SSA Report to Congress - December 2002

Report to the House and Senate Appropriations Committees on Increasing Access and Services to SSA Benefits by the Homeless

The report is being submitted pursuant to the House Committee on Appropriations Report 107-229, which requires SSA to prepare and submit a report that describes current policy and practice barriers to access and utilization of the Supplemental Security Income and Social Security Disability Insurance programs by homeless people and recommendations for removing such impediments and strengthening these programs.

SSA's Major Programs and Services

• For the fiscal year ending September 30, 2001, 6.7 million Americans were receiving DI benefits, totaling $58 billion.
• For the fiscal year ending September 30, 2001, 6.7 million people were receiving Federally administered SSI benefits, totaling a combined $31 billion in Federal benefits and State supplemental payments.

Overview of DI and SSI Programs

The DI program, financed out of payroll taxes, is an insurance program that provides disability benefits based on previous employment covered by Social Security. In addition to benefits to disabled workers, the DI program also provides benefits to a disabled worker’s spouse, children, and disabled adult children, and to disabled widows and widowers. Individuals disabled and entitled to DI disability benefits for 24 months are entitled to Medicare benefits.

SSA also administers the SSI program. Through this program, monthly benefits are paid to people with limited income and resources who are aged 65 or older, blind or disabled. Blind or disabled children, as well as adults, can receive SSI. By filing for SSI in most States, SSI beneficiaries also can get Medicaid to pay for hospital stays, doctor bills, prescription drugs and other health costs. Also, in most States, if an individual is applying for or receiving SSI, he or she gets Food Stamp information and an application form from the SSA field office. Thus, for homeless individuals, who are 65 and older or blind or disabled, SSA plays a critical role in helping provide monthly benefit payments and linkages to medical and nutrition services.

One provision of SSI law is designed to divert individuals from homelessness. Under this provision, SSA enters into agreements with public institutions (including prisons) under which SSI applications are taken for individuals shortly before their release from the institution. This allows SSA to process the application and, if the individual is eligible, have benefits paid very soon after he or she leaves the institution. The benefits help the individual avoid homelessness and provide access to needed medications in most States through the Medicaid program.

National estimates on homelessness indicate there are anywhere from 500,000 - 700,000 homeless on any given night. A 1996 study found that of approximately

4,000 homeless individuals surveyed, 11 percent received SSI. Although we do not currently have any way to measure how many of the current 6.7 million SSI beneficiaries are homeless, based on this study, the number of homeless SSI recipients could range from 55,000 - 77,000.* It is apparent that receipt of SSI benefits can be a critical element in avoiding homelessness.

Definition of Disability

In order to be found disabled, an individual generally must be unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that is expected to result in death or has lasted or can be expected to last for a continuous period of 12 months. (The law specifically provides that an individual shall not be considered to be disabled if alcoholism or drug addiction would be a contributing factor material to a determination that the individual is disabled.)

Initial disability determinations are generally made by State disability determination services (DDSs) on behalf of SSA. The DDSs, which are fully funded by the Federal Government, are responsible for developing medical and other evidence. In cases in which the existing medical evidence is insufficient to render a determination, the DDS will ask a claimant to attend one or more consultative medical examinations at SSA’s expense.

When there is evidence that an individual is not able to manage or direct the management of DI and/or SSI benefits in his or her own best interests, SSA will appoint a representative payee to handle the individual's benefits. Individuals who have been determined legally incompetent are required to have representative payees.

SSA Actions Addressing Impediments to Access to Programs and Services by Homeless Individuals

Typically, homeless populations face barriers in applying for, retaining and using the services of mainstream programs. The inherent conditions of homelessness, such as transience, instability and lack of basic resources can compound these barriers.

As an Agency, SSA is uniquely positioned through its network of over 1,300 field offices to provide assistance to the homeless. SSA field offices have established a variety of activities and special procedures to reduce the problems faced by homeless individuals in obtaining Social Security or SSI benefits for which they are eligible

The primary impediment known to field office and DDS staff is the difficulty of maintaining contact with the homeless individual. It is also difficult for homeless individuals to keep appointments and to maintain records of medical treatment. To address these impediments, SSA:

• Allows homeless individuals to receive their monthly checks at the local field office;
• Assists individuals in establishing bank accounts for direct deposit of SSA benefits and using automatic teller machines; and
• Allows individuals to use the field office as a message center, so that DDS appointments or requests for information are not missed.

