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Final Tribal LC Bonus Session: Building an HDAP Program

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Building an hDap program: The essentials

Learning Community: Session 7 November 1, 2023

Land Acknowledgement

We recognize and acknowledge the First People of this ancestral and unceded territory – the land that today we call California. With respect to their elders, past and present, we recognize the tribal communities as the original stewards of this land, and who continue to lift up their stories and cultures. Adopted from Los Angeles County’s Land Acknowledgment

Disability Benefits Advocacy Training & Support Team

Eve Rutzick

Rebecca Watson

Agenda

04

Targeting HDAP Services: Who is Eligible?

03

HDAP Core Components Overview

02

The Big Picture: Purpose of HDAP

01

Welcome, Introductions, & Overview

06

Q&A with Meagan Smith

07

Open Discussion

05

Building Your Program

  • Defining Roles
  • Workflows
  • Administrative Systems
  • Onboarding Staff

THE BIG PICTURE

Purpose of HDAP

The 3 A's

Affordable Housing

as a solution

Solving homelessness and resolving housing crises require that participants have access to the 3As. Affordable Housing Adequate Income Appropriate Services

HDAP programs combine services intended to give participants' access to each of the 3 A's.

Appropriate Services

Adequate Income

How does your work help end homelessness?
HDAP Purpose: Two Program Goals

Secure Disability Benefits

Long-Term stability

Stabilize in Permanent Housing

Rates of SSI Participation Are Low Despite It Being Critical Income for Disabled and Aged Individuals

40-50%

of older individuals who are eligible for SSI are not receiving it

30%

New benefits awards went down

during the first year of the pandemic

Our communities are missing key income

Low-Income Seniors Living Alone

People with Disabilities Experiencing Homelessness

Low-Income Parents with Minor Children

Youth With Disabilities Aging Out of Foster Care

Veterans Receiving VA Benefits

Most people's income goes up when they change from receiving General Relief/General Assistance, CalFresh, and/or CalWORKs to receiving SSI/SSDI. Once on SSI/SSDI, GA/GR and CalWORKs cease and CalFresh is reduced.

Why is it so hard for individuals to get these benefits?

Confusing Process

Outdated Systems

Geared Towards Denial

SSA Is Understaffed

SSA's process is confusing and long and hard for people with disabilities to manage. SSA does not develop their processes to make it easier for the very individuals they serve to access their services and benefits

There is a huge backlog of work and not enough people to do the work.

SSA makes changes very slowly and uses outdated technology. This makes it harder for their system to efficiently respond to customers' needs.

Approximately 64% of applicants are denied at the initial level and 85% are denied at the reconsideration level. Many people stop appealing their denials because they lose faith that they will be approved. This keeps the number of individuals receiving benefits lower.

hdap core components

Overview

Key Takeways: Program Success

Be realistic about timelines & success rates.

Have well-defined roles that allow staff to build expertise.

Be realistic about staff capacity.

Remember the recommended staff to participant case ratios.

Successful programs do not take on too much too quickly. They understand the program must invest heavily in each participant.

Don't neglect systems needed to track this complex work.

Use existing resources to build the program & expertise.

HDAP Core Services

Partnership with Community Systems
  • Outreach partnerships
  • With Homeless System of Care
  • With Healthcare systems
Goals Met
Housing Case Management
  • Immediate crisis needs and long term housing case management
  • Housing Direct Financial Assistance
Disability Benefits Advocacy
  • Trained Advocates who develop, submit & track complete applications for benefits
  • Connections to Appeals Representation
Medical Care Coordination
  • Assistance connecting to medical treatment
  • Necessary for effective disability benefits advocacy and to promote long-term stability

Big Picture: HDAP Rules

HDAP Services must be offered concurrently

Participants are eligible for, and should continue to be offered, any of the program components until a final disability benefits determination is made and the participant is stabilized in permanent housing. Eligibility for the HDAP services is not based on the disability benefits application timeline alone. It is unlikely that the disability benefits determination timeline and housing stabilization timeline will be fully aligned. Rather, it is highly likely that one may be achieved before the other, and programs should be designed accordingly. HDAP ACL 19-104

We created this summary of key HDAP program requirements to help you plan and administer your HDAP program.

Key program guidance is set out in HDAP ACL 19-104 (11/1/19) and ACWDL 9/13/21.

