SSI/SSDI and Powerful Click toMedicaid: edit Master title Tools style for Reentry Success
Moderated by Dr. Fred Osher Director, Health Services and Systems Policy Council of State Governments Justice Center
March 12, 2014
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This presentation was prepared by the Council of State Governments Justice Center. Presentations are not externally reviewed for form or content. The statements reflect the views of the authors and should not be considered the official position of the CSG Justice Center, the members of the Council of State Governments, or the U.S. Department of Justice. 5
Brief Issue Overview }
Large population with a critical need for health care } }
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Nearly 700,000 individuals released from prison and jail each year This population has a significantly higher than average rate of serious mental illness, substance abuse, and other disabilities
Benefits are key tool for successful reentry } } }
Individuals with SMI and certain disabilities may be eligible for benefits such as SSI, SSDI, and Medicaid Enrollment in these benefits has been shown to contribute to lower rates of re-arrest and increased time in the community The SOAR program is a great way to facilitate enrollments 6
Webinar Agenda Introduction Dr. Fred Osher, Council of State Governments Justice Center
SOAR and Justice-Involved Persons Dazara Ware, Policy Research Associates, Inc.
Using SOAR to Facilitate Re-entry From Jail Cindy Schwartz, Eleventh Judicial Criminal Mental Health Project
Community Re-Integration Project in NYS Prisons Eda Franco, Center for Urban Community Solutions
Moderated Q&A Session Dr. Fred Osher, Council of State Governments Justice Center
Council of State Governments Justice Center
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SOAR and Justice-Involved Persons
Dazara Ware Senior Project Associate Policy Research Associates SAMSHA SOAR Technical Assistance Center
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Today’s Presentation
Section 1 : SOAR
Section 2: The Basics of SSA Eligibility and Determination
Section 3: The Affordable Care Act and Justice-Involved Persons
Council of State Governments Justice Center | Policy Research Associates, Inc.
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SOAR Technical Assistance Center at Policy Research Associates, Inc.
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SAMHSA funds the SOAR TA Center to support states and communities
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Offers virtual and on-site technical assistance
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SOAR TA Liaisons are responsible for SOAR in multiple states
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Get to know your SOAR TA Liaison
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Reach out for help or answers to questions about any aspect of SOAR
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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SOAR }
SOAR stands for SSI/SSDI Outreach, Access and Recovery
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Focus is on people who are homeless or at risk for homelessness
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Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with SSA since 2005
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All 50 states currently participate; no direct funding provided to states
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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2013 SOAR Outcomes }
19,008 persons experiencing or at risk for homelessness have been approved on initial application
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65 percent approval rate overall
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Compares to 10-15 percent for unassisted applications from people who are homeless and 29 percent for all applicants
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Approvals were received in an average of 100 days in 2013 Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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SOAR Has Broader Goals
Housing
Decrease in adverse outcomes (incarceration & hospitalization)
Community Investment
SOAR
Access to treatment and other services
Employment Opportunities
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Why is SSI/SSDI Important for Individuals? }
SSA disability benefits can provide access to: } } } } }
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Income Housing Health Insurance Treatment Other supportive services
For people with disabilities, SSI/SSDI can be a critical step towards ending homelessness and promoting recovery
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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SSI/SSDI:The Basics }
SSI: Supplemental Security Income; needs based; federal benefit rate is $721 per month in 2014; provides Medicaid in most states
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SSDI: Social Security Disability Insurance; amount depends on earnings put into SSA system; Medicare generally provided after 2 years of eligibility
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The disability determination process for both programs is the same
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Benefits for offenders begins upon release
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Application Process
Application Initiated at SSA
SSA Determines NonMedical Eligibility
SSA Transfers Claim to DDS
DDS Determines Medical Eligibility
DDS Returns Record to SSA
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
SSA Notifies Applicant
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Criteria for Eligibility 1. Medically Determinable Physical or Mental impairment } Illness must either meet or be equivalent to the “listing” criteria used by DDS. Supporting information must be documented in medical records 2. Duration } The impairment tied to the illness(es) must have lasted OR be expected to last 12 months or more OR be expected to result in death 3. Functional Information } Applicants must demonstrate that significant functional impairment related to the illness(es) exists that impede their ability to work Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Sequential Evaluation
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Step 3 is Key }
Person can be found disabled at Step 3 and begin receiving benefits
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If adequate evidence is presented that impairment meets the Listings and the applicant is unable to work
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Connecting functional limitations to their inability to work with appropriate medical documentation is key
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Functional Information }
For mental illnesses, the applicant must demonstrate functional impairments that meet the Listings
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Document all four areas } } } }
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Activities of daily living Social functioning Concentration, persistence and pace Repeated episodes of decompensation
Must demonstrate marked functional impairments in at least two areas
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Functional Information }
For physical impairments, the application must demonstrate significant limitations in meeting physical, mental, sensory and other requirements of work.
