SOAR practices

Expediting Access to SSA Disability Benefits:

Promising Practices for People Who Are Homeless

H

Deborah Dennis, Yvonne Perret, Aaron Seaman, and Susan Milstrey Wells

elping people with disabilities who are homeless
gain access to the Social Security Administration’s
(SSA) benefit programs for people with physical
and/or mental disabilities—Supplemental Security
Income (SSI) and Social Security Disability Insurance
(SSDI)—is a financially sound investment in people,
in programs, and in communities. For individuals, the
immediate gains of SSI and SSDI are clear: a steady
income and health coverage. In addition, having SSI
and/or SSDI brings homeless adults a step closer to
accessing stable housing, treatment, and support
services. Using SSA’s work incentive programs,
individuals can return to or begin employment, which
may be an integral part of their recovery from serious
mental illness.
For community providers, SSI/SSDI eligibility for
individual clients, and Medicaid eligibility that results
from SSI eligibility in most States, help agencies
expand their capacity to serve people with the most
complex needs. State and local governments may
recoup money spent on general assistance to applicants,
and health care providers may receive Medicaid
reimbursement for services they provide. These are
not small incentives. In San Francisco, the County
Department of Public Health realizes a 7:1 return
on investment for assisting SSI applicants. State and
local agencies that recoup such monies then have funds
to provide services and support to
other people who are homeless.
Despite the benefits to individuals
and communities, many homeless
adults, particularly those who
are chronically homeless and
have mental illnesses or other
disabilities, do not receive SSA
disability benefits. Estimates are
that two-thirds of people who are
chronically homeless have one or
more serious health or behavioral
health problems. Many likely would
be eligible for SSA benefits. Overall,

only 11 percent of the homeless population is estimated
to receive SSI.1 There are many reasons why eligible
people who are homeless do not receive benefits; chief
among these are:
 They are unaware of SSA programs.
 They have difficulty completing the

application and are unable to get help in
applying.
 Factors related to homelessness—such as
lack of an address, not keeping in contact
with SSA, and not keeping essential records,
including records of treatment—can
complicate the application process.
 Factors related to mental illness—such
as denial of mental illness because of the
associated stigma and the effect of symptoms
on the ability to work—may inhibit individuals
or the agencies that serve them from filing a
complete application.
The process of applying for SSA disability benefits is
difficult for anyone to navigate, regardless of whether
they are homeless or housed. Nationally, the success
rate on initial application for all applicants is 37
percent.2 However, successful programs cited in this
report, serving people who are homeless, have achieved
approval rates on initial determinations, of between 65
and 95 percent.

www.prainc.com/SOAR

What Works? Key
Qualities for Success
As communities become increasingly
aware of the costs of homelessness,
they are helping people who are
homeless and who have disabilities
access SSA disability benefits.
Staff that work in mental health
and homeless assistance programs
become knowledgeable about the
application process and work closely
with the SSA and the State-level
Disability Determination Services

Recommended Citation: Dennis, D., Perret, Y., Seaman, A. & Wells, S. M. (2007). Expediting Access to SSA Disability
Benefits: Promising Practices for People Who Are Homeless. Delmar, NY: Policy Research Associates, Inc.

(DDS).3 The strategies that successful programs use
to enhance access to SSA disability benefits can be
replicated by other communities as part of their efforts
to end chronic homelessness.

Promising Practices
1. Focus on initial applications
. Become an applicant’s representative
3. Avoid the need for CEs or collaborate with
DDS to make CEs more effective
4. Work closely with health care providers
5. Reach out to medical records departments
. Establish ongoing communication with SSA
and DDS
7. Create a summary report

What does it take to make a difference? While the
specifics of their programs vary, successful SSI
initiatives have several qualities that contribute to their
success. In particular, they:






Use promising practices (see text box)
Ensure adequate staffing
Provide staff training
Collaborate with other key stakeholders
Collect and report on outcomes

 Focus on initial applications

These approaches are examined in the following pages
in an effort to help others identify strategies they may
wish to adopt or adapt for use in their own agencies or
communities.

On average, only 37 percent of initial determinations
for all applicants are favorable.4 With appeals,
this figure rises to 52 percent. The appeals process,
however, is lengthy and can take years. By focusing on
improving documentation for the initial application
submission, organizations assisting people who
are homeless are able to offer more effective and
timely service to their clients. The national average
turnaround time for initial determinations for all

Use Promising Practices
Organizations and communities have identified the
following practices as key to their success:

Success on Initial Applications in Baltimore
Starting in 1993 with a 1-year SSA demonstration grant, the Baltimore SSI Outreach Project was created in response to
the obstacles that homeless adults with mental illnesses face when applying for SSI:
 Mental illness makes navigating the complicated application process more difficult.
 Stigma surrounding mental illness affects people’s willingness to acknowledge it.
 People who lack a fixed address face extra challenges keeping and organizing paper records.

