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DDSD Decision Chart
The DDSD decision chart shows when a DDSD referral must be made, and when a DDSD referral must be denied. “Denied RSDI or SSI” includes denials and discontinuance of benefits.
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If the client...
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And the client...
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Then the EW must... |
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Has not applied for RSDI or SSI benefits, |
Is not required to apply for RSDI, |
Complete a DDSD referral. |
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Has applied for RSDI or SSI, |
States the RSDI or SSI application is pending |
Complete a DDSD referral. |
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Has been denied RSDI or SSI (regardless of the denial date), |
Claims a new or different disabling condition from the one denied by Social Security, |
Complete a DDSD referral. |
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Has been denied RSDI or SSI |
Within the past 12 months |
Claims the disabling condition denied by Social Security has worsened or changed, |
Deny Medi-Cal based upon disability and refer client to Social Security to appeal. Issue MC 239 SD and MC Information Notice 13. |
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More than 12 months ago, |
Claims the disabling condition denied by Social Security has worsened or changed, |
Complete a DDSD referral. Note: Send a copy of SSA denial letter with the DDSD packet. |
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Has been denied RSDI or SSI,
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Does not claim that the disabling condition denied by Social Security has worsened, or that a new condition exists, |
Deny Medi-Cal based upon disability and refer client to Social Security to appeal. Issue MC 239 SD and MC Information Notice 13. Note: Denial may be rescinded if SSA subsequently approves the disability claim. |
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Has been denied RSDI or SSI,
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Has received a Social Security notice of refusal to reconsider or reopen the claim, |
Complete a DDSD referral. A copy of the notice or other documentation must be attached to the DDSD referral packet. |
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Has been denied RSDI or SSI |
Has an SSA appeal pending, |
Do not refer the client to DDSD, regardless of whether or not the condition has worsened, even if the condition now meets the PD criteria. Deny the MC application. Denial must be rescinded if SSA subsequently approves the disability claim. |
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Reminder: When DDSD is denied, evaluate other program linkage.
Social Security Administration/DDSD Client Referral Chart
The following chart helps to identify where the claim should be referred:
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Client Status with Social Security Administration |
Situation |
Where to Refer |
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1. Did not apply |
N/A |
DDSD |
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2. Applied |
Application status unknown. |
DDSD |
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3. Pending |
Application status is pending. |
DDSD |
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4. Approved |
Has SSA award letter. |
No Referral |
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5. Approved |
Has SSA award letter - needs retro MC. |
DDSD |
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6. Denied |
Decision on appeal. Note: No time limit nor medical conditions considered. |
SSA |
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7. Denied |
Has SSA denial letter based on income/resources. |
DDSD |
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8. Denied |
Denial within previous 60 days. Did not ask SSA to reconsider. |
Social Security Administration (SSA) |
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9. Denied |
Denial within 12 months. alleges worsening of same condition. Did not ask SSA to reopen previous denial. |
SSA |
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10. Denied |
Denial within 12 months. Has SSA letter verifying SSA refusal to reopen previous denial. |
DDSD |
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11. Denied |
Denial within 12 months. Alleges new condition not considered by SSA. Has not reapplied with SSA. |
DDSD |
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12. Denied |
Denial within 12 months. Same condition worsened and does not allege new condition. |
SSA |
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13. Denied |
Denial over 12 months. Same condition worsened, or has new condition not considered by SSA. Has not reapplied nor appealed with SSA. |
DDSD |
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14. Denied |
Denial over 12 months. No worsening of same condition or has no new condition. |
SSA |
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