Big Picture: Appeals

Initial Determination

Reconsideration Determination

Hearing Decision

Appeals Council Decision

Federal Court Decision

Application Submitted

Typically issued 12-24 months after filing

Typically issued 12 months after filing

Typically issued 12 months after filing

Typically issued 4-8 months after filing

Typically issued 3-6 months after filing

Approximately 1% of cases are approved at federal court and 60% are remanded for a new hearing

Approximately 12% of cases are approved at reconsideration level

Approximately 46% of cases are approved at hearing level

Approximately 30% of cases are approved at the initial level

Approximately 1-2% of cases are approved at Appeals Council

"It is strongly recommended that advocacy related to appeals (including representation at hearing) is provided by qualified disability benefits attorneys." ACL 19-104

HDAP Budgeting

What should you expect?

HDAP has two distinct areas of work (housing and benefits advocacy) as well as care coordination. This increases the amount of staff time per participant.

Specialized Staffing/Roles

Plan for additional program costs in areas of:

  • Transportation (to medical appointments)
  • Medical records
  • Tracking systems

Added Program Costs

Some programs plan for appeals representation by contracting with a legal aid provider to represent HDAP clients in the appeals process.

Appeals Representation

Targeting hdap services

Who is eligible?

Who is eligible for HDAP services?

The Housing and Disability Advocacy Program (HDAP) was established in 2016 to assist individuals and families who are: 1. experiencing or at risk of homelessness and 2. who are likely eligible for disability benefits

Wait, what does that mean exactly?

Let's discuss the purpose of each program

Supplemental Security Income (SSI)

Social Security Disability Income (SSDI)

Social Security Retirement

Survivors' Benefits

  • Monthly benefits paid to individuals who paid FICA taxes on their earnings for long enough and earned enough money to qualify
  • Benefits are paid out based on how much the individual earned over the course of their life
  • Retirement benefits paid beginning at age 62 at the earliest
  • Monthly benefits paid to the spouses and minor children of deceased individuals who paid FICA taxes on their earnings for long enough and earned enough money to qualify
  • Benefits also paid to very low-income individuals who cannot work due to disability even if they have no history of working before becoming disabled
  • Monthly benefits paid to very low-income individuals who are 65 and older, regardless of whether they worked
  • Monthly benefits paid to workers who paid FICA taxes on their earnings and who are no longer able to work due to disability
  • Benefits can also be paid to spouses and minor children of the disabled worker

Wondering what FICA taxes are?

How hard is it to get benefits from SSA?

Hard to Prove

Easy to Prove

Retirement Benefits and Survivors Benefits are quite easy to get. After applying, SSA checks if the individual is eligible for benefits and typically pays out without much trouble. Supplemental Security Income (SSI) Aged Benefits are easy to get. One must only prove they are 65 or older and very low-income and meet immigration status requirements.

Social Security Disability Income (SSDI) is more difficult. An individual has to prove that they meet SSA's definition of disability prior to their date last insured. This will be discussed shortly. Supplemental Security Income (SSI) Disability Benefits are also difficult. In addition to proving one is disabled, the individual must meet all of the income and resource rules as being a very low-income person.

So how does one prove disability for SSA?

SSA has a specific definition of disability that is different than in other contexts

SSA's definition of disability is not the same as the definition under the Americans with Disabilities Act (ADA), or under other laws such as the Fair Housing Act, or laws about eligibility for special education services.

Watch this video to learn more about how SSA defines disability

SSA's Definition of Disability

The legal definition is:

which can be expected to result in death or to last for a continuous period of not less than 12 months

by reason of any medically determinable physical or mental impairments

The inability to engage in any substantial gainful activity

Let's translate! Click on the symbols to learn more

SSI, SSDI, and CAPI have strict rules about who is eligible to receive benefits. This is separate from whether the person can be found disabled due to medical conditions under their rules.

SSI and CAPI require the applicant to have resources worth $2,000 or less. SSDI and Retirement do not have resource limits.

Immigration Status

Work History

Resources

Income

All of these programs have specific immigration requirements. Many immigrants are eligible.

SSI and CAPI require the applicant to be low income. Income limit depends on type of income. SSDI does not have these same limits.

SSDI and Retirement typically require the applicant to have 40 work credits (10 years of work). SSI and CAPI do not require work history.

