DEC. 07

U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

Research for

Practice

Helping Inmates Obtain Federal Disability Benefits
www.ojp.usdoj.gov/nij

U.S. Department of Justice

Office of Justice Programs

810 Seventh Street N.W.
Washington, DC 20531

Michael B. Mukasey
Attorney General
Cybele K. Daley
Acting Assistant Attorney General
David W. Hagy
Acting Principal Deputy Director, National Institute of Justice

This and other publications and products
of the National Institute of Justice can be
found at:
National Institute of Justice
www.ojp.usdoj.gov/nij

Office of Justice Programs
Innovation • Partnerships • Safer Neighborhoods
www.ojp.usdoj.gov

DEC. 07

Helping Inmates Obtain Federal
Disability Benefits

This publication is based
on “Helping Inmates
Obtain Federal Disability
Benefits: Serious Medical
and Mental Illness,
Incarceration, and Federal
Disability Entitlement
Programs,” final report to
the National Institute of
Justice, NCJ 211989,
available online at
www.ncjrs.org/pdffiles1/
nij/grants/211989.pdf.

Findings and conclusions of the research reported here are those of the
author and do not necessarily reflect the official position or policies of the
U.S. Department of Justice.
This research was supported by the National Institute of Justice and the
Centers for Disease Control and Prevention under contract number
99–C–008 2002TO097 000.

NCJ 216297

RESEARCH FOR PRACTICE / DEC. 07

ABOUT THIS REPORT
This report looks at three
programs that assist inmates
in preparing and filing pre­
release applications for Fed­
eral disability benefits so they
can continue to receive treat­
ment without interruption
after they are released from
prison or jail.

What did the
researcher find?
The results of the research in
three study sites—the State
of Texas, the city of Philadel­
phia, and the State of New
York—indicate that helping
offenders obtain Federal ben­
efits not only can increase
releasees’ access to care, but
also can reduce the financial
burden on State and local
governments that fund indi­
gent health care systems.
The most important lessons
learned were—
❋	

ii

Interagency partnerships
are an essential ingredient
in the benefits application
process.

❋	

Dedicating staff to benefits
tasks can build expertise
and streamline administra­
tive processes.

❋	

Finding ways to finance
treatment and monitor

releasees until benefits
commence is essential.
❋	

Tracking outcomes of the
process is beneficial to
improving procedures and
sustaining funding.

❋	

Centralizing operations can
help reduce delays and
improve communication
among partner organizations.

❋	

Assisting mentally ill
inmates and releasees can
pose special challenges.

What were the study’s
limitations?
The innovative programs
studied generally have not
conducted adequate out­
come research. Systematic
data collection would aid
research and help guide
practice.

Who should read this
report?
Correctional administrators,
probation and parole officers,
prison counselors, health
care advocates, correctional
medical staff, and health care
and social workers in correc­
tional settings.

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

Catherine H. Conly

Helping Inmates Obtain Federal
Disability Benefits

About the Author
Catherine H. Conly
prepared the final report
as an independent
consultant to Abt
Associates Inc.,
Cambridge, Massachusetts,
under contract number
99–C–008
2002TO097 000
with the National
Institute of Justice.

On any given day, tens of
thousands of inmates with
serious medical or mental
health conditions are housed
in Federal, State, and local
correctional facilities around
the Nation.1 Prevalence rates
for certain mental illnesses
such as schizophrenia and
bipolar disorder; chronic dis­
eases such as asthma; and
infectious diseases such as
tuberculosis, hepatitis C, and
human immunodeficiency
virus/acquired immunodefi­
ciency syndrome (HIV/AIDS)
are estimated to be signifi­
cantly higher among prison
and jail inmates than among
the population at large.2 In
addition, for a major portion
of these inmates, regular use
of drugs or alcohol has con­
tributed to or exacerbated
their health or mental health
conditions. Both before and
after incarceration, many
experience precarious
lifestyles marked by periods
of homelessness, jobless­
ness, incarceration, hospital­
ization, family instability, and
limited or sporadic health and
mental health care.3

Although access to effective
screening and treatment dur­
ing incarceration appears to
vary considerably according
to jurisdiction, correctional
setting, or type of illness,
many severely ill inmates
receive assessment and care
for the first time in their lives
while incarcerated, and many
of them are released while
still receiving treatment.4
Continuing this care after
release or ensuring that
proper treatment com­
mences immediately follow­
ing community reentry can—
❋	

Increase the probability of
positive health outcomes
and prevent relapse.

❋	

Prevent the spread of
disease.

❋	

Prevent the development
of drug-resistant strains of
viruses.

❋	

Reduce the likelihood
of recidivism related to
illness.

❋	

Insure the health, safety,
and stability of families and
communities that must
assist and cope with
releasees who are ill.
1

RESEARCH FOR PRACTICE / DEC. 07

❋	

Minimize costs to commu­
nity health care systems
or to prison and jail health
care systems should
releasees return to correc­
tional facilities.

Helping ill releasees find
ways to pay for medical and
mental health care and for
living expenses is thought
to be a crucial part of accom­
plishing these goals. Options
for some releasees include
disability benefits available
through five Federal entitle­
ment programs.5 The five
programs are—
❋	

Supplemental Security
Income (SSI).

❋	

Social Security Disability
Insurance (SSDI).

❋

Medicaid.

❋

Medicare.

❋	

Veterans compensation or
pension funds.

Making these types of bene­
fits available to qualifying
releasees as soon after their
release as possible may be a
key factor in their successful
return to the community.
Without resources to cover
care and a place to live,
releasees can be at increased
risk for lapses in treatment,
rehospitalization, or return to

2

the criminal justice system.
Although research to deter­
mine whether having bene­
fits improves the health and
criminal justice outcomes of
severely ill releasees is only
now underway or being
planned,6 researchers hypoth­
esize that releasees who
obtain benefits are more likely
to seek and continue care
than releasees who do not.7
Estimates of the number of
severely ill inmates who may
be eligible for entitlement
benefits at release are not
readily available, but experi­
ence suggests that these
inmates may include—
❋	

Those who were receiving
benefits when they
entered jail or prison and
had their benefits reduced,
suspended, or terminated
following admission.

