HOMELESS SSI DEMONSTRATION PROJECT – HPI FUNDED

Purpose To coordinate efforts to identify homeless individuals who may be eligible for SSI benefits or who have a pending application to SSI by providing health care expertise, coordinated document retrieval of medical and mental health records and submission of complete applications

Partners CEO/SIB Department of Public Social Services Department of Health Services Department of Mental Health Sheriff’s Department Community-Based Federally Qualified Health Clinic (FQHC) HOPE Grantee Social Security Administration

Eligible FQHC Partners Three FQHC’s that are funded for Healthcare for the Homeless (NEVHC, JWCH and LA Mission Community Clinic) Request for Information offered to all three If more than 2 respond, RFP required

Eligible Clients Homeless General Relief homeless participants Homeless clients referred from DHS, DPSS, DMH, Sheriff’s, and possibly other County dept’s. Screened as someone likely to be eligible for SSI based on disability, age or blindness

Model Components 2 Health Teams DPSS’ SSI Advocates Homeless Outreach Projects and Evaluation (HOPE) Grantee County Departmental SSI Specialists Social Security Administration (SSA) Liaisons

Model Structure 2 Health Teams Sited within 2 DPSS District offices Team #1 – Psychiatrist, Nurse Practitioner and staff support provided by FQHC, and 3.5 DPSS SSI Advocates Team #2 – M.D., Licensed Clinical Social Worker (LCSW), staff support provided by FQHC, and 3.5 DPSS SSI Advocates Each team to process approximately 500 clients per year

Model Structure, cont. 2 Health Teams, cont. FQHC will subcontract with 1 of 4 local HOPE grantees* to provide a staff person per team to assist the DPSS SSI Advocates aim for a significant increase in homeless clients’ SSI approval rates. * Federal SSA project that previously funded 4 local grantees to increase the number of homeless individuals on SSI

Model Structure, cont. 2 Health Teams, cont. Each health team will conduct disability evaluations in support of the client’s SSI disability claim, determine type of documentation needed to establish eligibility, provide primary care as needed or in coordination with other health providers to establish needed history for SSI eligibility

Model Structure, cont. 2 Health Teams, cont. DPSS SSI Advocates will oversee cases by ensuring regular contact and follow-up with clients, assistance with SSI application, tasks needed to complete application such as I.D. acquisition, coordination with health team, County SSI Documentation Specialists and SSA Liaisons, etc.

Model Structure, cont. County Departmental SSI Documentation Specialists DHS, DMH and Sheriff’s will identify staff that have expertise on strategies to qualify eligible homeless for SSI and who will gather documentation of services provided within their respective departments or improve upon such documentation DHS – 2 RNs DMH – 2 Clinical Staff Sheriff’s – 1 RN

Model Structure, cont. Social Security Administration (SSA) Liaisons SSA committed homeless Liaisons to be identified within local SSA and Disability Determination Services (DDS) to facilitate the application process, communicate between agencies and review documentation that verifies eligibility

Training Health teams and other stake holders will access trainings to gain expertise on homeless and documenting disability for SSI eligibility SSA provides training on the SSI application process. SSA/DDS provides training on documentation of eligibility SSI/SSDI Outreach Access and Recovery (SOAR) offers training on strengthening documentation for successful SSI applications for homeless individuals Many National trainings offered on improving homeless access to SSI benefits United Homeless Healthcare Partners (UHHP) will be offering SSI documentation training for clinicians

Budget FQHC Staff Salaries and Employee Benefits 30% FQHC Health Teams – per year M.D. $135,000 salary and $40,500 EB Psychiatrist $135,000 salary and $40,500 EB Nurse Pract. $124,500 salary and $37,350 EB LCSW $72,400 salary and $21,720 EB 2 Support Staff $78,000 salary and $23,400 EB Total Staff - 2 years$1,416,740

Budget, cont. FQHC subcontract – HOPE Grantee $240,000 – 2 years FQHC start-up costs $60,000 FQHC indirect 10% of S&B $283,260 – 2 years Total Project Budget $2,000,000

In-Kind Contributions County Departments DHS – 2 RNs (SSI Documentation Specialists) DMH – 2 Clinical Staff (SSI Documentation Specialists) Sheriff – 1 RN (SSI Documentation Specialists) DPSS – 10 SSI Advocates (7 assigned to health teams, 1 to support DPSS project staff, 2 assigned to assist DHS, DMH, and Sheriffs’ SSI Documentation Specialists) Health Team Service Sites – Provided by DPSS SSA Liaisons Training Opportunities SOAR UHHP SSA

Potential Reimbursement/Cost Savings Reimbursement Opportunities FQHC can license space as a satellite clinic to bill primary health care visits. Funds can be used to extend the project into the future and add to sustainability County departmental increased reimbursement potential due to automatic Medi-Cal with SSI approval General Relief Interim Assistance Reimbursement Cost Savings Opportunities GR grant savings Savings to DHS, DMH, and the Sheriff’s Department These cost savings can be used to extend and/or expand the pilot.

Differences between SSI Demonstration & DPSS’ GR to SS&I Projects SSI Demonstration Project Homeless clients will come from DMH, DHS, DPSS, and Sheriff Two year pilot HPI funded Two dedicated DPSS District office sites 500 clients served per year per team SSI advocates for case management to be provided in-kind by DPSS County depts. to provide applicable documentation of services Two health teams provided via contract with Federally Qualified Health Center (FQHC) designation – can bill for services Subcontract with a HOPE grantee to provide ongoing case management leadership GR to SS&I Project Long-term GR recipients that are homeless or at-risk for homelessness One year pilot DPSS funded County wide 1000 clients served SSI Advocates will be utilized to provide case management services DPSS will amend its current employability screening services contract to include comprehensive evaluations and documentation services for pilot participants