The Baltimore SSI outreach team includes two case managers (a Master’s-level clinician director and an administrative
assistant) and has an annual operating budget of $190,000. Because applying at SSA field offices was so difficult for
many homeless adults, the team was trained by SSA to complete the application on an outreach basis, notes Yvonne M.
Perret, LCSW-C, former Project Director.
The SSI Outreach Project focuses on getting approvals at the initial stage of disability determination. The project
obtains relevant information about the applicant from a large network of collaborating partners, including psychiatrists,
medical records departments, and other homeless services, mental health, and housing providers. To help DDS make an
accurate determination, the team then creates a medical summary report that is signed by a community psychiatrist or
other physician who has met with the individual. (Occasionally, the reports have been signed by a psychologist instead
of a physician.)
In addition, the project recommends presumptive disability payments, where appropriate, based on the project
clinician’s evaluation, along with a physician’s signature on a form that addresses the disability criteria. Since the project
began, 95 percent of individuals recommended for presumptive disability have been approved on initial application.
During the process of helping people apply for benefits, case management staff also provide direct assistance to
facilitate access to needed services and housing. “The project helps people get what they need to recover,” Perret says.
The Baltimore SSI Outreach Project was named a Best Practice by the National Alliance to End Homelessness in 2001
and an Exemplary Program by the Federal Substance Abuse and Mental Health Services Administration in 2005.



applicants is about 3½ months. The projects featured
here report that decisions often are made much more
quickly. The sooner a person receives benefits, the
sooner he or she receives income, accesses health
insurance, and obtains housing. When people who
are homeless receive SSI and/or SSDI, State or local
governments may be able to recover costs for general
assistance, interim health insurance provided, or
previously uncompensated health care costs.

Documenting Cognitive Impairments in Contra
Costa County, California
Virginia Luchetti, Ed.D., Clinical Director of Homeless
Services for Phoenix Programs, Inc., of Contra Costa
County, California, supervises a multidisciplinary
outreach team called HOPE (Homeless Outreach Project
to Encampments). Despite her clients’ lack of success
in being approved for SSI, she was certain that many
clients would qualify. Eighty percent of the people
served by the HOPE team have been homeless for more
than 1 year and 40 to 50 percent self-report mental
illness. To help provide objective documentation of her
clients’ difficulties, Luchetti began conducting cognitive
assessments and was surprised at what she found.

 Become an applicant’s representative One
common reason that applicants who are homeless are
denied disability benefits is that SSA and DDS cannot
reach the applicant to request more information,
such as additional medical records, or to schedule a
consultative examination. To avoid these types of
denials, a case manager can become an applicant’s
representative.5 This is an approach used by many SSI
initiatives, such as the Baltimore SSI Outreach Project
and those of Clackamas County Social Services in
Oregon, and Jewish Family Services of Atlantic and
Cape May Counties in New Jersey.

“I couldn’t believe the low level of functioning in people
who appeared to be doing fairly well,” Luchetti says.
Her testing revealed that, among other shortfalls,
“many people who are chronically homeless have an
inability to learn new information.” In addition, she
found that regardless of whether or not they have a
diagnosable mental illness, they have deficits in what
is termed “executive processing,” which includes the
ability to pay attention, sequence, make decisions,
and plan and coordinate their activities. This means
they have a difficult time managing simple tasks, such
as using public transportation, that are critical to the
ability to work. Average or above average verbal
abilities may mask these deficits.

Becoming an applicant’s representative is a simple
process that opens the channel of communication
between the case manager and SSA and DDS. The
case manager can then “stand in” for the applicant
and reply to requests for information from SSA and
DDS. The case manager receives a copy of every
written communication that SSA and DDS send to the
applicant and, if the application is denied, the case
manager has access to the applicant’s file. In addition,
SSA and DDS are much freer to discuss the progress of
an application.

Luchetti uses the Woodcock Johnson III Test of Cognitive
Abilities available from Riverside Publishing (see
www.riverpub.com/products/clinical/wj3/cognitive.
html). By sending the results of the objective tests,
along with a report that details how these impairments
relate to the person’s ability to work, directly to the
DDS examiner, “we often can avoid the need for a
consultative examination,” Luchetti notes.

To become an applicant’s representative, a case
manager must submit an SSA-1696 Appointment of
Representative form to the local SSA office where the
application is on file. This form can be downloaded from
the SSA website at www.socialsecurity.gov. An applicant
may change representatives at any time (e.g., if a case
manager serving as an applicant’s representative leaves
the agency before the case is decided).

need an additional exam to make their determination.
CEs are conducted by a physician or psychologist
under contract with DDS. Typically, the consultant
is not familiar with the applicant and may lack
information about his or her treatment history. This
can be a problem, particularly for an applicant who
is homeless and who has a mental illness. He or she
may not be symptomatic during the CE, may deny his
or her illness, or may make a special effort to present
well. If the consulting physician or psychologist does
not observe evidence of a disability, the person is more
likely to be denied.

 Avoid the need for consultative
examinations (CEs) or collaborate with DDS
to make CEs more effective
The term “consultative examination” (CE) is a
technical term for a specific type of evaluation that
DDS may request when the information submitted to
them doesn’t address the disability criteria and they



Homeless Program, to conduct CEs on site. “Homeless
individuals are more likely to participate in a CE at
the Stout Street Clinic because they are familiar with
the clinic and its staff,” notes Don Ketcham, Executive
Officer of the SSA regional office in Denver.

Conduct comprehensive evaluations to avoid the
need for a CE when possible—There are, however,
strategies for dealing with this dilemma. The first is
to avoid the DDS CE process altogether. Although
treating physicians who care for homeless adults may
be trained by DDS to conduct CEs under contract, it
is preferable to avoid the delays inherent in waiting
for DDS to order a CE. Community clinicians can
conduct comprehensive assessments and collaborate
with a physician who is willing to develop an accurate
diagnosis. This saves time and helps reduce the risk of
denial.