❋	

Those who have never
applied for benefits but
whose circumstances sug­
gest that they may qualify
for disability benefits.

❋	

Those who applied some
time prior to incarceration
but had their claims denied
or closed for lack of
information.

❋	

Those who entered jail or
prison with applications for
benefits pending.

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

❋	

Those who have received
benefits at some time in
their lives but lost them.

Individuals in each group face
unique issues with respect to
obtaining benefits, but across
these groups the probability
that qualifying individuals will
receive benefits shortly after
release may increase dramat­
ically when benefits planning
occurs during the incarcera­
tion period and the necessary
paperwork is filed before the
inmate is released.
Discharge planners in correc­
tional facilities may help in
cases where inmates have
impaired health, limited selfadvocacy skills, inability to
collect information due to
incarceration, and difficulty
understanding the complexi­
ties of the benefits application
process. These individuals are
likely to require assistance
from discharge planners to
guarantee that applications
are filed and reviewed in a
timely fashion.
Depending on individual cir­
cumstances, this assistance
may involve simple tasks such
as helping inmates assemble
identification materials (e.g.,
Social Security cards) and
release papers and helping
them contact benefits person­
nel. The assistance may also

include more complicated
tasks such as preparing and
filing prerelease applications
for benefits on inmates’
behalf, assembling their
financial and health records,
monitoring the status of
applications, assisting with
appeals when necessary, and
ensuring that releasees actu­
ally obtain benefits that are
approved.
Discharge planning for
severely ill inmates is still
more the exception than
the rule, but political leaders,
corrections departments,
social services agencies,
community-based organiza­
tions, and researchers are
turning their attention to
this issue. They are looking
for ways to guarantee that
releasees who qualify for
medical and cash benefits
obtain them in a timely
manner.
To shed light on how some
jurisdictions are approaching
this challenge, the National
Institute of Justice and the
Centers for Disease Control
and Prevention sponsored
a study to investigate and
report the experiences of
three sites that help severely
ill inmates prepare and file
prerelease applications to
initiate or restart Federal
entitlement benefits (i.e.,

3

RESEARCH FOR PRACTICE / DEC. 07

SSI, SSDI, Medicaid,
Medicare, or veterans’ bene­
fits).8 These sites were—
❋	

❋	

4

The State of Texas, where
the Texas Correctional
Office on Offenders With
Medical or Mental Impair­
ments (TCOOMMI), part of
the Texas Department of
Criminal Justice, has a
Memorandum of Under­
standing (MOU) with the
Social Security Administra­
tion (SSA) to aid inmates
with mental illness, mental
retardation, or physical
disabilities to file prere­
lease applications for SSI
and SSDI.9
Philadelphia County (City
of Philadelphia), Pennsyl­
vania, where individuals in
the Coordinating Office for
Drug and Alcohol Programs
(CODAAP) of the City of
Philadelphia Behavioral
Health System have estab­
lished an informal agree­
ment with the Philadelphia
County Assistance Office
of the Pennsylvania Depart­
ment of Public Welfare to
expedite access to Federal
or State medical assistance
for parolees from the city
jail who participate in the
city’s Forensic Intensive
Recovery (FIR) Program.

❋

The State of New York,
where the Division of
Parole has established an
MOU with SSA to file
prerelease applications for
SSI and SSDI for severely
mentally and medically ill
inmates housed in State
prisons.

Although their inmate popula­
tions and benefits assistance
procedures differ, all three
sites—
❋	

Provide benefits assistance
to sentenced jail or prison
inmates prior to release.

❋	

Target inmates who have
been screened (and, in
many cases, treated) for
medical or mental illnesses
while incarcerated.

❋	

Rely on interagency part­
nerships to help inmates
to initiate benefits claims.

❋	

Have several years’ experi­
ence assisting inmates
with benefits applications.

Programs in three sites
The experiences of the three
sites show that arranging for
severely ill offenders to quali­
fy for Federal entitlements
not only facilitates access to
community-based care but
also can reduce the financial

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

burden on State and local
governments that fund indi­
gent health care systems and
allow community-based serv­
ice providers to increase the
number of disabled offenders
served. Nonetheless, to vary­
ing degrees the sites have
learned that helping offend­
ers obtain benefits can be a
challenging enterprise. (See
“Challenges in the Benefits
Application Process.”)
The Texas Correctional
Office on Offenders With
Medical or Mental Impair­
ments. TCOOMMI, which
offers institutional and com­
munity-based services to
juvenile and adult offenders
with special needs (including
those with mental illness,
mental retardation, or termi­
nal illness), was created by
the State legislature in 1987.
After a decade of administer­
ing TCOOMMI programs,
staff saw the need to develop
a consistent and effective
process to aid these offend­
ers in applying for Social
Security, medical, and other
benefits. Experience demon­
strated considerable variation
in the processing of parolees’
and probationers’ SSI and
SSDI applications. In addition,
although the Social Security
Administration allows resi­
dents of public institutions to
submit prerelease applications

CHALLENGES IN THE BENEFITS APPLICATION PROCESS
Program participants in the three sites identified a number
of challenges in the benefits applications process:
❋

Staff resistance. Some staff and professionals may
resist assisting inmates because they feel that offenders
do not deserve this type of assistance. Corrections staff,
including contract medical and mental health staff, may
not view benefits planning as part of their job descrip­
tions and may resist participating in the process
because it places additional burdens on their time.
Parole officers may not assign high priority to having
parolees apply for or obtain benefits.

❋

Applicant impairments. Illiteracy, language barriers,
and physical and mental health conditions can make it
difficult for severely ill offenders to participate effectively
in the application process. Illness may also impair their
memory of prior treatment.

