Individuals Who Must Not be Referred to DDSD

Situation

Do not refer a client:

Prior DDSD Decision

- Disabled

Who had a prior DDSD decision made within the past 12 months unless the reexamination date is due or has passed, or there is an indication that the medical condition has improved.

Prior DDSD Decision

- Not Disabled

Who had a claim denied within the past 90 days. Client should be advised of the appeal process. However, if the EW believes that DDSD’s denial is incorrect, the case may be sent back for a reevaluation within 90 days.

Note: Do not refer a client to DDSD who has an appeal pending with SSA.

Other Factors Causing MC Ineligibility

Who does not clearly meet other MC eligibility requirements (i.e., no California residency, over property limit, etc.).

Client Refusal

Who refuses to be evaluated. Clients have the right to refuse to be evaluated for a disability. Other linkage must exist to potentially qualify for MC. The client must be informed of potential advantages of being determined disabled (i.e., higher income deductions, etc.)

Prior SSA Decision -

Not Disabled

Who was denied disability status by Social Security:

• Within 60 days. Refer the client to SSA for a reconsideration.
• Within 12 months and the client alleges the same condition has worsened; and does not allege a new condition. Refer the client to SSA to reopen the claim.
• More than a year ago and the client does not allege that the same condition has worsened or a new medical condition does not exist.
• At any time when the client appealed the denial, and the decision on the appealed claim is pending.