Best Practice | August 11, 2006
The Maryland SSI Outreach Project helps homeless mentally ill people become enrolled in the Supplemental Security Income (SSI) program. It does this by providing services that the Social Security Administration does not: outreach, help with record gathering and application completion, and advocacy on the clients' behalf.
The Maryland SSI Outreach project was started in 1993 as a demonstration project in the Social Security Administration (SSA). The outreach demonstration funded staff costs, including salaries for a project director, two counselors, and an administrative assistant. The project was intended to link SSI benefits to homeless people of age 18 and over who have serious and consistent mental illness. The program went through a number of incarnations from 1994-1998, as funding from SSA diminished. Starting in 1998, the Social Security Outreach Project coordinated with the Baltimore continuum of care in order to obtain $190,000 in HUD funding each year.
The SSI Outreach Project is geared toward severely mentally ill people who are living on the streets. In addition to the street outreach done by the staff, the SSI Outreach project takes referrals from all over the city -- from the Department of Social Services, transitional housing programs, emergency shelters, and drop-in centers. Clients are usually those who are clearly good candidates for SSI, but by virtue of their disabilities, have been either unable to navigate the application process or simply unaware that they might be eligible for such an entitlement.
The SSI Outreach project remains staffed by a project director, two counselors, and an administrative assistant. According to their grant agreement, they must serve at least 100 people a year. The project is set-up to address what Project Director Yvonne Perret sees as the three major obstacles to severely mentally ill people seeking benefits:
- the illness itself, which makes navigating a complicated application process nearly impossible,
- the fact that mental illness is stigmatized to the point that people won't admit to suffering from one, and
- the challenge of paper management, especially while lacking a fixed address.
The SSI Outreach team makes it a point to see each referred client within three days of a phone call. They conduct a twenty-minute screening on-site, complete an information sheet (largely on income and resources), and have the client sign "appointment of representative" forms, which allow SSA to release the client's information to the Project. Once the appropriate forms have been reviewed by SSA, the counselor receives a determination on whether the client is eligible for the SSI or SSDI programs, or whether an application is already pending, in which case the counselor can only help the client with the paperwork.
The second and more challenging part of the process is preparing the disability report. The counselor collects all information available on the client's treatment records -- where people have been treated, and for what. They conduct a clinical evaluation that takes anywhere from 1-10 hours, extended over a number of meetings. The Project Director then writes a report describing a diagnosis and any functional impairment, and submits it to the Disability Determination Services office. In all, the staff spends an average of 30 hours on each case.
The SSI Outreach Project is also able to provide "presumptive" benefits to people they are certain will join the SSI rolls. This means that for up to six months while waiting for their eligibility determination, clients receive SSI payments. This part of the program is a remaining perk from the original demonstration project, which allowed for presumptive eligibility. After the first year of the demo, all of the 54 people who received their benefits presumptively were eventually enrolled in the SSI program. Those who do not receive presumptive eligibility are less visibly disabled -- either they may not have received treatment for their mental illness, or there is difficulty teasing out the substance addictions from the mental illness.
For some of the severely disabled clients, the Maryland SSI Outreach Project acts as the representative payee, and SSA sends all benefits to the staff, which acts as the clients' money manager.
Sources of Funding:
The SSI Outreach Project is part of the Baltimore continuum of care, and receives $190,000 per year from HUD. Yvonne Perret believes that the Social Security Administration, which currently does not provide grants for outreach projects, is the more appropriate source of funds.
Since 1994, the SSI Outreach Project has deemed between 400-450 people presumptively eligible. Of this number, only two people have been denied SSI.
The benefits of this program do not end with SSI payments. The SSI Outreach project also succeeds in linking people with other county services. Typically the SSI Outreach staff spends between 20 and 40 hours with each person. They serve, as a precondition of their grant, at least 100 people per year.