Meeting Information


Meeting Type
Friday Provider Meeting
Date
Friday, 5/25/2018
Start
9:15 AM
End
11:00 AM
Agenda
Agenda
Summary
Keys to successful Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) applications, SOAR (Social Security Outreach Access to Recovery), and a Tent City Tacoma Discussion.
Minutes

Presentation

Keys to successful Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) applications

  • Michael Gilbert, CEO of Pounce Law, michael@pouncelaw.com
  • Was an administrative Law Judge with the Social Security Administration
  • Now works representing SSI and SSDI applicants at Pounce Law
  • Many of you connect folks to SSI or SSDI, or refer folks to other agencies to apply for benefits.
  • There are lots of disconnects between applying for benefits and getting denied.  I would often see clients needing benefits denied at the State level. 
  • Over and over again, saw the same problems with the applications occurring. 
  • Background Information
    • I’ve helped people for a long time.  In the Navy, worked as a  Helicopter Search and Rescue Swimmer.
    • Spent time in the Marines – helped Afghanistan rebuild its legal system.
    • Like to improve systems – find choke points, and get around them
    • You all want to help folks bet benefits as quick as possible.  Some people need more help than others – you have to triage who to help all the time.
    • After Afghanistan, I got a job as an administrative law judge.  – Not so happy heading into a bureaucratic nightmare (are there bureaucratic utopias, or would that be an oxymoron? –ed)  .  People in bureaucracies are still working hard, but it can be a tough place to be successful.
    • When application reviewers see gaps, they are given a reason to deny a claim.  When reviewing a case, clients are usually denied because of gaps in the application. 
    • I was listening to appeals – both the initial appeal and the reconsideration.  In reviews – individuals are often represented by an attorney.  As a judge, I can see why someone was denied benefits.  That info isn’t given to the applicant. 
    • As a judge, I was a hard ass.  It is hard to see folks who were denied and should have been paid at day one.  Often the evidence of their meeting the eligibility criteria wasn’t in the record – this is a gap that can cause problems. 
  • These are personal opinions – not those of the Social Security Administration (I’m pretty sure no one was going to confuse Michael’s opinions with those of the Social Security Administration – for instance, I doubt the Social Security Office refers to their own bureaucratic hell as such.  Good to be clear, though. –ed.)
  • Folks at SSA and DES – are all overwhelmed.  Approach them with the mindset that they are overwhelmed with their cases.
  • There is mythology that judges just want to deny cases. One often hears that you “need to get denied twice to get your claim approved”.   
  • 3 kinds of Gaps cause SSI and SSDI denials.
    • On the subway in England – there is a recording at the stations saying “mind the gap”.  (https://www.youtube.com/watch?v=L0otYijxNbc )
    • Gaps in treatment in the medical record
      • Treatment records.  if there are no medical records, treatment didn’t happen.  Must find the medical records and get them in the application record.  If there is no treatment, there is no disability.
    • Gaps in Communication.  Communication is difficult.  People often disappear.  It is hard to help folks get benefits when you can’t contact them for more information or details or medical records.
    • Gaps in Focus.  These are gaps in the focus of the claim.  If the real problem is mental health, if doesn’t do any good to work on documenting a back problem that isn’t disabling. 
    • Gaps are all related.  If no communication with client – you won’t be able to find the treatment records.
    • 2017 – study by Social Security Office shows 1.1 million folks waiting for a disability hearing.  Asking for a disability hearing means they’ve been denied twice already. 
    • On average, 1 American dies per hour waiting for their hearing. (this statistic kind of bummed me out. –ed.)
    • According to Gerrit’s Statistics, 50% of the homeless population, at any given time, is within 4 months of being homeless.  We should engage early to get resources to these folks.  We need to come up with ways to get folks SSI and SSDI quicker – and we can by minding the gaps.
    • Based on SSA records, average wait in days for a hearing is 528 days from the day they are denied twice.  526 days before a hearing.  And that wait is still going up.  That is the average – some are longer, some are faster.
    • Straight from Social Security Office – the average processing time – start to decision – is 609 days or 20 months.  It is 572  days in Tacoma.  It is 664 days in Eugene. 
