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SAMHSA News - March/April 2007, Volume 15, Number 2

Social Security Benefits: Outreach, Access, and Recovery (Part 1)

People who are homeless and have serious mental illnesses need much more than housing.

Besides a stable address and steady income, they also need access to the mental health and substance abuse treatment that could help them take the first steps to recovery.

Obtaining benefits from the U.S. Social Security Administration (SSA) can play a crucial role in access to housing and services needed for a homeless person’s return to a life in the community. These benefits include Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI).

Why are these benefits so critical? Because in addition to providing a monthly income, SSI can offer eligibility for Medicaid. And that means a way to pay for treatment.

SAMHSA is a partner in a Federal interagency initiative—SSI/SSDI Outreach, Access, and Recovery (SOAR)—that helps homeless individuals, most of whom also have serious mental illnesses. SOAR helps them access these crucial benefits.

Launched in 2005 with SAMHSA’s support, SOAR helps states and communities develop strategies and provide training to case workers who counsel individuals in preparing accurate and complete SSI or SSDI applications.

“The ultimate goal is to get more people into recovery ” said A. Kathryn Power, M.Ed., Director of SAMHSA’s Center for Mental Health Services (CMHS). “The results of SOAR are timely and measurable, and we will continue to track them.”

SAMHSA’s support of SOAR is part of an overall Agency effort to help people with serious mental illnesses. Other efforts include programs to prevent and reduce homelessness and efforts to help people with serious mental illnesses obtain employment.

SOAR is supported by SAMHSA and the Health Resources and Services Administration—both within the U.S. Department of Health and Human Services. In addition, the U.S. Department of Housing and Urban Development supports the initiative in collaboration with many states and localities.

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SSA approves 37 percent of initial disability applications from all people who apply. For applicants who are homeless, however, that percentage may drop to 15 percent. Although appeals can increase the approval rate for all applications from 37 percent up to 53 percent, the process can take years.

“SOAR targets some of this country’s most vulnerable and chronically disabled citizens,” said Fran Randolph, Dr.P.H., Director of the Division of Service and Systems Improvement at CMHS. “The initiative helps people prepare accurate and complete applications so that SSA can determine their eligibility quickly and efficiently on the first submission. The determination process is not unnecessarily delayed by the need for individuals to submit multiple, time-consuming applications.”

When homeless individuals start receiving benefits, state and local governments may be able to recoup the cost of providing general assistance, interim health insurance, or previously uncompensated health care.

And, health care providers may receive Medicaid payments for services that otherwise would not be reimbursed. That’s a special incentive for hospitals to support SOAR efforts. With Medicaid reimbursement, hospitals have more capacity to treat homeless people, who have little or no income and assets.

But even though it’s to a community’s advantage for homeless persons to receive the SSA benefits they need, there are many challenges.

Lack of Documentation. Sometimes, homeless individuals literally haven’t even been able to make it through the door. For access to Federal buildings, people usually must show a driver’s license, birth certificate, or some other form of identification. Many individuals who are homeless don’t have such identification.

Also, when individuals can submit documentation of their disability along with their application, this speeds up the process considerably. Many people who are homeless have a hard time collecting that documentation.

Feelings of Hopelessness. Rejection may cause discouragement. “Many homeless individuals have lost hope after applying unsuccessfully again and again,” explained Lawrence Rickards, Ph.D., Chief of the Homeless Programs Branch at CMHS. “Others have had negative encounters with bureaucracies in the past or have symptoms of serious mental illness—for example, paranoia.

That makes asking for help difficult.” And because these individuals lack an address, they are not easy for the SSA to find—even if their applications are approved.

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The SOAR Approach

That’s where the SOAR initiative comes in. The project first helps states and communities strategize on how to ensure that crucial components for success will be implemented in local efforts.

In each locale, the SOAR team begins by helping the community bring together key players to identify priorities and make a plan to adopt promising practices to enhance access to SSA disability benefits.

A critical part of the strategy process is to address workforce issues. Decisionmakers need help understanding that current staffing levels—particularly of case managers who work with homeless individuals—may not be sufficient.

Each case manager interviews applicants, observes their functioning, arranges for medical assessments, obtains prior records, writes summaries, and compiles applications.

In short, Dr. Randolph noted, writing successful applications takes time. “Each agency may need more case managers assisting applicants,” Dr. Randolph said. “That’s a workforce challenge.”

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