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Bring Badly Needed Federal Dollars Into Rural Communities

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Title: Bring Badly Needed Federal Dollars Into Rural Communities


1
Bring Badly Needed Federal Dollars Into Rural
Communities
  • Creating a Rural Federal Disability Benefits
    Specialist Program
  • SSD/SSI advocacy A very big missing piece in
    social service work

2
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)

3
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

4
Community Service Block Grants
  • Oregon Housing and Community Services office
    administers these federal funds (OHCS)
  • CSBG provides
  • Core funding to local agencies to reduce poverty
  • Revitalize low-income communities, and
  • Empower low-income families to become
    self- sufficient.

5
Community Service Block Grants
  • CSBG funds are used to provide services for
  • Employment
  • Education
  • Better use of available income
  • Housing
  • Nutrition
  • Emergency services
  • Health

6
The CSBG Network
  • Most agencies are Community Action Agencies
  • Oregon has 17 CAAs and
  • Statewide farm-worker 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

7
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

8
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

9
Timeline Cont.d
  • OHCS invites CAAs 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 CAAs are chosen for the
    pilot
  • June 4, 2010 Contract signed with DBTC

10
  • 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 DBTCs contract for 12 months to
  • Develop a statewide peer group
  • Continue to collect data

11
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

12
Pilot Project Results
  • Total of Referrals from 5 sites 93
  • Cases accepted for representation 48
  • Not accepted for representation 31
  • Decisions still pending for repg 14
  • Cases Allowed 8

13
Coos/Curry Counties, Coos Bay, Oregon
14
Lane County Eugene Springfield , Oregon
15
Klamath/Lake Counties Klamath Falls, Oregon
16
DBTCs SSI BOOT CAMP
17
Douglas/Josephine Counties, Canyonville, Oregon
18
UCANs SSI BOOT CAMP
19
Lets take a break
20
My Message in a Nut Shell
  • HUGE missing piece in social services its
    foundational to self sufficiency for a person
    with severe disabilities
  • You already navigate so many other complex DHS
    systems WHY NOT LEARN THIS ONE TOO?
  • This work should NOT default to attorneys as it
    is not in their financial interest to be
    proactive
  • The learning is in the doing!

21
Social Security Disability (SSD) and Supplemental
Security Income (SSI)
  • THE BASICS, THE PROCESS

22
What is Social Security Disability?
FICA taxes
  • Social Security Trust Fund
  • Retirement Benefits
  • Survivors Benefits
  • Disability insurance (SSD)
  • Medical insurance component
  • Medicare

23
What is Supplemental Security Income?
Federal General Funds
  • Absolute basic needs
  • Food
  • Shelter (SSI) 674/mth
  • Clothing
  • Must not have any assets equaling over 2000/mth.
  • Exemptions House, Car, Household items
  • Medical insurance component
  • Medicaid

24
Levels of Administrative Review
  • Initial Handout (C)
  • Reconsideration
  • Hearings
  • Appeals
  • Federal District Court
  • US Ninth Circuit Court of Appeals
  • US Supreme Court
  • Continuing Disability Review

25
Common Misconceptions
  • Decision is all or nothing, not disabled or
    disabled, no partial disability
  • My medical records will show I am disabled
  • My doctor will make sure I get disability
  • Ill need to hire an attorney to get benefits
  • It will take years to get my benefits
  • I cant be working when I apply
  • Lack of support and preparation result in denials

26
What Most People Dont Know
  • In order to be eligible for benefits
  • One has to be severely disabled with a diagnosis
  • The conditions have to prevent work for 12
    consecutive months or are expected to end in
    death
  • Your medical records dont even begin to tell
    the whole story of how poorly you function during
    the day, let alone in a work setting
  • You have prove that you cannot sustain a job,
    making 1000.00/mo. for any real length of time

27
Again, far too few know how to effectively help
the severely disabled through this system
  • When thinking about budget shortfalls and new
    revenue streams, dont forget about SSD/SSI,
    Medicare and Medicaid
  • 100 of these federal dollars go directly back
    into your community

28
The Community Connection Stakeholders
Disabled citizen becomes a consumer
All SSA/DDS Offices
Families of the disabled
All Medical Providers
Dept. of Corrections Jails
SSI/SSD Benefits Assistance
Child Support
Mental Health Providers
TANF
A D Treatment Centers
State Medicaid Programs
Legal Aids
Housing Programs
29
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

30
Why a Benefits Specialist vs. a Case Manager?
  • Two thirds of disability applicants nationawide
    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

31
Critical Components for Success
  • Very organized, proactive benefits specialist
    with good writing skills
  • Trained benefits specialist in SSAs 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.

32
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
  • Research SSAs eligibility criteria
  • Write a comprehensive narrative report for each
    client
  • File the application with SSA and monitor it
    closely
  • File all appeals timely
  • Track all referral and case progress data

33
Why train benefits specialists?
  • This is a whole different niche than case
    management
  • 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

34
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

35
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

36
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!

37
Basic Funding for one FTE
  • One Benefits Specialist _at_ 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 (trainers 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

38
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

39
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
  • Fee generating case work

40
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)

41
What made the Portland, Ore. project work so well?
  • Portland added benefits to their 10 year plan to
    end homelessness
  • Seed money from City of Portland Housing Bureau
  • Two grants from hospitals
  • 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

42
Expected ResultsIn 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

43
Some other successful models
  • B.A.R.T., Denver, Colorado
  • S.M.A.R.T., Sacramento, California
  • Legal Aid Society of Hawaii
  • Miami/Monroe, Florida
  • Atlanta, Georgia
  • Albuquerque, New Mexico
  • Boston, Massachusetts
  • Philadelphia, Pennsylvania
  • Nashville, Tennessee

44
The Klamath Falls, Oregon Project
45
Our Service Area
  • Klamath 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

46
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

47
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

48
Our community really Got It
  • Medical community very receptive with prompt,
    free medical records
  • DHSs 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

49
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

50
KLCASs 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 niches 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

51
KLCASs 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 Specialists
    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.

52
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
  • lynn.d.adams_at_hcs.state.or.us
  • 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
  • disabilitybenefitstraining_at_hevanet.com
  • www.DisabilityBenefitsTraining.com
  • Walter Davis, Homeless Benefits Specialist
  • Klamath-Lake Community Action Services
  • 1803 Main St. Klamath Falls, OR 97601
  • (541) 882-3500
  • wdavis_at_klcas.org
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