    • Looking at the future from current receipts – if you apply for a hearing in October of 2017, you won’t get a decision until 2019.  Apply for a hearing in October of 2018 and you’ll not get it until June 1st of 2020.
    • This huge wait is a major problem that we need solutions for.  That is the reality of this environment.
    • Workloads – in Tacoma, they are just barely completing more cases than they are getting.  It will take Tacoma 10.5 years to get to a point where they can do a hearing in one year.
    • We need keep people from going into that limbo. 
    • How do we speed up the process, or help the meritorious not get denied?  Follow these steps:
  • Understand the process
    1. There is a field office where you can get service.  You can apply for disability at the field office.  The field office sends the application to the state agency for approval.
    2. Disability Determination Service (DDS), a state office, is overwhelmed by huge need.  They have doctors and psychiatrists on staff.  A case worker develops the record.  When there are gaps, they will send a questionnaire to the claimant.  Will indicate that if in 10 days they don’t get records from claimant, they will assume there are no records.  Unfortunately, claimants often avoid government communication.  The DDS is where the state agency determines disability.  If there is inadequate medical documentation, the case worker might ask for an assessment.  When the record is as complete a possible, a decision is issued.  If someone doesn’t like the decision, they can ask for reconsideration.  If the claimant is still denied, they can then appeal to the judge.  If still not approved, it goes to the appeals council.  Finally, they can go to federal court. 
    3. There is a 5 step process to determine if someone qualifies for SSI or SSDI - adjudicator follows this process:
      1. Work earnings – are you working – if you earn too much, you are not eligible.  Must early less than $1,200 from substantial gainful earnings.
      2. Do you have a severe medical impairment .  severe medical impairment must be diagnose by acceptable medical source with objective evidence supporting disability.  Need over 12 months of disability.  With back problems, you need x-ray, not just pain. 
        1. Has to affect 1 or more work activities
        2. Many folks make poor decisions or don’t interact well with supervisors, because of PTSD, pain, etc.  Need to communicate that to the case manager.
  • Each disability has a set of evidence that is needed.  All needed information is the evidence that must be used to show the disability and its impact on work. Also check for residual functional capacity –
  1. Does the person have the ability to do other work they did in the past?  If so, they are not qualified.. 
  2. Are there other jobs in the economy that the person can perform -  if so, then they are not qualified.
  1. Adjudicator reviews lots of other information
    1. Agency needs information on lots of points. 
    2. Claimants have the burden proof.  This can be a real challenge.  People who are unable to help themselves often have trouble providing the information the adjudicator needs.
  • Adjudicator often rejects something with insufficient evidence.  Without enough evidence, they will deny. 
  1. Full information is needed to eliminate gaps.
  2. How to eliminate gaps.  Keep a log on the questions that crack the dam.  Straightforward questions don’t always work.  Asking leading questions about why someone can’t get to work.  If someone can’t get a ride, that is not disabled.  If someone can’t leave their house, find out why – no transportation, no initiative, or crippling anxiety.  Different reasons have different impacts on eligibility.  Need to cross examine folks. 
  3. Need to establish a timeline – find documentation from when they were treated.  Need to find out what doctors have diagnosed.  Find out what someone is getting treated for –
  4. Don’t give up because things don’t make sense – follow oddities to see if you can understand what is happening.  There are often lots of good reasons for the gaps.  Find ways to get folks services if they are not able to get treatment. 
  5. Don’t worry about prior history.  Only get funding from when they apply – don’t look too far back for an SSI case. 
  6. Get the CD copy of all the medical records that state agency has from the field office.  Claimants may have real problem but no documentation.  You need to know what a client has in a record – need to see where the gap in documentation is. 
  7. Develop a checklist of the providers in an area – ask if they’ve seen so an so.  Can ask if they are seeing folks – this helps to get records, but  can also help folks get help if they need it. 
