NAMI Maryland 2015 Annual Conference Expediting SSI/SSDI Claims: The Maryland SOAR Program October 16, 2015

Excerpted from…. Perret, Y & Dennis, D. STEPPING STONES TO RECOVERY: A STEPPING STONES TO RECOVERY: A TRAINING CURRICULUM FOR CASE MANAGERS ASSISTING ADULTS WHO ARE HOMELESS WITH SOCIAL SECURITY DISABILITY AND SUPLEMENTAL SECURITY INCOME APPLICATIONS. DHHS Pub. No. SMA 06-Rockville, MD: CMHS, SAMHSA, 2006

The Federal Disability Programs: SSI and SSDI

SSI and SSDI: The Basics SSI: Supplemental Security Income (Title 16) SSI: Supplemental Security Income (Title 16) Federal benefit that provides income ($733 per month in 2015) to individuals that are low-income and disabled, blind, or aged Federal benefit that provides income ($733 per month in 2015) to individuals that are low-income and disabled, blind, or aged Medicaid in Maryland Medicaid in Maryland SSDI: Social Security Disability Insurance (Title 2) SSDI: Social Security Disability Insurance (Title 2) Federal benefit that provides income (dependent on earnings put into SSA system) to individuals with qualifying earnings history and that are disabled Federal benefit that provides income (dependent on earnings put into SSA system) to individuals with qualifying earnings history and that are disabled Medicare provided after two years of eligibility in most instances Medicare provided after two years of eligibility in most instances SSA SSA Both programs are administered by the Social Security Administration (SSA) with disability evaluated by state contracted agency – Disability Determination Services (DDS) Both programs are administered by the Social Security Administration (SSA) with disability evaluated by state contracted agency – Disability Determination Services (DDS)

The Problem Only about 30% of all applicants are typically approved on initial application Only about 30% of all applicants are typically approved on initial application Only about 10-15% of homeless adults who apply are typically approved on initial application Only about 10-15% of homeless adults who apply are typically approved on initial application Appeals take years and many potentially eligible people give up and do not appeal Appeals take years and many potentially eligible people give up and do not appeal

Barriers to Accessing SSI/SSDI Complexity of process Complexity of process Medical records do not address functional impairments and inability to work Medical records do not address functional impairments and inability to work Knowledge of the disability determination process and disability programs Knowledge of the disability determination process and disability programs Communication at all levels of the process (community providers, SSA, DDS) Communication at all levels of the process (community providers, SSA, DDS) Possible inconsistent treatment history Possible inconsistent treatment history

Why is access to SSI/SSDI so important for individuals? SSI/SSDI can provide access to: SSI/SSDI can provide access to: Housing Housing Income Income Health insurance Health insurance Preventing or ending homelessness Preventing or ending homelessness And promoting recovery for people with disabilities And promoting recovery for people with disabilities

Determining Disability

SSA Definition of Disability “The inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than 12 months.” Basically asking: Can you work?

Sequential Evaluation Process Is the claimant engaging in SGA? Is the claimant engaging in SGA? Is the impairment(s) severe? Is the impairment(s) severe? Does the impairment(s) meet/equal listings? Does the impairment(s) meet/equal listings? Does the impairment(s) preclude the ability to perform past relevant work? Does the impairment(s) preclude the ability to perform past relevant work? Does the impairment(s) preclude the ability to perform other work? Does the impairment(s) preclude the ability to perform other work?

Listings for Mental Impairments (SSA Blue Book) Organic Mental Disorders Organic Mental Disorders Schizophrenia, Paranoia, and other Psychotic Disorders Schizophrenia, Paranoia, and other Psychotic Disorders Affective Disorders Affective Disorders Intellectual Disability Intellectual Disability Anxiety-Related Disorders Anxiety-Related Disorders Somatoform Disorders Somatoform Disorders Personality Disorders Personality Disorders Substance Addiction Disorders Substance Addiction Disorders Autistic Disorder and Other Pervasive Developmental Disorders Autistic Disorder and Other Pervasive Developmental Disorders

Example Listings: ‘A’ criteria Example Listings: ‘A’ criteria Depressive syndrome characterized by at least four of the following: a. Anhedonia or pervasive loss of interest in almost all activities; or b. Appetite disturbance with change in weight; or c. Sleep disturbance; or d. Psychomotor agitation or retardation; or e. Decreased energy; or f. Feelings of guilt or worthlessness; or g. Difficulty concentrating or thinking; or h. Thoughts of suicide; or i. Hallucinations, delusions, or paranoid thinking

Example Listings: ‘B’ criteria I II III IV Marked restrictions of activities of daily living Marked difficulties in maintaining social functioning Marked difficulties in maintaining concentration, persistence, and pace (as they relate to the ability to complete tasks) Repeated episodes of decompensation (each of extended duration)