 Work closely with hospitals and other
health care providers
Hospitals and other health care providers, such
as physicians and community health centers, are
important allies and collaborators in any effort to
increase access to SSA disability benefits for people
who are homeless. Community providers that do
not directly provide medical services can establish
relationships within the medical community to help
develop evidence of an applicant’s disability and
incorporate the SSI/SSDI application process in
discharge planning from hospitals and other health
care facilities.

When a DDS adjudicator indicates a need for more
information concerning a client of the Freestore
Foodbank’s SSI outreach programs in Cincinnati,
Ohio, staff arrange a comprehensive evaluation
with one of several SSA-contracted providers with
whom program staff have developed good working
relationships. Clients receive a comprehensive medical
or psychological examination focused specifically
on evaluating disability. “We can schedule a
comprehensive evaluation within a week, and we pick
up our clients and take them to the appointment,”
says Robert VieBrooks, Homeless Outreach Projects
Coordinator. “The report is sent to us, and we send
it to DDS. This cuts weeks off the process and may
avoid the need for a consultative exam.” Agency staff
also transport clients to and from any consultative
exams that DDS may order. Eighty-one percent of the
program’s clients are approved for disability benefits on
initial application in an average of 60 days.

Hospitals and other health care providers also benefit
from such collaborations since SSI beneficiaries
generally receive Medicaid support that pays for health
care services otherwise not reimbursed. In addition,
once a beneficiary receives Medicaid, providers can
recoup expenses for medical care given while a person
is awaiting an SSI determination and for up to 3
calendar months prior to the month of application.6
For hospitals, receiving retroactive Medicaid may
result in their ability to recoup thousands of dollars in
uncompensated care.

Staff of the Washington State SSI Facilitation
Program conduct and pay for comprehensive
evaluations to avoid the need for a CE, whenever
possible. “We work with a cadre of practitioners
that have an awareness of what DDS needs,” says
Mark Dalton, an administrator with Washington
Department of Social and Health Services’ Belltown
Community Services Office (CSO). “Most doctors are
good at diagnosing illnesses, which is very different
than documenting how a person’s illness affects his or
her employability,” Dalton notes.

Health Care for the Homeless (HCH) providers are
particularly important partners and often offer both
health care and case management services. These
agencies have a distinct advantage because they have
an in-house capacity to develop the medical evidence
necessary to document an applicant’s disability.
Community mental health centers (CMHCs) may also
be important collaborators. Many CMHCs receive
Federal PATH (Projects for Assistance in Transition
from Homelessness) funding from their State
mental health agency to provide outreach and case
management services to people who are homeless and
have mental illnesses and/or co-occurring substance use
disorders. Health and behavioral health care providers
can help in several ways:

Work with DDS to make CEs more effective—At
the Colorado Coalition for the Homeless in Denver,
the Benefits Acquisition and Retention Team (BART)
advisory committee recognized that people who are
homeless often are “no shows” at DDS-ordered CEs.
In response, DDS—represented on the committee—
arranged for its medical providers to travel to the Stout
Street Clinic, site of the Coalition’s Health Care for the

Develop medical evidence—Developing medical
evidence for a disability determination involves more
than making a diagnosis or recording symptoms and



treatment history. The connection between the person’s
impairment and his or her inability to work must be
explicit. However, some medical providers may not be
aware of that expectation or may not feel competent
to describe their patients’ functional impairments.
Providers that routinely document functional
impairments in clinic notes may be more prepared to
do this.7 When a case manager or agency works with
the same practitioners over time, both parties learn
what the other needs to provide complete medical
evidence to DDS.

 Establish ongoing communication with
SSA and DDS
Many mental health or homeless service agencies
develop relationships with local SSA and DDS staff
to try new ideas for working with applicants who
are homeless and who have mental illnesses. As Dan
Reardon, Benefits Acquisition Retention Team
(BART) coordinator for the Colorado Coalition for the
Homeless, states, “One of the most important steps
we took was to reach out to our regional and local SSA
and DDS offices. SSA buy-in has made everything
possible.” Programs in a number of states, including
Colorado, Massachusetts, Rhode Island, and Maryland,
have collaborated with SSA and DDS to expedite the
application process in several ways. Some examples are
highlighted below:

Conduct comprehensive examinations focused
on documenting disability—As discussed above,
when a physician or psychologist knows what the DDS
disability examiner seeks in the medical evidence, he
or she can conduct an examination to assess relevant
health questions. A physician or psychologist who
can present a longitudinal picture of the applicant
and respond to these relevant DDS requirements is
a tremendous asset. Mark Dalton of Washington
State’s Belltown CSO credits that agency’s access
to practitioners that understand and address DDS
disability determination criteria as one of the keys to
the program’s success.

Dedicated staff—Local SSA and DDS offices can
dedicate specific staff to work with applicants who are
homeless. The DDS office in Boston has a specific unit
that works on determinations for applicants who are
homeless. This helps DDS staff expedite applications

DDS Takes a Lead Role in Boston
In response to barriers identified for people who are
homeless, a special unit was started in the Boston area’s
DDS office in 1985 to handle all disability determinations
for applicants who are homeless. When an application is
filed at the local SSA office for a person who is homeless,
the application is flagged and assigned directly to the
DDS homeless unit. The flagged file is dealt with promptly
by disability examiners and doctors in the unit who are
well versed on issues related to homelessness.

 Reach out to medical records
departments
The medical records department of local health care
facilities can provide necessary information about an
applicant. However, to obtain the most useful and
comprehensive information, an agency assisting an
applicant may need to be very specific about the types
of records it requires, or agency staff may need to
review, at the medical records office, the information
that is gathered to select only those records that are
relevant for a disability application.

