soar initiatives and the aca

Why our advocacy Why our advocacy is still importantis still important

Christina Clayton – DESC Rhonda Hauff – Yakima Neighborhood

Health Services

Kate Budd – Clark County DCS

Sue Chance -- DSHS

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The Essential SOAR Process

ACA & Implications

SOAR Initiatives & Action Planning

Community Efforts

Practical Tips

Q & A

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National program focused on expediting access to SSI/SSDI for:◦ Adults with◦ Serious mental illness and/or co-occurring disorders◦ Homeless or at risk of homelessness◦ In WA, also includes focus on veterans and tribes

Recovery from homelessness and mental and physical health problems is goal

Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with SSA since 2005

All 50 states currently participate; no direct funding provided to states

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Includes training of staff focusing on:◦ Eligibility criteria for SSI/SSDI◦ Development of claims◦ Collection and development of relevant clinical

information◦ Sharing (with appropriate releases) of individual

information to facilitate service delivery and planning

SOAR trained staff typically are experts in mental health/mental illness and/or homelessness

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SSI and SSDI: Social Security Administration disability benefits

Often only income source for people with disabilities SSI: Supplemental Security Income◦ Provides Medicaid in WA once eligible◦ Low-income individuals who have a disability, are blind, or

who are age 65 or over◦Maximum Federal benefit changes each year

SSDI: Social Security Disability Insurance◦ Income based on earnings◦Medicare after two years of receipt of payments for most

individuals

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3-part initiative:◦Systems change planning

through local and state planning groups

Collaboration Process changes

◦Training: Stepping to Stones to Recovery: 2-day and/or online

◦Technical assistance

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SSA disability benefits can provide access to:◦ Income◦ Housing◦ Health Insurance◦ Treatment◦Other supportive services

For people with disabilities, SSI/SSDI can be a critical step towards ending homelessness and promoting recovery

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People experiencing homelessness are frequent users of expensive uncompensated health care

Can recoup cost of this care from Medicaid for up to 90 days retroactive to date of SSI eligibility

States and localities can recoup from SSA the cost of public assistance provided during the application process

SSI, SSDI and Medicaid bring federal dollars into states, localities and community programs

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Initial application approval rates for people who are homeless: 10-15%

General initial application approval rates: 37% Complicated application process Extensive need for documentation Lack of understanding of criteria and their

documentation requirements Takes several months SOAR: Addresses all these

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19,008 persons experiencing or at risk for homelessness have been approved on initial application

65 percent approval rate overall

Compares to 10-15 percent for unassisted applications from people who are homeless and 29 percent for all applicants

Approvals were received in an average of 100 days in 2013

Appeals can take a year or more; many people give up and do not appeal

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Expedited process approved by SSA Regional Office Close collaboration to serve veterans through SOAR◦Only state to establish such extensive collaboration

for veterans who are homeless or at risk of homelessness

Extensive collaboration with PATH/use of PATH staff to do applications

Planning groups begun through several areas in state State planning group active since 2010

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Signed into law in March 2010Health Insurance Marketplace◦Qualified Health Plans

MedicaidMedicare benefits◦ Preventative care coverage at no-cost◦ Addresses the prescription drug “donut-hole”

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Oct 1 2013

Jan 1 2014

March 31 2014

Dec 7 2014

Oct 15, 2014

Exchange open enrollment

Exchange open enrollment

Medicaid enrollment

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Begin with trusted sources◦ Case workers, community

providers Peers are crucial Deliver positive

messages◦ Can stay independent and

in control◦ Be more financially secure◦ Improve and maintain health

and well-being Emphasize availability,

ease of enrollment, affordability

Consolidated Homeless Grants (CHG)◦ State support to Counties / CACs

Emergency Solutions Grants (ESG)◦ State support to Counties / CACs

Housing & Essential Needs (HEN)◦ Dept of Commerce to Counties ◦ Clients already on Medicaid- but

often attached to uninsured Low Income Energy Assistance

Program (LIHEAP)

ACA brings expanded access to Medicaid for States participating

SSI/SSDI remain crucial income supports SOAR providers can continue their work and help

with outreach for the Medicaid Expansion population

Medicaid enrollment workers can also help screen and refer people to SOAR providers and/or additional resources if seem eligible for SSI/SSDI

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Enrollment is not automatic. Individuals still need to apply for Medicaid, and assistance for this is variable.

