Interviewing and Problem Solving for Public Benefit1

							Interviewing and Problem Solving for Public Benefits INTRODUCTION As a public benefits counselor, you should establish clear goals that will help you accomplish the following:  identifying the consumer's problem, and assessing their need and eligibility for benefit programs  gathering the information needed to assist the consumer in finding solutions  developing a plan with the consumer that outlines the steps that both you and she/he will take to resolve the problem and  following up with the consumer to see if the problem has been resolved and determine what additional steps need to be taken.

At an interview, you need to develop skills in gathering information, developing a rapport with the consumer, and working with them in outlining a course of action. Several obstacles may hinder the process including the need to find out very specific, personal and financial information, and the difficulty a consumer may have with recalling or explaining the detailed information required. Thus, you must be able to overcome a consumer� reluctance to discuss personal matters, as well as identifying ways to obtain s information from other sources if the consumer forgets or cannot provide it, and acquiring the skills needed to sort through complicated situations and to prioritize the needs presented. During the interview, you should always keep the purpose clearly in mind and follow a definite structure that will enable you to meet your goals. The following outline will be useful to accomplish this process and includes steps in problem solving, conducting an entitlement interview, and establishing a good consumer-advocate relationship During an initial interview you should begin by introducing yourself to the consumer and establishing rapport with a warm, friendly greeting. Explain your role as a helping person within your organization and outline the type of assistance you are able to provide. Begin the dialogue by asking the consumer what it is you can help them with, or what has brought them in to see you. STEPS IN PROBLEM SOVLING FOR PUBLIC BENEFITS


Gather information and establish the facts of the case

Whether you are interviewing the consumer to screen them for benefits or to help them with an existing public benefit problem, you will need to start by gathering the necessary information to establish a full and clear picture of the consumer's situation. Basic questions should determine information about the consumer's family, community and support systems. Allow the consumer time to explain their story. Keep the consumer on track by asking clarifying questions that focus in on the problem. Move slowly into more personal questions such as income and resources, and explain why you need this information. Continue to probe as much as possible to obtain a coherent understanding of the consumer� situation. Information is the key to being a s successful interviewer. Do not limit information to only what the consumer tells you. Determine the facts, not only by asking the consumer detailed questions, but also by reading agency notices. Official notices are often confusing and difficult to understand. As a result some consumers may misinterpret the reason why specific action was taken on their case and thus provide misleading information. To assure an accurate understanding of what occurred, ask to see all correspondence and documents, including decisions, denial and reduction notices. Read these notices carefully as they usually provide information pertinent to the case. Use a good screening or intake form. The record keeping form you use should collect information on identity, age, household size and relationships among members, marital status, citizenship status, Social Security number, and case numbers, if currently receiving benefits. Financial information collected should include earned and unearned income, in kind assistance from friends and relatives, resources. Household expenses should include the amount spent on rent or housing costs, utilities and food. Finally the screening form should include the type of housing they reside in, as well the type of medical coverage they may have and any out-of-pocket expenses. 1. Determine what the problem is An advocate represents the consumer� interests and it is the consumer who s should ultimately define what those interests are. Be sure you and the consumer agree on what the problem is. Once you have identified and defined the problem in your mind, restate it for the consumer. This will insure that your perception of the problem concurs with the consumer's. You will then need to determine which parts of the problem you can help the consumer with and those parts you cannot help with. Be realistic with the consumer about how you will be able to assist them. 2. Prioritize the problems The consumer may present overwhelming and complex problems that are

interrelated. You can assist the consumer by sorting them out and discussing what is most urgent and should be handled first, and what can wait to be resolved. When problems are prioritized and broken down into steps or tasks, the problem will seem less overwhelming and the consumer will feel a sense of control. 3. Determine the rules and guidelines that apply to the case If you are screening someone for benefits, you need to gather sufficient information about his/her financial status, household composition, housing and benefits already received, to be able to screen the individual for potential benefits. Use the screening chart at the beginning of this section as a guide to determine eligibility for benefits. If you are assisting a consumer with an existing problem with a public benefit, you will need to understand the program guidelines and laws that are being applied to their situation. Specifically, what rules and regulations are being applied in the case? Are these being applied correctly or have errors been made? What is preventing the consumer from receiving the appropriate benefits and services? Has the consumer fulfilled their responsibilities in the process, such as submitting documentation, cooperating with program staff, and showing up for appointments, recertifications and interviews? What needs to be done to resolve the problem? Be sure you understand the regulations and guidelines involved in the program and determine whether they have been applied correctly in this case. Use resource books and reference guides from advocacy organizations, government agencies and legal resources to determine if the correct action was taken. This is the type of information that the PBRC Manual provides. 4. Establish a plan to resolve the problem Before you end the interview, both you and the consumer should establish a plan of action. This is an informal agreement or "contract" that lays out the steps to be taken in your work together. It outlines what each of you will do to resolve the defined problem. This is especially important when the consumer presents a complex array of problems. It is easy for both the worker and the consumer to forget what they said they would do. Each task should also have a time frame indicating when it should be accomplished. 5. Establish a plan for follow up At this point, the consumer should know when they will either hear from you, when they should get back to you, or when their next appointment is. Very often, consumers who are applying for public benefits, especially when they are unfamiliar with the systems, will attempt to apply but become discouraged by something the agency worker tells them. The client may have difficulty in fully

