Transcript Access to Benefits as a Key Component to Discharge Planning for Offenders with Disabilities July 23, 2012

Access to Benefits as a Key
Component to Discharge Planning
for Offenders with Disabilities
July 23, 2012
Presenters

Policy Research Associates
Delmar, NY
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Dazara Ware, Senior Project Associate
11th Judicial District Criminal Mental Health Project
Miami, FL
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Cindy Schwartz, Project Director
Faculty Disclosure
Presenters do not have any relevant financial
relationships with any commercial interests
Educational Objectives
1. Participants will have a basic understanding of SOAR and
how implementation can increase access to SSI & SSDI for
those who are eligible
2. Participants will learn how SOAR has been successfully used
in criminal justice settings
3. Participants will be able to assess the benefits and
challenges of SOAR implementation in jails and prisons
SOAR Technical Assistance Initiative
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SOAR -- SSI/SSDI Outreach, Access & Recovery
Sponsored by the Substance Abuse and Mental Health
Services Administration (SAMHSA) in collaboration with
the Social Security Administration
No direct funding provided to States or localities
50 States now participate; SOAR TA Center helps States
and communities increase access to SSI/SSDI through:
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Collaboration and strategic planning
Training
Technical assistance
Why is Access to SSI and SSDI
So Important for Re-entry?
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For people who are disabled, these
benefits provide access to:
Income
Housing
Health insurance and treatment
SSA’s Two Disability Programs
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SSI: Supplemental Security Income; needs based,
federal benefit rate is $698 per month in 2012;
provides Medicaid in most states
SSDI: Social Security Disability Insurance; amount
depends on earnings put into SSA system; Medicare
generally provided after 2 years of eligibility
The disability determination process for both
programs is the same
SSA’s Criteria for Disability
1. Must have a medically determinable physical or
mental impairment that either meets or is equivalent
to the listing of impairments that DDS considers
2. Duration of the impairment must have lasted or be
expected to last 12 months or more or result in
death
3. Person must show significant functional problems
caused by the medical impairment
The Problem
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Only about 31 percent of all applicants are typically
approved on application
People coming out of prison or jail are approved at
a much lower rate
Appeals take years and many potentially eligible
people give up and do not appeal
Outcomes from SOAR States
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As of June 2011, 10,493 individuals -- 71
percent of those assisted in 44 states -- were
approved for benefits in 101 days on average
In 2011 alone, SSI/SSDI brought at least $85
million into the state and local economies of
these states
For every person approved for SSI, an
average of $10,700 in uncompensated care
became reimbursable by Medicaid
How Is This Model Different?
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Staff actively assist applicants
Step-by-step explanation of SSI application
and disability determination process
Focuses on the initial application – “Get it right
the first time!”
Avoids appeals whenever possible
Focuses on documenting the disability
If Incarcerated…
SSI…
 Is suspended when a person is in a jail/prison for a full
calendar month
 After 12 months, SSI benefits are terminated; must re-apply
upon release
SSDI…
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Continues while in jail/prison until convicted of a felony;
after conviction benefits are suspended during incarceration
Upon release – no need to reapply; just ask SSA to reinstate
Legal proof of release is required to reinstate benefits
JIP
hospitalized
SOAR
ODD
approval
Short staff –
can’t transport
J IP
Working
w/o
notice to
SSA
CIP
moves
correspo
ndence
lost start
over.
DDS
approval
Med
Record
Lost
CM
change
d
ICM
assigned
Release
before
decision
DDS
can not
locate
CIP
denies
case
CM
provides
add. Info
JIP
scheduled
to SSA
Office
Interested
staff file
app
SOAR
Training
pays off
SSA –
incomplete
app
SSA
receives
app.
DDS
receives
app
PRA/CSG Jail Prevalence Study

Sites:
5 jails (2 – MD; 3 – NY)

Time:
2002 and 2006

Serious Mental Illness:
Schizophrenia
Schizo Affective Disorder
Schizophreniform


Prevalence:
Depression
Bipolar Disorder
Brief Psychosis/Delusional/Psychosis NOS
Last month
Prevalence Rates: Men – 14.5%
Women – 31%
Four Functional Areas Considered
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Activities of daily living

