Access to Benefits as a Key Component to Discharge Planning for Offenders with Disabilities July 23, 2012

Presenters  Policy Research Associates Delmar, NY  Dazara Ware, Senior Project Associate  11 th Judicial District Criminal Mental Health Project Miami, FL  Cindy Schwartz, Project Director

Faculty Disclosure Presenters do not have any relevant financial relationships with any commercial interests

Educational Objectives 1.Participants will have a basic understanding of SOAR and how implementation can increase access to SSI & SSDI for those who are eligible 2.Participants will learn how SOAR has been successfully used in criminal justice settings 3.Participants will be able to assess the benefits and challenges of SOAR implementation in jails and prisons

SOAR Technical Assistance Initiative  SOAR -- SSI/SSDI Outreach, Access & Recovery  Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with the Social Security Administration  No direct funding provided to States or localities  50 States now participate; SOAR TA Center helps States and communities increase access to SSI/SSDI through:  Collaboration and strategic planning  Training  Technical assistance

Why is Access to SSI and SSDI So Important for Re-entry?  For people who are disabled, these benefits provide access to:  Income  Housing  Health insurance and treatment

SSA’s Two Disability Programs  SSI: Supplemental Security Income; needs based, federal benefit rate is $698 per month in 2012; provides Medicaid in most states  SSDI: Social Security Disability Insurance; amount depends on earnings put into SSA system; Medicare generally provided after 2 years of eligibility  The disability determination process for both programs is the same

SSA’s Criteria for Disability 1.Must have a medically determinable physical or mental impairment that either meets or is equivalent to the listing of impairments that DDS considers 2.Duration of the impairment must have lasted or be expected to last 12 months or more or result in death 3.Person must show significant functional problems caused by the medical impairment

The Problem  Only about 31 percent of all applicants are typically approved on application  People coming out of prison or jail are approved at a much lower rate  Appeals take years and many potentially eligible people give up and do not appeal

Outcomes from SOAR States  As of June 2011, 10,493 individuals percent of those assisted in 44 states -- were approved for benefits in 101 days on average  In 2011 alone, SSI/SSDI brought at least $85 million into the state and local economies of these states  For every person approved for SSI, an average of $10,700 in uncompensated care became reimbursable by Medicaid

How Is This Model Different?  Staff actively assist applicants  Step-by-step explanation of SSI application and disability determination process  Focuses on the initial application – “Get it right the first time!”  Avoids appeals whenever possible  Focuses on documenting the disabil ity

If Incarcerated… SSI…  Is suspended when a person is in a jail/prison for a full calendar month  After 12 months, SSI benefits are terminated; must re-apply upon release SSDI…  Continues while in jail/prison until convicted of a felony; after conviction benefits are suspended during incarceration  Upon release – no need to reapply; just ask SSA to reinstate  Legal proof of release is required to reinstate benefits

Interested staff file app SSA receives app. DDS receives app SSA – incomplete app SOAR Training pays off JIP scheduled to SSA Office CM provides add. Info DDS can not locate CIP denies case CIP moves correspo ndence lost start over. ICM assigned Release before decision CM change d Short staff – can’t transport Med Record Lost DDS approval ODD approval JIP hospitalized J IP Working w/o notice to SSA SOAR

PRA/CSG Jail Prevalence Study  Sites:5 jails (2 – MD; 3 – NY)  Time:2002 and 2006  Serious Mental Illness:  Prevalence:Last month  Prevalence Rates: Men – 14.5% Women – 31% Schizophrenia Schizo Affective Disorder Schizophreniform Depression Bipolar Disorder Brief Psychosis/Delusional/Psychosis NOS

Four Functional Areas Considered  Activities of daily living  Social functioning  Maintaining concentration, persistence and pace in the completion of tasks  Repeated episodes of decompensation Three or more attempts to work in last year resulting in symptom increase and inability to maintain employment

Overlooked Diagnostic Indicators  Trauma Pulling Punches 0-1:40Pulling Punches 0-1:40  Stigma Transitions 6Transitions 6  Lack of community mental health treatment history  Culture of incarceration Transitions 2:25-5:10Transitions 2:25-5:10  Substance abuse as primary diagnosis

Applying Prior to Release from Jail or Prison  Individuals can apply for SSI benefits within 30 days of their release.  Institutional pre-release agreements with SSA, may allow applications to be submitted up to 120 days prior to release  Agreements usually made between jail/SSA or DOC/SSA for all prisons  Payment starts after release

SOAR Collaborations in Correctional Settings In 2011, collaborations with corrections were reported by 24 states; collaborations included:  Jail in-reach and collaboration with parole and probation to coordinate services  Jail diversion programs  Pre-Release planning from state prison  Training in state departments of corrections

1825 Sing Sing – “Up the River” 19

Successful Models: Collaborations with Corrections  NY’s Sing Sing Prison:  Applications done prior to release by a community services agency  Same staff who does applications follow folks in community and access housing for them  89% of 100 pre-release SSI applications approved in 59 days on average  73% of approved received within one month of release; 31% approved prior to release  In Oklahoma DOC, 90% approval on pre-release apps

Michigan DOC SOAR Program  2011: 72 SSI applications filed; 60% approved in 105 days on average  Impact on recidivism: 2% of people approved for SSI were readmitted to DOC compared to 17% of those denied benefits  Challenge #1: 39% of SSI applications were submitted AFTER release from MDOC; important to submit applications days BEFORE release (as early as SSA will allow)  Challenge #2: 76% of SSA decisions were received an average of 119 days AFTER release – four months without income, health insurance, and probably without permanent housing is a recipe for disaster…

Using SOAR for Jail Populations Miami – Dade  In Miami-Dade County SOAR is part of The Criminal Mental Health Project- Jail Diversion Programs for mentally ill offenders  Impacts:  Reduction of jail overcrowding  Access to housing with treatment & wrap around services  Recidivism reduced from 70% to 22% for misdemeanor and to 5% for felony defendants  Created specialized unit to expedite access to benefits

Outcomes (August present)  Total number of individuals screened152  Ineligible48  SSA applications filed65  SSA approvals43  Reinstatements9  Number of reconsiderations3  Number of denials2  Average time from application to approval 28 days

Challenges and Benefits Cross-system collaboration Participants become “more attractive paying customers” to community providers Obtaining medical recordsRetroactive Medicaid reimbursement for treatment and services Immigration statusImproved relationships with community stakeholders

Domains to Predict Success in Jail or Prison Projects  Leadership  Collaboration  Competing Initiatives/Projects  Resources

Lesson Learned: Community Collaboration Needed  Community Provider to work with in either setting is essential  Role of Community Provider is different when working with jails or prisons  Greater focus on reentry in prisons may mean larger role for prison staff to assist with SSI  Prisons sentences are usually longer – greater chance of decision upon release than in jails  Jail “in-reach” by community provider ensures continuity and responsibility for treatment and other needs once released  Prisons benefit from collaboration with community providers to complete the process started in the prison (e.g., getting the person to SSA to get their check started or helping with a SOAR-assisted reconsideration or appeal

Conclusion  Focusing on expediting benefits as a tool for reentry works!  Its a win-win for the individual, for states and localities, and for community programs  A major tool in recovery for persons with serious mental illnesses and other disabilities

Contact Information  SOAR Technical Assistance Center  SOAR Website