The Boston unit uses presumptive disability whenever
appropriate, which allows applicants to begin receiving
benefits based on the presumption that they will be found
disabled once the usual process is complete. In addition,
the unit expedites consultative examinations when they
are necessary.

If agencies serving people who are homeless develop
collaborative relationships with the medical records
staff of area health care facilities, obtaining this
information can be much easier. It may be helpful to
point out to a medical records administrator that SSI
eligibility will not only benefit the individual applicant
but will likely also reduce the health care facility’s
amount of uncompensated care. The Baltimore SSI
Outreach Project offers to copy the records (with the
proper releases of information in hand) to reduce the
burden on short-staffed medical records departments.
Once established, this arrangement is often welcomed
by medical records departments.

The Massachusetts DDS also actively encourages
relationships with agencies throughout the State. The
DDS statewide homeless liaison provides trainings to
shelter staff regarding SSA disability programs and the
application process. In 2004, a DDS employee began
visiting two area shelters once a week to assist with
applications. Staff also work closely with an advisory
board made up of DDS employees, advocates, and
consumers, and they actively participate on the board’s
subcommittee on homelessness.



Cause for HOPE in Denver, Colorado
When Dan Reardon began working as a volunteer at the Colorado Coalition for the Homeless (CCH), he was the
benefits acquisition team. In 2004, when CCH received an SSA HOPE (Homeless Outreach Projects and Evaluation)
grant,8 the Benefits Acquisition and Retention Team (BART) program became a full-fledged department. Reardon was
appointed project director, and the unit is staffed with medical providers, case managers, an occupational therapist,
and a data specialist. The program has an advisory committee that includes representatives from SSA, DDS, the Office
of Hearings and Appeals (OHA), and consumers.
BART team members help clients with the application, which they complete together and submit to the local SSA office.
They also compile a complete medical evidence package, which is sent with the application. The application is flagged
and expedited by SSA and DDS. OHA also expedites hearings when an appeal is necessary. Due to relationships BART
has developed, the staff has open communication with SSA and DDS, who will contact them when further information is
needed to make a determination. This open and expedited communication process has shown great success. In Denver,
only 10 percent of homeless applicants were approved on initial application (compared to the national average of
37 percent for all applicants). When DDS dedicated a staff person to focus on applications from homeless adults, the
approval rate rose to 20 percent. Since the BART team began assisting applicants, 75 percent of initial applications
are approved, and the average processing time is only 40 days.
for people who are homeless because the staff become
expert in the complexities of such determinations.

In a summary report, the case manager or other
clinician outlines the applicant’s personal, medical, and
employment histories in a single document, relating
the diagnosis and resulting impairment to the person’s
ability to work. He or she also is able to reference the
applicant’s medical records, as well as provide thirdparty evidence such as testimony of family and friends
and the case manager’s and other clinicians’ own
observations. Whenever possible, this summary report
is co-signed by a physician or psychologist who has
seen the person. This report then is submitted to DDS
along with the rest of the application information.
Although the summary report is important regardless
of whether a physician signs it or not, without a
physician’s or psychologist’s signature, it does not
constitute medical evidence, a fact that can be crucial to the
DDS determination. Sample medical summary reports
can be found at www.prainc.com/SOAR.

Flagged applications—Some local SSA and DDS
staff “flag” applications of people who are homeless.
Flagged applications can be identified easily for
speedier determinations. In addition, flagging
applications from people who are homeless makes it
possible for SSA and DDS to report on approval rates
and processing time for this group of applicants. These
data can be used to spot important trends and make
improvements in how cases from claimants who are
homeless are handled.

 Create a summary report
In applications for SSI/SSDI, the most critical
challenge often is to understand and provide the
medical information that DDS needs to make a
disability determination. Physicians and psychologists
are trained to produce a patient’s diagnosis. However,
DDS is looking not only for the diagnosis, but also for
how the diagnosed impairment has affected and does
affect the person’s ability to work.

Ensure Adequate Staffing
Any effort to prioritize SSI outreach most likely will
involve an increase in staff or reallocation of existing
resources to accommodate the increased work demands.
However, staff can be organized in any number of
ways to be effective. Dedicated benefits specialists,
case managers, consumers, or attorneys may staff an
SSI outreach effort. For example, since helping people
with SSI applications is only one part of its overall
work, Jewish Family Services of Atlantic and Cape
May Counties in New Jersey has a dedicated benefits
specialist who helps people with the application
process and acts as the agency’s liaison with the local
SSA office. Focusing on SSA disability benefits allows

Many case managers and benefits specialists, including
those at the Baltimore SSI Outreach Project and
Jewish Family Services (JFS) of Atlantic and Cape
May Counties in New Jersey, write a medical summary
report about each applicant. Laura Rodgers of JFS
credits the use of the medical summary report with
a marked “decrease in turnaround time. We’ve also
gotten many more initial approvals.”



the specialist to develop an expertise and foster a
relationship with claims representatives (the staff who
process applications) at the local SSA office.

approval rate over the three levels (initial application,
reconsideration, and hearing), according to Jane
Gelfand, Program Director.

Other organizations have taken a different approach.
Heartland Alliance in Chicago and the Baltimore
SSI Outreach Project use a team model, where every
member of the team is trained and has a role in
assisting a person not only with SSI but with other
service needs. “Since we do a lot of outreach, it doesn’t
make sense for us to have a single person with all the
SSI knowledge,” Heidi Nelson of Heartland Alliance
points out. “Instead, every person on our team is
involved in all aspects of a client’s service provision.”