❋

Offender resistance. Inmates may refuse to participate
in making prerelease applications for SSI or SSDI only
to discover after release that they cannot support them­
selves or obtain care. Parolees who have obtained
prerelease approval for benefits may not follow through
with obtaining benefits following release.

❋

Disability determination delays. Even when applications
for SSI or SSDI are filed prior to release, review of those
applications can take a long time. As a result, benefits
may not start for weeks or months after release.

❋

High rates of denial for SSI. Initial SSI applications are
often denied, which necessitates appeals that produce
significant delays. If releasees do not have help filing
appeals following release or cannot be located, they
may lose the opportunity to obtain benefits.

❋

Lack of information. Medical and mental health records
necessary to substantiate the nature and duration of
disability may be difficult to obtain because offenders
typically have seen multiple health care providers in the
community. In addition, correctional records may be
inaccurate or incomplete.

❋

Inability to locate releasees. Even if they receive med­
ical approval prior to release, releasees who cannot be
located are likely to have their SSI or SSDI applications
closed for lack of important information.
5

RESEARCH FOR PRACTICE / DEC. 07

for benefits, application sub­
missions prior to release
were typically limited to the
few inmates whose work his­
tories allowed them to apply
for SSDI or whose illnesses
were terminal. Most TCOOM­
MI participants were instruct­
ed to wait until after release
to file their benefits applica­
tions, which generally result­
ed in a 3- to 4-month delay
before they heard whether the
applications were approved.
Releasees with severe mental
illness were especially vulner­
able during this period, often
failing to stabilize in the com­
munity when they lacked an
income and medical assis­
tance.
Federal benefits were critical
to help offset the huge drain
that releasees placed on State
and county indigent resources,
which were stretched to their
limits. Further, staff realized
that additional clients could
be served if Federal benefits
were available to cover some
or all of the cost of services
paid by TCOOMMI. Believing
strongly that TCOOMMI
clients who received medical
and cash assistance shortly
after release would be less
likely to require emergency
hospitalization or to reoffend
to obtain income, staff
approached the State legisla­
ture for authorization to

6

launch a pilot program to aid
inmates with benefits appli­
cations prior to release. In
July 1999, the legislature
authorized the Social Security
Pilot Project. The Texas
Department of Criminal Jus­
tice and SSA signed an MOU
to process inmates’ prere­
lease applications for SSI and
SSDI. The MOU specifies that
applications for Social Security
benefits may be filed 90 days
prior to an offender’s sched­
uled release date and appli­
cants may receive medical
approval of their applications
prior to release.
Operating the benefits pilot.
The Pilot Project targets adult
inmates with special needs
who are eligible for one of two
types of TCOOMMI services:
❋	

Medically Recommended
Intensive Supervision
(MRIS), an early parole
program for inmates who
are sentenced to serve
nonaggravated felonies and
who are elderly, physically
handicapped, mentally ill,
terminally ill, or mentally
retarded, or who have a
condition requiring longterm care.

❋

Continuity of Care (COC),
which offers formal prere­
lease and postrelease plan­
ning and aftercare services

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

to inmates and releasees
who have certain psychi­
atric diagnoses or are men­
tally retarded, physically
handicapped, terminally ill,
HIV positive, or elderly.
Twelve full- or part-time bene­
fits eligibility specialists assist
inmates eligible for MRIS or
COC services with all applica­
tions for Federal entitlements
(e.g., SSI, SSDI, food stamps,
AIDS medications, veterans’
benefits). Up to 120 days
prior to an inmate’s projected
release date, TCOOMMI staff
notify a benefits eligibility
specialist that an inmate from
a target unit is scheduled for
release. The eligibility special­
ist contacts SSA to verify the
inmate’s Social Security num­
ber, citizenship, and current
benefits status. He or she
then meets with the inmate
at the correctional facility,
completes a prescreening
questionnaire to determine if
the offender will have difficulty
obtaining or maintaining
employment, receives per­
mission from the inmate to
initiate an SSI/SSDI applica­
tion, and obtains signatures
on release-of-information
documents.
Depending on the nature of
the inmate’s disability, eligibili­
ty specialists work with prison
mental health or medical

staff to compile institutional
documentation for disability
applications. A specialist
checks automated records
from the Mental Health and
Mental Retardation agency
and Department of Human
Services10 to ascertain
whether those agencies ever
treated the applicant prior to
incarceration. Whenever pos­
sible, the eligibility specialist
also gathers records from
any community-based
providers the inmate saw
prior to incarceration. The eli­
gibility specialist then sub­
mits the application packet,
including medical and mental
health documentation, to
SSA; monitors the review
status of the application; and,
if benefits are denied while
the applicant is still incarcer­
ated, assists inmates with
appeals.
After filing a claim, the eligi­
bility specialist keeps SSA
informed regarding the
inmate’s release status,
release date, and any changes
in the applicant’s expected
postrelease address or tele­
phone number. The eligibility
specialist also maintains
contact with the Disability
Determination Services
(DDS) examiner assigned
to the case to assist with
obtaining any additional infor­
mation (e.g., mental status

7

RESEARCH FOR PRACTICE / DEC. 07

examinations, consultative
examinations) SSA may
require to complete its
review.
Following release, an individ­
ual’s file is transferred to the
Mental Health and Mental
Retardation agency or
Department of Human Ser­
vices office nearest the area
where the offender will
reside. In most cases, an
eligibility specialist or COC
caseworker at that location is
assigned to monitor the SSA
application, which includes
providing additional informa­
tion if the claim is open,
assisting with appeals if the
claim has been denied, or
ensuring that the offender
takes the necessary steps
to have benefits begin (e.g.,
reporting to SSA so they may
confirm income, resources,
and residence; reporting to
the Department of Human
Services to start Medicaid).
Data on the filing and deci­
sion status of benefits appli­
cations (including data on
inmates who refuse to submit
applications) are reported to
TCOOMMI staff and entered
daily into a computer file.
TCOOMMI staff then prepare
statistical tables and distrib­
ute benefits status reports to
the Mental Health and Men­
tal Retardation agency and

