Research for Practice

Helping Inmates Obtain Federal Disability Benefits 

U.S. Department of Justice 

Office of Justice Programs 

DEC. 07 

National Institute of Justice 

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 

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. 

Helping Inmates Obtain Federal 

Disability Benefits 

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 
R ESEARCH FOR PRACTICE / DEC. 07 

ABOUT THIS REPORT 

This report looks at three 

programs that assist inmates 

in preparing and filing prerelease applications for Federal disability benefits so they 

can continue to receive treatment 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 Philadelphia, and the State of New 

York—indicate that helping 

offenders obtain Federal benefits not only can increase 

releasees’ access to care, but 

also can reduce the financial 

burden on State and local 

governments that fund indigent health care systems. 

The most important lessons 

learned were— 

❋	 Interagency partnerships 

are an essential ingredient 

in the benefits application 

process. 

❋	 Dedicating staff to benefits 

tasks can build expertise 

and streamline administrative 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 outcome 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 correctional settings. 

ii 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

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 diseases such as asthma; and 

infectious diseases such as 

tuberculosis, hepatitis C, and 

human immunodeficiency 

virus/acquired immunodeficiency syndrome (HIV/AIDS) 

are estimated to be significantly 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 contributed to or exacerbated 

their health or mental health 

conditions. Both before and 

after incarceration, many 

experience precarious 

lifestyles marked by periods 

of homelessness, joblessness, incarceration, hospitalization, family instability, and 

limited or sporadic health and 

mental health care.3 

Although access to effective 

screening and treatment during 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 commences immediately following 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 
R ESEARCH FOR PRACTICE / DEC. 07 ❋	 Minimize costs to community health care systems 

or to prison and jail health 

care systems should 

releasees return to correctional 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 accomplishing these goals. Options 

for some releasees include 

disability benefits available 

through five Federal entitlement 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 benefits 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 

the criminal justice system. 

Although research to determine whether having benefits improves the health and 

criminal justice outcomes of 

severely ill releasees is only 

now underway or being 

planned,6 researchers hypothesize 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 experience 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 suggest 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. 

2 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

❋	 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 dramatically when benefits planning 

occurs during the incarceration period and the necessary 

paperwork is filed before the 

inmate is released. 

Discharge planners in correctional facilities may help in 

cases where inmates have 

impaired health, limited selfadvocacy skills, inability to 

collect information due to 

incarceration, and difficulty 

understanding the complexities 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 personnel. 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 actually 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 organizations, 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 
R ESEARCH FOR PRACTICE / DEC. 07 

SSI, SSDI, Medicaid, 

Medicare, or veterans’ benefits).8 These sites were— 

❋	 The State of Texas, where 

the Texas Correctional 

Office on Offenders With 

Medical or Mental Impairments (TCOOMMI), part of 

the Texas Department of 

Criminal Justice, has a 

Memorandum of Understanding (MOU) with the 

Social Security Administration (SSA) to aid inmates 

with mental illness, mental 

retardation, or physical 

disabilities to file prerelease applications for SSI 

and SSDI.9 

❋	 Philadelphia County (City 

of Philadelphia), Pennsylvania, where individuals in 

the Coordinating Office for 

Drug and Alcohol Programs 

(CODAAP) of the City of 

Philadelphia Behavioral 

Health System have established an informal agreement with the Philadelphia 

County Assistance Office 

of the Pennsylvania Department 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 populations 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 partnerships to help inmates 

to initiate benefits claims. 

❋	 Have several years’ experience assisting inmates 

with benefits applications. 

Programs in three sites 

The experiences of the three 

sites show that arranging for 

severely ill offenders to qualify for Federal entitlements 

not only facilitates access to 

community-based care but 

also can reduce the financial 

4 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

burden on State and local 

governments that fund indigent health care systems and 

allow community-based service providers to increase the 

number of disabled offenders 

served. Nonetheless, to varying degrees the sites have 

learned that helping offenders obtain benefits can be a 

challenging enterprise. (See 

“Challenges in the Benefits 

Application Process.”) 

The Texas Correctional 

Office on Offenders With 

Medical or Mental Impairments. TCOOMMI, which 

offers institutional and community-based services to 

juvenile and adult offenders 

with special needs (including 

those with mental illness, 

mental retardation, or terminal illness), was created by 

the State legislature in 1987. 