Although SSI outreach efforts may be staffed or
organized differently, there is little evidence yet
available that supports one model over another. Most
programs choose an approach that works within
their existing management and financial structure.
Regardless of how they are organized, all programs
that conduct SSI outreach recognize the importance
of having sufficient time from physicians, particularly
psychiatrists, to conduct physical and psychiatric
examinations and to help document resulting
impairments.

Positive Resource Center in San Francisco has a
Benefits Counseling Program that employs a staff of
five attorneys, two legal assistants, and one benefits
specialist who work in concert to advocate for and
assist applicants. Staff assist clients from initial
application through the hearing and appeals process,
if that becomes necessary. They help more than
700 clients a year; in 2004, they had an 85 percent

Provide Staff Training
Heidi Nelson and Ed Stellon of Heartland Alliance
in Chicago credit two things for the success of their
program: training and collaboration. Ongoing training
is crucial to the success of any effort to increase
access to SSA disability benefits. As Mark Dalton of
Belltown CSO in Washington State remarks, “You
need experienced, knowledgeable staff. Helping people
apply for SSI benefits is not easy. The individuals’
situations can be challenging and the documentation
process takes time and good detective work.” Ideally, a
supervisor or someone in the agency who is experienced
with the SSI/SSDI application process should review
the work of case managers or benefit specialists
to provide quality control for the agency’s SSI
outreach efforts and ensure, prior to submission, that
applications are complete.

Helping Peers Access Benefits in Los Angeles
When it began in Los Angeles in 1986, BACUP (Benefit
Assistance Clients Urban Projects) was one of the first such
agencies of its kind—created and staffed by current and
former mental health consumers to help their peers apply
for SSI and SSDI. “Clients choose to work with BACUP
because staff members have a personal understanding
of the application process for benefits,” says Director
Andrew Posner. Consumer case workers represent 90
percent of the agency’s staff.

Many training resources are available to community
mental health centers and homeless service agencies—
within experienced agencies, within the community at
large, and within SSA and DDS. The Federal Substance
Abuse and Mental Health Services Administration
(SAMHSA) has recently completed one such resource,
a case manager training curriculum, an accompanying
train-the-trainer curriculum, and a reference manual
as part of its Stepping Stones to Recovery series designed
to enhance access to SSI and SSDI for people who are
homeless.9

Several of the strategies that make the program
successful—BACUP has a 75 percent approval rate for
initial applications and reconsiderations—are shared
by programs with non-consumer staff, including having
a good working relationship with the local SSA field
office and with DDS. But it’s the use of consumers and
former consumers, some of whom have experienced
homelessness, that sets BACUP apart from similar SSI
outreach efforts. Though the agency does not require that
consumer staff self-disclose, when they do, “often a real
connection is made,” Posner says. In addition, consumer
staff who receive benefits while working part-time serve
as role models for clients who want to work. To be certain
that all case workers are qualified and prepared to
help applicants, staff receive training from the agency,
through their SSA HOPE grant, and from local advocacy
organizations.

An agency may have a benefits specialist or clinician
who can share his or her knowledge and experience
with others. Programs such as the Colorado Coalition
for the Homeless conduct regular in-service trainings
to keep their staff up to date. Several local and State



governments, such as the Virginia Department of
Mental Health, Mental Retardation and Substance
Abuse Services, have developed trainings or have hired
trainers to present information on SSA disability
benefits and the application process for local providers.

Training also can be extended beyond agency staff to
include other key stakeholders. For example, programs
that have relationships with health care providers can
train those providers to document impairments more
effectively. Correctional facility employees who work
with pre-release programs also can benefit, as can local
and State agency administrators.

As the people involved in making disability
determinations, SSA and DDS staff offer a wealth
of information. They can provide training on
the many intricacies of the disability application
process, including how to fill out and file the various
application forms, document income and resources,
and navigate the appeals process. Most important,
they can provide information on exactly what they
need when making determinations. The Community
Partnership for Southern Arizona (CPSA) invited two
professional relations officers from the Arizona DDS
to provide trainings throughout the State. Barbara
Montrose, the CPSA Housing and Homelessness
Specialist, credits them with “demystifying and
simplifying the process. They answered questions,
dispelled some of the common myths about
determinations, and even gave out their contact
information so that people could ask questions later.”
The assistance, she says, has been invaluable.

Collaborate with Other Key
Stakeholders
Collaboration is critical to any successful effort to
increase access to SSA disability benefits. The process
of applying for, receiving, and maintaining SSI benefits
is one that involves many different organizations and
people within a community. It makes sense that the
process can be improved by facilitating communication
and cooperation among those key stakeholders.
Regardless of a program’s role in the process—service
provider, hospital, correctional facility, State mental
health office, etc.—a collaborative perspective is needed
to create a strong, community-wide outreach initiative.
Collaborative efforts with health care providers and
with SSA and DDS were cited earlier. Additional
avenues for collaboration include the following:

Collaborating to Train Providers in Virginia

The Criminal Justice System

Led by Michael Shank and Sarah Paige Fuller of the
PATH program in the Virginia Department of Mental
Health, Mental Retardation and Substance Abuse
Services (DMHMRSAS), the State is working to improve
access to SSA disability benefits for people who are
homeless and who have mental illnesses. Beginning in
2003, the Department provided statewide training for
mental health and homeless service providers. Yvonne
Perret, former Director of the Baltimore SSI Outreach
Project and developer of SAMHSA’s Stepping Stones to
Recovery training curriculum, conducted four regional
trainings on the application process and strategies for
creating more effective applications.

