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HomeMy WebLinkAboutMINUTES - 06181996 - SD2 TO: BOARD OF SUPERVISORS FROM: John B. Cullen, Director Social Service Departmen and William B. Walker, M. D., Dir ctor Health Services Department CONTRA DATE: June 18, 1996 COSTA COUNTY SUBJECT: County Response to Termination of SSI/SSP Eligibility for Recipients Disabled by Alcohol and/or Other Drugs SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION: RECOMMENDATIONS: 1. DIRECT the County Administrator to authorize the Departments of Social Service and Health Services to develop and implement a plan for county response to the Social Security Administration's termination of SSI benefits to recipients disabled by alcohol and/or other drugs, according to recommendations two and three below. 2. DIRECT the Social Service Department to implement an SSI Reapplication Unit (SRU) to provide assistance to recipients of SSI/SSP in filing reapplications and/or appeals based on a different disability, and to assist and advocate for the individuals through the process, for the period June 1, 1996 through January 31, 1997. This will not require additional appropriation of funds, but will be achieved through redirection and diversion of existing staff, and is expected to cost less than $250,000, depending on the number of SSI clients served. 3. DIRECT the Health Services Department to implement a medical evaluation process for SSI/SSP recipients using the Public Health Division's Occupational Health Clinic. BACKGROUND: The Title 16 Supplemental Security Income (SSI) and Title 2 Social Security Disability Insurance (SSDI) programs exist to provide services to citizens who have a disability that prevents them from occupying gainful employment. In addition to a variety of physical and mental disabilities, current law allows individuals to qualify for the programs due to a disability caused by (or with a significant contribution of) an alcohol and/or other drug addiction. Eligibility for SSI and SSDI automatically makes recipients eligible for other government services, including medical care through Medi-Cal. CONTINUED ON ATTACHMENT X YES SIGNATURE AAU RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON June 18, 1996 APPROVED AS RECOMMENDED X OTHER X The Board APPROVED the recommendations listed above and additionally DIRECTED:,the Social Services Director and the Health Services Director to provide tracking of the financial impact on the County due to the termination of the specified SSI/SSP eligibility; and inform community service providers about the eligibility changes and request that the community service providers also track the impact of this SSI/SSP eligibility termination policy. VOTE OF SUPERVISORS I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the X UNANIMOUSABSENT: -------- ( ---' ) Board of Supervisors on the date shown. ATTESTED: June 18, 1996 AYES: NOES: PHIL BATCHELOR, Clerk of the Board f Supe sors a unty ministrato ABSENT: ABSTAIN: Q14 By Deputy CC: Contact: J. Mansapit 3-1601 Social Service Dept. Health Services Dept. County Administrator 51>..2- On D.zOn March 29, 1996, the President signed Public Law 104-121, which deletes alcohol and/or other drug addition as an eligibility factor for SSI and SSDI benefits. This change becomes effective immediately for new claims, and effective January 1, 1997 for current recipients. Currently, Contra Costa County has approximately 1400 individuals who will no longer qualify for SSI and/or SSDI unless they can establish that they are disabled due to a reason other than alcohol or other drug addiction. DISCUSSION Impacts of New Eligibility Criteria The loss of eligibility for the County's current SSI/SSDI population will result in a very significant fiscal impact to the county. Once the recipients lose their SSI eligibility, they will lose their Medi-Cal eligibility and become potentially eligible for General Assistance and Basic Adult Care health care. Without a proactive response from the affected departments, the county could suffer additional unfunded expenditures of as much as $10 million annually in future years if all current recipients lose SSI eligibility. In addition, the loss of eligibility for SSI resulting from the change in criteria will result in a devastating human impact of the individual recipients. ;Current recipients will receive an approximate $370 reduction in monthly income from $670 in SSI to $300 per month in General Assistance. The economic multiplier affect ensures a negative economic impact on the community caused by the loss of this funding. Proposed Solution The two Departments propose a proactive, interdepartmental approach to mitigate the impacts of this change on the county, the clients, and the community. The Departments of Social Service and Health Services will work together to help the approximately 1400 affected SSI recipients qualify for SSI through disabilities other than alcohol and other drug addiction to the extent that they are