The Social Security Administration (SSA) focuses on a specific segment of the homeless population: people with serious physical and mental impairments. SSAs mission has always been to provide income support, initially to retired workers and their families and later also to workers with disabilities and their dependents. Most homeless people served by SSA receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). When SSDI was established in 1956, policymakers expected that individuals who became disabled enough to qualify for benefits would not return to the labor force unless their medical condition significantly improved. Indeed, eligibility for SSDI and SSI has always been contingent on the inability of the applicant to work at any job in the national economy. Disability determination is binary; an applicant is found either disabled or not disabled. As a result, SSA did not initially have a work-support strategy. A strategy modification has gradually evolved during the last 30 years, allowing beneficiaries to earn a limited amount through employment or, on a trial basis, to earn more. Employment-related assistance is offered to all beneficiaries. Earning more than the allowed amount, however, results in termination of benefits, and this has created widespread fear of attempting any work.
SSDI provides monthly benefits to qualifying adults with a significant work history. SSDI benefits vary based on the amount of time worked and the money earned from employment. Using the same disability standard, SSI is the disability benefit program for low-income people who have never worked, have an insufficient work history to qualify for SSDI, or would receive less in SSDI than the maximum SSI cash grant. Individuals who are disabled are only eligible for SSI if they meet federal income and asset guidelines. Benefits are currently capped at $623 per month for an individual and $934 per month for a couple. An individual who has been found disabled and eligible for SSDI or SSI will continue to receive benefits as long as SSAs disability standard is met and the individual does not receive more earnings than program rules allow.
SSA Programs and Homelessness
SSDI and SSI benefits are important both as income supports and as gateways to the receipt of other supports. SSDI receipt provides eligibility for Medicare after a waiting period, and in most states SSI recipients are immediately eligible for Medicaid. Medicare and Medicaid permit homeless persons to obtain primary and specialty health care as well as prescription drug coverage. These services can help to stabilize people with mental health disorders, and provide proper therapy and other treatment for people with physical disabilities. This care may help people return to work.
A major anti-poverty program targeted to disabled individuals and their families, SSI has been credited with lifting 2.4 million people out of poverty in 2003 (Sweeney & Fremstad, 2005). SSI recipients include many current and formerly homeless people. The National Survey of Homeless Assistance Providers and Clients (NSHAPC) found that 8 percent of homeless people surveyed were receiving SSDI, and 11 percent were receiving SSI.
Receipt of SSI or SSDI can be an important protective factor, preventing people with disabilities from becoming homeless, and may partly explain the finding that homeless people do not have higher rates of disability than other poor people (U.S. Department of Housing and Urban Development, 2007a). Furthermore, both SSDI and SSI are important sources of income for people who move from homelessness into permanent housing. Among formerly homeless people, NSHAPC found that 29 percent received SSI (Burt, Aron, & Lee, 1999).
Barriers to Receiving SSA Income Supports
A recent report found that many homeless persons who are eligible for disability benefits do not receive them. In 2000, the General Accounting Office (GAO, now the Government Accountability Office) estimated that 39 percent of homeless persons reported mental health problems and 46 percent of homeless persons had chronic physical disabilities, far more than the 11 percent receiving SSI. While not all persons with disabilities are eligible for SSDI or SSI, these disparities suggest that at least some eligible individuals who are homeless are not receiving benefits (GAO, 2000). One cause of this gap is a 1997 change in SSI eligibility criteria that prevents receipt of benefits by individuals whose drug or alcohol addiction is a contributing factor material to the determination of disability (Employees Benefits, 2006). A 1999 survey revealed that homeless people losing benefits under the 1997 eligibility changes were more likely than other homeless persons to lose access to both housing and substance abuse treatment services (National Health Care for the Homeless Council and the National Law Center on Homelessness and Poverty, 1999).
Another reason that many homeless individuals are unable to access disability benefits is that, at the beginning of the application process, they may have difficulty verifying identity or immigration status, because they do not have copies of the necessary documentation. Similarly, homeless persons are often unable to provide documentation of their work history or past medical treatment. Once an application is filed, homeless people are often without a mailing address to receive important communications such as decisions or hearing notices. As a result, their cases can be closed on procedural grounds (Rosen, Hoey, & Steed, 2001).
In recent years, federal agencies have begun programs designed to help homeless persons obtain SSDI and SSI benefits. In 2004, Congress gave SSA funding to operate the Homeless Outreach Projects and Evaluation (HOPE) demonstration grant programs. Each HOPE grantee developed a collaborative relationship with its local SSA office to facilitate the claims of homeless clients. A year later, the Substance Abuse and Mental Health Services Administration (SAMHSA) began its SSI/SSDI Outreach, Access and Recovery (SOAR) technical assistance. The SOAR program provides state agency officials and service provider staff within SOAR states with training and technical assistance designed to improve the work of case managers or other program staff who are handling SSI/SSDI claims on behalf of homeless persons. Both the HOPE and SOAR programs appear to be adopting good practices, but neither initiative has yet been evaluated. However, some preliminary SOAR program data can be discussed.