Social functioning
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Maintaining concentration, persistence and
pace in the completion of tasks
Repeated episodes of decompensation
Three or more attempts to work in last year resulting
in symptom increase and inability to maintain
employment
Overlooked Diagnostic Indicators
Trauma Pulling Punches 0-1:40
 Stigma Transitions 6
 Lack of community mental health treatment history
 Culture of incarceration Transitions 2:25-5:10
 Substance abuse as primary diagnosis
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Applying Prior to Release
from Jail or Prison
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Individuals can apply for SSI benefits within 30 days
of their release.
Institutional pre-release agreements with SSA, may
allow applications to be submitted up to 120 days
prior to release
Agreements usually made between jail/SSA or
DOC/SSA for all prisons
Payment starts after release
SOAR Collaborations
in Correctional Settings
In 2011, collaborations with corrections were reported
by 24 states; collaborations included:
 Jail in-reach and collaboration with parole and
probation to coordinate services
 Jail diversion programs
 Pre-Release planning from state prison
 Training in state departments of corrections
1825 Sing Sing – “Up the River”
19
Successful Models:
Collaborations with Corrections
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NY’s Sing Sing Prison:
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Applications done prior to release by a community services
agency
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Same staff who does applications follow folks in community and
access housing for them
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89% of 100 pre-release SSI applications approved in 59 days
on average
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73% of approved received within one month of release; 31%
approved prior to release
In Oklahoma DOC, 90% approval on pre-release apps
Michigan DOC SOAR Program
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2011: 72 SSI applications filed; 60% approved in 105 days
on average
Impact on recidivism: 2% of people approved for SSI were
readmitted to DOC compared to 17% of those denied
benefits
Challenge #1: 39% of SSI applications were submitted
AFTER release from MDOC; important to submit applications
90-120 days BEFORE release (as early as SSA will allow)
Challenge #2: 76% of SSA decisions were received an
average of 119 days AFTER release – four months without
income, health insurance, and probably without permanent
housing is a recipe for disaster…
Using SOAR for Jail Populations
Miami – Dade
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In Miami-Dade County SOAR is part of The Criminal
Mental Health Project- Jail Diversion Programs for
mentally ill offenders
Impacts:
 Reduction
of jail overcrowding
 Access to housing with treatment & wrap around services
 Recidivism reduced from 70% to 22% for misdemeanor
and to 5% for felony defendants
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Created specialized unit to expedite access to benefits
Outcomes (August 2011- present)
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Total number of individuals screened
Ineligible
SSA applications filed
SSA approvals
Reinstatements
Number of reconsiderations
Number of denials
Average time from application to approval
152
48
65
43
9
3
2
28 days
Challenges and Benefits
Cross-system
collaboration
Participants become
“more attractive paying
customers” to community
providers
Obtaining medical records Retroactive Medicaid
reimbursement for
treatment and services
Immigration status
Improved relationships with
community stakeholders
Domains to Predict Success
in Jail or Prison Projects
Leadership
 Collaboration
 Competing Initiatives/Projects
 Resources
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Lesson Learned:
Community Collaboration Needed
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Community Provider to work with in either setting is essential
Role of Community Provider is different when working with jails
or prisons
Greater focus on reentry in prisons may mean larger role for
prison staff to assist with SSI
Prisons sentences are usually longer – greater chance of
decision upon release than in jails
Jail “in-reach” by community provider ensures continuity and
responsibility for treatment and other needs once released
Prisons benefit from collaboration with community providers to
complete the process started in the prison (e.g., getting the
person to SSA to get their check started or helping with a
SOAR-assisted reconsideration or appeal
Conclusion
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Focusing on expediting benefits as a tool for
reentry works!
Its a win-win for the individual, for states and
localities, and for community programs
A major tool in recovery for persons with
serious mental illnesses and other disabilities
Contact Information
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SOAR Technical Assistance Center
Email: [email protected]
SOAR Website www.prainc.com/SOAR