disabled. Social Service will create a Reapplication Unit to provide recipients assistance in filing reapplications based on another disability and case manage the individuals through the process. Health Services will implement a clinic to complete medical evaluations of disability and identify specialty care needs and to coordinate medical appointments with specialists who will complete the medical documentation and the disability application. In addition to the county's efforts, Health Services and Social Service have approached community based organizations serving SSI recipients to enlist them in our efforts. Representative payee organizations, treatment providers, legal advocates, and housing programs are supporting the project and will assist in any way they can. Costs To accomplish the goals and provide the necessary services, the departments need additional staff and appropriation authority. However, since the departments plan to conduct the reapplication activities for only a limited period of time (not to exceed sone year), the departments are not requesting any additional permanent positions for this project. The departments will utilize some existing staff on a diversion basis and some limited term, temporary and contracted staff only. The Social Service Department estimates a cost of approximately $250,000 to provide for nine project staff, including one social worker, five eligibility workers, one eligibility supervisor, two experienced level clerks, and ancillary expenses. The Health Services Department expenses will be dependent on the volume of clients served. Medi-Cal revenue will be used to offset costs of current SSI eligibles. Anticipated Results The Social Security Administration has estimated that up to 70% of the affected SSI recipients can remain eligible for the programs with proper and timely application and documentation, which the departments propose to facilitate. Under this scenario, the departments anticipate that the proposed measures can save the county approximately $7 million per year. Under this best-case scenario, as determined by SSA, 30% of the SSI recipients will still lose their eligibility for SSI, which can result in an annual impact to General Assistance of $1.5 million, and additional annual medical care costs 5P. .1 of $1.5 million. Without the proposed county intervention, most of this population will lose eligibility, which would result in an annual increase of up to $5 million in General Assistance, and $5 million in medical care. We will, of course, be aiming for reapplication and approval of closer to 100% of this population. For every client re-established on SSI, the County could realize an annual savings of over $7000 in General Assistance and Health Services (Basic Adult Care) costs. Time Lines Affected SSI recipients will receive notification of termination of their eligibility for benefits in June, 1996. If these clients file a reapplication and request requalification under another disability within ten days, they will continue to receive SSI until a decision is made, even if the decision is made after January 1, 1997. If the recipient misses the ten day deadline, and subsequently files a reapplication prior to July 28, 1996, benefits will stop on January 1, 1997, if a decision has not been made by that time. Realistically speaking, most of these recipients will not refile within the ten day period, and will be eligible for GA dollars after January 1, 1997, until SSI starts again. The departments propose to work with disqualified SSI recipients beginning June 19, 1996 and anticipate completing the project and requalifying all possible recipients by January 31, 1997. Should more time become necessary to fully achieve all possible savings, the departments will return to the Board for reauthorization for the balance of the FY 1996-97. Other Alternatives Considered The departments have explored alternative methods to continue the eligibility for SSI for recipients affected by the change in eligibility criteria. Unfortunately, the departments determined that no other alternative(s) appear feasible at this time. One alternative which was explored in Sacramento county, was to have a private organization review medical files prior to submission to the Social Security Administration after receiving all pertinent medical files, at an estimated cost of $250 per case. Most of the cost in documenting eligibility relates to obtaining the pertinent medical files, so this suggestion would not significantly benefit the county. Private attorneys have indicated that they are not willing to pursue these on less than a fee for service contract. Community based organizations, for the most part, lack the expertise to provide this advocacy. Blake & Associates -- contractors for the Zebley SSI project -- have not demonstrated that they have the ability to provide the face-to-face, in depth service required for this project. Funding The Social Service Department will use General Assistance funds to