What are common client profiles you will see?

HAS A DISABILITY AND HISTORY OF WORKING

HAS A DISABILITY WITH Limited or no WORK HISTORY

non-citizens

65+ years old

How strict should you be in enrolling HDAP clients based on likely eligibility for disability benefits?

In general, enroll individuals who:

  1. Have conditions that seem potentially disabling or are age 65 or older
  2. Are very low-income and don't have many resources or have a significant work history

In general, do not enroll individuals who:

  1. Have no history of medical treatment and are not willing to seek treatment unless you can apply for an age-based benefit (i.e., retirement or SSI-Aged or CAPI-Aged benefits)
  2. Do not feel they are unable to work due to their medical conditions unless you can apply for an age-based benefit (i.e., retirement or SSI-Aged or CAPI-Aged benefits)

Prioritizing in HDAP

ACWDL 9/13/21

Consistent with homeless assistance best practice, programs should evaluate funding and program capacity to prioritize serving people with the highest needs and vulnerabilities, which should include individuals who are experiencing chronic homelessness or with severe health conditions.

building your program

Defining Roles

Benefits Advocates play the following roles for clients:

Act as an advocate during communications with SSA & DDS

Guide through the difficult process

Roles of a Benefit Advocate

Gather information & complete application forms correctly

Connect clients to legal and other services

Assist in obtaining medical care

Support during appointments

Obtain medical records

HDAP Benefits Advocates help participants navigate these obstacles

Navigating SSA and DDS

Confusing Process

Obtaining Medical Records

Submitting Complete Applications

SSA denies many applications because they don't have all necessary information

Communicating with these agencies is very hard

SSA's process is long and confusing; Benefits Advocates can help participants understand it

SSA only approves applications where the person's medical records supports finding them disabled

We have template Position Descriptions that your program can use or adapt as desired

A program may have separate Benefits Advocates and Housing Case Managers or one person may do both roles. However, the roles are different.

Housing Case Manager

Benefits Advocate

  • Assists in getting participant into medical treatment if needed
  • Has an official role as an Appointed Representative
  • Completes and submits paperwork for client
  • Communicates with SSA and DDS on participants' behalf
  • Informs participant of SSA rules and guides them through the process and their rights
  • Maintains awareness of available local housing stock and eligibility rules
  • Assists participant in viewing housing options
  • Assists participants in submitting applications for housing and for voucher programs or other permanent housing opportunities
  • Assists participants in obtaining identification documents

Both types of advocates build rapport and trust with participants over time. Services need to be coordinated with each other.

Participant-Staff Case Ratios

HDAP Guidance says: Participant-Staff case ratios should be between 10:1 to 25:1. This applies to both Housing Case Managers & Disability Benefits Advocates. Ratios may vary locally but must allow for the highly intensive advocacy services to be provided.

VIEW

Staffing Example

Manager

HDAP & Home Safe Programs

Housing Case Manager (HDAP, Home Safe)

Disability Benefits Advocate (HDAP)

Medical Care Coordinator

Connects clients to medical care (HDAP & Home Safe)

Completes all disability benefits advocacy work

Housing Direct Financial Assistance

Requests & tracks medical records (HDAP)

Housing-related Case Management

five minute break

PUTTING IT TOGETHER

Program Workflow

Mapping Your Program

In HDAP, you are laying out two different, connected client journeys through your program.

  • Housing-Related Case Management
  • Disability Benefits Advocacy

CLIENT STABILIZES

CLIENT MOVE-IN

Client moves in to housing.

SEARCH FOR HOUSING

Cilent and Housing Team search for stable housing.

With support of housing team, client stabilizes in housing.

CLIENT PLACED IN TEMP HOUSING

CLIENT ENROLLED

TITLE HERE

Hotel/Motel room is provided.

Lorem ipsum dolor sit amet, consectetuer

Client is enrolled in the program

CLIENT ASSESSED

REFERRED TO PROGRAM

Client is assessed for eligibility and immediate needs.

CLIENT CRISIS

This participant journey only shows half of the story.

Client is referred to program.

Client presents at Tribal Housing office in crisis.

Mapping Your Program

The Disability Benefits Advocacy has a different journey that looks like this:

FOLLOW UP

Track application and communicate with gov't agencies

INITIAL DECISION

APPLICATION

Prepare and submit complete disability benefit application.

