Assisting Disabled TANF Participants to Apply for Social Security Benefits Mary Hanley Ramsey County, Minnesota July 11, 2007

Overview of Social Security Disability Programs SSI SSDI/RSDI Similarity and difference between the 2 programs.

Criteria for Disability Diagnosis meeting or equal to “Blue Book” listings Unable to work at Substantial Gainful Activity (SGA) -- $900 per month gross income in 2007 Duration of one year or expected to last one year or result in death Functional Impairment in 2 of 4 areas Donna Pavetti:

How Eligibility is Decided Non-medical information Role of Disability Determination Services (DDS) Consultative Exams (CE) Work History Function Reports Third Party Reports

Important Information Sources The applicant and significant others Service providers Vocational programs Longitudinal evidence Work attempts One time psychological and cognitive assessments Medical tests such as Xrays, MRIs, EKGs etc. Functional assessment

Benefits of SSI Advocacy Once approved, participants receive increased income and medical benefits Lengthy appeals are avoided Participants gain access to disability programs that can be a path to employment, training, reasonable accommodations, job coaching, etc. that limited TANF funds don’t cover, including work incentives programs exclusive to SSI/RSDI TANF agencies can focus on providing services to parents that are more job ready and caseloads decrease Housing agencies are able to collect additional rent and can provide more subsidies States recover interim reimbursement and can pass some of the funds on to SSI advocacy programs to offset the cost of advocate salaries

Why Do TANF Participants get Denied?? IT is NOT because everyone gets denied the 1st time!! This commonly held myth leads to complacency! Appeals can be avoided!

So…Why are TANF Participants Denied so Often? Complete the applications themselves Overestimate their abilities and underestimate their impairment Reporting discrepancies Denial of disability by TANF recipient Family and community members reinforce the denial Have diagnosis or low IQ score, but don’t meet severity criteria for functional impairment

Why …..Denied? (2) Go to medical appointments alone and aren’t able to communicate needs effectively Don’t show up for scheduled appointments with us or their treatment providers Co-occurring disorders No treatment history or insufficient treatment history Evidence Disability Determination Services (DDS) needs is not obtained in a timely manner

How Can SSI Advocates Help? Conduct home visits Become the applicant’s authorized representative Discover and explain context of co-occurring chemical dependency disorders Communicate the severity of functional impairment to the often too busy medical providers and to DDS Persuade applicant to follow through with treatment for their illness(es) Attend the Consultative Exam (CE) and talk with the examiner directly to provide collateral functional information

How can SSI Advocacy Help? (2) Fill out all Adult Function Reports and Third Party forms with the applicant and family members If history of Special Education in school, attempt to obtain school records Have all information at time of application and hand it off to the SSA staff member taking the application Accompany to all appointments from the application to the award appointment and all medical appointments Do the legwork of obtaining medical records

Necessary Components for SSI Advocacy Programs Agency and supervisory support Thorough knowledge of the process Comprehensive training Communication with SSA and DDS Adequate time and resources

History/Overview of the Ramsey County’s SSI Advocacy Program (1) Intensive Integrated Intervention (III) program for TANF recipients nearing the time limit Intensive case managers with caseloads of 25 assisted clients who were disabled with obtaining SSI benefits. 43% of III closed TANF cases closed due to approval for SSI benefits Funding ended in 2003, unable to continue this intensive advocacy due to increased caseloads

History/Overview of the Ramsey County’s SSI Advocacy Program (2) Temporary SSI advocacy program started in social workers/advocates Goals: increase the number of successful first time applications for TANF participants who we thought were disabled develop a process that decreased waiting time for benefits Unexpected Success In just 6 months, 39 referred participants were approved for benefits on first time applications Estimated there were 1600 possible additional disabled participants

History/Overview of the Ramsey County’s SSI Advocacy Program (3) Response to RFP from MN DHS for SSI Advocacy for TANF Recipients County contracted with Goodwill Easter Seals to hire 8 full time, permanent advocates to provide the services State reimburses the county $2500 for each successful first time application (SSI only) If the application is denied, but is later approved on appeal, the county gets $500 and the legal services attorneys collect $2000 Ramsey County is the most successful county in the state for obtaining reimbursement for advocacy services

How the Current Ramsey County Project Works The Referral process All employment counselors are able to refer any participants or their household members who they suspect are disabled through a centralized intake coordinator Certain participants are mandatory referrals: IQ below 70, Severe and Persistent Mental Illness (SPMI), children with Severe Emotional Disturbance (SED), and individuals ill and incapacitated for one year or more The Advocacy Process Initial home visits to begin the process Advocate sees the participant through every step of the application process accompanies them to the initial application assists with gathering all necessary documentation to prove disability obtain necessary evaluation and treatment for the participant’s disabling conditions, usually including functional assessment.