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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
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]