Advocacy for SOAR Initiatives & ACA Implications: A Comprehensive Guide

1. SOAR Initiatives and the ACA Why our advocacy is still important

2. Introductions • Christina Clayton – DESC • Rhonda Hauff – Yakima Neighborhood Health Services • Kate Budd – Clark County DCS • Sue Chance -- DSHS

3. Agenda • The Essential SOAR Process • ACA & Implications • SOAR Initiatives & Action Planning • Community Efforts • Practical Tips • Q & A

5. SSI/SSDI Outreach, Access and Recovery • National program focused on expediting access to SSI/SSDI for: • Adults with • Serious mental illness and/or co-occurring disorders • Homeless or at risk of homelessness • In WA, also includes focus on veterans and tribes • Recovery from homelessness and mental and physical health problems is goal • Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with SSA since 2005 • All 50 states currently participate; no direct funding provided to states

6. SSI/SSDI Outreach, Access and Recovery: • Includes training of staff focusing on: • Eligibility criteria for SSI/SSDI • Development of claims • Collection and development of relevant clinical information • Sharing (with appropriate releases) of individual information to facilitate service delivery and planning • SOAR trained staff typically are experts in mental health/mental illness and/or homelessness

7. SSI / SSDI • SSI and SSDI: Social Security Administration disability benefits • Often only income source for people with disabilities • SSI: Supplemental Security Income • Provides Medicaid in WA once eligible • Low-income individuals who have a disability, are blind, or who are age 65 or over • Maximum Federal benefit changes each year • SSDI: Social Security Disability Insurance • Income based on earnings • Medicare after two years of receipt of payments for most individuals

8. SOAR • 3-part initiative: • Systems change planning through local and state planning groups • Collaboration • Process changes • Training: Stepping to Stones to Recovery: 2-day and/or online • Technical assistance

9. Why is SSI/SSDI Important for Individuals? • SSA disability benefits can provide access to: • Income • Housing • Health Insurance • Treatment • Other supportive services • For people with disabilities, SSI/SSDI can be a critical step towards ending homelessness and promoting recovery

10. Why is Access to SSI/SSDI Important for States & Localities? • People experiencing homelessness are frequent users of expensive uncompensated health care • Can recoup cost of this care from Medicaid for up to 90 days retroactive to date of SSI eligibility • States and localities can recoup from SSA the cost of public assistance provided during the application process • SSI, SSDI and Medicaid bring federal dollars into states, localities and community programs

11. WHY SOAR?: THE PROBLEM • Initial application approval rates for people who are homeless: 10-15% • General initial application approval rates: 37% • Complicated application process • Extensive need for documentation • Lack of understanding of criteria and their documentation requirements • Takes several months • SOAR: Addresses all these

12. Changing Lives Since 2005 • 19,008 persons experiencing or at risk for homelessness have been approved on initial application • 65 percent approval rate overall • Compares to 10-15 percent for unassisted applications from people who are homeless and 29 percent for all applicants • Approvals were received in an average of 100 days in 2013 • Appeals can take a year or more; many people give up and do not appeal

13. SOAR IN WASHINGTON • Expedited process approved by SSA Regional Office • Close collaboration to serve veterans through SOAR • Only state to establish such extensive collaboration for veterans who are homeless or at risk of homelessness • Extensive collaboration with PATH/use of PATH staff to do applications • Planning groups begun through several areas in state • State planning group active since 2010

14. Affordable Care Act (ACA) Signed into law in March 2010 • Health Insurance Marketplace • Qualified Health Plans • Medicaid • Medicare benefits • Preventative care coverage at no-cost • Addresses the prescription drug “donut-hole”

15. Timeline for enrolling newly eligible Exchange open enrollment Exchange open enrollment Medicaid enrollment  Oct 15, 2014  March 31 2014  Oct 1 2013 Jan 1 2014  Dec 7 2014

16. New Adult Group

17. Don’t Forget - Medicaid Plan Choice

18. Since October – New to Apple Health 341,714 adults

19. Why Enroll Consumers ?54% of our Homeless in 2013are Uninsured

20. Engagement Challenges & StrategiesKnow Who They Know / Where They Go • Begin with trusted sources • Case workers, community providers • Peers are crucial • Deliver positive messages • Can stay independent and in control • Be more financially secure • Improve and maintain health and well-being • Emphasize availability, ease of enrollment, affordability • Consolidated Homeless Grants (CHG) • State support to Counties / CACs • Emergency Solutions Grants (ESG) • State support to Counties / CACs • Housing & Essential Needs (HEN) • Dept of Commerce to Counties • Clients already on Medicaid- but often attached to uninsured • Low Income Energy Assistance Program (LIHEAP)

21. SOAR and ACA • ACA brings expanded access to Medicaid for States participating • SSI/SSDI remain crucial income supports • SOAR providers can continue their work and help with outreach for the Medicaid Expansion population • Medicaid enrollment workers can also help screen and refer people to SOAR providers and/or additional resources if seem eligible for SSI/SSDI

