SOAR in Arizona

Soar across the state Southern Arizona – Cristina Benitez Northern Arizona – currently vacant and looking Maricopa County – Jeremy Huntoon State Lead – Joy Johnson SSA Phoenix – Amber Allery

Soar local leads across the state Southern Arizona Cristina Benitez, Arizona Complete Health Covers 8 counties Pima, Pinal, Cochise, Yuma, La Paz, Graham, Greenlee, Santa Cruz Southern Arizona is re-starting SOAR in the Southern part of the state and working with Social Security Administration in Tucson which serves Southern Arizona Pinal County Lead- Elizabeth Flores- Pinal Hispanic Council South Eastern Arizona- Annette Eastman-Community Partners Integrated Health

Soar local leads across the state Maricopa County Jeremy Huntoon, Community Bridges Covers Maricopa County

Soar local leads across the state balance of state Joy Johnson, Arizona Department of Housing Covers the 13 “rural” counties (Balance of State) Administers homeless programs funding COC and/or HTF funds in every “rural” county SOAR goals Lead in every “rural’ county

Social Security Disability Insurance (SSDI) What is it? SSDI is a program to provide income supplements to people who are no longer able to work because of a significant disability. Who is it for? People who are no longer able to perform substantial work activity may qualify if they: have a medical condition that’s expected to last at least one year or result in death, are younger than full retirement age (FRA) and earn less than the substantial gainful activity (SGA) limit, are blind and at least age 55 for certain individuals, and have earned a certain number of work credits. Social Security’s disability definition is based on your medical condition and the fact that you are not expected to be able to do any work for at least 12 months or your condition is terminal. This work determination is based on your age, education and work experience. The actual disability definition makes the clear distinction between Social Security’s disability requirements compared to other disability programs, such as Veterans and Workman’s Compensation. After becoming eligible for a disability benefit, the law requires us to conduct a medical review to ensure that the beneficiary still qualifies for the program. This generally occurs every 3 to 7 years, depending on the severity of the disability.

Supplemental Security Income (SSI) What is it? SSI is a federal program that provides monthly payments to people who have limited income and few resources. Who is it for? People who are 65 or older, as well as for those of any age, including children, who are blind or who have disabilities. SSI stands for Supplemental Security Income. Social Security administers the SSI program, which pays monthly benefits to adults with limited income and resources who are disabled, blind, or age 65 or older. Blind or disabled children may also get SSI.  People who have worked long enough, recently enough, may be able to receive Social Security benefits – such as disability or retirement – and SSI benefits at the same time, if the amount of Social Security benefits in combination with the person’s other income falls below the SSI income limits.

SSDI vs. SSI Social Security Disability Insurance Supplemental Security Income Payments come from the Social Security trust funds and are based on a person’s earnings. Payments come from the general treasury fund, NOT the Social Security trust funds. SSI payments are not based on a person’s earnings. An insurance that workers earn by paying Social Security taxes on their wages. A needs-based public assistance program that does not require a person to have work history. Pays benefits to disabled individuals who are unable to work, regardless of their income and resources. Pays disabled individuals who are unable to work AND have limited income and resources. Benefits for workers and for adults disabled since childhood. Must meet insured status requirements. Benefits for children and adults in financial need. Must have limited income and limited resources. When you file an application for disability benefits with Social Security, we always check on your eligibility for both of our programs. The same medical requirements apply to both programs, but the non-medical requirements differ. Staff at your local Social Security field office review your non-medical eligibility. If you meet the non-medical requirements for SSDI, SSI, or both programs, we send your claim – or claims – to a medical examiner who works for the state of ___(your state). Specifically, the medical examiners work for a state agency called the Disability Determination Service, or DDS. Once the medical examiner makes a medical decision on your application, you receive notification by mail, and your local Social Security field office receives notification electronically. If your claim is approved, you start receiving monthly disability benefits. If denied, you have 60 days to file an appeal. For SSDI, you must have recent work history in order to receive benefits. Adults must have worked and earned Social Security credits in 5 out of the 10 years prior to the onset of the disability. For younger workers, however, less work is required. For example: Before age 24: 1 ½ years of work in a three-year period before becoming disabled Age 24-31: work during half the time between age 21 and the time the disability began Age 31 or older: work during five out of the 10 years before the disability began However, since you do not need to work and gain insured status for SSI, babies and older people who have never worked can receive SSI benefits. They just need to be blind, disabled, or age 65 or older and have limited income and resources. Social Security has a specific set of rules that apply to disability beneficiaries. If you receive Social Security disability benefits or Supplemental Security Income payments, you must report all earnings to Social Security.