documenting their case and never complete the process, or become frustrated by the long application process, repeated trips back to the office or other procedures that can deter them. Your intervention at this point may be crucial in ensuring that the consumer receives the benefits to which they are entitled. If you are working on an existing problem, determine what steps need to be taken to prevent this problem from reoccurring. Once the presenting problem has been resolved, determine what other benefits and programs the consumer might be eligible for and offer your assistance in applying. 6. Keep accurate case records Finally, keep records of your work. You may want to write down some notes during the interview. However, you should complete your record keeping immediately following the interview while it is still fresh in your mind. Be sure to write down facts about the consumer's situation and what you and the consumer agreed upon to resolve the problem.

CONDUCTING AN ENTITLEMENT ELIGIBILITY INTERVIEW To properly assess benefit eligibility it is important to obtain specific information about your consumer. You will need particular information to explore eligibility for insurancebased programs verses needs-based programs. Below are some appropriate questions you can ask to ensure the collection of relevant information.

1.  Does the consumer have a work history? If so, do they have a sufficient work history to meet the necessary requirements of the program? Check first to determine if the consumer is eligible for any insurance-based benefit. Eligibility for a needs-based benefit can be determined after eligibility for an insurance-based benefit has been made. Receipt of an insurance-based benefit, however, does not preclude eligibility for a needs-based benefit. The income and resources of an individual in receipt of an insurance-based benefit may still be low enough for them to qualify for a needs based benefit. 2.  Which entitlement is the consumer categorically eligible for?

Entitlement to many of the benefits is category specific, that is, the applicant must be part of a specific population group, such as aged, blind, disabled, family with children, to be eligible for the benefit. This is true of both insurance-based and needs-based benefits.

For example, for Social Security retirement benefits (an insurance-based benefit) an individual must be aged. The Social Security Administration defines aged for full retirement benefits as 65 an older (although this will increase for those born 1938 and later). For Supplemental Security Income an individual must be aged, blind or disabled. Again, the Social Security Administration defines aged as 65 and over, disabled as inability to engaged in substantial gainful activity for 12 months or more, and blind as meeting the blind definition of the Commission for the Blind. 3.  Does the consumer meet citizenship requirements?

Insurance-Based In order to receive an insurance based benefit you must be legally present in the U.S., have a social security number and INS authorization to work. Needs-Based In most circumstances the applicant must be a U.S. citizen. An immigrant� s eligibility for needs based benefits vary by program and depends on whether an immigrant is a qualified alien, the date of entry into the U.S. and how long they have been residing in the country.

1. 

Does the consumer meet residency requirements?

Insurance-Based

For Social Security benefits the applicant can reside anywhere in the U.S. or in other parts of the world. However, there may be withholding taxes when residing outside the U.S.

Needs-Based

The applicant must be permanently residing in the U.S. in order to be eligible for any needs based benefit, and must apply in the county of their residency.

2. 

What are the living arrangements of the consumer?

Living arrangement includes:

1. who is living in the household with the consumer, including family or non-family members 2. who purchases and prepares meals together 3. how are the costs of shelter and utilities split among the household members

Insurance-Based

Regardless of the household's living arrangement, the amount of the benefit is not affected.

Needs-Based

The household's living arrangement may affect benefit amounts. Each of the above listed factors has different effects on different benefits. For example, who purchases and prepares meals together in a household effects the amount of Food Stamps as well as SSI amounts. 3. 

What are the lines of legal responsibility?