Application is approved or denied. Continue to appeal if denied.

GATHER EVIDENCE

Request medical records and other necessary evidence to support application.

CLIENT ENROLLED

TITLE HERE

Lorem ipsum dolor sit amet, consectetuer

Determine disability benefits advocacy case plan.

CLIENT ASSESSED

REFERRED TO PROGRAM

Client is assessed for disability benefits eligibility.

CLIENT CRISIS

Client is referred to program.

Client presents at Tribal Housing office in crisis.

Disability Benefits Advocacy: HDAP Rules

Disability Benefits advocacy shall include:

  • Developing and filing completely prepared applications
  • Filing appeals including Requests for Reconsideration
  • Obtaining all relevant documentation from hospitals, medical centers, clinics, and others to meet the necessary burden of proof of a participant’s disability
(ACL 19-104; ACWDL 9/13/21)

"Disability benefits advocacy services may be provided through legal representation (at no cost to program participants) or through disability advocacy case managers with benefits assistance training." ACL 19-104 Training is essential.

It will help your program run well if staff roles and responsibilities are well-defined and workflow between staff is visible and transparent. Start by designing your Referral, Intake, & Assessment Workflow.

Referral

01

Phone Screening

02

Intake

03

Eligibility Assessment

04

After intake, there are essentially three tracks of Disability Benefits Advocacy
Refer to Other Services
Assist with Existing Application
Apply Now
Build Up Medical Treatment Records Before Applying
HDAP programs exist to assist individuals with benefits applications while supporting their housing. It is not required to submit an application *immediately* and some enrolled participants may not end up submitting an application.

Building your program workflow Tips for using this tool: Template documents are linked on the Lucid Spark. You will get an individual copy on your board to use.

Building your program workflow This tool helps you think through defining role-specific workflows. You will also get this on your individual board.

Let's introduce you to the Lucid Spark Tool

building your program

Administrative Systems

What areas benefit the most from having standardized processes for getting work done?

EFFICIENT ADMINISTRATIVE SYSTEMS

Team's workflow and processes

Having standardized ways of doing your work can make your time more efficient and effective. This doesn't mean that you can't be creative and individualize your work. It just means that you don't have to spend time recreating the wheel so your time can instead be spent doing what you do best: helping participants!

Notetaking

Participant folder organization

Medical records requests

Application filing and follow-up process

Recording participant outcomes

building your program

Onboarding Staff

Setting Realistic Expectations about HDAP Program Start-Up

Staff need to be hired and trained up and applications need to be reviewed prior to submission; this is not an overnight process

Beneficial to have basic systems in place before starting to submit applications

We can assist you in prioritizing what to do first (budgeting, setting up systems, hiring up, management and training tools, etc.)

Next Cohort starts in February!

Disability Benefits Advocacy Fundamentals Core Learning Journey

Below is a description of each module in the Disability Benefits Advocacy Fundamentals training. You will have 2 weeks to complete the self-paced content in the module. At the end of each module, there will be a live Putting Knowledge into Practice session with your instructors.

Module 3

Module 4

Module 5

Module 6

Module 1

Module 2

Proving Disability in Application Forms

Crossing the Application Finish Line

Advocating for Immigrant Participants

Introduction to Your Work & SSA's Rules

Working with Participants & Developing Cases

Income, Resources & Living Arrangement Rules

+ INFO

+ INFO

+ INFO

+ INFO

+ INFO

+ INFO

It will take approximately 2-3 hours to complete each self-paced module.

Our additional support for HDAP Programs

Ask an Attorney

Monthly meeting to learn new skills & ask questions.

Benefits Helpline

Assistance by email for Benefits Advocates with specific questions.

Submit a question at the link here

Register at the link here

info

info

Ask for additional help!

Case conferencing? Technical Assistance? Just ask.

key takeaways

Key Takeways: Program Success

Be realistic about timelines & success rates.

Have well-defined roles that allow staff to build expertise.

Be realistic about staff capacity.

Remember the recommended staff to participant case ratios.

Successful programs do not take on too much too quickly. They understand the program must invest heavily in each participant.

Don't neglect systems needed to track this complex work.

Use existing resources to build the program & expertise.

q&A with Meagan Smith

open discussion

https://www.ssa.gov/people/materials/pdfs/EN-05-10297.pdf