Current Liaison and Outreach Activities

Field offices and DDSs throughout the nation have established liaisons with various organizations to assist homeless populations in applying for and maintaining entitlement to DI and SSI benefits by:

• Establishing ongoing relationships with homeless organizations, agencies, shelters, churches, county welfare and local healthcare providers that serve homeless populations in order to provide immediate assistance and resolve issues related to homelessness;
• Scheduling appointments with various agencies to facilitate the provision of benefits and services;
• Coordinating development between DDSs and treatment providers to expedite the disability claims process;
• Arranging for field offices to contact DDSs to schedule consultative examinations for homeless individuals with no medical sources so that the individual is provided the date and time of the appointment before leaving the field office;
• Working with the Veterans Administration to assist homeless veterans filing claims or maintaining eligibility;
• Visiting, regularly, homeless shelters and hospitals to take applications for benefits and assist individuals with other SSA business;
• Attending meetings of community based service organizations for the homeless to provide ongoing information about SSA programs and to maintain good lines of communication;
• Distributing public information materials to appropriate agencies involved with the homeless and maintaining resource information from those agencies in field offices in order to provide referral services as needed; and,
• Identifying new community service programs that assist the homeless and developing liaisons as appropriate.

Current Training Initiatives

Field and regional office staff provide ongoing training to other agencies and community service organizations that serve the homeless. For example:

• Field offices train social workers and advocacy groups on the completion of claims forms and documentation requirements for claims processing;
• Field office staff participate in workshops to disseminate information on programs and services; and
• Public Affairs Specialists and field office management establish relationships with legal aid and law enforcement agencies to provide basic eligibility training on SSA programs.

Providing Information about Social Security and SSI Benefits

SSA also provides information about DI and SSI benefits to national advocacy organizations for dissemination to affiliates, professionals, and consumers. SSA prepares and releases a monthly information package to all field offices that contains print media products for placement with local media. The Social Security Electronic Newsletter (eNews) is sent to over 200,000 subscribers, including advocacy groups, nonprofit organizations and governmental agencies. SSA's Public Affairs Specialists regularly visit national organizations to brief them about SSA issues. SSA's Office of Communications maintains a database of more than 400 national organizations and alerts organizations to specific SSA issues with "Dear Colleague letters." SSA's regional communications directors and field offices routinely work with local branches of national organizations. Organizations may also visit SSA's organizational website that has downloadable information that can be sent to constituents or put in their newsletters.

Overview of SSA's Homeless Plan and Activities

In support of the President's initiative to end chronic homelessness within 10 years, we participate in the Interagency Council on Homelessness. In addition, we have an Agency-wide plan to address homeless issues. SSA's homeless plan lays out specific activities that will provide access to benefits and services to homeless populations. We will institutionalize the homeless plan and its activities by convening a workgroup that will be responsible for coordinating and monitoring homeless plan activities.

Our approach is to determine what actions and resources are needed to fulfill our commitment to ending homelessness. In order to achieve this, we need to improve our ability to identify homeless applicants and beneficiaries. SSA's homeless plan includes activities to identify locations of high homeless populations to determine what areas to target for outreach activities and reevaluating current policy and implementation strategies. SSA’s homeless plan objectives seek to:

• Further identify and remove barriers homeless individuals face in accessing SSA's programs;
• Review prior outreach activities targeting homeless populations and distribute successful methods of working with community based organizations;
• Ensure access to our programs and services to the homeless by identifying areas for improvement in current policy and operating procedures and submitting recommended changes;
• Develop and expand SSDI/SSI outreach and application assistance to the homeless by developing content for and implementing a web page for homeless advocates;
• Identify homeless beneficiaries who need representative payees, recruit representative payees for such individuals, and provide technical training for organizational payees;
• Address service delivery issues through collaborative initiatives: For example, with:
• The Department of Justice on its "Going Home" project, which focuses on providing services and benefits to serious and violent offenders in order to prevent homelessness and deter recidivism; and
• The Department of Health and Human Services (HHS) on its project to provide training for case managers whose clients are homeless and potentially eligible for SSI and SSDI, and with its Health Care for the Homeless program, which seeks to improve access to health care and mental health and substance abuse treatment by homeless individuals.

Summary

SSA has a long history of providing service to the American public that includes access to the programs we administer by homeless populations. We are committed to improving this service and strengthening our efforts in working with other Federal agencies, States, and community organizations to help homeless people access benefits. This commitment is embodied in detail in SSA's Homeless Plan, which was sent to the Interagency Council on Homelessness this past October. In addition, we will continue to work with Congress in assuring that vulnerable individuals such as the homeless receive the Social Security and SSI benefits to which they are entitled.

* We do not know of any studies on which to base an estimate of the potential number of DI beneficiaries who may be homeless.