  8. Negative branding – people can be embarrassed about asking for help – don’t want to be seen as getting resources they don’t deserve.
    1. Look for a spouse or a child who can help get information to and from the claimant, then work to get that information directly from the claimant.
  9. Gaps in communication – If claimants won’t call case managers or miss medical appointments it can cause a denial. 
  10. Cricket sound - if they aren’t talking to you, they probably aren’t talking to social security.  (is this the right cricket sound Michael? - https://www.youtube.com/watch?v=uUZskFKxLlQ –ed.)
  11. Inconsistency in earnings records from IRS are reviewed. -  must communicate to ensure things are understood. 
  12. New treatment records must be pushed to the Social Security Office.  They can have a bar code added to medical records and have them faxed in to the field office.  Claimants always need to ask for a copy of the medical records when they visit the doctor. 
  • Claimants can be sent to a Consultancy Examination (CE).  If no treatment records show a disability – case manager will get an evaluation.  If you don’t show to the CE, Social Security will set us a second appointment – if no show again, get denied. 
  • When the CE exam is missed and there was no response to DDS – difficult to defend.  The credibility piece is a challenge and important for appeals. 
  • Create a timeline of the events – also timeline the application process.  Keep in contact with Social Security Office – try to get in the communication channel.  If there is a trusted 3rd party that is trying to help someone, try to keep them in the loop to assist collecting information.  Procrastination and no response is a problem.  Tell them benefits are being shut off to get folks to show up. 
  • Gaps in focus – they think is a back problem, it is uncontrolled diabetes.  Focus on the actual problem.  Need to focus on the right problem – mental health or physical problem. 
  • If a physical problem is identified but no findings come back from a CE.  If you say a back problem – but no evidence of a back problem – claim is denied.  No time to figure out the real problem.  SSA won’t look for the root issue, just at the identified issue. 
  • Want the treatment needed for the disability that is impacting their ability to work.  Need treatment to fit the evidence.  
  • Each case is unique.  We are in an overwhelmed system – anything we can do to assist these individuals to close these gaps will really benefit the claimant.
  • Al – Could you make this presentation available to everyone?  Michael – sure. (and he did, and I attached it to this e-mail. –ed.)
  • Michael – I also want to put together a little 3 pager on this.
  • Al – when should someone seek the assistance of an attorney.  Michael - In the first step, you don’t need an attorney.  In step 1, when there are lots of symptoms and lots of different ailments – cases with nuance may need an attorney earlier.  Attorneys are paid based on the size of the back award – 25% of award up to $6,000.  Early in the process, the attorney can’t get much pay because this is so little back pay – so there is a bad incentive for attorneys to help.  Decisions happen hopefully in 90 days, but just to get a 2nd determination can take up to a year.  Bring an attorney in if there is nuance – not if they have terminal cancer – but something more complex.  Get an attorney at the hearing level, as well.  In litigation, skills matter – so attorneys are useful there.  Get an attorney after a denial. 
  • Judges do 500 -700 cases a year.  Each case is about 1,000 pages.  That is like reading war and peace 40 times a month (and Helene still cheat on Pierre every single time you read it, but he still ends up with Natasha in the end, so it is OK –ed).  Judges just aren’t able to read every case. 
  • Effran - Is there a check sheet with check points – often lots of folks work with a client, and we could use some tools to help them navigate the process.  Michael – the key is getting the CD with the evidence – so you can see where the gaps are.    
  • Question – We need cultural competency – I worry that folks who are African American don’t trust the system.  The system doesn’t work the same for everyone.  Michael – there are groups that are discriminated against in the system so you need to be careful.  Folks coming out of prison – DDS often denies the case.  There is no identification of race in the records – but names are often identifying.  Social Security will pay interpreters.  Limited proficiency in English can get folks quicker access to resources.  Everybody is different.  Question: you understand these racial differences are real.  Michael – yes, I do understand.  As a judge I kept track of my decisions based on race – so I see how I’ve treated people over time to ensure by biases weren’t in play. 