cover the costs of the SSI Reapplication Unit, including staff and ancillary costs such as outreach, supplies, transportation (clients and staff), toll-free telephone number, and so forth. The Health Services Department will use a combination of Basic Adult Care and Medi-Cal funds to provide for the related medical work and reports, including specialist examinations, and obtaining current medical reports from clients' other treatment sources. J� � sE _L �•� CONTRA COSTA COUNTY - Social Service Department a a ; O John Cullen, Director SpA-cou DATE: June 5, 1996 TO: Board of Supervisors cc: Phil Batchelor FROM: John B. Cullen, Social Services DireY . William B. Walker, M.D., Health Services Director L) SUBJECT: County Response to Termination of SSI/SSP Eligibility for Recipients Disabled by Alcohol and/or Other Drugs RECOMMENDATIONS: 1. Direct the County Administrator to authorize the Departments of Social Services and Health Services to develop and implement a plan for county response to the Social Security Administration's termination of SSI benefits to recipients disabled by alcohol and/or other drugs, according to recommendations two and three below. 2. Authorize the Social Services Department to implement an SSI Reapplication Unit (SRU) to provide assistance to recipients of SSI/SSP in filing reapplications and/or appeals based on a different disability, and to assist and advocate for the individuals through the process, for the period June 1, 1996 through January 31, 1997. This will not require additional appropriation of funds, but will be achieved through redirection and diversion of existing staff, and is expected to cost less than $250,000, depending on the number of SSI clients served. 3. Authorize the Health Services Department to implement a medical evaluation process for SSI/SSP recipients using the Public Health Division's Occupational Health Clinic. BACKGROUND The Title 16 Supplemental Security Income (SSI) and Title 2 Social Security Disability Insurance (SSDI) programs exist to provide services to citizens who have a disability that prevents them from occupying gainful employment. In addition to a variety of physical and mental disabilities, current law allows individuals to qualify for the programs due to a disability caused by (or with a significant contribution of) an alcohol and/or other drug addiction. Eligibility for SSI and SSDI automatically makes recipients eligible for other government services, including medical care through Medi- ADMINISTRATIVE OFFICE: 40 Douglas Drive - Martinez - CA - 94553-4068 - Voice (510) 313-1500 - FAX (510) 313-1575 Cal. On March 29, 1996, the President signed Public Law 104-121, which deletes alcohol and/or other drug addition as an eligibility factor for SSI and SSDI benefits. This change becomes effective immediately for new claims, and effective January 1, 1997 for current recipients. Currently, Contra Costa County has approximately 1400 individuals who will no longer qualify for SSI and/or SSDI unless they can establish that they are disabled due to a reason other than alcohol or other drug addiction. DISCUSSION Impacts of New Eligibility Criteria The loss of eligibility for the County's current SSI/SSDI population will result in a very significant fiscal impact to the county. Once the recipients lose their SSI eligibility, they will lose their Medi-Cal eligibility and become potentially eligible for General Assistance and Basic Adult Care health care. Without a proactive response from the affected departments, the county could suffer additional unfunded expenditures of as much as $10 million annually in future years if all current recipients lose SSI eligibility. In addition, the loss of eligibility for SSI resulting from the change in criteria will result in a devastating human impact of the individual recipients. Current recipients will receive an approximate $370 reduction in monthly income from $670 in SSI to $300 per month in General Assistance. The economic multiplier affect ensures a negative economic impact on the community caused by the loss of this funding. Proposed Solution The two Departments propose a proactive, interdepartmental approach to mitigate the impacts of this change on the county, the clients, and the community. The Departments of Social Services and Health Services will work together to help the approximately 1400 affected SSI recipients qualify for SSI through disabilities other than alcohol and other drug addiction to the extent that they are disabled. Social Services will create a Reapplication Unit to provide recipients assistance in filing reapplications based on another disability and case manage the individuals through the process. Health Services will implement a clinic to complete medical evaluations of disability and identify specialty care needs and to coordinate medical appointments with specialists who will complete the medical documentation and the disability application. In addition to the county's efforts, Health Services and