Under the law, parents are legally responsible for their children up until 21 (18, if it is a disabled child) and spouses are legally responsible for each other. This means the parent's and the spouse's income and resources are deemed (considered available) to the applicant, even if the parent or spouse is not applying.

Insurance-Based

Spouses and dependents may be eligible for certain insurance-based benefits under their spouses' or parents' work record.

Needs-Based� � Lines of legal responsibility have a significant impact on needs-based benefits.� Since the income and resources of the legally responsible relative is counted when determining the applicant's eligibility (deeming) some applicants may be ineligible for needs based benefits.

For example, a woman informs you she wants to apply for SSI, but her husband does not.�Although she may not have any of her own income or resources, a portion of her husband's income and resources would count as if they were hers.� This may make the wife ineligible for SSI.�This is true for all needs based benefits.�

1. 

Does the consumer meet resource requirements?

Resources are assets, and include savings, checking accounts, life insurance policies, cars, CD's, IRA's, bonds, burial funds, etc.�Each benefit has different rules regarding how to handle excess resources.�Check to see what is allowable under each benefit program.

Insurance-Based�

�
Insurance-based benefits have no resource eligibility guidelines.�

Needs-Based� �

Each needs based entitlement has different resource limits by which applicants are evaluated.�Some factors to keep in mind are:

1. Certain resources are exempt (not counted) when determining whether an applicant meets the resource requirements of the program.� There are allowable exemptions for resources.� A home in which an applicant lives, for example, is always an exempt resource for any entitlement in which an applicant applies.� Liens, however, may be placed on the home when applying for some benefits.�

2. Resource exemptions vary by program.� For example, a burial fund is an exempt resource for Medicaid disabled, aged and blind applicants, as well as SSI applicants, but not for Public Assistance applicants, unless established by the NYS Office of Mental Retardation and Developmental Disabilities.

3. Find out about transfer of asset rules, some benefits allow an applicant to transfer their resources before application without any penalty, others do not.

4. If a consumer� resources exceed the limits, assist them by providing information s on how they can become eligible.� For example, spending down excess resources, establishing burial funds.� This type of information is found under Eligibility Criteria/Resources for the various needs-based benefits described in this manual.

1. 

Does the consumer meet income requirements?

Insurance-Based

Insurance-based benefits have no income eligibility guidelines. However, work income may affect eligibility for certain benefits.

Needs-Based

Income can include both earned, unearned, and in-kind income. Each needs based entitlement has different income limits by which the program evaluates an applicant� eligibility. Some factors to keep in mind are: s

1.  Certain types of income are deducted from the applicant� gross income s when determining whether an applicant meets income requirements.

2.  Income deductions vary by program. Research what is an allowable deduction under each benefit program. For example, in-kind income does not count as income for Food Stamps, Public Assistance or Medicaid. It does count for SSI, although there are maximum limits.

3.  Consumers who do not meet income criteria are generally not eligible for the benefit. That is, an individual cannot "spend down" excess income to become eligible. There is one notable exception with Medicaid; the Excess Income Program.

2. 

Prepare your consumer for the application process.

The entitlement system is a bureaucratic maze. Advocacy on behalf of the consumer may be needed to ensure the consumer receives the entitled benefit. Keep in mind the following points:

1.  Send the consumer to the appropriate agency. Food Stamps is distinct from Medicaid, SSI is distinct from Public Assistance, etc. When you determine which benefits your consumer is eligible for, send them to the appropriate agency.

2.  Be aware that application for some benefit programs have specific catchment areas. For example, PA applicants must apply at the office that serves their geographic locations.

3.  Sometimes, an applicant has the ability to apply thorugh the mail, for example, Social Security applicants.

4.  Assessing eligibility is just the first step in the process. If a consumer is eligible for a benefit program, documentation is necessary to prove eligibility.

1.  Encourage the consumer to cooperate with the agency because benefits can be denied for failure to cooperate. However, be sure to monitor the agency because there are instances when the agency will request information the consumer is not obligated to provide.

ESTABLISHING A GOOD CONSUMER-ADVOCATE RELATIONSHIP

Establishing a good rapport with a consumer is crucial to the success of the interview. Listed below are several tips to create a trusting atmosphere.

5. 

Acknowledge the seriousness of the consumer� concerns. s

6.  Listen with your full attention and observe all non-verbal behavior so you can respond appropriately.

7.  Do not make any false or empty promises. Know what you can and cannot do. Explain your boundaries if the client asks for help you cannot provide.