8

regional Department of
Human Services staff who
will provide services to clients
following release. Weekly,
monthly, and quarterly reports
on the status of applications
managed by eligibility special­
ists in each contracting
agency are also forwarded
to TCOOMMI’s director, who
uses the information to
assess how different agen­
cies and contractual staff
handle their responsibilities
for the benefits process.
Exhibit 1 illustrates the
process for prerelease appli­
cations for SSI and SSDI used
in the TCOOMMI programs.
Outcome of the pilot project.
TCOOMMI’s benefits data
show that the pilot project
has succeeded in helping
inmates obtain Social Security
benefits, but it is a challenging
task. Of 1,686 individuals
referred to benefits eligibility
specialists in the first 9
months of fiscal year 2002,
1,076 (64 percent) did not
submit applications to SSA.
Most refused to apply.11
Reportedly, some believe they
are capable of working, others
do not feel they are ill enough
to warrant receiving benefits,
and still others do not want
the perceived stigma of being
welfare recipients. Once
released, many apply for

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

Exhibit 1. Processing Inmates’ Prerelease Applications for SSI and SSDI in Texas

Benefits eligibility staff receive
list of targeted inmates who are
scheduled for release.

Benefits eligibility specialists check
each inmate’s Social Security number,
citizenship, and current benefits status.

Benefits eligibility specialists
meet with each inmate
and complete a prescreening
questionnaire to determine
potential eligibility for SSI or SSDI.

Inmate candidates refuse
to participate in the
prerelease applications
process; many
apply after release.

For inmates who agree to participate,
benefits eligibility specialists
check public health data systems
for prior treatment information,
gather all institutional and
“free world” records, and submit
applications to SSA.

Inmates medically
approved for benefits
prior to release.

Contract Mental Health/
Mental Retardation or
Department of Human
Services caseworkers in
community where
releasees live assist releasees
with obtaining benefits.

SSA forwards all claims eligible
for disability consideration
to the Disability Determination
Services (DDS) office. Benefits
eligibility specialists maintain
contact with SSA and DDS.

Benefits determination still pending
when inmates are released.

Claims approved
following release.

Claims denied
following release.

Releasees fail
to provide
information to
SSA; cases
closed.

No appeals
filed.

Inmates’ initial
applications denied
prior to release.

Benefits eligibility
specialists or
community-based
caseworkers assist in filing
appeals, depending on
inmates’ release status.

9

RESEARCH FOR PRACTICE / DEC. 07

benefits because they realize
that their expectations were
unrealistic or their views
were naive. In delaying the
process, they lose precious
time and money. Of the 610
cases processed by SSA in
the first 9 months of fiscal
year 2002, 297 (49 percent)
were approved, 232 (38 per­
cent) were denied, and 81
(13 percent) were awaiting
a decision.
The application success rates
vary across benefits eligibility
specialists. One specialist
had a 92-percent approval
rating in fiscal year 2002. The
keys to his success were his
attention to detail, ability to
obtain supporting medical
examinations or documenta­
tion, and responsiveness to
requests for additional infor­
mation. TCOOMMI has capi­
talized on his acumen by
having him train other benefits
specialists around the State.

procedures, dedicated staff,
and measurable outcomes.
❋	

Filing applications prior to
release means that more
inmates now have benefits
when they leave institu­
tions than in the past.

❋	

Having dedicated eligibility
specialists prepare benefits
applications and gather
medical records has
reduced the burden on
prison medical staff that
once had sole responsibility
for preparing the applica­
tions and sometimes felt
overwhelmed at having
benefits tasks added to
their numerous treatment
responsibilities.

❋	

Because eligibility special­
ists screen prospective
applicants, provide consid­
erable medical and mental
health documentation with
the applications, and offer
prompt support if ques­
tions arise during the
review process, State DDS
processing of inmate appli­
cations is reportedly more
efficient than in the past.

❋	

Finally, even when finding
applicants following release
is difficult, TCOOMMI’s
tracking procedures are
usually very effective and
most applicants are located.

Anecdotal evidence suggests
that by improving procedures
and staffing arrangements,
the benefits pilot has helped
inmates and staff alike:
❋	

10

What was once a reactive
process with few standards
and relatively ad hoc identifi­
cation of potentially eligible
inmates is now a proactive
one, with a system for iden­
tifying candidates, written

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

The City of Philadelphia’s
Forensic Intensive Recovery
Program. Since 1993, the
Coordinating Office for Drug
and Alcohol Abuse Programs
of the City of Philadelphia’s
Behavioral Health System
has administered the FIR
Program, which provides
behavioral health treatment,
case management, and voca­
tional services to individuals
released via early parole or
reparole from the Philadelphia
Prison (local jail) System.

State medical assistance
dollars,12 which support the
treatment services of 66
providers across the city, are
the major sources of funding.
Less than one-fifth of the
budget ($3.6 million) comes
from city funds and State
grants, which support the
salaries of a medical assis­
tance coordinator (who helps
inmates apply for benefits),
clinical evaluators, case man­
agers, vocational education
staff, and supervisors.

Inmates with substance
abuse disorders who have
served at least half their
minimum sentences, have 6
months to a year left on their
sentences, and pose no
threat to the community are
referred to FIR. Candidates
are screened while incarcer­
ated, and those who qualify
for program services are rec­
ommended for early parole.
If approved for FIR, clients
are released to residential
or intensive outpatient treat­
ment programs.

