Bring Badly Needed Federal Dollars Into Rural Communities

1. Creating a Rural Federal Disability Benefits Specialist Program SSD/SSI advocacy: A very big missing piece in social service work Bring Badly Needed Federal Dollars Into Rural Communities

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 CAA’s 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 CAA’s 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 CAA’s 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 DBTC’s 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 rep’g 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. DBTC’s “SSI BOOT CAMP”

17. Douglas/Josephine Counties, Canyonville, Oregon

18. UCAN’s “SSI BOOT CAMP”

19. Let’s take a break

20. My Message in a Nut Shell • HUGE missing piece in social services; it’s 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” • “I’ll need to hire an attorney to get benefits” • “It will take years to get my benefits” • “I can’t be working when I apply” • Lack of support and preparation result in denials

26. What Most People Don’t 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 don’t 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

27. Again, far too few know how to effectively help the severely disabled through this system When thinking about budget shortfalls and new revenue streams, don’t forget about SSD/SSI, Medicare and Medicaid 100% of these federal dollars go directly back into your community

28. The Community Connection & Stakeholders Disabledcitizen becomes a consumer All SSA/DDS Offices Families of the disabled Dept. of Corrections & Jails All Medical Providers Child Support SSI/SSD Benefits Assistance Mental Health Providers TANF A & D Treatment Centers Legal Aids State Medicaid Programs 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 SSA’s 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 SSA’s 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 @ $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 (trainer’s 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 Results:In 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 • DHS’s 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. KLCAS’s 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 niche’s 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