Medical Summary Report

Things to remember… Medical evidence is the heart of disability determination Medical evidence is the heart of disability determination Only physicians and psychologists can make diagnosis Only physicians and psychologists can make diagnosis Often medical records do not sufficiently document functioning Often medical records do not sufficiently document functioning Family/other health care professionals can provide valuable information on functional impairment Family/other health care professionals can provide valuable information on functional impairment Writing a medical summary report which provides a comprehensive picture of the applicant can be very effective Writing a medical summary report which provides a comprehensive picture of the applicant can be very effective

Content of Medical Summary Report Reference Section Introduction Personal History Diagnostic and Treatment Information Functional Descriptions Summary Contact Information

Importance of Functional Descriptions Impact of person’s impairment(s) Impact of person’s impairment(s) Based on collection of personal, medical, and collateral information Based on collection of personal, medical, and collateral information Clearly explains: Clearly explains: Nature of impairment Nature of impairment How/if linked to illness How/if linked to illness Impact on functioning and life, especially regarding ability to work Impact on functioning and life, especially regarding ability to work

Example Functional Description (ADLs) Bob exhibits significant restrictions in his activities of daily living. His mood fluctuations, intrusive worry, and low motivation negatively impacts his ability to get out of bed in the morning. He reports that he knows how to cook, but has little motivation to do so. He does not go grocery shopping for himself because he finds it difficult to be in the store with other people. He gets easily frustrated with having others around him and he cannot tolerate it if the store does not have the exact item he is looking for.

SSI/SSDI Outreach, Access, and Recovery SOAR – A Tool in Access and Recovery

What is SOAR? Strategy to help states and communities increase access to SSI and SSDI benefits for individuals who are homeless or at risk of homelessness and diagnosed with a severe mental illness Strategy to help states and communities increase access to SSI and SSDI benefits for individuals who are homeless or at risk of homelessness and diagnosed with a severe mental illness National program sponsored by SAMHSA with programs in all 50 states and Washington, DC National program sponsored by SAMHSA with programs in all 50 states and Washington, DC Increases provider role and engagement Increases provider role and engagement Aims to serve those who are most vulnerable Aims to serve those who are most vulnerable Focuses on obtaining benefits as an aid to recovery, not an end in itself Focuses on obtaining benefits as an aid to recovery, not an end in itself

How Is This Model Different? Case managers actively assist applicants and collate evidence, including obtaining medical records and producing a medical summary report Case managers actively assist applicants and collate evidence, including obtaining medical records and producing a medical summary report Focuses on the initial application – “Get it right the first time!” and avoids appeals whenever possible Focuses on the initial application – “Get it right the first time!” and avoids appeals whenever possible Only those who have been SOAR trained can submit applications under SOAR, thus ensuring high quality applications Only those who have been SOAR trained can submit applications under SOAR, thus ensuring high quality applications Processes are in place to expedite SOAR cases at DDS Processes are in place to expedite SOAR cases at DDS Robust data is collected and approval rates/processing times are closely monitored Robust data is collected and approval rates/processing times are closely monitored Brings together SOAR partners, including community providers, DDS, SSA, BHA, DPSCS Brings together SOAR partners, including community providers, DDS, SSA, BHA, DPSCS

SOAR Eligibility Must be 18+ Must be 18+ Must be homeless or at risk of homelessness Must be homeless or at risk of homelessness Must have a severe mental health issue Must have a severe mental health issue Must be unable to work because of mental health issues Must be unable to work because of mental health issues Cannot have an SSI/SSDI case already pending at the Hearing Level Cannot have an SSI/SSDI case already pending at the Hearing Level Must be referred to, assessed by, and prepared to work with a SOAR-trained case manager Must be referred to, assessed by, and prepared to work with a SOAR-trained case manager

Maryland SOAR Outcomes Maryland SOAR Outcomes Over 1000 applications submitted through SOAR with overall approval rate of over 80% Over 1000 applications submitted through SOAR with overall approval rate of over 80% Approval rate for initial SOAR claims is 84% in an average processing time of 76 days Approval rate for initial SOAR claims is 84% in an average processing time of 76 days Many applicants have previously had claims denied prior to using the SOAR process Many applicants have previously had claims denied prior to using the SOAR process Over $4 million federal dollars are estimated to have been brought into the state through the SOAR program Over $4 million federal dollars are estimated to have been brought into the state through the SOAR program

SOAR Sites Within Maryland X X X X X X X X X X X X X X X X X X X X X X X

Resources For more information visit: For more information visit: SSA Web site SSA Web site Blue Book Listings: Blue Book Listings: bluebook/ SOAR Web site SOAR Web site C - 4

Presenters’ Contact Information Caroline Bolas, MSW, MS Director: SOAR Initiative Behavioral Health Administration Bilqis Rock, LGSW Lead SOAR Specialist Health Care for the Homeless