A key reason for the
increased size of the FIR Pro­
gram, despite virtually static
core funding and cuts in
other funding sources, is that
program managers have
found ways to facilitate client
access to medical assistance.
In 1999, when they realized
that medical assistance could
play a significant role in
defraying program costs,
CODAAP staff met with staff
at the Philadelphia County
Assistance Office (which is
operated by the Pennsylvania
Department of Public Welfare
[DPW] and is responsible for
the administration of cash,
food stamps, Medicaid, and
energy assistance benefits)
to discuss ways to improve
the medical assistance appli­
cation process for FIR partici­
pants. These efforts resulted
in significant changes in the

Originally intended to reduce
jail crowding by providing a
minimum of 250 communitybased treatment slots, and
funded initially with city grant
money totaling $3.3 million,
FIR now serves 1,300 partici­
pants and has a total budget
of $20 million. Federal and

11

RESEARCH FOR PRACTICE / DEC. 07

existing medical assistance
applications process and
increases in the number of
FIR clients covered.
Streamlining medical assis­
tance claims for FIR clients.
At the inception of the FIR
Program, clients were
released without medical
assistance. Individual,
community-based treatment
providers transported released
FIR clients to one of 19 differ­
ent county assistance offices
to initiate benefits claims.
This system increased the
risk of client flight, interrupt­
ed treatment, and required
considerable DPW staff time
because multiple DPW work­
ers were involved in making
decisions and multiple visits
were often necessary before
eligibility was established.
Moreover, it took between 30
and 45 days for clients to
enroll initially in Medicaid and
up to 90 days more to enroll
in Community Behavioral
Health, a managed care
program. Until Community
Behavioral Health enrollment
was complete, FIR’s program
managers had to pay for
client care with Behavioral
Health Special Initiative
moneys—State funds allocat­
ed for indigent residents who
are not eligible for medical
assistance—which severely
drained available resources

12

and limited the number of
clients the program could
serve.
In 2000, through an informal
agreement, CODAAP, FIR,
the Defender Association of
Philadelphia,13 and the
Philadelphia County Assis­
tance Office devised a
method to streamline the
applications process and
reduce the drain on Behav­
ioral Health Special Initiative
funds. Three concepts
formed the foundation of
the multifaceted reform:
❋	

The application process
was centralized to a single
assistance office.

❋	

Benefits applications were
completed while FIR candi­
dates were still incarcerated.

❋	

A medical assistance
coordinator was assigned
to help inmates complete
applications, and one
income maintenance
caseworker reviewed the
applications.

See exhibit 2, “Weekly Pro­
cessing of FIR Clients’ Med­
ical Assistance Applications.”
Outcome of FIR’s modified
medical assistance process.
Streamlining the medical
assistance application process
has had positive outcomes for

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

Exhibit 2. Weekly Processing of FIR Clients’ Medical Assistance Applications

Each week, a list of soon-to-be-released FIR clients is forwarded
to FIR’s medical assistance coordinator and to the income
maintenance caseworker who handles FIR cases.

FIR’s medical assistance coordinator interviews
FIR candidates on the list and obtains each inmate’s
signature on a limited power of attorney.

The medical assistance coordinator gathers inmates’ medical
and mental health records, completes applications for medical
assistance, and forwards materials to medical consultants.

Medical consultants review the medical and mental health
documentation to determine the nature and extent of
each inmate’s disability, sign relevant forms, and return
the application packets to the medical assistance coordinator.

The medical assistance coordinator meets with the
income maintenance caseworker and reviews all
applications, filling in any missing information.

The income maintenance caseworker approves applications
for medical assistance and notifies each prospective
treatment provider that the FIR client has been approved.

FIR clients are eligible for medical
assistance the day they leave the institutions.

Clients’ Community Behavioral Health membership commences
an average of 38 days after eligibility determination.

13

RESEARCH FOR PRACTICE / DEC. 07

the FIR Program and for
providers. It has resulted in a
dramatic increase in the num­
ber of clients receiving med­
ical assistance. Of the 2,329
applications for medical
assistance acted on by DPW
between July 1, 2000, and
October 11, 2002, 97 percent
were approved for eligibility.
Between fiscal years 2000
and 2001, the percentage of
FIR clients receiving medical
assistance more than dou­
bled, from 38 percent to 90
percent. In addition, shifting
responsibility for benefits
applications to a single bene­
fits case manager and com­
pleting applications prior to
release has significantly
reduced the client flight rate
and has reduced disruption in
treatment associated with fil­
ing applications after release.
Assigning a single DPW staff
person to process FIR claims
and having that person coor­
dinate with a single medical
assistance coordinator has
reduced the amount of time
that DPW staff must spend
processing applications and
has helped standardize appli­
cations review.
Benefits strategy for prison
inmates in New York State.
Since 1988, the New York
State Division of Parole has
had an MOU with SSA to sup­
port prerelease applications
for SSI and SSDI benefits.
14

Background. The original
MOU, which had few specific
protocols, was updated in
2000 to include a more for­
malized application process
and additional partners. In
addition to the Division of
Parole and SSA, the partner­
ship now includes medical
relations staff from the Divi­
sion of Disability Determina­
tion (DDD) in the State’s
Office of Temporary and
Disability Assistance; the
State Office of Mental
Health, which provides
inmates with mental health
care and discharge planning;
and the Department of Cor­
rectional Services’ Health
Services, which provides
medical care to inmates.
Following the signing of the
updated MOU, Division of
Parole, SSA, and DDD staff
offered statewide training on
the process, procedures,
forms, and decisionmaking
steps required for effective
implementation. In addition,
to bolster participation and
become a more active partner
in the discharge planning
process, SSA identified con­
tacts in each of its field offices
who could respond to ques­
tions from parole, mental
health, and corrections staff.
The multistage application
process outlined in the

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

revised MOU involves identi­
fying severely medically and
mentally ill inmates eligible
for SSI or SSDI benefits prior
to release, completing and
filing paperwork, filling in
information to ensure the
applications are complete,
and monitoring outcomes
once the completed applica­
tions have been submitted to
SSA. According to the MOU,
prerelease applications may
be submitted to SSA up to
120 days prior to an inmate’s
anticipated release date. See
exhibit 3, “New York’s Pro­
cessing of Prerelease Appli­
cations for SSI and SSDI.”
Strategy outcomes. Division
of Parole officials estimate
that between 200 and 400
prerelease applications are
submitted annually. Although
data on outcomes are not
maintained, anecdotal evi­
dence from staff involved in
the program suggests that
a significant portion of these
applications are denied.
The high denial rate is not
surprising given that State
DDD records indicate that
statewide only about 38 per­
cent of initial claims for SSI
are approved. Reasons that
inmate applications are
denied include the following:
❋	