Presentation

SOAR (Social Security Outreach Access to Recovery)

  • James Pogue, Comprehensive Life Resources
  • SOAR – Social Security Outreach Access to Recovery. (https://soarworks.prainc.com/ )
  • People are deputized to know their clientele and to support their client when applying for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). 
  • Dawna Bryant – dbryant@cmhshare.org - team lead with Comprehensive Life Resources – she is the Pierce County SOAR lead – trying to deputize as many folks as possible.  Will get trained with a checklist, forms, how to get access to records. 
  • Recent case – 100 days to approval – getting benefits 40 days after that (a hushed awe filled the auditorium, followed by scattered clapping, then full on applause and cheering.  If Dawna had been here, she would certainly have been carried around the room on folks shoulders. –ed).
  • You can be trained yourself – you do lots of the work the social security office does, but prior to submittal. 
  • 85% success for 1st applications  in Pierce County.  Real powerful tool –
  • Training requires a few sessions over 5 or 6 weeks. 

Presentation

Tent City Tacoma – (I highlighted in bold a the specific needs that Patricia would like someone to help with.  Also, this discussion started with a plan to put a tent city on the Salvation Army Parking lot, and ended with Martha indicating a more limited number of individuals and doing Safe Parking at the site. –ed). 

  • Patricia Menzies –pmenzies48@gmail.com - feeling rushed for time (sorry about that, tried to put too much on the agenda again –ed.)
  • Martha is ready to file for a permit to host a temporary shelter
  • Who wants to help her manifest this first tent city in Tacoma?
  • We don’t need to reinvent the wheel – they have these in Seattle – we’ve visited them (info about them at http://www.sharewheel.org/Home/tent-cities -ed.)
  • The area is big enough for a temporary shelter for up to 100 people.  Can do a full temporary shelter for 100  people. 
  • What does that look like?  Go to Seattle to see one – perhaps tent city 3 or tent city 4.  We have photos we will share (I put a note in for myself to get photos, but I didn’t do that. I’ll see if Patricia can send us some –ed.).
  • There is great community support – but some in the community don’t want tent cities.  Se we need to be very vocal in support.
  • Questions – what about liability or insurance?  Do we need another policy?  Will they sue the church? 
    • Dozens of churches in Seattle have hosted tent cities – they haven’t lost their churches
    • Need someone to contact the churches and see what they do about liability.
  • There are some pallet houses – the city has 30 or more of those
    • Need someone to find the pallet houses. James - stored in the fire department – talk to Tory Green with the Fire Department
  • Need  a nonprofit we can slide under to receive money or submit grant through
  • Need to contact tent cities in Seattle – they have inventories of tents and canopies and such
    • Need someone to get that inventory so we can start to get the supplies
  • Figure out the logistics –
    • Neal – One thing we need to implement is a 3 tiered system
      • Tier 1 – host
      • Tier 2 – administrative organization – people who back this, make it happen with administration, finances, logistics on moving things around. 
      • Tier 3 – residents at the tent city – screening process needs to be consistent with those of share wheel – no active warrents, sex offender, restraining orders.  Otherwise, no real restrictions.
    • Another concern is the on-site leadership or management – leaders would be elected out of the camp residents.  There is an executive council that operates the day-to-day stuff at the camp – where things are located at camp – how to distribute tents, and simple decisions like that.  Long term decisions – should smoking or pets be allowed – are all made by the camp as a whole.  This is how many of the organizations do this, and hit has proven successful for decades. 
    • From the Sponsor end – need a “provider-plus-one” approach.  That means that at any event that communicates information on the status of the camp, there are always more residents present and making decisions than members of the sponsor organization (the number of residents should equal the number of providers plus at least one extra resident – the plus-one). 
    • Patricia – Even though it looks kind of cookie cutter, each camp can decide on more restrictions, or can decide to be a family camp.  Each camp can decide to be adults only, or only at risk youth with carefully screened youth.  They must use “scientifically based” reasons.  Please don’t have shut doors for sex offenders – review each case individually to make sure they really can’t be a safe resident. 
    • Neal – absolutely agree – want each camp to make its own rules.
    • ready to work anywhere it Tacoma. 
    • Neal – want an organization like “Greater Seattle Cares” (http://greaterseattlecares.org/ ) that manages resources going in to Share Wheel that runs the encampments. 
    • Lavada – when you talk about rules and regulations.  Will rules be written down?  Neal – absolutely.  That would be part of the job of the liaison between the tent cities and the sponsor organization. 
    • Neal – Staff coordination is the job of the liaison from the sponsor organization.  Sponsor liaison will work with outside agencies, and will bring residents in to conversations as needed. 
  • Maureen – this is very exciting – might talk to Trinity Presbyterian as a nearby sponsor option.  Work with groups that may be in opposition to bring them on board.  Patricia – we want a group that is
  • Martha – probably not going to have tents – going to do just safe parking to start off with 5 to 10 cars, which could be up to 40 people.  Cars make people feel safer.  Want to pave the ground for other organizations.  Looking at safe parking, using Y for showers,
  • James – will have a breakout session next week on this topic.   We said we’d rally around the first site sponsor.  Thanks everyone.