Individuals who experience homelessness with serious mental health issues and/or co-occurring substance use unlikely to access ACA without significant outreach

SOAR workers will be especially poised to help those who are still experiencing homelessness, to connect to insurance as well as essential services and health care

Look at ways current systems can be modified to address Medicaid expansion efforts

ACA & Medicaid provides eligibility for health coverage, not actual health care access per se

Income supports like SSI & SSDI are critical for safe and stable housing, which in turn lead to better health outcome and recovery

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Access to SSI/SSDI income support remains essential◦Housing◦ Living expenses

Consumer should enroll in health coverage as soon as possible

Once approved for SSI they can change their Medicaid coverage based on their SSI eligibility◦ Indicate they are disabled on original application

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SOAR Case Managers can improve client health outcomes and be a part of Health Homes

CMHCs can and should be key players in community SOAR efforts and ACA implementation

Talk to State legislators and Medicaid agency staff about how SOAR can be a partner in health care reform efforts

The National SAMHSA SOAR TA Center is prepared to help address the expanding need

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Establish local planning groups Determine staffing model: ◦ Training of staff in multiple agencies◦ Team of staff in one agency serves community◦ Pooling of funds from multiple agencies to create team that

develops expertise Inform atypical partners of benefits to community:

Chambers of Commerce, large corporations, police, judges, local governments

Use data to illustrate funds brought in and spent in communities

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Completing ApplicationsCollaborations (SSA, DDS, Medical providers, other)

Training, Tracking Outcomes and Sustainability

Local Leadership Team

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Establish leads Identify existing resources Introduce SOAR Collaborate Train & support staff who do applications Quality review Track & report outcomes Fund & Sustain

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DESC & partners in Seattle-King County SOAR Steering Committee

Background Mission Strategy Outcomes Lessons

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Get the right people!

Survey of staff

Staff informational groups

Engaging & observing

Focus on choice & respect

Ask in a new way

Underpromise & overdeliver

Helpful things to do:◦ Authorized Representative

forms◦ SOAR Fax Sheet◦ SSIF & Adjudicator Contact◦ Medical/Job Worksheet (SSA-

3381)◦ Medicare Savings Program◦ Understand the Listings for

disability reports◦ Get information after denial

(CD-ROM)◦ Spenddown—getting

information◦ Apply for ABD online

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DSHS role in Washington & SOAR Training

History Collaboration Recommendations

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Washington Department of Veterans Affairs

Giving voice to those who struggle Partnerships Outcomes Sustainability Commitments Opportunities

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Clark County Department of Community Services

Systems approach Funders and providers working together Staffing model Outcomes Hopes for the future

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http://www.prainc.com/soar/ and NEWER site http://soarworks.prainc.com/ (SOAR Technical Assistance Website)

http://www.prainc.com/SOAR/tools/manual.asp (manual for Stepping Stones to Recovery, SOAR binder from training)

http://soarworks.prainc.com/course/ssissdi-outreach-access-and-recovery-soar-online-training (online SOAR training, at own pace)

www.pathprogram.samhsa.gov/SOAR (PATH program site)

http://www.nhchc.org/policy-advocacy/issue/disability/ (National Health Care for the Homeless Council)

http://www.ssa.gov/

http://www.hca.wa.gov/hcr/me/Pages/training_education.aspx (online training for HCA Medicaid)

http://youtu.be/fd6e5ORJ8i0 (training video from HCA, 15”)

http://www.wahbexchange.org/info-you/partners/ (tip sheets, etc. from WA health exchange)

http://www.dshs.wa.gov/

http://pathprogram.samhsa.gov/super/path/Grantees.aspx (site to find out where PATH programs are by area/state)

http://www.dva.wa.gov/

http://www.co.clark.wa.us/community-action/soar.html

http://www.desc.org/

http://www.ynhs.org

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Christina Clayton: cclayton@desc.org

Rhonda Hauff: rhonda.hauff@ynhs.org

Kate Budd: Kate.Budd@clark.wa.gov

Sue Chance: chancsa@dshs.wa.gov

Yvonne Perret, founder of SOAR, Exec. Dir., Advocacy and Training Center, Maryland: 301-777-7987; yvonne.perret@gmail.com CALL OR WRITE ANY TIME!

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