Applicants cannot be locat­
ed following release (e.g.,

because they fail to appear
at their designated parole
office, move from their
approved residences, or are
not under parole supervi­
sion). In these cases, even
if applicants have been
medically approved by DDD
prior to release, their cases
will be coded as “where­
abouts unknown” by SSA
and then closed for lack of
information.
❋	

Releasees leave institutions
while their applications are
still under review by DDD,
reportedly because release
dates cannot always be
anticipated accurately 120
days in advance of release.
This is especially true for
parole violators—one-third
of new admissions to New
York’s prison system—who
often move through the
system quickly with little
time for discharge planning
before release. Their appli­
cations are often filed 60
days or less before release.
In these cases, if DDD
officials cannot find them
following release to obtain
additional documentation
(e.g., consultative examina­
tions), or if their field parole
officer does not make ben­
efits a priority, applications
may again be closed for
lack of information.

15

RESEARCH FOR PRACTICE / DEC. 07

Exhibit 3. New York’s Processing of Prerelease Applications for SSI and SSDI

Facility parole officers distribute
list of release-eligible inmates.

Department of Correctional Services
Health Services and Office of Mental
Health staff review list of prospective
releasees to assess SSI or SSDI eligibility.

Applications for inmates with
too much income or too many
resources forwarded for
“Medicaid only” consideration.

Potentially eligible inmates are
interviewed and SSI or SSDI
applications are prepared and
forwarded to the SSA field office
nearest the prison.

SSA staff screen applications.

Deny claims for
nonmedical reasons.

Inmates medically approved
for benefits prior to release.

SSA forwards applications to the
Division of Disability Determination
and facility parole staff help locate
additional information while the
inmate is still incarcerated.

Inmates’ initial applications
denied prior to release.

Field parole officers assist
releasees with obtaining
benefits following release.

Benefits determination still
pending when inmates are released.

Facility or field parole
officers assist with filing
appeals, depending on
inmates’ release status.

Releasees fail to provide
information to SSA;
cases closed.

Claims
approved.

Field parole
officers assist
releasees with
obtaining benefits.

16

Claims
denied.

No appeals filed.

Field parole officers
assist with appeals.

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

❋	

Applications are denied
because applicants are
nonqualified aliens.

available when DDD or SSA
questions need answering.
❋	

❋	

Applications may be denied
because important medical
records are not complete
enough to determine dis­
ability according to SSA
specifications or are not
obtained in a timely fashion.
Inmates cannot always
accurately recall their med­
ical or mental health histo­
ries; even those who do
remember may have re­
cords that are difficult to ob­
tain because the records are
in multiple locations (in the
community or in the correc­
tional system). In these
instances, cases may be
closed or SSA may require
new applications to address
missing information.

❋	

Documentation provided by
prison medical or mental
health staff may not be suf­
ficient to determine the
level of impairment and the
effect of the impairment on
employability.

❋	

The high rate of turnover
and reassignment among
parole officers can mean
that individuals listed as
points of contact on appli­
cations and in supporting
documentation may not be

Applicants whose initial
claims are denied may
refuse to appeal and may
apply for State-funded pub­
lic assistance, which is
available to some individu­
als who have been denied
SSI.

The Division of Parole is
working to address some of
these issues by providing
written directives to all its
institutional and field agents
to reinforce the importance
of the prerelease application
process. In addition, in 2004,
DDD staff began working in
conjunction with other part­
ners on a pilot project to
develop training protocols for
medical and mental health
staff at two prisons to ensure
that mental health and med­
ical examinations and corre­
sponding paperwork meet
the requirements for disability
determination.

Lessons from the sites’
experience
The experiences of the three
study sites suggest six les­
sons regarding efforts to
assist inmates with benefits
applications:

17

RESEARCH FOR PRACTICE / DEC. 07

❋	

Partnerships keep the
process alive.

❋	

Dedicating staff has
rewards.

❋	

Filling gaps until benefits
commence is essential.

❋	

Tracking outcomes is
beneficial.

❋	

Centralizing operations
reduces delays and
improves communication.

❋	

Assisting mentally ill
offenders poses special
challenges.

Partnerships keep the
process alive. Whether the
benefits applications process
is outlined in a formal MOU,
as in Texas and New York, or
operates through informal
agreement, as in Philadelphia,
many agencies, organizations,
and individuals are necessary
to ensure that applications
for severely ill offenders do
not fall through the cracks.
Multiple decisionmakers
are involved in determining
disability so the process
works more smoothly when
all parties coordinate and
collaborate. This also creates
the opportunity for communi­
cation about the strengths
and weaknesses of the
applications process. Indeed,
as a result of this type of

18

information sharing, New
York launched its pilot project
to have State Division of Dis­
ability Determination staff
train prison mental health and
medical staff on ways to
improve the documentation
they provide. Many claims
are still open when inmates
return to the community—all
parties must work with
offenders before and after
release to make sure the
applications process continues
following release.
Dedicating staff has
rewards. Both TCOOMMI
and FIR staff have seen sig­
nificant advantages to fund­
ing eligibility staff whose sole
function is to help offenders
access benefits. For exam­
ple, since the primary burden
of gathering medical and
mental health documentation
has shifted from corrections
staff to the benefits eligibility
specialists in Texas, medical
staff are reportedly more will­
ing to assist in preparing
applications. In Texas, special­
ization means that TCOOM­
MI’s benefits staff are able to
submit application packets
that contain more information
(i.e., including both institu­
tional and community-based
records) than in the past,
which has accelerated the
review process. In Philadel­
phia, having dedicated staff