After a decade of administering TCOOMMI programs, 

staff saw the need to develop 

a consistent and effective 

process to aid these offenders in applying for Social 

Security, medical, and other 

benefits. Experience demonstrated considerable variation 

in the processing of parolees’ 

and probationers’ SSI and 

SSDI applications. In addition, 

although the Social Security 

Administration allows residents 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 descriptions 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 themselves 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 medical 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 
 

R ESEARCH FOR PRACTICE / DEC. 07 

for benefits, application submissions prior to release 

were typically limited to the 

few inmates whose work histories allowed them to apply 

for SSDI or whose illnesses 

were terminal. Most TCOOMMI participants were instructed to wait until after release 

to file their benefits applications, which generally resulted in a 3- to 4-month delay 

before they heard whether the 

applications were approved. 

Releasees with severe mental 

illness were especially vulnerable during this period, often 

failing to stabilize in the community when they lacked an 

income and medical assistance. 

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 legislature for authorization to 

launch a pilot program to aid 

inmates with benefits applications prior to release. In 

July 1999, the legislature 

authorized the Social Security 

Pilot Project. The Texas 

Department of Criminal Justice and SSA signed an MOU 

to process inmates’ prerelease applications for SSI and 

SSDI. The MOU specifies that 

applications for Social Security 

benefits may be filed 90 days 

prior to an offender’s scheduled release date and applicants 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 prerelease and postrelease planning and aftercare services 

6 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

to inmates and releasees 

who have certain psychiatric diagnoses or are mentally retarded, physically 

handicapped, terminally ill, 

HIV positive, or elderly. 

Twelve full- or part-time benefits eligibility specialists assist 

inmates eligible for MRIS or 

COC services with all applications 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 specialist contacts SSA to verify the 

inmate’s Social Security number, 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 permission from the inmate to 

initiate an SSI/SSDI application, 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 possible, the eligibility specialist 

also gathers records from 

any community-based 

providers the inmate saw 

prior to incarceration. The eligibility specialist then submits 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 incarcerated, assists inmates with 

appeals. 

After filing a claim, the eligibility specialist keeps SSA 

informed regarding the 

inmate’s release status, 

release date, and any changes 

in the applicant’s expected 

postrelease address or telephone number. The eligibility 

specialist also maintains 

contact with the Disability 

Determination Services 

(DDS) examiner assigned 

to the case to assist with 

obtaining any additional information (e.g., mental status 

7 
R ESEARCH FOR PRACTICE / DEC. 07 

examinations, consultative 

examinations) SSA may 

require to complete its 

review. 

Following release, an individual’s file is transferred to the 

Mental Health and Mental 

Retardation agency or 

Department of Human Services 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 information 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 decision status of benefits applications (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 distribute benefits status reports to 

the Mental Health and Mental Retardation agency and 

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 specialists in each contracting 

agency are also forwarded 

to TCOOMMI’s director, who 

uses the information to 

assess how different agencies and contractual staff 

handle their responsibilities 

for the benefits process. 

Exhibit 1 illustrates the 

process for prerelease applications 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 

8 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

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

laim enie

ollowing release.

Benefits eligibility staff receive

list of targete inmates who are

cheduled for release.

Benefits eligibility specialists check

ach inmate’s Social Security number,

citizenship, and current benefit status.

Benefits eligibility specialist

meet with each inmate

nd complete a prescreening

uestionnaire to determine

otential eligibility for SSI or SDI.

or inmates wh agree to participate,

enefits eligibility specialists 

heck public health dat systems

for prior treatment information,

ather all institutional and

“free world” records, and submit

plications to SSA.

SSA forwards all claims eligible

for disability consideration

to the Disability Determination

Services ( DS) office. Benefits

eligibility specialists maintain

ontact with SSA an DDS.

Benefits determination still pending

when inmate are released.

laim proved

ollowing release.

nmate candidates refuse 

articipate in th

rerelease applications 

roce s; many

ply after release.

nmates’ initial 

plication enie

rio release.

nmates medica ly 

proved for benefits 

rio release.

Benefit eligibilit

pecialists or 

ommunity-based

aseworkers assis in

peals, depending on 

nmates’ releas tatus.