Departments of Corrections and criminal justice
agencies are important collaborative partners.
Connecting people who have been incarcerated to
services, including SSA disability benefits, can reduce
recidivism and prevent homelessness. This, in turn, can
help prisons or jails reduce costs. Collaborations with
the criminal justice system often focus on providing
pre-release services.
Pre-release programs—While people who are
incarcerated typically wait to apply for benefits until
they are released from prison or jail, they can file an
application for SSI benefits 30 days prior to release.
Documenting the applicant’s disability can start
much earlier so that a complete application can be
filed as soon as possible. Programs such as Oregon’s
Joint Access to Benefits (JAB) and Legal Action in
Wisconsin have developed successful programs with
several correctional facilities to prepare applications for
individuals prior to their release. Such arrangements
are often sanctioned and welcomed by SSA, which has
a process for setting up pre-release agreements with
such programs. These agreements are crucial because,
as Liv Jenssen, Program Manager for the Transition
Services Unit in the Multnomah County (OR)

Following these trainings, DMHMRSAS worked with
the Virginia Department of Rehabilitative Services to
produce a series of four additional trainings, which
brought together experts from the State, including
representatives from SSA and DDS. Since the trainings,
attendees have reported an increased level of
involvement with SSI, more comfort working with clients
on applications, and a greater knowledge of the
intricacies of the application process.



Pre-Release Outreach in Multnomah County, Oregon
Joint Access to Benefits (JAB) was started to initiate the SSA disability application process for individuals who are
being released from incarceration in Multnomah County, Oregon, or who have been released and are homeless. JAB
is a collaborative project among the Multnomah County Department of Community Justice’s Transition Services Unit,
the State of Oregon Departments of Corrections and Human Services, the Multnomah County Sheriff’s Office, the
Multnomah County Department of Human Services, and the SSA district office.
Much of JAB’s work is done inside correctional facilities. To ensure a complete application, the application development
process is begun 4 months prior to release (though the application itself can be submitted no more than 30 days before
the individual is expected to be released). The JAB staff works with corrections counselors inside the correctional
facilities to complete the application by phone. The application is then flagged as a JAB file and expedited through the
process so that the applicant can begin receiving benefits as soon as he or she is released. To facilitate this process, JAB
has developed relationships with the county, SSA, and DDS staff.
in Washington has managed a highly successful SSI
outreach effort for more than 15 years. The DSHS has
been able to facilitate the development of a complex
network of social workers, clinics, outreach teams,
physicians, lawyers, SSA claims representatives,
DDS disability examiners, and other key people. All
these groups work together with the Belltown CSO to
increase access to SSA disability benefits for individuals
who are eligible to receive them.

Department of Community Justice, states, “If clients
are unable to receive benefits within a reasonable time
frame, they are left with few options and many return
to jail or prison, or their chronic homelessness and
disabling condition worsens.”
Agencies can help reduce the chances that a person
will become homeless on release by working with staff,
benefits specialists, physicians and psychologists, and
social workers within the correctional facility to screen
for people who are eligible to receive SSA benefits and
to help them with the application process. For those
individuals who have been receiving SSI prior to their
incarceration, SSA policy specifies that SSA field
offices should suspend, but not terminate, eligibility
status for SSI recipients incarcerated for less than 12
consecutive months.10

Create an internal program—While some programs
have been developed through external partnerships,
others have found success working from within.
Clackamas County, just south of Portland, Oregon, for
example, was awarded one of 41 SSA HOPE grants in
2004 to help people access SSI benefits more effectively.
The County Social Services agency has designed its own
SSI HOPE Project unit that works directly with people
on their SSI applications, guiding them through the
process.

Local and State Governments
Government, whether local or State, can play a
role in creating a successful SSI outreach initiative.
Many effective programs either originate within a
government agency or are able to attract the support
of government officials. Governments can help develop
the infrastructure, intervene to reduce complexity
wherever possible, and foster the support to begin
and sustain efforts to increase access to SSA disability
benefits. This can involve several strategies:

Collect and Report on Outcomes
One barrier to starting an SSI outreach effort is
convincing key stakeholders within an agency, as well
as in the larger community, that such an effort is worth
the resources necessary to make it happen. As noted
earlier, when people who are homeless receive SSI
and/or SSDI, State or local governments may be able
to recover costs for general assistance or interim health
insurance provided. Health care providers also benefit
since SSI beneficiaries generally receive Medicaid
support that pays for health care services otherwise
not reimbursed. Also, individuals with a regular source
of income are able to contribute toward their housing
costs. Seen in this light, even benefits that accrue to the

Create partnership opportunities—Many
successful SSI initiatives have been developed through
partnerships between government and community
agencies, including those in Washington State;
Savannah and Atlanta, Georgia; Franklin County,
Ohio; and Broward County, Florida. For example, the
Belltown Community Services Office (CSO) of the
Department of Social and Health Services (DSHS)



individual, such as having regular income and health
insurance, benefit the community as a whole.

Department of Public Health, whose calculations have
led to increased funding for her programs.

