Bring Badly Needed Federal Dollars Into Rural Communities Creating a Rural Federal Disability Benefits Specialist Program SSD/SSI advocacy fills a very.

Bring Badly Needed Federal Dollars Into Rural Communities

Creating a Rural Federal Disability Benefits Specialist Program

SSD/SSI advocacy fills a very large missing piece in social service work

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)

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

Community Service Block Grants

Oregon Housing and Community Services office administers these federal funds (OHCS)

OHCS provides:

• Core funding to local agencies to reduce poverty

• Revitalize low-income communities, and

• Empower low-income families to become self-sufficient.

Community Service Block Grants

CSBG funds are used to provide services for

• Employment

• Education

• Better use of available income

• Housing

• Nutrition

• Emergency services

• Health

The CSBG Network

Most agencies are Community Action Agencies

Oregon has 17 CAA’s; 1 Farm Workers 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

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”

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

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

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

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

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

Enrolled statuses:

Preparing cases for application 11

New applications filed 20

Cases that had applications already 17

Number of Allowances so far 6

Coos/Curry Counties, Coos Bay, Oregon

Lane County; Eugene & Springfield , Oregon

Klamath/Lake Counties; Klamath Falls, Oregon

DBTC’s “SSI BOOT CAMP”

Douglas/Josephine Counties, Canyonville, Oregon

UCAN’s “SSI BOOT CAMP”

Let’s take a break

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

Far too few know how to effectively help the severely disabled through this system

Who benefits from SSI/SSD work?

Not just the recipient......

100% of these federal dollars go directly back into your community

SSI/SSD Benefits

Assistance

State Medicaid ProgramsHousing

Programs

All Medical Providers

Disabled citizen

becomes a consumer

Legal Aids

TANF

Child Support

Dept. of Corrections

& Jails

Families of the

disabled

Mental Health

Providers

A & D Treatment

Centers

All SSA/DDS Offices

The Community Connection & Stakeholders

Why a Benefits Specialist?

Two thirds of disability applicants 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

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.

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

• Write a comprehensive narrative report for each client

• File the application with SSA

• File all appeals timely

• Track all referral and case progress data

Why train a benefits specialists?

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

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

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!

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

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

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

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

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)

What made the Portland, Ore. project work so well?

Portland added benefits to their 10 year plan to end homelessness

Two grants from hospitals Seed money from the City of Portland 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

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

Some other successful models

B.A.R.T., Denver, Colorado S.M.A.R.T., Sacramento, California Miami/Monroe, Florida Atlanta, Georgia Albuquerque, New Mexico Boston, Massachusetts Philadelphia, Pennsylvania Nashville, Tennessee

The Klamath Falls, Oregon Project

Our Service AreaKlamath 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

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

Outreach to the CommunityOur 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

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

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

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

KLCAS’s Commitment – The Difference Between Failure and Success

• Funding is currently an ongoing problem but KLCAS is committed to the program and has sought innovative ways to ensure the program continues

• Organizational Representative Payee Program – Social Security allows Rep Payees to collect a nominal fee for money management services. In Klamath Falls there was no Organizational Payee service; able to fill another need while supplementing funding for the Benefits Specialist Program.

• Supportive Services for Veteran Families – All of the services we offer at KLCAS, including the Benefits Specialist Program, are sought after by the VA for their Veteran Families. We are currently seeking a $600,000+ grant from the VA that will allow part of the Benefits Specialist’s time to be charged to that grant.

• We hope to establish a success rate that will convince our community partners to invest real dollars in our program.

Presenters Contact Information:

Lynn Adams, CSBG Program AnalystState of Oregon, Housing & Community Services

725 Summer St. NE Suite B, Salem OR 97301-1266(503) 986-6736

[email protected]

Mellani Calvin, Program Director Disability Benefits Training & Consulting, LLC

1336 E. Burnside St., Ste. 130 Portland OR 97214

Phn: 503-888-2690, Fax: [email protected]

www.DisabilityBenefitsTraining.com

Walter Davis, Homeless Benefits SpecialistKlamath-Lake Community Action Services1803 Main St. Klamath Falls, OR 97601

(541) [email protected]