Social Services have approached community based organizations serving SSI recipients to enlist them in our efforts. Representative payee organizations, treatment providers, legal advocates, and housing programs are supporting the project and will assist in any way they can. 2 Costs To accomplish the goals and provide the necessary services, the departments need additional staff and appropriation authority. However, since the departments plan to conduct the reapplication activities for only a limited period of time (not to exceed one year), the departments are not requesting any additional permanent positions for this project. The departments will utilize some existing staff on a diversion basis and some limited term, temporary and contracted staff only. The Social Services Department estimates a cost of approximately $250,000 to provide for nine project staff, including one social worker, five eligibility workers, one eligibility supervisor, two experienced level clerks, and ancillary expenses. The Health Services Department expenses will be dependent on the volume of clients served. Medi-Cal revenue will be used to offset costs of current SSI eligibles. Anticipated Results The Social Security Administration has estimated that up to 70% of the affected SSI recipients can remain eligible for the programs with proper and timely application and documentation, which the departments propose to facilitate. Under this scenario, the departments anticipate that the proposed measures can save the county approximately $7 million per year, with a one-time cost of $500,000 in FY 1996-97. Under this best-case scenario, as determined by SSA, 30% of the SSI recipients will still lose their eligibility for SSI, which can result in an annual impact to General Assistance of $1.5 million, and additional annual medical care costs of $1.5 million. Without the proposed county intervention, most of this population will lose eligibility, which would result in an annual increase of up to $5 million in General Assistance, and $5 million in medical care. We will, of course, be aiming for reapplication and approval of closer to 100% of this population. For every client re-established on SSI, the County could realize an annual savings of over $7000 in General Assistance and Health Services (Basic Adult Care) costs. Time Lines Affected SSI recipients will receive notification of termination of their eligibility for benefits in June, 1996. If these clients file a reapplication and request requalification under another disability within ten days, they will continue to receive SSI until a decision is made, even if the decision is made after January 1, 1997. If the recipient misses the ten day deadline, and subsequently files a reapplication prior to July 28, 1996, benefits will stop on January 1, 1997, if a decision has not been made by that time. Realistically speaking, most of these recipients will not refile within the ten day period, and will be eligible for GA dollars after January 1, 1997, until SSI starts again. 3 Sp. Z. The departments propose to work with disqualified SSI recipients beginning June 15, 1996 and anticipate completing the project and requalifying all possible recipients by January 31, 1997. Should more time become necessary to fully achieve all possible savings, the departments will return to the Board for reauthorization for the balance of the FY 1996-97. Other Alternatives Considered The departments have explored alternative methods to continue the eligibility for SSI for recipients affected by the change in eligibility criteria. Unfortunately, the departments determined that no other alternative(s) appear feasible at this time. One alternative which was explored in Sacramento county, was to have a private organization review medical files prior to submission to the Social Security Administration after receiving all pertinent medical files, at an estimated cost of $250 per case. Most of the cost in documenting eligibility relates to obtaining the pertinent medical files, so this suggestion would not significantly benefit the county. Private attorneys have indicated that they are not willing to pursue these on less than a fee for service contract. Community based organizations, for the most part, lack the expertise to provide this advocacy. Blake & Associates -- contractors for the Zebley SSI project -- have not demonstrated that they have the ability to provide the face-to- face, in depth service required for this project. Funding The Social Service Department will use General Assistance funds to cover the costs of the SSI Reapplication Unit, including staff and ancillary costs such as outreach, supplies, transportation (clients and staff), toll-free telephone number, and so forth. The Health Services Department will use a combination of Basic Adult Care and Medi- Cal funds to provide for the related medical work and reports, including specialist examinations, and obtaining current medical reports from clients' other treatment sources. 4