As of November 2006, eight states had reported outcomes from the SOAR training. Prior to SOAR, only 1015 percent of the homeless SSDI/SSI applicants being assisted by participating agencies were awarded benefits on their initial application. After SOAR, the percentage of successful initial applications increased dramatically. For example, service providers in Montana and the city of Nashville reported 100 percent success rates, while service providers in New York reported a 96 percent success rate. Several other participating states had success rates ranging from 64 percent to 91 percent. In Oklahoma, the success rate lagged at 33 percent, although this was still a notable improvement over prior performance. In addition to higher success rates, the states that documented case processing times all reported significant reductions. In Oregon, cases were approved in an average of 4.5 months, versus 8 months prior to training. In Oklahoma, approval took an average of 80 days, versus 120 days before the training (Policy Research Associates, Inc., 2006).
Rosenheck and colleagues (2000) evaluated outcomes among homeless, mentally ill veterans who applied for SSDI or SSI through a special outreach program. Veterans who were awarded benefits were compared with those who were denied benefits. Beneficiaries were more willing to delay gratification, as reflected in scores on a time preference measure. Three months after the initial decision, beneficiaries had significantly higher total incomes and reported a higher quality of life. They spent more on housing, food, clothing, transportation, and tobacco products, but not on alcohol or illegal drugs. The authors concluded that receipt of disability payments is associated with improved quality of life and is not associated with increased alcohol or drug use.
SSA Employment Supports
Once disabled people begin receiving SSI or SSDI, the probability of their becoming employed is greatly reduced (Rosenheck et al., 2006; Resnick et al., 2003). The work disincentives of SSI and SSDI are well documented (Stapleton & Burkhauser, 2003). There also is widespread fear among recipients of both SSI and SSDI that, by becoming employed and earning too much money, they risk losing eligibility for continued benefits, including health insurance. In addition, severely disabled individuals face substantial barriers to employment.
A number of studies have shown, however, that disabled people who are homeless and receive vocational services can achieve promising employment outcomes (Shaheen, Williams, & Dennis, 2003; Zlotnick, Robertson, & Tam, 2002; Picket-Schenk et al., 2002; Cook et al., 2001; Quimby, Drake, & Becker, 2001; Rog et al., 1999; Becker et al., 1999; Trutko et al., 1998). The best research evidence on the effectiveness of employment services for SSI and SSDI recipients comes from Project NetWork, which was evaluated using a rigorous random assignment research design (Kornfeld et al., 1999). SSA implemented NetWork, beginning in 1991, to provide rehabilitation and employment services to SSI and SSDI applicants and recipients. Four program models were tested in eight sites around the country. NetWork significantly increased the earnings of both SSI and SSDI recipients, but these impacts declined in magnitude over time. The least intensive intervention tested the referral manager model also appeared to be the least effective in improving earnings and other outcomes. The evaluation did not isolate the impacts of NetWork on sample members who had experienced homelessness.
SSAs Ticket to Work (TTW) program has sought to make a wider range of employment and training services accessible to beneficiaries. TTW gives eligible beneficiaries tickets that may be used to obtain employment-related services from participating providers. The eligible providers are called Employment Networks (ENs). Beneficiaries may choose to work with any approved EN from a range of service providers in public and private sectors. The most common providers are state vocational rehabilitation agencies. The TTW Program is designed to provide the specific services needed to meet a beneficiarys employment goals and ultimately move him or her off disability insurance. The maximum allowable payment to an EN for a SSDI beneficiary is approximately $20,000.
In addition, the Ticket to Work legislation improved work incentives in several respects, most notably by allowing people who work to maintain Medicare and/or Medicaid coverage even as their income rises. The legislation also funded counselors to provide reliable information to beneficiaries about pertinent SSA rules and opportunities. Finally, people who lose benefits altogether due to significant work can get those benefits reinstated in an expedited manner if their disability returns and they must reduce or stop their work activity as a result.
A large-scale, rigorous evaluation of TTW is currently underway (Thornton et al., 2004). The evaluations most important interim finding is that the participation rates of SSI and SSDI beneficiaries in the Ticket program are extremely low. The cause of low participation is said to be the TTW payment system. ENs are paid for services they provide in two ways. One, the outcome payment system, provides higher payments, but only when a beneficiary leaves the rolls due to earnings. The other option provides smaller outcome payments, but allows up to four milestone payments for services while the beneficiary is still on the rolls. Recently proposed changes in the EN payment system allow for higher milestone payments.