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A limited ability to perform certain physical demands of work activity (e.g. sitting, standing, walking, lifting, carrying, etc.) may reduce a person's ability to do past work and other work
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Make the Link
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The MSR is the link that connects the diagnosis to the limitations that the applicant experiences
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Being able to document this link is very important in order to demonstrate the applicant’s inability to engage in substantial gainful activity Diagnosis
Limitations in Functioning
Why can’t the applicant work?
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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What Happens to Benefits for Justice-Involved Persons? }
For SSI
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Incarcerated for a full calendar month, benefits are suspended
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Released in less than 12 calendar month, benefits can be reinstated upon release
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If an SSI recipient is incarcerated for 12 consecutive calendar months their SSI benefits are terminated and they must reapply
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Reapplication can be made 30 days prior to their expected release date but benefits cannot begin until release. Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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What Happens to Benefits for Justice-Involved Persons? For SSDI } Recipients are eligible to continue receiving their benefits until they are convicted of a criminal offense and confined to a penal institution for more than 30 continuous days. After that time, their benefits are suspended. Benefits are reinstated the month following their release into the community }
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Affordable Care Act (ACA) Signed into law by President Obama in March 2010 } Health Insurance Marketplace }
Qualified Health Plans
Medicaid } Medicare benefits }
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Preventive care coverage at no-cost Addressing the prescription drug “donut-hole”
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Medicaid }
State-operated, federal and state share the cost
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In 32 states, SSI eligibility = Medicaid eligibility
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Some states use the same eligibility rules as SSI but require a separate application }
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AK, ID, KS, NE, NV, OR, UT
Other states have additional eligibility rules }
CT, HI, IL, IN, MN, MO, NH, ND, OH, OK, VA
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Medicaid and Justice Involved Persons }
90% of those entering jail have no health insurance and 60% earned less than 133% FPL.
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People currently incarcerated are not eligible for the Medicaid expansion.
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People with a criminal history are eligible, as income is the only criteria upon which Medicaid expansion eligibility is based.
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Connecting people in jails and prisons with Medicaid enrollment upon release could significantly improve the reentry process. Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Access to Benefits for Justice-Involved Persons Summary }
Acquiring SSA disability benefits and the accompanying Medicaid/Medicare benefit provides the foundation for reentry plans to succeed
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SOAR can be used as a tool to access these benefits
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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Resources Visit the SOAR website at http://soarworks.prainc.com SAMHSA SOAR TA Center Policy Research Associates, Inc. 518-439-7415 soar@prainc.com www.facebook.com/soarworks Twitter: @soarworks
Council of State Governments Justice Center | Policy Research Council of State Governments Justice Center Associates, Inc.
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The Eleventh Judicial Criminal Mental Health Project Miami-Dade County, Florida
Using SOAR to Facilitate Re-Entry from Jail 30
JAIL DIVERSION PROGRAM
Designed and implemented to divert people with serious mental illnesses away from the criminal justice system into community-based treatment and services Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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The Problem }
The application process is difficult for most people but especially for individuals who have mental illnesses and co-occurring substance use disorders that are re-entering the community from jail
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Only about 37 percent of all those who apply (all disability groups) are typically approved on initial application
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People that are homeless have a lower percentage of approval on the initial application (10-15%)
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Appeals take years and many potentially eligible people give up and do not appeal Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Why Is Access To SSI So Difficult?