What’s New in 2019? The Substantial Gainful Activity (SGA) amount for individuals with disabilities, other than blindness, increased from $1,180 to $1,220. The SGA amount for individuals who are blind increased from $1,970 to $2,040 for 2019. The monthly earnings amount that we use to determine if a month counts for the Trial Work Period month is $880 per month in 2019.   The Supplemental Security Income (SSI) Federal Benefit Rate (FBR) is $771.00 per month for an eligible individual (was $750) and $1,157 per month for an eligible couple. (was $1125.00) There are several important adjustments to the work incentive programs that went into effect January 1, 2018. Details about these changes can be found in the Red Book. The Substantial Gainful Activity (SGA) amount for individuals with disabilities, other than blindness, increased from $1,170 to $1,180. The SGA amount for individuals who are blind increased from $1,950 to $1,970 for 2018. The monthly earnings amount that we use to determine if a month counts for the Trial Work Period month is $850 per month in 2018.   The Supplemental Security Income (SSI) Federal Benefit Rate (FBR) is $750 per month for an eligible individual and $1,125 per month for an eligible couple.

What is SOAR? SOAR stands for: SSI/SSDI Outreach, Access and Recovery A process designed to help states increase access to SSI/SSDI for eligible adults who are homeless or at risk of homelessness, have a serious mental illness (or exhibit symptoms), and/or have serious physical illnesses that affect their ability to work at a substantial gainful level ($1180 per month or $1970 for blind people) Encourages a collaborative process between SSA and DDS Offers training for case managers Provides individualized TA for support

SOAR Partners Social Security Administration (SSA) Federal agency that administers SSI/SSDI Makes the non-medical decision Disability Determination Services (DDS) State agency under contract to SSA Makes the medical/disability determination Medical/treatment providers Assessments/evaluations Medical records

Collaborating with SSA and DDS The Phoenix downtown SSA office assigns a specific claims representative to assist with all SOAR applications. SSA flags all homeless applicants to expedite processing. DDS and SOAR work together to ensure the applicants attend any medical/psychological consultative examinations. SSA offices in the BOS Give update on progress of SSA offices process training for handling SOAR applications

The soar applicant functional impairments

The soar applicant functional impairments Neglects to attend to basic needs including medical, nutrition, hygiene and grooming Needs assistance in caring for self in a safe or sanitary manner Housing, food, clothing must be provided or arranged for by others Unwilling to seek care for serious medical conditions or refuses treatment for life threatening illnesses due to mental illness

The soar applicant functional impairments Risk of serious harm to self or others Seriously disruptive to family and/or community Regularly engages in assaultive behavior Has been institutionalized due to dangerous behavior Currently displays, or has a history of abusive behavior towards others in the persons care i.e. children caretakers caseworkers

The soar applicant functional impairments Risk of Deterioration A qualifying diagnosis with probable chronic, relapsing and remitting course Co-morbidities (mental retardation, substance dependence, personality disorders) Persistent or chronic factors such as social isolation poverty Extreme chronic stressors such as life threatening medical illness victimization

The soar applicant functional impairments Dysfunction in Role Performance Frequently disruptive or in trouble at work or school Unable to maintain employment or requires high level of supervision at work or school Meet other developmentally appropriate responsibilities

Soar has broader goals SOAR Housing Access to treatment, health insurance, and other services Employment opportunities Community investment Decrease in adverse outcomes (incarceration and hospitalization)

How is the SOAR Model different? Case managers actively assist applicants, maintaining contact and acting as their representative Emphasis on obtaining approval on initial application and avoiding appeals Collaboration with local agencies, medical providers, and SSA/DDS Focus on thoroughly documenting the disability and its effect on functioning, reducing the need for consultative exams

Critical Components Serving as the appointed representative Collecting and submitting medical records Electronically submitting applications and medical evidence whenever possible Collaborating with physicians for assessments and medical information Collaborating with SSA and DDS Submitting a Medical Summary Report

Medical Summary Report (MSR) The MSR is a letter which describes the individual and his/her functional limitations and struggles Critical component of the SOAR model Paints a vivid picture of the individual for the DDS examiner who never sees them Provides a clear link to the functional impairment which links directly to; “Why can’t the applicant work?”