8.  Move slowly into personal questions. Be attuned to the consumer� level of s comfort in discussing these areas. Explain that you are asking these questions to� get information you need to help the consumer obtain entitled benefits.

9.  Respect the consumer� right to confidentiality. Assure the consumer that the s information gathered will not be made public or used to deny them benefits. The information is used for the sole purpose of determining their eligibility.

10.  Be comfortable with silences. The consumer should do most of the talking. However, some people will be quieter than others and will need more time to think about and respond to your questions.

11.  Make sure the interview remains focused on the issue at hand. It is often difficult for consumers to order the events in a logical approach. You can help the consumer by providing a timetable of events. This will assist both you in understanding what happened when and will assist the consumer in filling in the gaps.

12.  Be neutral and objective. Try not to express opinions or pass judgment. You are there to provide information, guidance and advocacy. Try not to let your own personal feelings interfere with your ability to help someone.

13.  Finally, be empathetic and compassionate. Try to identify with this person. It has been said that you can never truly understand another person until you have walked a mile in their shoes.

Section 385.9 Work activities and work requirements. (a) Social services districts may provide, and require applicants for and recipients of public assistance to participate in a variety of activities, including but not limited to the following:

(1) unsubsidized employment; (2) subsidized private sector employment; (3) subsidized public sector employment; (4) work experience in the public sector or nonprofit sector, (including work associated with refurbishing publicly assisted housing) if sufficient private sector employment is not available as determined by the social services official. The maximum number of hours a recipient or applicant may be required to engage in this activity is limited to the number which equals the amount of assistance payable with respect to the public assistance household of such individual (inclusive of the value of food stamps received by the public assistance household of such individual, if any) divided by the higher of (i) the Federal minimum wage, or (ii) the State minimum wage. The limitation of the number of hours of work experience to which a participant may be assigned is a calculation of allowable hours in a work activity and does not mean that such participant is receiving a wage for the performance of such activities. The participant is not working off the grant, but is engaged in work activities as an element of his/her plan to become self-sufficient; (5) on-the-job training; (6) job search and job readiness assistance, as time limited by Federal law, provided that job search is an active and continuing effort to secure employment, configured by the social services official; ` (7) community service programs provided, however, the number of hours a participant in community service activities authorized pursuant to this section may be required to work in such assignment shall not exceed a number which equals the amount of assistance payable with respect to the public assistance household of such individual (inclusive of the value of food stamps received by the public assistance household of such individual, if any) divided by the higher of (i) the Federal minimum wage, or (ii) the State minimum wage. No participant shall be assigned to a community service activity that conflicts with his/her bona fide religious beliefs. The definition or parameters of this activity shall be set forth in the local plan submitted by the social services district,

provided that an individual needed in the home because another member of the household requires his/her presence due to a verified mental or physical impairment shall be deemed to be engaged in community service to the extent such person is actually providing care for such member of the household. The limitation of the number of hours of community service to which a participant may be assigned is a calculation of allowable hours in a work activity and does not mean that such participant is receiving a wage for the performance of such activities. The participant is not working off the grant, but is engaged in work activities as an element of his or her plan to become self-sufficient. For purposes of calculating the participation rate, recipients who are acting as foster parents for children are deemed engaged in community service to the extent they are actually providing care for such children; (8) vocational educational training as time limited by Federal law and pursuant to subdivision (c) of this section; (9) job skills training directly related to employment; (10) education directly related to employment, in the case of a recipient who has not yet received a high school diploma or a certificate of high school equivalency; (11) satisfactory attendance at secondary school or a course of study leading to a certificate of general equivalency in the case of a recipient who has not completed secondary school or received such certificate; (12) provision of child care services to an individual who is participating in community service; (13) job search and job readiness assistance once the individual has exceeded the six week limit set in Federal law; (14) educational activities pursuant to subdivision (c) of this section; and (15) other activities set forth in a local district plan. (b) Additional provisions:

