Accessing Public Benefits: SSI and SSDI

1. Accessing Public Benefits: SSI and SSDI Yvonne M. Perret, MA, MSW, LCSW-C Advocacy and Training Center National Alliance to End Homelessness Conference July 19, 2006

2. Mental Illness and Co-Occurring Disorders in Homeless Population • In 2000, the Urban Institute estimated that 1% of the population are likely to experience homelessness at least 1/year • Estimates of adults with mental illness in the homeless population vary from 25%-60% (National Health Care for the Homeless Council, Community Action Network) • Approximately half of those with mental illness also have a substance use disorder • Ongoing physical health problems, including infectious diseases, are common and debilitating

3. What are SSI/SSDI? • Supplemental Security Income (SSI): Income benefit, with set Federal Benefit Rate, available to low-income individuals who are blind, or who have a disability or who are 65 or older. Maximum benefit: 2006-$603 • Social Security Disability Insurance (SSDI): Disability benefit whose amount is based on earnings put into the Social Security System. Has a family benefit as well.

4. Current Reality… • Only 11% of homeless population currently receiving SSI/SSDI • Many more are estimated to be eligible

5. Getting this Benefit is Difficult in the Best of Circumstances… • Nationally, 37% of SSA disability applications are approved upon initial submission • This is an aggregate number • Not broken down by housing status • Increases to 52% after appeals

6. What We Know is Possible… Approval rates on initial application of 60-95% can be achieved for people who are homeless

7. Components of Successful Work • Focus on recovery • Successful engagement and relationship building • Attention to all needs of individual • Skilled development and understanding of SSI/SSDI applications/medical evidence • Addressing co-occurring disorders

8. Benefits and Recovery • What does recovery from homelessness involve? A holistic approach to work with homeless individuals and encompasses: • Life stability: Housing, treatment and supportive services • Employment • Ongoing human relationships • Successful community living • Hope for reaching life goals • Without income, recovery is extraordinarily difficult.

9. Successful Engagement • Characteristics: • Respect • Safe environment • Promises kept • Listening, clarifying, and believing • Addressing of basic needs • Assurance of future contact

10. Obstacles to Engagement • Obstacles/problems to address: • Trauma of homeless experience • Past experience of disrespect • History of receiving poor services • Symptoms of mental illness • Mistrust and disconnection • Practical issues (e.g., transportation)

11. Making Characteristics Come to Life • Respect: • Ask how individual prefers to be addressed • Address basic needs; bring, when possible, food drink, clothing • Provide choice and be clear what can do • Safe environment: • Meet where individual choices; outreach • Inquire about comfort; explain purpose • Provide personal space

12. Making Characteristics Come to Life • Promises Kept • Rule of practice: Under-promise and over-deliver—offer only what you can provide • If you don’t know an answer, say so and offer to find out. Don’t fake it! • Listening, Clarifying, and Believing • Homeless people often don’t feel heard • Clarify any questions using clear language • Don’t refute someone’s perception of experience

13. Making Characteristics Come to Life • Addressing of basic needs • Ensure the person is warm/cool enough, can get food, clothing, etc. • Ask for housing wishes and work on referrals • Assurance of future contact • At first meeting, find out how to contact • Be clear about next steps and follow them • Keep appointments

14. SSI/SSDI Eligibility Criteria • Non-medical: Different for SSI and SSDI • More detailed for SSI as is needs-based • Cleared by SSA • Must be cleared for application to proceed • Medical: Exactly the same for both • Disability Determination Services (DDS): State agency • Makes disability determination for SSA

15. Medical Criteria for Eligibility for SSI/SSDI • Individual must have medically determinable physical or mental impairment; • Impairment must result in death or have lasted or be expected to last 12 months or more • Impairment must cause functional limitations that keep the individual from working Substantial Gainful Activity (SGA) (2006: defined as $860/mo. gross earnings)

16. Functional Areas • Activities of Daily Living: Washing, dressing, bathing, using transportation, budgeting, housekeeping, using a phone, etc. • Social Functioning: Ability to communicate clearly with others; also ability to tolerate being around and interacting with other people on a consistent basis

17. Functional Areas (continued) • Ability to maintain pace and persistence in the completion of tasks: Cognitive functions such as concentration, memory, following directions, focus, repeated ability to do • Periods of decompensation of extended duration: Must have lasted at least 2 weeks or more 3 or more times in the last year

18. Eligibility for SSI/SSDI • After meeting non-medical criteria, individual must: • Meet diagnostic and durational criteria • Show “marked” functional impairment in at least two of the four functional areas • “Marked” defined as more than “moderate” • To determine eligibility, DDS follows a sequential evaluation

19. Importance of Sequential Evaluation • Includes 5 steps • Eligibility possible at 3rd and 5th steps • Need to understand “medical listings” • At 4th and 5th step, prior work and residual functional capacity (RFC) considered • Person can be denied if can do work that “exists in national or regional economy”

20. Current Consideration of Substance Use • 1996: Legal change; prior to this, if material, ok • If substance use deemed “material,” can be denied • Determining material: • If a person were to be clean and sober, would he or she still be disabled by another illness or impairment? • If the answer is yes, the person more likely would be approved • If no, the person would be denied.

21. Deciding “Material” Requires Comprehensive Evaluations Evaluations • Must be longitudinal • Must be comprehensive and address all relevant information • Should be done with use of open ended questions whenever possible • Must understand early and ongoing context of substance use

22. Comprehensive Evaluations • Must consider: • Trauma history: Discipline, “brain hurt” • Educational and other learning difficulties • Context of substance use—its purpose for individual • Employment: Duration, relationships, tasks, why left

23. For more information… CONTACT: Yvonne M. Perret Executive Director Advocacy and Training Center 1116 Bedford St. Cumberland, MD 21502 Yvonne.perret@gmail.com