Access to Benefits as a Key Component to Discharge

Planning for Offenders with DisabilitiesJuly 23, 2012

Presenters Policy Research Associates Delmar, NY

Dazara Ware, Senior Project Associate

11th Judicial District Criminal Mental Health ProjectMiami, FL Cindy Schwartz, Project Director

Faculty Disclosure

Presenters do not have any relevant financial relationships with any commercial interests

Educational Objectives1. 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

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: Collaboration and strategic planning Training Technical assistance

Why is Access to SSI and SSDI So Important for Re-entry?

For people who are disabled, these benefits provide access to: Income Housing Health insurance and treatment

SSA’s Two Disability Programs

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 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

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?

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 releaseSSDI… 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

Interested staff file app

SSA receives app.

DDS receives app

SSA –incomplete app

SOAR Training pays off

JIP scheduled to SSA Office

CM provides add. Info

DDS can not locate CIP denies case

CIP moves correspondence lost start over.

ICM

assignedReleasebeforedecision

CM changed

Short staff – can’t transport

Med RecordLost

DDS approval

ODD approval

JIPhospitalized

J IPWorkingw/o notice to SSA

SOAR

PRA/CSG Jail Prevalence Study

Sites: 5 jails (2 – MD; 3 – NY) Time: 2002 and 2006 Serious Mental Illness:

Prevalence: Last month Prevalence Rates: Men – 14.5%

Women – 31%

SchizophreniaSchizo Affective DisorderSchizophreniform

DepressionBipolar DisorderBrief Psychosis/Delusional/Psychosis NOS

Four Functional Areas Considered

Activities of daily living Social functioning 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

Applying Prior to Releasefrom Jail or Prison

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 NY’s Sing Sing Prison:

Applications done prior to release by a community services agency

Same staff who does applications follow folks in community and access housing for them

89% of 100 pre-release SSI applications approved in 59 days on average

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 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 PopulationsMiami – Dade

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 Created specialized unit to expedite access

to benefits

Outcomes (August 2011- present)

Total number of individuals screened152

Ineligible 48 SSA applications filed

65 SSA approvals 43 Reinstatements

9 Number of reconsiderations

3 Number of denials 2 Average time from application to approval

28 days

Challenges and BenefitsCross-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

LeadershipCollaborationCompeting Initiatives/Projects

Resources

Lesson Learned: Community Collaboration Needed

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

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 SOAR Technical Assistance Center

Email: SOAR@prainc.com

SOAR Website www.prainc.com/SOAR