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What Medical Providers Need to Know

What do medical providers need to know about SOAR and the Medical Summary Report?

About SSI and SSDI

  • Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) are disability income programs administered by the Social Security Administration (SSA).
  • A disabled adult is defined by SSA as “…an individual (age 18 or older) who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months…”i
    • Substantial gainful activity is based on a person’s ability to earn a certain amount each month.ii
  • In most states Medicaid and/or Medicare health insurance accompany these benefits.
  • SSI and SSDI include incentives that assist people to return to work and applicants can be working while they apply.

Who determines whether someone is eligible for SSI/SSDI?

  • SSA contracts with the disability determination service (DDS) in each state to determine medical eligibility.
  • SSA determines non-medical eligibility and makes the final decision.

Why do people with serious mental illness and/or co-occurring substance use disorders need SSI/SSDI?

  • The path to recovery can be extraordinarily challenging when one is constantly struggling to meet basic needs.
  • The income and health care benefits that SSI/SSDI provide are often a critical first step.
  • Lack of stable housing is a major obstacle to an individual’s health and recovery. Without an income, individuals can’t establish and maintain safe, appropriate and affordable housing, even with rental subsidies.

What is SOAR?

  • SOAR is a national program designed to increase access to SSI/SSDI for eligible adults who are experiencing or at risk of homelessness and have a mental illness, medical impairment, and/or a co-occurring substance use disorder.
  • SOAR-trained case managers assist with the SSI/SSDI application process by, for example, serving as the applicant’s appointed representative, collecting medical records, obtaining needed assessments, and writing a Medical Summary Report (MSR).
  • SOAR works! Without SOAR, only about 30 percent of initial applications are approved.iii For people who are homeless, the approval rate is even less (about 10-15 percent). With SOAR, 60 percent of initial applications are approved in an average of 155 days.iv

What is a Medical Summary Report (MSR)?

  • The MSR is a succinct, comprehensive summary of the applicant’s personal and treatment history and its impact on his or her life. It also clearly describes the factors affecting functioning and ability to work
  • The SOAR-trained case manager writes the MSR based on factual evidence gathered from medical records, progress notes, applicant interviews, observations, and collateral information. 
  • Although the SSI/SSDI application does not require a MSR, it can help support an SSI/SSDI application and potentially expedite the determination process.  If signed by an acceptable medical source (AMS) who knows the applicant, the MSR will be considered a “medical opinion.”

Who is considered an Acceptable Medical Source (AMS)?

  • Physicians
  • Licensed PhD/PsyD Psychologists
  • Advanced Practice Registered Nurses (APRNs)
    • This category includes: Certified Nurse Midwife, Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist.
  • Physician Assistants
  • Audiologists

Documenting Disability

The National Health Care for the Homeless Council (NHCHC) offers an online training, Documenting Disability for Medical Providers.

As described by NHCHC, this training "provides a special opportunity for clinicians to learn how they can effectively document disabilities in order to expedite Federal benefits for individuals who are entitled to Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Participants will also learn why it is especially important for clinicians to support homeless individuals’ disability claims, and how to relate to others involved in the process."

This is a great resource to which SOAR providers can refer doctors in their community to learn about creating medical records and documentation that can assist with SSI/SSDI applications. It clarifies myths and helps develop a better understanding of and support for what SOAR case managers are doing.

You can access the training on the National Health Care for the Homeless Council website

What else do Medical Providers Need to Know?

  • The MSR does not need to include an opinion about the applicant’s ability to work or be employed.
  • Treatment staff are not responsible for determining if an applicant meets disability criteria.
  • Individuals who meet the criteria for disability specified by SSA are entitled to SSI and/or SSDI.

Resources

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