Good of the Order

  • Al - 2 managed care organization in the room – thanks for coming
  • Project homeless Connect, June 22nd, People’s Park (People’s park is at 900 S MLK, Tacoma, WA – event info at -  http://www.soundoutreach.org/project-homeless-connect/ -ed.)
  • Molina Health Care has a Community Champion Awards – nominate someone – a volunteer- doing a  great thing in the community.  If selected, the volunteer is awarded $1000 to give to the nonprofit of their choice.  All nominees and nominators (I didn’t know that was even a word –ed) are invited to dinner at Renton Pavilion. (Nomination form at http://www.molinahealthcare.com/members/common/en-US/abtmolina/whymolina/yourcomm/nominationform/Pages/wa/nominationform.aspx - ed.)
  • Reminder, listserv is public information, keep information de-identified
  • James – am meeting with Rick Talbert to discuss political will around a brand new supportive housing or tent city or something.  Will try to bring Rick Talbert here if this is moving ahead. He is a huge advocate for Tiny Homes.  Lots of folks are building tiny homes, hoping to find a place to put them.  Next Friday – looking to  have a discussion focused on Tiny Homes.
  • Low Income Housing Alliance – which will support the social security office – clients can now maintain Housing and Essential Needs (HEN) voucher if temporary disability becomes more permanent and they are applying for SSI or SSDI. 

Coming Attractions

  • June 1stCommittee work time
  • June 5th – Hire253 Job Fair
  • June 8th – an open schedule – it could be you…
  • June 15th - Prosperity Wellness Center and ACTS Behavioral Health & Recovery Overview
  • June 22nd – Project Homeless Connect

Restaurant Review

If you’ve never been to MSM (Magic Sandwich Makers) on 6th Ave (2220 6th Ave, Tacoma, WA  98403 – phone 253-272-4814) then you are missing out.  It is deli sandwiches done right.  Fast, cheap, and tasty.  Well, they are fast, but there is often a line – so call ahead.  I’m a fan of their Rueben with everything on it.  It isn’t a traditional Rueben, but still darn good.  Their chicken salad is lovely.  You can’t go wrong with Mike’s deluxe, either.  I love the ambiance, if you can call it that.  They aren’t trying to be anything other than a deli in a minimart.  I’ve eaten on their cheap plastic chairs like once – I pretty much always go for take out.  The staff are as friendly as they need to be – there are really just trying to make and sell sandwiches, and are nice about it, but they have things to do that aren’t chatting with the customers.  Like making me a sandwich.  They are a minimart too, so you can grab a soda and some chips to go with your sandwich (and pickle spear).  MSM isn’t organic this or locally sourced that or turkey roasted on site – just a solid deli sandwich.  And I’d recommend taking that sandwich to Wright Park and enjoying all the good things Tacoma has to offer. 

