FAQ

The Projects for Assistance in Transition from Homelessness (PATH) program is administered by the Center for Mental Health Services, a component of the Substance Abuse and Mental Health Services Administration (SAMHSA). PATH is a formula grant to the 50 states, the District of Columbia, Puerto Rico, the Northern Mariana Islands, Guam, American Samoa, and the U.S. Virgin Islands. There are nearly 600 local organizations that provide PATH services. PATH provides services to people with serious mental illness, including those with co-occurring substance use disorders, who are experiencing homelessness or at imminent risk of becoming homeless.

PATH and SOAR programs directly complement each other’s work and nearly half of the SOAR State Team Leads are also the State PATH Contacts. The PATH program’s objective to connect individuals to mental health services and stable housing is more easily accomplished when people who are homeless have access to the income and health insurance that comes with Social Security benefits. SOAR provides PATH case managers the tools necessary to expedite access to these benefits, resulting in improved housing and treatment outcomes.

Read more: PATH and SOAR Overview

Absolutely! The U.S. Department of Housing and Urban Development (HUD) Continuum of Care Program (CoC) plays a key role in ending homelessness in communities and states. HUD’s description of the program includes: “The Continuum of Care (CoC) Program is designed to promote communitywide commitment to the goal of ending homelessness; provide funding for efforts by nonprofit providers, and State and local governments to quickly rehouse homeless individuals and families while minimizing the trauma and dislocation caused to homeless individuals, families, and communities by homelessness; promote access to and effect utilization of mainstream programs by homeless individuals and families; and optimize self-sufficiency among individuals and families experiencing homelessness” (emphasis added)

SOAR is critical in HUD’s mission to promote access to Social Security disability benefits for individuals with disabling conditions. This access helps promote housing stability and prevents future homelessness for these individuals. As a result, SOAR should be included in local CoC plans to end homelessness.

If a person is working while applying for SSI and is earning above the Substantial Gainful Activity (SGA) limit set annually by SSA, they will not be eligible for benefits.

However, SSA has many work incentive programs for SSI beneficiaries to assist their efforts to return to work. These programs exclude some income/resources so that SSI recipients can attempt work, and even earn above SGA, without fear of losing their benefits. We recommend that beneficiaries speak with a work incentives specialist to discuss how work will affects their own benefits. A good place to start to find local resources is SSA's Ticket to Work website.

First, here is some information about overpayments and how to help prevent them in the future: Avoiding and Managing SSI/SSDI Overpayments. Reporting earnings is absolutely essential to prevent overpayments. SSA has some options for requesting waivers of overpayments and can set up payment plans if they deny the waiver request. 

Deciding whether to quit or cut back their hours depends on the person’s circumstances. No matter what, they need to report their earnings. Those earnings will impact SSI and SSDI differently (read some basic information about SSA Work Incentives). For some people, they can earn a lot more income by working and if they are feeling well and are able to work, that is probably what they should do (their decision!). For others, the stability of their SSDI payment is important and so they work under SGA each month to keep their benefit. Ultimately, I would recommend that they talk to a Benefits Counselor to discuss their options.

We recommend using headings throughout the MSR to divide information so that DDS can quickly find the evidence they are looking for. These headings typically include: personal history, employment, physical health, psychiatric health, and functional information. You can include sub-headings in these categories to further organize the information if you’d like.

Naturally, information may overlap in some of the sections. For instance, in legal history you may talk about how an applicant’s incarceration was related to their symptoms and then add extra information about symptoms in medical history. In these areas of overlap, there’s no need to repeat information you have already provided. By avoiding excessive repetition in the MSR and grouping the information using broad headings, we can help walk DDS through the documentation of how the applicant meets the disability criteria.

The SOAR TA Center is available to review Medical Summary Reports from SOAR practitioners. To submit your MSR for review, email soar@prainc.com and attach your MSR with the applicant’s name, birthdate, and Social Security number removed for HIPAA compliance.

The Medical Summary Report (MSR) Interview Guide and Template is a great tool for writing the MSR. The Interview Guide portion contains key questions to ask applicants when gathering evidence for the application. The Template contains main headings that may be used when formatting the MSR. Be sure to remove the Interview Guide and guidance under the Template headings before turning the MSR in to DDS. It is also important to put the MSR on your agency's letterhead whenever possible.

This guide and template can be found on the SOAR Tools and Worksheets page.

It is unfortunate when we run across physicians who are unwilling to help people access the benefits that they are entitled to, although it is a common problem.  Many doctors will say that they have not seen a person enough to support a report such as the MSR.  Sometimes doctors on ACT (Assertive Community Treatment) teams or in PSR (Psychosocial Rehab) programs may be willing to co-sign reports. When you can’t find a doctor to cosign the report, we recommend you submit the MSR as collateral information along with the medical records that you have collected that document the diagnostic information from a physician.  

You may want to find out why they are refusing to sign the report. Is it because they feel they don't know enough to sign it?  Or that it wasn't written by them so they don't want to sign it?  Are there other reasons?  One of the things we find is that the doctors often misunderstand what we are asking them to do. They believe that, by signing the report, they are "approving" the person for disability benefits. DDS makes that decision. What they're doing is simply attesting that the information contained in this report is true. It's fine if they even write a statement that they believe the information in this report is true. 

You might remind the doctor and the clinic/hospital that when someone is approved for SSI/SSDI they are also going to be eligible for Medicaid/Medicare which means retroactive reimbursement for services provided and ongoing payment for treatment and services in the future.  

One SOAR program contacted the state medical association for the names of retired physicians and asked if anyone was willing to do one assessment pro-bono.  It was fairly successful.

The short answer is "yes." If someone asks to see their Medical Summary Report, you can provide it to them in the same manner that your agency would release a copy of their medical records to them.

However, there are some other factors to keep in mind.  Since the MSR focuses on an applicant's symptoms and functional limitations rather than their strengths, we recommend talking with them first to explain that the report is written in this manner to demonstrate how they may be eligible for SSI/SSDI and that SSA needs to see numerous examples of their limitations. Remind them that they have a lot of personal strengths and that this report is not a full reflection of that.

It is important to speak with the applicant throughout the process in order to alleviate any concerns about what information will be included in the MSR. One best practice to establish transparency and trust is to ask permission on the first interview to take notes. Tell the applicant that at any time they can ask you to stop taking notes or to see what you are writing.  Emphasize that your goal is to capture their words so that they can tell their story to SSA through this process.  Ultimately, the MSR is comprised mainly of their quotes and information they have provided to you.

Reading about one's symptoms and limitations can be very difficult and through this conversation applicants may find that they aren't prepared for that or that it would not be beneficial for their recovery. But, if after this preparation, the applicant wants to read the MSR, then that is their right to do so, following your agency's guidelines.

An MSR that has been written based on properly released records can be shared with the primary AMS.  At the point of obtaining the signature, it is primarily a privacy issue, not HIPAA. However, it would be a best practice to have a release signed by the applicant permitting the case worker to communicate with the AMS.