SSI/SSDI Outreach, Access, and Recovery (SOAR)
SSI/SSDI Outreach, Access, and Recovery (SOAR) is a national project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) that is designed to increase access to Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) for eligible adults who are experiencing or at risk of homelessness and have a mental illness, medical condition, and/or a co-occurring substance use disorder. Using a three-pronged approach of strategic planning, training, and technical assistance (TA), the SOAR TA Center coordinates this effort at the state and community level.
Problem or Challenge:
Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are disability income benefit programs administered by the Social Security Administration (SSA). In most states enrollment in SSI/SSDI also provides access to Medicaid and/or Medicare health insurance to individuals who are eligible. Without SSI/SSDI many people with disabilities both lack the income to pay rent and are uninsured and may be unable to obtain the health care, treatment, and recovery support services they need. The health care providers that serve them cannot obtain Medicaid reimbursement for the costs of services they deliver.
The SSI/SSDI application process is complicated and difficult to navigate, particularly for people who are experiencing homelessness or who are returning to the community from jails, prisons, or hospitals. For those who have a mental illness, substance use issues, or co-occurring disorders that impair cognition, the application process poses an even greater challenge. Many health care providers and case managers often lack the skills or training to prepare applications that satisfy the requirements for a determination of eligibility for benefits. As a result many applications are denied or approved only after a series of appeals that can take years. Yet accessing these income and health care benefits is often a critical first step on the road to recovery.
SOAR was created with support from SAMHSA to provide support to people who work at the state and local levels to increase access to Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) for eligible adults who are experiencing or at risk of homelessness and have a mental illness, medical condition, and/or a co-occurring substance use disorder. The SOAR TA Center helps states and local community partners to implement a three-pronged approach:
- Strategic planning: A state planning team is established and a state team leader is designated. The planning team includes representatives of the Social Security Administration (SSA) and the state’s Disability Determination Services agency, as well as representatives of agencies and community organizations responsible for mental health, substance abuse, health care and homeless assistance services, and other stakeholders. The team develops a strategic plan for outreach, training, and partnerships to facilitate access to SSI/SSDI benefits for people experiencing homelessness.
- Training: Training of case managers using SAMHSA’s Stepping Stones to Recovery curriculum. Available in-person or online, this training includes a step-by-step explanation of an improved SSI/SSDI application process. A Leadership Academy program creates strong local leaders to support SOAR-trained case managers and coordinate local SOAR programs. The curriculum provides step-by-step explanations, sample forms, and tips to guide healthcare providers and case managers in compiling the documentation needed to document disability and support an application for benefits. The online training consists of seven classes, each of which has a series of articles, short quizzes, and a practice case. The practice case provides an opportunity for case managers to apply what they have learned by completing an SSI/SSDI application packet for a fictitious applicant using SOAR techniques. Video interviews, medical records, and progress notes provide the information needed to complete SSA forms and write a Medical Summary Report (MSR) for the fictional applicant. The complete application packet is submitted to the SOAR TA Center for review. Upon approval, the participant receives a certificate of completion and 16 Continuing Education Units (CEUs) from the National Association of Social Workers (NASW).
- Technical assistance: In addition to the intensive training provided to SOAR trainers, the SOAR TA Center offers ongoing support to states and communities for the development of action plans, newsletters, web-based learning tools and webinars, and tracking outcomes.
A strategic planning process can help to articulate shared goals and commitments and build relationships across organizations. This can open up lines of communications between the people who work in organizations that serve people experiencing homelessness and the people who work in government agencies responsible for reviewing applications. In some cases the planning process led to designating individuals in each agency to manage all applications submitted on behalf of people who are experiencing homelessness and establishing systems to track and expedite these applications.
Training and tools provided to case managers result in more complete applications that contain the documentation needed to support an eligibility determination. The result is faster approvals and fewer applications are denied.
Partnerships with hospitals and other health care providers have been established in many communities to provide access to medical records and needed assessments. Some states or communities have provided SOAR training to dedicated benefits specialists who work in hospitals or who provide health care or behavioral health services to persons with mental illness or co-occurring disorders in jail or prison settings to facilitate enrollment in benefits upon reentry.
Some parents in homeless families may be eligible for SSI/SSDI. While SOAR has been used primarily to improve access to SSI/SSDI benefits for adults who are experiencing chronic homelessness and other individuals with disabilities who are experiencing homelessness, it is important to recognize that some parents in families experiencing homelessness may also have disabling health and/or behavioral health conditions. These disabling conditions may create significant barriers to employment or compliance with the requirements of welfare-to-work programs, and as a result some of these families do not have income from either work or welfare benefits. SSI/SSDI can provide an important safety net and a source of income for parents who are unable to work. Some communities are using and adapting the tools and procedures developed through SOAR to help some parents in families experiencing homelessness.
The SAMHSA SOAR Technical Assistance Center reported the following 2014 National SOAR Outcomes:
- Since 2006 there have been nearly 42,000 decisions on initial applications reported by 49 states. The allowance or approval rate on these applications was 65 percent in an average of 94 days (from date of application submission to the date of decision).
- In 2014 SSI/SSDI brought at least $227 million into state and local economies by providing income to eligible applicants in these states, often reducing costs to states or local governments for general assistance.
- In most states, because people become eligible for Medicaid when they become eligible for SSI, SOAR resulted in substantial increases in Medicaid reimbursement to local hospitals, clinics, and community mental health service providers. The average per person reimbursement was $10,465.
- Based on data from 29 states reporting this information, persons served through SOAR had been experiencing homelessness for an average of nearly three years.
- SOAR helps to facilitate access to housing and many applicants succeed in obtaining housing when their benefits are approved.
For more information and the complete report with state by state data, please visit: http://soarworks.prainc.com/article/2014-national-soar-outcomes
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