It sometimes takes a lawyer to move a chronically homeless persons SSI application through to approval. Advocacy organizations such as Health and Disability Advocates (HDA) in Chicago take on the more complicated SSI application cases, often involving appeals and hearings. Even organizations that routinely help clients with their initial application for SSI often do not do appeals. These organizations may send clients needing to appeal an SSA decision to a legal aid organization with resources to support staff that help people who need to appeal. HDA, for instance, has a private three-year foundation grant that supports an experienced lawyer and a social worker devoted completely to SSI applications. The project has about 100 cases open at any given time. Some organizations using the SOAR approach refer persons who need to file an appeal to legal services. Other SOAR providers are increasingly filing requests for reconsiderations and hearings on their own. They use the same techniques they have used for initial applications, and they are experiencing considerable success. In 2011, 33 states reported that their SOAR case managers were working on appeals. SOAR case managers had filed nearly 2,000 appeals as of June 2011 with a 66 percent approval rate in an average of 159 days.11
HDA staff recommend that health care organizations try to ensure that clients have already taken some steps toward collecting information and, if possible, have filed an initial application before they are referred. Ninety-five percent of the people HDA sees have tried to apply for SSI or had received it at one time and fell off the rolls for one reason or other. The first thing the project staff do is to get a release from the client (SSA-3288) to get all information on past claims or benefits from SSA. They also get an earnings record from electronic sources. Often this search yields enough evidence of disability to proceed directly to filing for reinstatement and back benefits or to making an initial application. It takes staff 1.5 hours to complete the paperwork once the information is in hand. HDA's efforts are supported by an extremely cooperative employee in one SSA office, who provides the SSA history information immediately in response to an SSA-3288 and also lets HDA project staff fill out the application with the client and then bring it in, if the client is unwilling or unable to go to the office.
If the case is clear-cut--say a clear history of mental illness treatment and related impairment, no substance abuse, and a long history of homelessness--project staff file for presumptive eligibility and often get it. This success results from a special arrangement that project staff have with SSA. There is some talk of having one staff person in each local SSA office in Chicago designated as the eligibility technician who handles all applications from homeless people, but this is not yet a reality. HDA staff feel they could succeed with many more presumptive eligibility filings if there were trained partners in each SSA office.
However, of the 100 cases open at a time, only 12-20 a year are of the type that can lead to a presumptive eligibility determination. If initial search procedures have not yielded anyevidence of disabling conditions in medical records, project staff get staff from caregivingorganizations to document conditions and related functional impairments, interview family members about severe cognitive impairments and other conditions, and also pay for new assessments to obtain specific test results. Project staff help clients to apply for Medicaid even before their SSI application goes in, so they will be insured immediately once they get SSI. (In Illinois, qualifying for SSI does not automatically lead to Medicaid enrollment; a separate application is needed even though SSI beneficiaries are categorically eligible.) They also help clients with transportation, linkages to needed services, and similar activities, all of which takes time. While staff are usually quite successful at achieving approvals, the number of people they can serve (100 a year) is very small in relation to the number of chronically homeless people in Chicago who need this level of support to qualify for SSI.