Attendees

  • Neal Rogers, Tent City Tacoma
  • Patricia Menzies, Tent City Tacoma
  • Marybeth McCarthy, Tacoma Community College
  • Matthew Jorgensen, City of Tacoma
  • Amy Van, Tacoma Housing Authority
  • Carolyn Weisz, University of Puget Sound
  • Jason Gauthier, Habitat for Humanity
  • Jeremy Ward, Habitat for Humanity
  • Maureen Howard, Maureen Howard Consulting
  • Jessica Arteaga, Sound Outreach
  • Lynn Jones, Catholic Community Services
  • Patty Schneider, Catholic Community Services
  • Frances Watanuki, Catholic Community Services
  • Rosemary Powers, New Connections
  • Charleen Fitzgerald, Coordinated Care
  • Brandon Chun, Metropolitan Development Council
  • Nicole Barrett, Coordinated Care
  • LaVada Kent-Napier, Zydeco Queen, Entrepreneur and small business owner (I usually look up new organizations that show up at our meeting so I can put a link to their webpage in the agency section, but the only thing I found in my google search for “Zydeco Queen” was a 1983 music video for “Zydeco Taco” by Ida Queen - https://www.youtube.com/watch?v=xom8cnaILHU – which was enjoyable, especially the accordion solo, but didn’t get me any closer to finding out what “Zydeco Queen” is.  I was hooked on the Zydeco Tacoma, though, so I had to look up Ida Queen, and her Wikipedia page says she’s the “first female accordion player to lead a zydeco band”.  Pretty impressive.  It also says that fact still needs a citation, but I’m just going to assume that something that important isn’t just made up by someone.  Anyway, I found a copy of an LP with Zydeco Taco for $2 on Discogs.com, and just placed an order.  My officemates are going to be super excited when it gets here… –ed.)
  • Timothy P. Glover, Shift Community Resources
  • Daryl Jones, Recovery Foundation
  • Ken Patterson, Property owner in Midland
  • Kenneth Moultry, Recovery Foundation
  • Caroline Belleci, Pierce County Human Services
  • Martha Sheppard, Tacoma Salvation Army
  • Larry Seaquist, League of Women Voters
  • Cynthia Stewart, League of Women voters
  • Stephanie Wright, Adonai Counseling
  • Heather Wiley, Tacoma Salvation Army
  • David Venes, Tacoma Needle Exchange
  • Kalena Towle, Multicare
  • Glen Kelley, Multicare
  • Judy Flannigan, Tacoma Salvation Army
  • Dru Gonia, Tacoma Salvation Army
  • Rainey Carley, Comprehensive Life Resources
  • Audrey Oliver, Comprehensive Life Resources
  • Liz Murphy, Comprehensive Life Resources
  • Che Smith, Sexual Assault Center of Pierce County
  • Heather Wesolowski, Marybridge Children’s/Multicare
  • Rich Berghammer, Fellowship Bible Church
  • Chris Boitano, Catholic Community Services
  • Carrie Ching, Molina Healthcare
  • Al Ratcliffe, Community Advocate
  • Alice Sofrias Diakonos, Industrial workers of the world
  • Tony martin, Passover gathering church
  • Starleen Howard, Homeless an dpregnat wome
  • Adrian Wilson, community activity, currently ohomeess
  • Pam Silver, Accountable Communities of Health (I think that was her. –ed.)
  • Sheila Miraflor, Sound Outreach
  • Paul Kasky, Needle Exchange
  • Kira Gilbert, Pouncelaw
  • Shane Wise, Washington Worksource
  • Effren Davis, Pierce County District Court
  • Nicole Barrett, Coordinated Care
  • Candace Madlena, Career Path Services
  • Star Howard, H.O.M.E - Homeless Pregnant
  • Tony Martin, Pastor
  • A boy playing video games