22. Expanded Access to Medicaid • Enrollment is not automatic. Individuals still need to apply for Medicaid, and assistance for this is variable. • Individuals who experience homelessness with serious mental health issues and/or co-occurring substance use unlikely to access ACA without significant outreach • SOAR workers will be especially poised to help those who are still experiencing homelessness, to connect to insurance as well as essential services and health care • Look at ways current systems can be modified to address Medicaid expansion efforts • ACA & Medicaid provides eligibility for health coverage, not actual health care access per se • Income supports like SSI & SSDI are critical for safe and stable housing, which in turn lead to better health outcome and recovery

23. Medicaid and SSI • Access to SSI/SSDI income support remains essential • Housing • Living expenses • Consumer should enroll in health coverage as soon as possible • Once approved for SSI they can change their Medicaid coverage based on their SSI eligibility • Indicate they are disabled on original application

24. Get Involved with the ACA • SOAR Case Managers can improve client health outcomes and be a part of Health Homes • CMHCs can and should be key players in community SOAR efforts and ACA implementation • Talk to State legislators and Medicaid agency staff about how SOAR can be a partner in health care reform efforts • The National SAMHSA SOAR TA Center is prepared to help address the expanding need

25. Practical Tips: Implementation • Establish local planning groups • Determine staffing model: • Training of staff in multiple agencies • Team of staff in one agency serves community • Pooling of funds from multiple agencies to create team that develops expertise • Inform atypical partners of benefits to community: Chambers of Commerce, large corporations, police, judges, local governments • Use data to illustrate funds brought in and spent in communities

26. Practical Tips: Action Planning • Completing Applications • Collaborations (SSA, DDS, Medical providers, other) • Training, Tracking Outcomes and Sustainability • Local Leadership Team

27. Practical Tips: Best Practices • Establish leads • Identify existing resources • Introduce SOAR • Collaborate • Train & support staff who do applications • Quality review • Track & report outcomes • Fund & Sustain

28. Local Community SOAR Initiatives • DESC & partners in Seattle-King County SOAR Steering Committee • Background • Mission • Strategy • Outcomes • Lessons

29. Agency Initiatives & Staff Tips • Helpful things to do: • Authorized Representative forms • SOAR Fax Sheet • SSIF & Adjudicator Contact • Medical/Job Worksheet (SSA-3381) • Medicare Savings Program • Understand the Listings for disability reports • Get information after denial (CD-ROM) • Spenddown—getting information • Apply for ABD online • Get the right people! • Survey of staff • Staff informational groups • Engaging & observing • Focus on choice & respect • Ask in a new way • Underpromise & overdeliver

30. Local Community SOAR Initiatives • DSHS role in Washington & SOAR Training • History • Collaboration • Recommendations

31. Local Community SOAR Initiatives • Washington Department of Veterans Affairs • Giving voice to those who struggle • Partnerships • Outcomes • Sustainability • Commitments • Opportunities

32. Local Community SOAR Initiatives • Clark County Department of Community Services • Systems approach • Funders and providers working together • Staffing model • Outcomes • Hopes for the future

33. What about your community?

35. Resource Links for more info. • http://www.prainc.com/soar/ and NEWER site http://soarworks.prainc.com/ (SOAR Technical Assistance Website) • http://www.prainc.com/SOAR/tools/manual.asp (manual for Stepping Stones to Recovery, SOAR binder from training) • http://soarworks.prainc.com/course/ssissdi-outreach-access-and-recovery-soar-online-training (online SOAR training, at own pace) • www.pathprogram.samhsa.gov/SOAR (PATH program site) • http://www.nhchc.org/policy-advocacy/issue/disability/ (National Health Care for the Homeless Council) • http://www.ssa.gov/ • http://www.hca.wa.gov/hcr/me/Pages/training_education.aspx (online training for HCA Medicaid) • http://youtu.be/fd6e5ORJ8i0 (training video from HCA, 15”) • http://www.wahbexchange.org/info-you/partners/ (tip sheets, etc. from WA health exchange) • http://www.dshs.wa.gov/ • http://pathprogram.samhsa.gov/super/path/Grantees.aspx (site to find out where PATH programs are by area/state) • http://www.dva.wa.gov/ • http://www.co.clark.wa.us/community-action/soar.html • http://www.desc.org/ • http://www.ynhs.org

36. Contact Information • Christina Clayton: cclayton@desc.org • Rhonda Hauff: rhonda.hauff@ynhs.org • Kate Budd: Kate.Budd@clark.wa.gov • Sue Chance: chancsa@dshs.wa.gov • Yvonne Perret, founder of SOAR, Exec. Dir., Advocacy and Training Center, Maryland: 301-777-7987; yvonne.perret@gmail.com CALL OR WRITE ANY TIME!