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People who re-entering the community need assistance to apply for Social Security benefits
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They need adequate assessment and documentation of how their disabling conditions limit their ability to work
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Providers who assist applicants need staff who understand the disability determination process and who have time to assist in all aspects of developing the application
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Relationships with SSA, the state Disability Determination Service (DDS), community medical providers and others are essential to changing the outcomes of SSI/SSDI applications
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Innovative Plan
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Utilize SOAR approach to access and expedite benefits
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All program participants are screened for eligibility for federal entitlement benefits
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Eligible participants are provided with assistance with the SSA application process as soon as possible
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Provide an incentive for treatment providers Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Recovery and Community Re-entry
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Self-sufficiency Access to basic needs: Housing Food Medical care Psychiatric treatment and services Reduce stigma
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant Expansion Grant Program }
Created specialized unit to expedite access to benefits
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Expand target population to include individuals reentering the community after completion of jail sentence
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Program Evaluation to assess efficiency of accessing benefits and effectiveness of jail diversion and re-entry planning
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Staffing }
3 Full-time Staff } } }
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Engagement Assessment Boundary Spanners
2 Part-time Peer Specialists } }
Support Assistance with access to community services
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Who? Female
19%
Male
81%
Average Age Homeless Average Time Homeless
36 years old 57% 22.2 months
At Risk Homeless
34%
Stably Housed
8%
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Diagnostic Criteria
Percent Bipolar
22.3
Depressive and Mood
14.2
Psychosis and Schizophrenia Spectrum
60.5
Other
1
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Results
Date of Decisions:
7/1/11 – 2/27/14
Total Number of Screenings: Total Number of Applications: Approved: Denied: Approval Rating:
445 220 207 13 94%
Average Time to Decision:
27 days
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Approved For:
} SSI
only
} SSDI } Both
only
94% 1% 5%
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Financial Benefits }
Approval rates far exceed national average in one tenth of the time to decision
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Maximize use of state funding
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Leverages the equivalent of more than $33,500 annually for each individual served in state funded treatment and support
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Access to approximately $5.9 million annually in state funded equivalent services
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Interesting Finding }
The number of bookings after the approval of benefits was statistically significantly lower than the one and two year period before the approval of benefits.
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The finding does not indicate that the SOAR program alone was responsible.
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SOAR leads to faster approval of benefits for individuals who historically do not have many resources; therefore by being approved for benefits it is easier for them to afford medical and mental health care, housing, and other basic needs.
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It is possible that these resources are resulting in the lower number of bookings, but based on the available data this relationship has not been explored at this time. Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Success Story }
22 y/o homeless, black male diagnosed with Schizophrenia Chronic Paranoid Type
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Homeless since age 14
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History of arrests in Texas and Florida
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Successfully engaged in housing, treatment and supportive services
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18 days to SSI approval
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Success Story }
21 y/o black male diagnosed with Schizophrenia Chronic Paranoid Type
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Charged with Petit Theft and Battery
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8 hospitalizations this year due to the psychiatric illness and lack of treatment
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Successfully engaged in treatment and services
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21 days to SSI approval
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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Summary }
Focusing on expediting benefits works!
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Its a win-win for the individual, for states and localities, and for community programs
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A major tool in community re-entry and recovery
Council of State Governments Council of State Governments Justice Center | EleventhJustice JudicialCenter Criminal Mental Health Project
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For Additional Information
Cindy A. Schwartz, MS, MBA Project Director cischwartz@jud11.flcourts.org
Council of State Governments Justice Center | Eleventh Judicial Criminal Mental Health Project
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Community Re-Integration Project in NYS Prisons Eda Franco, Associate Director
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Components §
Entitlements Liaison at the Community Orientation and Reentry Program (CORP) unit at Sing Sing Correctional Facility
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Expansion to Bedford Hills Correctional Facility
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Training and Technical Assistance to Pre-Release Coordinators in other NYS Prisons
Council of State Governments Justice Center | Center for Urban Community Solutions
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CORP Outcomes §
86% approval rate for SSI/D
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100% Medication Grant Program approvals; Medicaid status barriers
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105 days average time for determination
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88% SSI/D decisions received prior to, or within 1 month of release
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99% approval rate for Supportive Housing applications
Council of State Governments Justice Center | Center for Urban Community Solutions
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STEP Outcomes §
66 % approval rate for SSI/D
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100% Medication Grant Program approvals; Medicaid status barriers
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54 days average for determination
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70% SSI/D decisions received prior to, or within 1 month of release
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100% approval rate for Supportive Housing applications
Council of State Governments Justice Center | Center for Urban Community Solutions
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Lessons Learned §
Avoid broad statements in discharge summary and/or psychiatric evaluations
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If possible, have a designated liaison at SSA and the DDS in your state
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Frame context for red flags
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Think in terms of and highlight functional impairment
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Good supporting documentation
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Engagement with aftercare provider prior to release is pivotal
Council of State Governments Justice Center | Center for Urban Community Solutions
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For Additional Information Eda Franco Associate Director efranco@cucs.org 212-801-3371 www.cucs.org
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Moderated Q&A Session
Please use the chat box on the lower right-hand corner of the WebEx window to submit your questions.
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Peer-to-Peer Connections www.csgjusticecenter.org
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Thank You! The webinar recording and PowerPoint presentation will be available on www.csgjusticecenter.org within a few days. This material was developed by the presenters for this webinar. Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Bureau of Justice Assistance, Justice Center, the members of the Council of State Governments, or funding agencies supporting the work. Suggested Citation: Presenter Last Name, Presenter First Name. “Title of Webinar.� Webinar held by the Council of State Governments Justice Center, New York, NY, Month day, year. .
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