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

has shifted responsibility for
seeking benefits from multi­
ple providers and numerous
disability examiners to just
one medical assistance coor­
dinator and one DPW exam­
iner. This has not only
streamlined the process but
also has resulted in improved
security and treatment out­
comes for program partici­
pants. Dedicated staff can
concentrate on filling gaps in
documentation without hav­
ing to postpone their other
institutional responsibilities.
Finally, having dedicated staff
increases the likelihood of
strong working relationships
with disability decisionmak­
ers who can rely on a quick
response to their requests
for assistance.
Filling gaps until benefits
commence is essential.
Filing prerelease applications
for benefits is not a panacea.
As experiences in the three
study sites demonstrate,
many severely ill inmates
who are approached about
benefits applications leave
prison or jail with little likeli­
hood that benefits will com­
mence soon after release.
Some inmates refuse assis­
tance prior to release; many
first-time applicants leave
correctional facilities before
applications processing is
complete; some have their

cases closed because their
whereabouts are unknown;
and others have their initial
applications denied. Both
TCOOMMI and FIR staff
address the gap in benefits
after release by using their
own program dollars to pay
for services during the period
between a client’s release
and the start of benefits. Pro­
gram funding also supports
clients who are ultimately
denied benefits. Any jurisdic­
tion that seeks to prevent
relapse and recidivism by
ensuring that severely ill
releasees receive medical
and cash assistance soon
after release should have
similar mechanisms for
funding treatment and provid­
ing other support until bene­
fits payments commence.
Tracking outcomes is bene­
ficial. Developing outcome
data on the benefits process
serves several important
functions. For one thing, data
can provide feedback on the
success of staff efforts and
identify areas where policy
changes may be warranted.
In Texas, TCOOMMI staff can
assess which contract agen­
cies and eligibility specialists
succeed in obtaining benefits
and can use the information
to improve overall perform­
ance (e.g., through staff train­
ing). In contrast, in New York,

19

RESEARCH FOR PRACTICE / DEC. 07

where data on Social Security
applications are not main­
tained, staff assume that
their efforts are largely
unsuccessful, which makes
it difficult for them to sustain
enthusiasm for filing applica­
tions. Benefits data can also
be used as a means of
demonstrating a program’s
ability to secure entitlement
dollars that offset program
costs. This type of informa­
tion has been used to per­
suade sources of government
funding in both Philadelphia
and Texas to continue to sup­
port program services.
Centralizing operations
reduces delays and
improves communication.
Sites have discovered the
benefits of centralizing the
processing of medical and
cash assistance claims. As
described earlier, partners
in FIR’s medical assistance
application process discov­
ered that by centralizing the
processing of benefits claims
they could reduce the num­
ber of individuals involved in
decisionmaking and signifi­
cantly reduce the amount
of time until eligibility is con­
firmed and enrollment in the
medical assistance managed
care organization occurs.
Faced with having cases
closed because inmates
cannot be located following

20

release, staff in New York’s
Division of Parole have also
centralized processing of
postrelease requests for
information by identifying
individuals whom SSA and
DDD staff may contact
with questions regarding
releasees. Staff anticipate
that this will help reduce
processing delays and denials
by making it easier for bene­
fits professionals to receive
assistance when they need
it. With a similar goal in mind,
staff in TCOOMMI’s Huntsville
office are available to field
questions and provide assis­
tance to SSA and Disability
Determination Services
examiners across the State.
Assisting mentally ill
offenders poses special
challenges. Program partici­
pants in New York and Texas
who prepare applications for
prison inmates noted that
assisting mentally ill inmates
with benefits applications is
especially challenging. Data
on TCOOMMI filings show
that in fiscal year 2002, 47
percent of the SSI or SSDI
applications that were filed
for mentally ill offenders
were denied compared to 38
percent of the medical claims.
Individuals in both sites sug­
gested that disability determi­
nation staff appear more
cautious about approving

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

benefits for mentally ill
inmates than they are about
approving inmates with a
medical illness. Program and
benefits staff offered the fol­
lowing possible explanations:
❋	

Fewer objective criteria
exist for diagnosing mental
illness than for diagnosing
medical illness.

❋	

A common perception
exists that some offenders
feign mental illness to
obtain more favorable treat­
ment while incarcerated.

❋	

When applicants have co­
occurring substance abuse
disorders and mental ill­
ness, it is difficult to deter­
mine which is the primary
diagnosis.

❋	

Mentally ill offenders can
appear stable in a correc­
tional setting because they
comply with treatment and
live in a structured environ­
ment where sources of
external disruption (e.g.,
lack of housing, drug use)
are largely eliminated. As a
result, it is difficult to use
their behavior in prison as
evidence that following
release, they will not be
able to engage in gainful
activities.

Program staff perceive that it
is easier to have applications

approved when the applicant
has a history of mental health
treatment in the community,
but they noted that, because
of illness and long periods of
incarceration, inmates fre­
quently cannot remember
whom they saw for treatment
in the community. Often an
offender’s first documented
treatment occurs during
incarceration.

Final thoughts
Helping inmates apply for
medical and cash assistance
can assist severely ill inmates
who are returning to the
community. Such assistance,
however, should be viewed
as only one facet of a broader
discharge plan. The applica­
tion process can be compli­
cated and take a long time to
complete if it involves SSI or
SSDI. There is no guarantee
that claims will be approved.
Relatively few inmates or
releasees apply for benefits,
and when the benefits
involve SSI or SSDI only a
small percentage of them
succeed on their first try.
Even releasees who ultimate­
ly qualify for benefits are like­
ly to find it challenging to
avoid relapse or recidivism
unless other supports (e.g.,
case management services,
housing) are made available.
21

RESEARCH FOR PRACTICE / DEC. 07

Although Philadelphia’s FIR
Program targets sentenced jail
inmates, none of the strate­
gies described in this report is
designed to assist persons
who are detained in local jails.
Corrections facilities should
develop ways to inform
inmates about the benefits
applications process and take
steps to ensure that incarcer­
ated inmates do not lose their
benefits unnecessarily.

