SSI/SSP Discontinuances and Denials Due to Excess Income

Individuals who lose SSI/SSP eligibility due to these reductions will continue to have zero SOC MC as long as there are no changes that impact their MC eligibility. Responsibility for the maintenance of the MC eligibility is now transferred to the counties. This will make sure that the State receives the increased federal funding from the American Recovery and Reinvestment Act (ARRA) of 2009.

Craig v Bontá

Persons discontinued from SSI/SSP due to the decreases in the SSI/SSP payment standard are included in the existing monthly Craig v Bontá process. These individuals may be eligible for the new Federal Poverty Level for the Blind (FPL-B), Medicare Savings Programs (MSP), Aged & Disabled (A&D) FPL program or another MC program.

SSI Denials

Effective July 1, 2009, persons who are denied SSI will have their application for MC processed back to the date of the SSI application. The application will be processed by the Social Services Agency.

Date of Application

The date of application for MC is:

The date the person applied for SSI, or The denial date (found on the SDX3 screen in MEDS) when the application date is a future date (an individual who is 64.9 years old applies for SSI), or
The initial MC application date when the case is currently pending.

Note: When the residency date is a later date, the EW must clarify with the client the actual residency date. The client’s statement is acceptable.

Eligibility Requirements

The EW will complete the application started by Social Security Administration. Since Social Security Administration stops their eligibility determination at the first SSI/SSP eligibility criteria that the applicant does not pass, the EW may need to request more information and verification about identity, citizenship, income, property and/or disability evaluations.

Example Example The EW receives the above mentioned SSI/SSP denial for the purpose of processing the MC portion of the application. Social Security Administration documented the client’s identity, citizenship and income but not the property or disability. The EW will request from the client information and verification of his property and submit a Disability Determination Service Division (DDSD) referral for his alleged disability.

Note: The MC 355 can be used to request necessary documents or verifications for determination of MC eligibility.

Redeterminations

When the SSI/SSP application received by Social Services Agency is for a period exceeding 11 months from the original application date and MC eligibility is established in the application month and ongoing, a redetermination must be completed. The Intake EW must enter a Special Indicator, SSI Denial - RRR Overdue in CalSAWS and transfer the case. The receiving office will review the case and mail a MC RD form to the client as well as a DDSD referral, if applicable.

Example Example Individual applied for SSI/SSP 3/1/2016. On 7/1/2017 he/she was denied SSI due to income and his/her MC application was transferred to Social Services Agency for processing. In July 2017, the EW completes the MC application process and approves MC back to 3/1/2016 and ongoing. Because the approval period covers more than 11 months from the date of approval, the MC redetermination is now due.

DDSD Referrals

Some of the SSI/SSP applicants may or may not have had a disability determination made by SSA so in some instances, a Disability Determination Service Division (DDSD) referral may be required to establish disability linkage. The EW should review the disability status and onset-date on [SDX3] screen to determine if the DDSD referral is needed or not. If the individual claims being disabled, the EW must complete a DDSD referral.

Retroactive Benefits

SSI applicants can or may apply for retroactive MC benefits from the date of the SSI/SSP application. To prevent future system problems, before granting the case, it is important that the EW processing the MC application asks the applicant if he/she incurred any medical expenses in the retroactive months.

Note: The “Supplement to Statement of Facts for Retroactive Coverage/Restoration” (MC 210 A) must be completed as applicable.

Continuing

A few individuals denied SSI will be in a currently open case. These individuals will be referred to the assigned district office for processing. The EW will proceed with the add-a-person procedures.

Documentation

Because the SSI application date may be more than 45 days before the date the application is received by Social Services Agency from Social Security Administration, it is important for the EW to identify when it is a Social Security Administration delay and document in the Journal page. This specific documentation is normally done at the point the case is registered in CalSAWS by clerical.

Forms

Since Social Security Administration began the application process, an EW can contact the client to obtain any missing information necessary to complete a MC eligibility evaluation. The EW must mail the SSI/SSP Denials Medi-Cal Packet to the client.