(1) No participant shall be required to provide child care services as a work activity described in this part unless the participant expressly requests in writing to provide such services. (2) Social services districts may enter into agreements with public and private employment agencies to assist recipients of public assistance to find jobs. (3) No participant shall in any case be required to engage in assigned activities for more than forty hours in any week. (4) A non-graduate degree student who is participating in a work-study, internship, externship, or other work placement that is part of the curriculum of a student approved for participation by the City University of New York (CUNY), the State University of New York (SUNY), another degree granting institution, or any other education, training or vocational rehabilitation agency approved by the state or social services district, shall not be unreasonably denied the ability to participate in such program as a work activity assignment made in accordance with the provisions of this Part. A social services district may deny such participation based upon consideration of factors including, but not limited to: (i) the determination that the student voluntarily quit a job or reduced earnings to qualify for initial or increased public assistance as determined in accordance with section 385.13 of this Part; (ii) that a job or on-the-job training position that is comparable to the work-study, internship, externship or other work placement cannot reasonably be expected to exist in the private, public, or not-forprofit sector; (iii) that the student is not maintaining a cumulative C average (or its equivalent), which may be waived by the district for cases of undue hardship based on the death of a relative, the personal injury or illness of the student or other extenuating circumstances as determined appropriate by the district;

Section 385.12 Failure to comply with the requirements of this Part. (a) Noncompliance of public assistance applicants and recipients with the requirements of this Part. (1) Potentially employable applicants and recipients. (i) An applicant who has been determined to be exempt from participation in work activities in accordance with the requirements of this Part due to being disabled pursuant to this section, who in the judgment of the social services official has the potential to be restored to selfsufficiency through rehabilitation, will be denied assistance if he/she fails to comply with requirements for potentially employable applicants pursuant to section 385.2 of this Part. Ineligibility for assistance continues until the applicant agrees to comply with the requirements and demonstrates such compliance where appropriate. (ii) A recipient who has been determined to be exempt from participation in work activities in accordance with the requirements of this Part due to being disabled pursuant to this section, who in the judgment of the social services official has the potential to be restored to selfsufficiency through rehabilitation, is ineligible to receive public assistance until such time as he/she is willing to comply with such requirements. (2) A public assistance applicant or recipient subject to employment requirements who is determined to have refused or failed to comply without good cause with the requirements of this Part in accordance with the provisions of section 385.11 of this Part regarding conciliation must be provided a notice of such determination and of the intent of the social services district to deny, discontinue or reduce assistance, as follows: (i) An applicant must be issued an adequate notice of denial of public assistance which informs him/her that he/she has refused or failed to comply without good cause with employment requirements in accordance with the provisions of this Part. (ii) A recipient must be issued an adequate and timely notice of intent to discontinue or reduce assistance

which informs him/her that he/she has refused or failed without good cause to comply with employment requirements in accordance with the requirements of this Part. (iii) The notices specified in subparagraphs (i) and (ii) of this paragraph must also inform: (a) the applicant or recipient of the specific instance(s) of willful refusal or failure to comply without good cause with the requirements of this Part and of the specific section of this Part in which the requirement(s) is contained; (b) the applicant or recipient that he/she has the right to apply for public assistance at any time, and for safety net recipients that he/she may reapply at least 45 days before the end of the sanction period to ensure restoration of benefits immediately following the applicable sanction period; (c) the recipient of the duration for which he/she will be ineligible for public assistance or for a reduced amount of public assistance in accordance with this section; and (d) that he/she has the right to a fair hearing in accordance with the provisions of Part 358 of this Title. (3) Refusal of employment. (i) In determining whether an applicant's or recipient's refusal to accept a referral to an employment opportunity or an offer of employment constitutes refusal or failure to comply without good cause, a social services official shall consider the report of the employment unit or agency through which the job referral was made, pertinent information supplied by the prospective employer, the explanation of the applicant or recipient for not accepting the offer of employment, and any other pertinent evidence. (ii) An individual is deemed not to have failed or refused to comply without good cause with employment program requirements or to have refused to accept a referral to an employment opportunity or an offer of employment in which such person is able to engage due to

his/her refusal to accept an offer of employment, if the evidence shows that: (a) the job offer was not bona fide; (b) the salary or wages were less than the minimum required by law, or the conditions of employment were otherwise contrary to law; (c) child care necessary for an individual to participate is not available in accordance with Part 415 of this Title; (d) necessary supportive services are unavailable; (e) a strike, lockout or other public or private industrial controversy was in progress at the place in which employment was offered; (f) the job would have been hazardous to the applicant's or recipient's life or health, or there was an absence, if appropriate, of workers' compensation; (g) the place of employment required unreasonable, based on the standards of the community, travel from the applicant's or recipient's home; (h) child care plans were temporarily disrupted, making it impossible for the applicant or recipient to report as required; (i) accepting a job would result in a net loss of cash income for the household and the social services district does not make supplemental payments pursuant to section 352.7(m) of this Title to prevent a net loss of cash income;