Providing data of past successes and cost savings
to stakeholders is one way to convince them of a
program’s potential value. As defined by researchers
and health economists, a true cost-benefit analysis,
which is often conducted from the perspective
of society at large, can be complex, costly, and
time-consuming. However, showing a return on
investment for SSI outreach from the point of view
of the stakeholder that funds these efforts (often a
government entity) can be far simpler. In particular,
recovery of past benefit payments and future cost
savings may be fairly straightforward to calculate. And
the question they answer is clear-cut as well: Are SSI
outreach activities worth supporting?

Future cost savings are more speculative and involve
determining how much would be spent on individuals
who are eligible for other assistance if they do not
receive SSI. Los Angeles County estimates cost savings
conservatively by using a proxy measure—the annual
cost to the county of maintaining a person who is not
receiving SSI on general relief. Staff determine this
cost for 1 year by multiplying the maximum general
relief benefit of $221 by 12 months by the number of
people approved for SSI. For State fiscal year 20042005, this figure amounted to $17 million for 6,500
people. However, according to Judith Lillard, Program
Director of General Relief and the Cash Assistance
Program for Immigrants (CAPI) in the Los Angeles
County Department of Public Social Services, the
single-year figure may be just a drop in the bucket. “If
an individual gets SSI, we may have prevented 10 to 20
years of general relief. This is a tremendous benefit to
the county and to the individual.”

For example, in San Francisco, the Department of
Public Health compiled data on recovery of past
benefit payments realized through SSI outreach
activities. Staff were able to show a nearly 7:1 return
on investment for the first year of an SSI pilot (i.e.,
approximately $7 was reclaimed for every $1 spent;
see the related case study for further details). They
arrived at this figure by determining how much they
recovered in retroactive SSI-linked Medicaid billing
and general assistance for individuals approved for
SSI and dividing this figure by the cost of providing
SSI outreach services. Although future income
projections are useful to know, these figures represent
“cold, hard cash,” notes Maria X. Martinez, Deputy
Director of Community Programs at the San Francisco

The case can also be made that a community avoids
other public costs after an individual becomes eligible
for SSI. For example, a person who receives SSI and
achieves a measure of residential and psychiatric
stability may spend less time in hospitals or jails or
have less uncompensated hospital or mental health
care. To reflect changes in service use related to receipt
of SSI, programs would have to track changed use
of public services for people who receive SSI, changed
costs resulting from the changed use, and savings

Using Data to Make the Case in San Francisco
Maria X. Martinez, Deputy Director of Community Programs at the San Francisco Department of Public Health,
compiled impressive figures on how much the City and County of San Francisco could save in the future for every
individual who was approved for SSI and Medi-Cal (California’s Medicaid program). Her prospective analysis revealed
that the county would be able to recoup $5,700 for each individual who was approved for Medi-Cal or approximately
$20 million a year for 3,500 uninsured mental health clients who are severely disabled. Individuals who have applied
for but not yet received SSI are eligible for another $7 million in cash assistance, bringing the total anticipated savings
to the City and County of San Francisco to $27 million a year.
But even Martinez was surprised when she conducted a retroactive analysis to calculate how much SSI-linked Medi-Cal
and general assistance revenue the county recovered. Her calculations revealed that the county Department of Public
Health recovered nearly $1.4 million in SSI-linked Medi-Cal billing alone for 63 clients whose health care had been
paid for by the county during the months, and sometimes years, since the SSI and Medi-Cal award effective dates. The
county paid $200,000 to a contractor, Positive Resource Center, to help individuals apply for SSI benefits. Therefore,
the department’s return on investment was nearly 7 to 1. Adding in general assistance recovered (and subtracting that
portion of the recovered fees paid to the contractor) yields a still impressive return of 6.7 to 1 for the City and County
of San Francisco. “This is cold, hard cash,” Martinez notes, adding that these have been powerful figures when trying to
convince key stakeholders of the need for SSI outreach.

10

Recouping State Funds to Pay for SSI Outreach in Washington
The Washington State SSI Facilitation Program began in 1989 as a pilot project to help the State recoup general
assistance (GA) funds. GA recipients apply for SSI benefits with the help of a social worker from the Department of
Social and Health Services’ (DSHS) Belltown Community Services Office (CSO). Through an agreement between the
State and Federal government, the State recoups from SSA the cost of GA payments to the applicant from the date of
SSI application to the date of eligibility. SSA deducts this amount from the retroactive payment to the recipient. These
GA recipients also become eligible for expedited Medicaid benefits. The social worker accompanies applicants through
the process, including appeals when necessary.
DSHS has developed relationships with physicians and psychologists to conduct medical or psychiatric evaluations and
with lawyers who have specialized knowledge of the appeals process and who are willing to represent applicants
at the hearing level. More than 15 years later, the program is going strong. As Mark Dalton of the Belltown CSO
describes it, “This is big business in Washington State. Our SSI Facilitation program collects over $20 million a year in
reimbursements statewide, which, in turn, helps support our program.
(whether individuals who receive SSI cost the same or
less than their pre-SSI use of services).11

a reduction in time from application to receipt of
benefits—can reveal how successful SSI outreach
efforts can be.

This is the most complex analysis, and there are a
number of challenges to conducting it successfully.
However, as part of preparing 10-year plans to end
homelessness, many communities around the country
are using simpler but equally illustrative calculations
to show what it costs to serve people who are homeless
in expensive systems of care; it is reasonable to assume
that if these individuals had benefits, they would have
greater access to more appropriate and less expensive
services.

