Establishing Eligibility for SSI for Chronically Homeless People. 3. Approaches to Increasing the Success of Supplemental Security Income Applications


Agencies that serve chronically homeless people might be able to cover many of their health-related costs if their clients were on Medicaid, so one would expect them to routinely help clients qualify for SSI. However, quite a few agencies serving homeless people, including major health care providers such as hospitals, do not mount active campaigns to help them obtain disability benefits. From what we learned during site visits for this study to the Boston, Chicago, and San Francisco Bay areas, the reasons differ by setting.

  • Primary care settings. Most health care environments such as clinics and hospitals do not help homeless patients apply for SSI. The application process is complicated, lengthy, and, in their experience, prone to failure. Even though most such agencies are Medicaid providers and it would ultimately be in their financial interest to obtain Medicaid reimbursement for the care they give homeless patients, they will not, or cannot, spend the staff resources needed to support SSI applications. In part, the availability of federal and state funds to pay for services reduces the incentive for providers to assist with SSI applications. This may change over time with the implementation of ACA.

  • PSH providers. Many PSH providers are not Medicaid providers themselves and are not partnering with any Medicaid provider. They have decided against trying to become Medicaid providers, wanting to avoid lengthy turnaround times for reimbursement and the risk of having charges disallowed. These PSH providers do not have the expertise to help tenants develop SSI applications that are likely to be successful, nor do they have access to the medical records that could help them do so.

Instead of making SSI applications part of their own missions, many health care and PSH providers rely on legal advocacy organizations to assist people with SSI applications. In some communities (e.g., San Francisco) nearly all of the SSI application support work is done by the staff of legal advocacy organizations. Even where homeless service-providers have received training and help their clients with SSI applications (e.g., Heartland Health Outreach (HHO) in Chicago) they usually turn to legal advocacy organizations to take on the more complicated cases.

In this section, we discuss three broad strategies for increasing the success of SSI applications: case worker training (including development of specialized staff roles), legal advocacy, and system changes. These strategies are not at all mutually exclusive. Communities intent on improving success rates for SSI applications often do several at once as well as sequentially. But each could be used without the others, so we discuss them here separately.

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