Notes
1. Roughly one-third of State prison
inmates and one-quarter of Federal
prison inmates surveyed in 1997
reported having some physical
impairment or mental condition, with
older inmates and women most like­
ly to report a health problem. See
Maruschak, Laura M., and Allen J.
Beck, Medical Problems of Inmates,
1997, BJS Special Report, Washing­
ton, DC: U.S. Department of Justice,
Bureau of Justice Statistics, January
2001:1, NCJ 181644, available online
at www.ojp.usdoj.gov/bjs/pub/pdf/
mpi97.pdf.
2. For example, prevalence rates of
schizophrenia and major affective
disorders among jail inmates are
estimated to be two to three times
higher than in the general popula­
tion. See Teplin, Linda, “The Preva­
lence of Severe Mental Disorder
Among Male Urban Jail Detainees:
Comparison With the Epidemiologic
Catchment Area Program,” American
Journal of Public Health 80 (6) (June
1990): 663–669.

22

3. According to results of inmate
surveys conducted by the Bureau
of Justice Statistics, mentally ill
inmates were more likely than other
inmates to report criminal histories
involving three or more offenses;
unemployment in the month prior to
arrest; family histories of incarcera­
tion and alcohol or drug use; periods
of homelessness during the year
preceding arrest; having been under
the influence of drugs or alcohol
when committing their incarceration
offense; past physical or sexual
abuse; and alcohol dependence. See
Ditton, Paula M., Mental Health and
Treatment of Inmates and Probation­
ers, BJS Special Report, Washington,
DC: U.S. Department of Justice,
Bureau of Justice Statistics, July
1999, NCJ 174463, available online at
www.ojp.usdoj.gov/bjs/pub/pdf/
mhtip.pdf.
4. National Commission on Correc­
tional Health Care, Report to Con­
gress, Volume 1, The Health Status
of Soon-To-Be-Released Inmates,
Chicago, IL: National Commission on
Correctional Health Care, 2001: xvii.
5. For an overview of these entitle­
ment programs and Federal policy
regarding entitlement benefits (with
a spotlight on inmate issues), see
“Federal Entitlement Benefits” in
the final report to NIJ, available
online at www.ncjrs.org/pdffiles1/
nij/grants/211989.pdf.
6. Researchers at the National
GAINS Center for People With CoOccurring Disorders in the Justice
System in Delmar, New York, are
studying offenders with mental
illness who are released from the
Pinellas County (Florida) jail to ascer­
tain whether releasees with medical
benefits fare better than releasees
who do not have medical benefits.

H E L P I N G I N M AT E S O B TA I N F E D E R A L B E N E F I T S

The Texas Council on Mental Impair­
ments plans to study whether its
clients who have benefits are less
likely to recidivate than clients who
do not.
7. Chitwood, Dale D., Duane C.
McBride, Lisa R. Metch, Mary Com­
erford, and Clyde B. McCoy, “A Com­
parison of the Need for Health Care
and the Use of Health Care by Injection-Drug Users, Other Chronic Drug
Users, and Nondrug Users,” Ameri­
can Behavioral Scientist 41 (8) (May
1998): 1112, 1117.
8. These sites were identified through
a review of existing literature on cor­
rectional health care and the need for
benefits and through telephone inter­
views with researchers and practi­
tioners familiar with these issues.
Telephone interviewees were identi­
fied through the literature review and
recommendations from other inter­
viewees. Following site identification,
each site was visited for a period of
2 to 3 days, and key decisionmakers
and staff were interviewed either
individually or in small groups.
9. In most States, approval for SSI
disability benefits automatically quali­
fies an applicant for Medicaid bene­
fits. Approval for SSDI benefits
qualifies an applicant for Medicare
benefits after a 2-year waiting period.

aliens, they were transferred out of
a pilot facility, or they died.
12. Pennsylvania offers two types of
medical assistance to low-income
residents with disabilities. One is the
Federal-State Medicaid program,
which provides assistance to lowincome individuals with disabilities
lasting 12 months or more whose
primary diagnosis is not substance
abuse. The other is a solely Statefunded medical assistance program
for low-income individuals with tem­
porary disabilities (i.e., those lasting
less than 12 months) or with primary
diagnoses of substance abuse disor­
der. Those with disabilities resulting
from substance abuse disorders are
entitled to a 9-month lifetime med­
ical assistance benefit. Many FIR
participants receive State-funded
medical assistance; others receive
support from the Federal-State Med­
icaid program. Regardless of the
source of the medical assistance dol­
lars, the process by which FIR clients
obtain medical assistance (i.e., filing
an application with the Department
of Public Welfare) is the same.
13. The Defender Association of
Philadelphia is an independent, non­
profit corporation that provides legal
services for indigent criminal defen­
dants. Although funded by the City
of Philadelphia, the Defender Associ­
ation is not a city or State agency.

10. The agency names used in this
report reflect those in use at the
time this study was conducted.
11. Fifty-eight percent of inmates
whose applications were not
processed in fiscal year 2002 refused
to apply. Among the remaining 42
percent, applications were not
processed because inmates’ release
dates changed, they had detainers
pending, they were nonqualified

23

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research, development, and evaluation
agency of the U.S. Department of Justice.
NIJ’s mission is to advance scientific research,
development, and evaluation to enhance the
administration of justice and public safety.

The National Institute of Justice is a component of
the Office of Justice Programs, which also includes
the Bureau of Justice Assistance; the Bureau of
Justice Statistics; the Community Capacity
Development Office; the Office for Victims of
Crime; the Office of Juvenile Justice and
Delinquency Prevention; and the Office of Sex
Offender Sentencing, Monitoring, Apprehending,
Registering, and Tracking (SMART).

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