Reporter Yvonne Wenger's article on the troubling reality of applying for federal disability benefits reflects what we see daily at Health Care for the Homeless in Baltimore City ("After a disability, long waits for federal benefits," Oct. 28).

As Ms. Wenger noted, around 31 percent of all initial applications for benefits are denied. But for individuals who are homeless, and who often have much higher rates of mental illness, the acceptance rate is even lower. Many of these individuals are uninsured and thus unable to access vital treatment and services.

This creates a vicious cycle in which individuals are unable to get care, which in turn makes it more difficult for them to prove they have a disability. Being unable to prove disability makes it harder for them to get disability income and health insurance in a timely manner — even though disability benefits often mean the difference between having their housing needs met and life on the streets.

Under these conditions, mental health impairments can be even more difficult to prove due to a lack of objective tests and medical criteria. As Ms. Wenger noted, many patients don't have the required medical documentation on hand, or never had it, because they lack the insurance records that form the heart of a disability application.

Individuals waiting for disability decisions often endure extended periods of life on the streets, which lead to their health deteriorating and more frequent use of hospital emergency rooms. They're also apt to end up in jails, where often inhumane living situations worsen their condition.

As we move forward with health care reform, individuals will have increased access to health insurance. However, this does not guarantee access to the unless we revise our current system. Accessing the entitlement programs is a vital first step toward getting housing, treatment and other support services, but we also must look at the human impact of long waits for benefits among people who are most disabled but have a hard time proving it.

Margaret Flanagan and Katie League, Baltimore

The writers are disability specialists at Health Care for the Homeless of Maryland.