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8/14/2019 Social Security: Starting%20a%20SOAR%20Project%204 18 07
http://slidepdf.com/reader/full/social-security-starting20a20soar20project204-18-07 1/22
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
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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.
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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%
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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
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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.
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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.
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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
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F M I f tiF M I f ti
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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