Baumohl, J., J.A. Swartz, and R.D. Muck (eds.). 2003. The multi-site study of the termination of Supplemental Security Income benefits for drug addicts and alcoholics. Contemporary Drug Problems , 30(1-2): 1-537.
SSI is extremely important for chronically homeless people now and will continue to be so even after the vast majority of chronically and other homeless people become eligible for Medicaid in 2014. SSI provides income that lets people contribute to rent, thereby greatly increasing the odds that they will become stably housed.
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 applica
We noted above that, for facilitating application review, it is better to have formal agency commitments to cooperation, rather than just personal relationships between case workers and eligibility technicians, although such relationships can be helpful as well. Not only will formal commitments survive staffing changes, but agencies that have form
Establishing Eligibility for SSI for Chronically Homeless People. 3.1. Case Worker Training and Specialization
Staff of homeless assistance agencies who work with chronically homeless people are often expected to help them apply for SSI. Without special training, such staff may be only slightly more successful than homeless people themselves in completing an application that SSA will approve on initial submission. Case workers need to know precisely wha
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 campaign
Establishing Eligibility for SSI for Chronically Homeless People. 2.3. Substance Use and "Material Contribution"
Disabling conditions wholly or partly attributable to drug addiction and alcoholism (DA&A, in SSA terminology) have been controversial since Congress established the SSI program in 1972. Over the more than two decades--from program inception to the end of benefits on January 1, 1997 for people whose substance use was material to their disa
Establishing Eligibility for SSI for Chronically Homeless People. 2.2. Adequacy of Existing Information
Even if successfully retrieved and assembled, existing documentation may not provide the information needed. Basic problems include: Doctors do not know what information SSA needs to see in order to make a determination of disability and approve an application. Doctors do not habitually focus on the impact of a patients condition(s) o
Establishing Eligibility for SSI for Chronically Homeless People. 2.1. Accessing Existing Information
SSA requires that the documentation to establish diagnosis, duration, and disability come from acceptable medical sources, which are usually charts or records made by doctors or letters from doctors detailing the contents of those charts and records. If such evidence is not readily available--and it usually is not to chronically homeless people ac
Establishing Eligibility for SSI for Chronically Homeless People. 2. the Challenge of Establishing Supplemental Security Income
To qualify for SSI on the basis of disability, one must be able to document a diagnosis that fits into one of SSAs medical listings of impairments. Further, a person must have had the condition associated with the diagnosis for at least a year or be anticipated to have it for at least a year ( duration ). In addition, the condition must meet S
Homeless people have two compelling reasons to seek enrollment in Supplemental Security Income (SSI): (1) obtaining a reliable income source that will help them afford housing; and (2) increasing their access to appropriate health care through "categorical" eligibility for Medicaid for people who participate in SSI. 1 Housing and health care pr
Establishing Eligibility for SSI for Chronically Homeless People. Second Phase: Case Studies of New Strategies
The second phase of this study involves case studies of six communities that are on their way toward early implementation of the ACAs Medicaid provisions or other Medicaid-related policies and practices designed to deliver care to chronically homeless people. The study will follow the six communities through fall 2012, watching as they design an
Establishing Eligibility for SSI for Chronically Homeless People. The Study's First Phase: Literature Synthesis, Environmental Scan, and Site Visits
The chronically homeless people on whom this study focuses have multiple, complex, and interacting physical and behavioral health conditions. Achieving the best results for these clients and the public institutions and systems from which they get care requires effective engagement, service delivery, and care coordination. To understand how this ca
In 2014, most homeless people will become Medicaid-eligible under the Affordable Care Act (ACA) of 2010 based on their low incomes. Many homeless people have complex physical and behavioral health conditions for which they seek care through frequent use of emergency rooms and inpatient hospitalization, at considerable cost in public resources.
This Issue Paper describes innovative approaches to establishing SSI eligibility. [33 PDF pages]
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. Notes
Some homeless persons with a qualifying mental illness may not be enrolled in Medicaid but they are likely to be eligible for Medicaid enrollment. Providers of services in PSH can usually assist these people to establish eligibility for Medicaid benefits, so our description of these three groups assumes that these people will be included in G
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. References
Buchanan, D.R., K. Romina, L.S. Sadowski, and D. Garcia. 2009. The health impact of supportive housing for HIV positive homeless patients: A randomized controlled trial. American Journal of Public Health , 99:6. Burt, M.R. 2009. Widening Effects of the Corporation for Supportive Housings System-Change Efforts in Los Angeles, 2005-2008: Hilt
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. 7. Segue to the Remaining Papers
This paper provides an overview of the types of chronically homeless people who may benefit from PSH and the types of care they are likely to need and receive while PSH tenants. It has not delved deeply into the details of Medicaid reimbursement for covered services, nor has it focused at all on the strategies that have been developed to facilitat
Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness. 6.2. Service Structures and Agencies Uniquely Focused on People in Group 3
Frequent reference has been made throughout this paper to specialized mental health services. These may include a variety of service structures that serve or focus on chronically homeless people with SMI, including assertive community treatment (ACT) teams, structures in which a mental health agency is in the lead, and structures that integrat