Releasees fail 

to provide

information to 

SSA; cases 

closed.

No appeals 

filed.

Contract Mental Health/

Mental Retardation or

epartment of Human

Services caseworker in 

ommunit where 

eleasees live assis eleasees 

with obtainin enefits.

9 
R ESEARCH 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 percent) 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 documentation, and responsiveness to 

requests for additional information. TCOOMMI has capi­ talized on his acumen by 

having him train other benefits 

specialists around the State. 

Anecdotal evidence suggests 

that by improving procedures 

and staffing arrangements, 

the benefits pilot has helped 

inmates and staff alike: ❋	 What was once a reactive 

process with few standards 

and relatively ad hoc identification of potentially eligible 

inmates is now a proactive 

one, with a system for identifying candidates, written 

procedures, dedicated staff, 

and measurable outcomes. 

❋	 Filing applications prior to 

release means that more 

inmates now have benefits 

when they leave institutions 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 applications and sometimes felt 

overwhelmed at having 

benefits tasks added to 

their numerous treatment 

responsibilities. 

❋	 Because eligibility specialists screen prospective 

applicants, provide considerable medical and mental 

health documentation with 

the applications, and offer 

prompt support if questions arise during the 

review process, State DDS 

processing of inmate applications 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. 

10 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

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 vocational services to individuals 

released via early parole or 

reparole from the Philadelphia 

Prison (local jail) System. 

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 incarcerated, and those who qualify 

for program services are recommended for early parole. 

If approved for FIR, clients 

are released to residential 

or intensive outpatient treatment programs. 

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 participants and has a total budget 

of $20 million. Federal and 

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 assistance coordinator (who helps 

inmates apply for benefits), 

clinical evaluators, case managers, vocational education 

staff, and supervisors. 

A key reason for the 

increased size of the FIR Program, 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 application process for FIR participants. These efforts resulted 

in significant changes in the 

11 
R ESEARCH FOR PRACTICE / DEC. 07 

existing medical assistance 

applications process and 

increases in the number of 

FIR clients covered. 

Streamlining medical assistance 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 different county assistance offices 

to initiate benefits claims. 

This system increased the 

risk of client flight, interrupted treatment, and required 

considerable DPW staff time 

because multiple DPW workers 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 allocated for indigent residents who 

are not eligible for medical 

assistance—which severely 

drained available resources 

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 Assistance Office devised a 

method to streamline the 

applications process and 

reduce the drain on Behavioral 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 candidates 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 Processing of FIR Clients’ Medical Assistance Applications.” 

Outcome of FIR’s modified 

medical assistance process. 

Streamlining the medical 

assistance application process 

has had positive outcomes for 

12 
13

HELPING INMATES OBTAIN FEDERAL BENEFITS

ach week, a lis on-to-be-released FI clients i orwarded

R’s medica sistance c ordinator and t the income 

maintenance caseworker wh andles FIR cases.

IR’ medical assistance c ordinator interviews

andidates on the lis nd obtains eac nmate’s

signature on mited powe torney.

he medical assistance c ordinator gathers inmates’ medical

nd menta ealt records, complete plication or medical

sistance, and forwards materials to medica onsultants.

he medical assistance c ordinator meet wit he

ncom maintenance caseworker an eviews all

plications, fillin ny missing information.

he incom maintenance caseworker approve plications

or medical assistance and notifies each prospective

treatmen rovider tha he FI clien as bee proved.

IR client are eligible fo medical 

sistance the day the eav he ins tutions.

lients Communit Behavioral Healt membership commences

verage o ays after eligibilit determination.

Medical consultant eview the medical and mental health

ocumentatio determine the nature and extent of

ach inmate’s disability, sign relevant forms, and return

he application packets to the medica sistance c ordinator.

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

 

 

R ESEARCH FOR PRACTICE / DEC. 07 

the FIR Program and for 

providers. It has resulted in a 

dramatic increase in the number of clients receiving medical 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 doubled, from 38 percent to 90 

percent. In addition, shifting 

responsibility for benefits 

applications to a single benefits case manager and completing applications prior to 

release has significantly 

reduced the client flight rate 

and has reduced disruption in 

treatment associated with filing applications after release. 