Conclusion

Some communities compare the costs of homelessness
to the costs of providing services, such as supportive
housing. For example, planners in Raleigh, North
Carolina, estimated that it costs $5,875 a month to
serve a single homeless man with untreated mental
illness who uses the local shelter, emergency room, and
psychiatric hospital. This compares to $33.43 per day,
or just over $1,000 a month, for supportive housing.
San Diego’s Serial Inebriate Program, which provides
treatment in lieu of custody for individuals who are
repeatedly intoxicated in public, calculated a cost of
$997 for maintaining one individual in housing plus
outpatient substance abuse treatment for 1 month.
This compares to $1,470 for the cost of one police
contact with an ambulance visit to the emergency room
followed by a day in jail.
These types of data can help make an already good
argument that much stronger for supporting programs
that assist homeless people. Even simple outcome
measures—such as an increase in the number of
SSI/SSDI applications for people who are homeless,
an increase in approvals on initial submission, and

SSA disability benefits are powerful tools in the
struggle to end chronic homelessness for people with
disabilities. Organizations around the country are
recognizing this and creating opportunities to help
people access these benefits. Although SSI outreach
efforts may use different strategies to accomplish the
same goals, a common denominator among them is the
ability to see beyond the current methods and try new
ideas. These range from completing applications on
outreach, to providing comprehensive evaluations, to
using peers to help homeless people apply for benefits.
By sharing what they have learned and encouraging
others to use their promising practices, these programs
help increase access to SSA disability benefits, reduce
chronic homelessness, and realize cost savings for State
and local governments.

Contact Us
If you have an SSI outreach program or promising
practice that you would like to share with others, please
contact Deborah Dennis at Policy Research Associates, Inc.,
[email protected].
To be added to the SOAR Listserv to receive information
about innovative approaches to SSI outreach for people
who are homeless, send an e-mail to [email protected].

11

For More Information
BACUP, Los Angeles
Andrew Posner
[email protected]

Joint Access to Benefits
Liv Else Jenssen
[email protected]

Citywide SSI Advocacy Workgroup of San Francisco
Maria X. Martinez
[email protected]

LA County Department of Public Social Services
Judith Lillard
[email protected]

Clackamas County Social Services
Sarah Briggs
[email protected]

Legal Action of Wisconsin
Karen Roehl
[email protected]

Colorado Coalition for the Homeless
Dan Reardon, JD
[email protected]

Maryland SSI Outreach Project
Yvonne Perret, MA, MSW, LCSW-C
Advocacy and Training Center
[email protected]

Community Partnership of Southern Arizona
Barbara Montrose
[email protected]

Phoenix Programs, Inc., of Concord, CA
Virginia Luchetti
[email protected]

Disability Determination Services, Boston
Clare Deucher
[email protected]

Stepping Stones to Recovery curriculum
Deborah Dennis
Policy Research Associates, Inc.
[email protected]

Freestore Foodbank of Cincinnati, OH
Robert VieBrooks
[email protected]

www.prainc.com/SOAR

Heartland Alliance
Ed Stellon
[email protected]

Virginia DMHMRSAS
SarahPaige Fuller, MSW
[email protected]

Jewish Family Services of Atlantic and Cape May Counties
Laura Rodgers, LCSW
[email protected]

Washington State SSI Facilitation Program
Mark Dalton, DSHS Belltown Office
[email protected]

Endnotes

1. Rosen, J., Hoey, R., & Steed, T. (2001). Food stamp and SSI benefits: Removing access barriers for homeless people. Journal of Poverty Law
and Policy, March-April 2001, 679-696.

2. Given the unique barriers that homeless claimants encounter, it is not surprising that their approval rates are lower than this figure, according
to comparative studies conducted by the Disability Determination Services (DDS) in some jurisdictions (e.g., Boston). Unless SSA or DDS flag
applications from people who are homeless, SSA does not differentiate between those who are homeless and those who are housed.

3. The Disability Determination Services (DDS) is a State office that contracts with SSA to make the medical determination on disability. The
office or unit is typically an organizational component of a larger State agency. For more information about DDS, see the section on Establish
Communication with SSA and DDS.

4. U.S. General Accounting Office. (July 2004). Social Security Administration: More Effort Needed to Assess Consistency of Disability Decisions.
GAO-04-656. Washington, DC: Author.

5. A representative is not the same as a representative payee. A representative assists an applicant in applying for benefits but has no role in
managing the applicant’s financial matters. A representative payee manages the SSI/SSDI income of a person who has become eligible for such
benefits. For more information, see www.ssa.gov/representation.
6. This is true unless this provision of the Medicaid statute has been set aside by a waiver requested by and granted to the State in which the
applicant resides. 42 USC § 1396a(a)(34).

7. O’Connell, J.J., Quick, P.D., Zevin, B.D., & Post, P.A. (Ed.). (2004). Documenting disability: Simple strategies for medical providers. Nashville, TN:
HCH Clinicians’ Network, National Health Care for the Homeless Council. www.nhchc.org/DocumentingDisability.pdf

8. See www.socialsecurity.gov/homelessness/outreach

9. See www.prainc.com/SOAR/tools/manual.asp to download a copy of the reference manual. For information about bringing a Stepping
Stones to Recovery training program to your area, contact Deborah Dennis at Policy Research Associates, Inc., [email protected]

10. The Bazelon Center for Mental Health Law. (2001). Finding the Key to Successful Transition from Jail to Community. www.bazelon.org/issues/
criminalization/findingthekey.html

11. For a discussion of preparing a cost avoidance study, see Burt, M. (2004). The do-it-yourself cost-study guide. New York: Corporation for
Supportive Housing. A copy can be downloaded from www.csh.org

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