Serving as the Appointed Representative SSA-1696: Appointment of Representative Permits communication with SSA and DDS about the applicant’s file Case Manager receives copies of all applicant communication from SSA and DDS The most important tool for working with someone who is experiencing homelessness Neither the agency or the Case Manager is liable for the decision made by DDS It is NOT the same as the Representative Payee SOAR providers should check “waiving fees from all sources”

Electronically Submitting Applications and Medical Evidence Saves Social Security Administration (SSA) and the Disability Determination Services (DDS) time, effort, and money during the disability process. Helps expedite the claim. Billie?

Activity: Reasons for the work we do This program is about: Ending homelessness Promoting recovery Transforming lives Discussion: What brought you to this work? How do you see this program helping your clients?

activity continued discussion Besides having that collaboration with SSA, what is the biggest difference you’ve witnessed when assisting individuals apply for SSA benefits with and without SOAR? Have there been any barriers that you have needed to overcome since you’ve been SOAR-trained? If so, have those barriers been resolved? What are some success stories you have to share with the audience?

How to get SOAR-Trained SOAR Online Course 16 hours of Continuing Education Unit (CEUs) upon successful completion You get 4-5 weeks to complete the overall training In-depth, step-by-step explanation of SSA’s disability determination process and SSI/SSDI application forms

How to get SOAR-Trained SOAR Online Course Self-directed learning, work at your own pace Sample reports, letters, forms and other tools Completion of a SOAR SSI/SSDI application packet, submitted to the SOAR T/A Center for review and feedback

New: Online course for child curriculum For children and youth experiencing or at risk of homelessness with a permanent disability (same as the adults) Seven classes with articles, videos and short quizzes Estimated time of completion is about 20 hours For more information enroll in SOAR 101; Class 1, no obligation to complete the entire course

SOAR Outcomes Approvals Over the past 12 years, SOAR has been used to assist over 63,861 people Of those applications, 65%, representing 34,919 persons, have been approved for SSI/SSDI on the initial application An additional 5,392 applications that were denied initially, approved on reconsideration or appeal Since 2006, SOAR is responsible for assisting 40,311 persons experiencing or at risk of homelessness

SOAR Outcomes 2017 3,563 approvals on initial applications Decisions on initial applications on average was 96 days Which equals 64% approval rate This compares to allowance rate of 28.5% for all persons 18 to 64 who applied for SSI or SSDI in 2015 The National approval rate is 65% Arizona’s approval rate is 65% in 115 days on average

SOAR Outcomes Top 10 States Have a cumulative approval rate of 84% At least 200 cumulative decisions Combined, these states had 10,416 decisions Average back pay received $5,520 from 1,677 cases Average Medicaid reimbursement $5,929 from 85 cases $356 million brought into the economy nationally It’s time AZ joined this grouping!!!! Pennsylvania, Tennessee, Maryland, Arkansas, North Carolina, Rhode Island, Washington, Oklahoma, Wyoming, District of Columbia

SOAR Outcomes Online Application Tracking (OAT) HIPAA compliant Web-based program that allows case managers to keep track of their outcomes Free Easy to use Accessible from any web browser Nothing to download HIPAA compliant No personal identifying information is collected

How to get started Below is the link to the website The course is explained on this page There is Q and A And a link to take you to the registration page Set up your account Class begins! https://soarworks.prainc.com/course/ssissdi-outreach- access-and-recovery-soar-online-training

How to stay involved in SOAR AZ SOAR State Steering Committee Contact the state lead or your local lead if interested in becoming a member AZ SOAR Local Steering Committee Contact state lead or your local lead if interested in becoming a member SOAR Refresher Trainings For those who have completed the Online Course (coming) SOAR T/A Center The Arizona SOAR contact is Pam Heine (pheine@prainc.com) Anyone can contact the SOAR T/A Center for any SOAR-related questions or concerns

Social Security Work Incentives Disability Benefits 101 (DB101) A user-friendly online tool that helps work through the myths and confusion of Social Security benefits, healthcare, and employment az.db101.org/ Other states need to know and understand Social Security Work Incentives…we have DB101 to do the work for us

Q & A from Audience

Thank you Joy Johnson, State Lead, Arizona Department of Housing Joy.Johnson@azhousing.gov Cristina Benitez, Southern Arizona Lead (8 Counties), Arizona Complete Health cbenite@azcompletehealth.com Jeremy Huntoon, Maricopa County Lead, Community Bridges jhuntoon@cbridges.com Amber Allery, Claims Representative, Social Security Administration Amber.allery@ssa.gov