Assigning a single DPW staff 

person to process FIR claims 

and having that person coordinate with a single medical 

assistance coordinator has 

reduced the amount of time 

that DPW staff must spend 

processing applications and 

has helped standardize applications 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 support prerelease applications 

for SSI and SSDI benefits. 

Background. The original 

MOU, which had few specific 

protocols, was updated in 

2000 to include a more formalized application process 

and additional partners. In 

addition to the Division of 

Parole and SSA, the partnership now includes medical 

relations staff from the Division of Disability Determination (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 Correctional 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 contacts in each of its field offices 

who could respond to questions from parole, mental 

health, and corrections staff. 

The multistage application 

process outlined in the 

14 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

revised MOU involves identifying 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 applications 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 Processing of Prerelease Applications 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 evidence 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 percent of initial claims for SSI 

are approved. Reasons that 

inmate applications are 

denied include the following: 

❋	 Applicants cannot be located following release (e.g., 

because they fail to appear 

at their designated parole 

office, move from their 

approved residences, or are 

not under parole supervision). In these cases, even 

if applicants have been 

medically approved by DDD 

prior to release, their cases 

will be coded as “whereabouts 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 applications 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 examinations), or if their field parole 

officer does not make benefits a priority, applications 

may again be closed for 

lack of information. 

15 
R ESEARCH FOR PRACTICE / DEC. 07 

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

acility parol officers distribute

list of release-eligible inmates.

Benefits determination sti

endin when inmate are released.

Department of Correctional Services

Health Services and Office of Mental

Health staff review list of prospective

releasees to assess SSI or SSD eligibilit

otentially eligible inmates ar

interviewe and SSI or SSDI 

plications are prepare nd

forwarded to the SSA field offic

earest th prison.

SSA forwards applications to the 

Division of Disability Determination

and facility parole staff hel locate

additional information while the

inmate is still incarcerated.

laim

proved.

Inmates medically a proved

for benefits prior to release.

A plication or inmates wit

much incom many

esources forwarded for

Medicaid only” consideration.

eny claims fo

onmedica easons.

No appeals filed.

nmates’ initial a plications

enie rio release.

iel parole officers

sis with appeals.

SSA staff screen applications.

Field parol officers assist 

releasee with obtaining 

enefits followin release.

acility or field parole

officers assist with filing 

peals, dependin on

inmates’ release status.

Releas es fail t provide 

nformation t SSA; 

ases closed.

laim

enied.

Field parol

officers assist 

releasee with 

btaining benefits.

16 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

❋	 Applications are denied 

because applicants are 

nonqualified aliens. 

❋	 Applications may be denied 

because important medical 

records are not complete 

enough to determine disability according to SSA 

specifications or are not 

obtained in a timely fashion. 

Inmates cannot always 

accurately recall their medical or mental health histories; even those who do 

remember may have records that are difficult to obtain because the records are 

in multiple locations (in the 

community or in the correctional 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 sufficient 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 applications and in supporting 

documentation may not be 

available when DDD or SSA 

questions need answering. 

❋	 Applicants whose initial 

claims are denied may 

refuse to appeal and may 

apply for State-funded public assistance, which is 

available to some individuals 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 partners on a pilot project to 

develop training protocols for 

medical and mental health 

staff at two prisons to ensure 

that mental health and medical examinations and corresponding paperwork meet 

the requirements for disability 

determination. 

Lessons from the sites’ 

experience 

The experiences of the three 

study sites suggest six lessons regarding efforts to 

assist inmates with benefits 

applications: 

17 
R ESEARCH 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 communication about the strengths 

and weaknesses of the 

applications process. Indeed, 

as a result of this type of 

information sharing, New 

York launched its pilot project 

to have State Division of Disability 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 significant advantages to funding eligibility staff whose sole 

function is to help offenders 

access benefits. For example, 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 willing to assist in preparing 

applications. In Texas, specialization means that TCOOMMI’s benefits staff are able to 

submit application packets 

that contain more information 

(i.e., including both institutional and community-based 

records) than in the past, 

which has accelerated the 

review process. In Philadelphia, having dedicated staff 

18 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

has shifted responsibility for 

seeking benefits from multiple providers and numerous 

disability examiners to just 

one medical assistance coordinator and one DPW examiner. This has not only 

streamlined the process but 

also has resulted in improved 

security and treatment outcomes for program participants. Dedicated staff can 

concentrate on filling gaps in 

documentation without having to postpone their other 

institutional responsibilities. 

