San Francisco GA/CAAP SSI Case Management

1. San Francisco GA/CAAP SSI Case Management Thomas Neill, Ph.D. Manager of Client Health Services thomas.neill@sfgov.org

2. SF GA/CAAP - SSI Advocacy Why SSI? It is a Win, Win! Good for the City City saves on GA/CAAP and medical costs. (Medi-Cal) Good for the client Doubles income ($422 to ~$890) Increases access to housing and health care

3. SF GA/CAAP - SSI Advocacy Return on Investment 1:5 Retroactive Return DPH / DHS study (2006) showed that each dollar for SSI Advocacy, the City recoups $5 GA/CAAP IAR & DPH Medi-Cal Ongoing Annual Savings Per Client Reduced GA/CAAP Grant ~$5,064 Medi-Cal to DPH ~$4,000

4. SF GA/CAAP - SSI Advocacy How many on GA/CAAP are SSI Eligible? • GA/CAAP Caseload: 7,300 & Rising • SSI Pending for GA/CAAP clients identified with disabling conditions~1,200 Clients • DPH CAAP Crossover Analysis • 978 CAAP clients diagnosed with disabling mental health conditions • Most do not have Medi-Cal

5. SF GA/CAAP - SSI Advocacy GA/CAAP - Large Older Population 55+ 1,975 or 29% of Caseload(June 2008)‏ Work Exempt by Age; Not Assessed for Disability Before FY09 SSA Disability Criteria Decrease after Age 50 Feb 2009 Triage Employability Unit Began Screening this Population Increase in Clients Likely SSI Eligible: June 2008 – 1,112 clients, 15% 55+ June 2009 – 1,524 clients, 30% 55+

6. SF GA/CAAP - SSI Advocacy Clients Lack Critical Medical Evidence Long-standing functional impairments – both vocational & social arenas Untreated medical, dental and behavioral health conditions Over-reliance on emergency services, least effective most costly services

7. SF GA/CAAP - SSI Advocacy CAAP SSI Program – Civil Service Began as a Pilot in 2003 Using Existing Staff, Gradually Expanded FY 09 Funding Supports 16 Case Managers & 2 Supervisors 5 Psychologist, 3.7 Physicians 2 Outreach Workers 2 Medical Records Clerks FY 10 Production Goals 1,152 Claims, ~1000 awards

8. SF GA/CAAP - SSI Advocacy GA/CAAP Model: Award Rate 91% Referrals Primarily from GA/CAAP Triage Select Clients with no Current Claim MD’s & PhD’s Screen Clients for Disability before accepting into Case Management Comprehensive Application Packet: Medical & Mental Health Exams by GA/CAAP MD’s & PhD’s Research and Collect Medical Records Third Party Information from Client’s Network

9. SF GA/CAAP - SSI Advocacy Keys to Success Stay Connected to Clients Network with staff who know client: EW, Housing Providers, Shelter CM’s, Care not Cash Staff, etc. Outreach Workers Hold benefits as needed Collaborative Relationships SSA & DDS to Manage Flow of Claims Community Treatment Providers Civil Service = Close Programmatic Control

10. SF GA/CAAP - SSI Advocacy Production Goals Tracked Monthly Case Managers Submit 6 Claims per Month (>5 Awards)‏ Maintain Award Rate >80% MD's and PhD's Each Completes ~12 Consultative Exams per Month & Screens Clients as needed Maintain Award Rate >80%

11. SF GA/CAAP - SSI Advocacy Challenges Recruiting & Hiring Qualified and Interested Staff Expanding Staff Requires Procedures Defined in an Handbook Developing Data Systems and Creating Reports to Track Key Measures