benefit from increased access to SSI,benefit from increased access to SSI,

SSDI and Medicaid:SSDI and Medicaid: Mental health centers and primary careMental health centers and primary care

clinicsclinics

Hospitals – public or privateHospitals – public or private Jails or prisons that are focused on Jails or prisons that are focused on

reentryreentry

State or County general assistanceState or County general assistance

programsprograms



SSI Outreach Can Make ASSI Outreach Can Make A

Big Difference…Big Difference…

In Denver, without a comparable SOAR model…In Denver, without a comparable SOAR model…

Only 10% of homeless applicants wereOnly 10% of homeless applicants wereapproved for SSI/SSDI on initial applicationapproved for SSI/SSDI on initial application

With a designated DDS staff person focusedWith a designated DDS staff person focused

on applications from homeless adults, thison applications from homeless adults, thisrose to 20%rose to 20%

With a community provider assistingWith a community provider assisting

applicants, the rate rose to 75%applicants, the rate rose to 75%



Initial SOAR ImpactsInitial SOAR Impacts

24 States are implementing local SSI24 States are implementing local SSIoutreach initiatives with State-leveloutreach initiatives with State-levelsupport for training and trackingsupport for training and trackingoutcomesoutcomes

92 new trainers certified to conduct92 new trainers certified to conductStepping Stones to RecoveryStepping Stones to Recovery

trainingstrainings

129 trainings in 79 cities in first year129 trainings in 79 cities in first year

More than 4,000 direct service staff More than 4,000 direct service staff trained



Preliminary SOARPreliminary SOAR

OutcomesOutcomes

In Nashville, 97% of their first 33 applications wereIn Nashville, 97% of their first 33 applications wereapproved in an average of 59 daysapproved in an average of 59 days

At NY’s Sing Sing prison, 46 of the 52 (88%) pre-At NY’s Sing Sing prison, 46 of the 52 (88%) pre-

release SSI applications were approved in 93 daysrelease SSI applications were approved in 93 dayson averageon average

Across 11 states, 506 SSI applications – 62 percentAcross 11 states, 506 SSI applications – 62 percentof those assisted – were approved in an average of of those assisted – were approved in an average of 96 days or less.96 days or less.

On average, the people receiving these benefits hadOn average, the people receiving these benefits hadbeen homeless 33 months.been homeless 33 months.

Approval rates are highest in places where moreApproval rates are highest in places where more

SOAR critical components are in place.SOAR critical components are in place.



SSI Improves Access toSSI Improves Access to

HousingHousing

In Covington, KY, 71% of homelessIn Covington, KY, 71% of homeless

persons approved for SSI werepersons approved for SSI werehoused in 7 days or less.housed in 7 days or less.

In Columbus, GA, 100% of successfulIn Columbus, GA, 100% of successfulSSI applicants were housedSSI applicants were housed

In Nashville, TN, 56% of SSIIn Nashville, TN, 56% of SSIrecipients were housed within 30recipients were housed within 30days after being homeless andays after being homeless an

average of 77 months.average of 77 months.



Cost SavingsCost Savings

Utah recovered $170,000 in general assistanceUtah recovered $170,000 in general assistancefrom SSA during the first four months of SOAR infrom SSA during the first four months of SOAR inone area of the stateone area of the state

In Covington, KY, a local hospital partially fundedIn Covington, KY, a local hospital partially fundedthe local SSI outreach project recouping its initialthe local SSI outreach project recouping its initialinvestment in less than a year by recoveringinvestment in less than a year by recoveringuncompensated care from Medicaiduncompensated care from Medicaid

San Francisco Dept. of Public Health estimatesSan Francisco Dept. of Public Health estimatesthat for every $1 invested in SSI outreach, theythat for every $1 invested in SSI outreach, theyrecoup $5 in Medicaid reimbursement forrecoup $5 in Medicaid reimbursement foruncompensated careuncompensated care

InIn one year one year in Baltimore, 20 newly approved SSIin Baltimore, 20 newly approved SSIreci ients received $300,000 in Medicaidrecipients received $300,000 in Medicaid



F M I f tiF M I f ti



For More Information onFor More Information on

SOAR andSOAR and Stepping StonesStepping Stones

to Recovery to Recovery Visit the SOAR website atVisit the SOAR website at

www.prainc.comwww.prainc.com/soar/soar

Or contact:Or contact:Deborah Dennis,

Vice President/SOAR Project

DirectorPolicy Research Associates, Inc.Delmar, NY

518-439-7415, ext. 238

ddennis@prainc com

http://www.prainc.com/soar




mailto:[email protected]

mailto:[email protected]



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