Finally, having dedicated staff 

increases the likelihood of 

strong working relationships 

with disability decisionmakers 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 likelihood that benefits will commence soon after release. 

Some inmates refuse assistance 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. Program funding also supports 

clients who are ultimately 

denied benefits. Any jurisdiction 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 providing other support until benefits payments commence. 

Tracking outcomes is beneficial. 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 agencies and eligibility specialists 

succeed in obtaining benefits 

and can use the information 

to improve overall performance (e.g., through staff training). In contrast, in New York, 

19 
R ESEARCH FOR PRACTICE / DEC. 07 

where data on Social Security 

applications are not maintained, staff assume that 

their efforts are largely 

unsuccessful, which makes 

it difficult for them to sustain 

enthusiasm for filing applications. 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 information has been used to persuade sources of government 

funding in both Philadelphia 

and Texas to continue to support 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 discovered that by centralizing the 

processing of benefits claims 

they could reduce the number of individuals involved in 

decisionmaking and significantly reduce the amount 

of time until eligibility is confirmed and enrollment in the 

medical assistance managed 

care organization occurs. 

Faced with having cases 

closed because inmates 

cannot be located following 

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 benefits 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 assistance to SSA and Disability 

Determination Services 

examiners across the State. 

Assisting mentally ill 

offenders poses special 

challenges. Program participants 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 suggested that disability determination staff appear more 

cautious about approving 

20 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

benefits for mentally ill 

inmates than they are about 

approving inmates with a 

medical illness. Program and 

benefits staff offered the following 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 treatment while incarcerated. 

❋	 When applicants have cooccurring substance abuse 

disorders and mental illness, it is difficult to determine which is the primary 

diagnosis. 

❋	 Mentally ill offenders can 

appear stable in a correctional setting because they 

comply with treatment and 

live in a structured environment 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 frequently 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 application process can be complicated 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 ultimately qualify for benefits are likely to find it challenging to 

avoid relapse or recidivism 

unless other supports (e.g., 

case management services, 

housing) are made available. 

21 
R ESEARCH FOR PRACTICE / DEC. 07 

Although Philadelphia’s FIR 

Program targets sentenced jail 

inmates, none of the strategies 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 incarcerated 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 likely to report a health problem. See 

Maruschak, Laura M., and Allen J. 

Beck, Medical Problems of Inmates, 

1997, BJS Special Report, Washington, 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 population. See Teplin, Linda, “The Prevalence 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. 

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 incarceration 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 Probationers, 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 Correctional Health Care, Report to Congress, 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 entitlement 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 ascertain whether releasees with medical 

benefits fare better than releasees 

who do not have medical benefits. 

22 
HELPING INMATES OBTAIN FEDERAL BENEFITS 

The Texas Council on Mental Impairments 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 Comerford, and Clyde B. McCoy, “A Comparison of the Need for Health Care 

and the Use of Health Care by Injection-Drug Users, Other Chronic Drug 

Users, and Nondrug Users,” American Behavioral Scientist 41 (8) (May 

1998): 1112, 1117. 

8. These sites were identified through 

a review of existing literature on correctional health care and the need for 

benefits and through telephone interviews with researchers and practitioners familiar with these issues. 

Telephone interviewees were identified through the literature review and 

recommendations from other interviewees. 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 qualifies an applicant for Medicaid benefits. Approval for SSDI benefits 

qualifies an applicant for Medicare 

benefits after a 2-year waiting period. 

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 

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 temporary disabilities (i.e., those lasting 

less than 12 months) or with primary 

diagnoses of substance abuse disorder. Those with disabilities resulting 

from substance abuse disorders are 

entitled to a 9-month lifetime medical assistance benefit. Many FIR 

participants receive State-funded 

medical assistance; others receive 

support from the Federal-State Medicaid program. Regardless of the 

source of the medical assistance dollars, 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, nonprofit corporation that provides legal 

services for indigent criminal defendants. Although funded by the City 

of Philadelphia, the Defender Association is not a city or State agency. 

23 
The National Institute of Justice is the 

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). 
DEC. 07 

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