Transcript Recommendation of a Strategy

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 selfsufficient.
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
The Community Connection & Stakeholders
Families
of the
disabled
Disabled
citizen
becomes a
consumer
All
SSA/DDS
Offices
Dept. of
Corrections
& Jails
All Medical
Providers
Mental
Health
Providers
SSI/SSD
Benefits
Assistance
Child
Support
A&D
Treatment
Centers
TANF
Legal Aids
Housing
Programs
State
Medicaid
Programs
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 “preapplication” 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 Description
Much 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 Area
Klamath County, OR
of 6,136 sq mi – 600 sq miles
larger than Connecticut
• Area
Lake County, OR
• Area of 8,358 sq mi – the size of
Connecticut AND Delaware
• County population 63,775 – fewer
than Kennewick, WA
• County population 7,442 – about the
same population as Chehalis, WA
• 15% unemployment rate
• 14% unemployment rate
• 20% poverty 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 Community
Our 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 Office
They 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 Analyst
State 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: 503-236-0028
[email protected]
www.DisabilityBenefitsTraining.com
Walter Davis, Homeless Benefits Specialist
Klamath-Lake Community Action Services
1803 Main St. Klamath Falls, OR 97601
(541) 882-3500
[email protected]