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Access to Benefits as a Key Component to Discharge Planning for Offenders with Disabilities. July 23, 2012. Presenters. Policy Research Associates Delmar, NY Dazara Ware, Senior Project Associate 11 th Judicial District Criminal Mental Health Project Miami, FL - PowerPoint PPT Presentation
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Access to Benefits as a Key Component to Discharge
Planning for Offenders with DisabilitiesJuly 23, 2012
Presenters Policy Research Associates Delmar, NY
Dazara Ware, Senior Project Associate
11th Judicial District Criminal Mental Health ProjectMiami, FL Cindy Schwartz, Project Director
Faculty Disclosure
Presenters do not have any relevant financial relationships with any commercial interests
Educational Objectives1. Participants will have a basic understanding of
SOAR and how implementation can increase access to SSI & SSDI for those who are eligible
2. Participants will learn how SOAR has been successfully used in criminal justice settings
3. Participants will be able to assess the benefits and challenges of SOAR implementation in jails and prisons
SOAR Technical Assistance Initiative
SOAR -- SSI/SSDI Outreach, Access & Recovery Sponsored by the Substance Abuse and Mental
Health Services Administration (SAMHSA) in collaboration with the Social Security Administration
No direct funding provided to States or localities 50 States now participate; SOAR TA Center helps
States and communities increase access to SSI/SSDI through: Collaboration and strategic planning Training Technical assistance
Why is Access to SSI and SSDI So Important for Re-entry?
For people who are disabled, these benefits provide access to: Income Housing Health insurance and treatment
SSA’s Two Disability Programs
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
SSA’s Criteria for Disability
1. Must have a medically determinable physical or mental impairment that either meets or is equivalent to the listing of impairments that DDS considers
2. Duration of the impairment must have lasted or be expected to last 12 months or more or result in death
3. Person must show significant functional problems caused by the medical impairment
The Problem Only about 31 percent of all applicants
are typically approved on application People coming out of prison or jail are
approved at a much lower rate Appeals take years and many potentially
eligible people give up and do not appeal
Outcomes from SOAR States
As of June 2011, 10,493 individuals -- 71 percent of those assisted in 44 states -- were approved for benefits in 101 days on average
In 2011 alone, SSI/SSDI brought at least $85 million into the state and local economies of these states
For every person approved for SSI, an average of $10,700 in uncompensated care became reimbursable by Medicaid
How Is This Model Different?
Staff actively assist applicants Step-by-step explanation of SSI
application and disability determination process
Focuses on the initial application – “Get it right the first time!”
Avoids appeals whenever possible Focuses on documenting the disability
If Incarcerated…SSI… Is suspended when a person is in a jail/prison for
a full calendar month After 12 months, SSI benefits are terminated;
must re-apply upon releaseSSDI… Continues while in jail/prison until convicted of a
felony; after conviction benefits are suspended during incarceration
Upon release – no need to reapply; just ask SSA to reinstate
Legal proof of release is required to reinstate benefits
Interested staff file app
SSA receives app.
DDS receives app
SSA –incomplete app
SOAR Training pays off
JIP scheduled to SSA Office
CM provides add. Info
DDS can not locate CIP denies case
CIP moves correspondence lost start over.
ICM
assignedReleasebeforedecision
CM changed
Short staff – can’t transport
Med RecordLost
DDS approval
ODD approval
JIPhospitalized
J IPWorkingw/o notice to SSA
SOAR
PRA/CSG Jail Prevalence Study
Sites: 5 jails (2 – MD; 3 – NY) Time: 2002 and 2006 Serious Mental Illness:
Prevalence: Last month Prevalence Rates: Men – 14.5%
Women – 31%
SchizophreniaSchizo Affective DisorderSchizophreniform
DepressionBipolar DisorderBrief Psychosis/Delusional/Psychosis NOS
Four Functional Areas Considered
Activities of daily living Social functioning Maintaining concentration, persistence
and pace in the completion of tasks Repeated episodes of decompensation
Three or more attempts to work in last year resulting in symptom increase and inability to maintain employment
Overlooked Diagnostic Indicators Trauma Pulling Punches 0-1:40 Stigma Transitions 6 Lack of community mental health
treatment history Culture of incarceration
Transitions 2:25-5:10 Substance abuse as primary diagnosis
Applying Prior to Releasefrom Jail or Prison
Individuals can apply for SSI benefits within 30 days of their release.
Institutional pre-release agreements with SSA, may allow applications to be submitted up to 120 days prior to release
Agreements usually made between jail/SSA or DOC/SSA for all prisons
Payment starts after release
SOAR Collaborations in Correctional Settings
In 2011, collaborations with corrections were reported by 24 states; collaborations included:
Jail in-reach and collaboration with parole and probation to coordinate services
Jail diversion programs Pre-Release planning from state prison Training in state departments of
corrections
1825 Sing Sing – “Up the River”19
Successful Models: Collaborations with
Corrections NY’s Sing Sing Prison:
Applications done prior to release by a community services agency
Same staff who does applications follow folks in community and access housing for them
89% of 100 pre-release SSI applications approved in 59 days on average
73% of approved received within one month of release; 31% approved prior to release
In Oklahoma DOC, 90% approval on pre-release apps
Michigan DOC SOAR Program 2011: 72 SSI applications filed; 60% approved in 105 days
on average Impact on recidivism: 2% of people approved for SSI
were readmitted to DOC compared to 17% of those denied benefits
Challenge #1: 39% of SSI applications were submitted AFTER release from MDOC; important to submit applications 90-120 days BEFORE release (as early as SSA will allow)
Challenge #2: 76% of SSA decisions were received an average of 119 days AFTER release – four months without income, health insurance, and probably without permanent housing is a recipe for disaster…
Using SOAR for Jail PopulationsMiami – Dade
In Miami-Dade County SOAR is part of The Criminal Mental Health Project- Jail Diversion Programs for mentally ill offenders
Impacts: Reduction of jail overcrowding Access to housing with treatment & wrap
around services Recidivism reduced from 70% to 22% for
misdemeanor and to 5% for felony defendants Created specialized unit to expedite access
to benefits
Outcomes (August 2011- present)
Total number of individuals screened152
Ineligible 48 SSA applications filed
65 SSA approvals 43 Reinstatements
9 Number of reconsiderations
3 Number of denials 2 Average time from application to approval
28 days
Challenges and BenefitsCross-system collaboration
Participants become “more attractive paying customers” to community providers
Obtaining medical records
Retroactive Medicaid reimbursement for treatment and services
Immigration status Improved relationships with community stakeholders
Domains to Predict Success in Jail or Prison Projects
LeadershipCollaborationCompeting Initiatives/Projects
Resources
Lesson Learned: Community Collaboration Needed
Community Provider to work with in either setting is essential
Role of Community Provider is different when working with jails or prisons
Greater focus on reentry in prisons may mean larger role for prison staff to assist with SSI
Prisons sentences are usually longer – greater chance of decision upon release than in jails
Jail “in-reach” by community provider ensures continuity and responsibility for treatment and other needs once released
Prisons benefit from collaboration with community providers to complete the process started in the prison (e.g., getting the person to SSA to get their check started or helping with a SOAR-assisted reconsideration or appeal
Conclusion
Focusing on expediting benefits as a tool for reentry works!
Its a win-win for the individual, for states and localities, and for community programs
A major tool in recovery for persons with serious mental illnesses and other disabilities
Contact Information SOAR Technical Assistance Center
Email: [email protected]
SOAR Website www.prainc.com/SOAR