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Referral for Former SSI/SSP Recipient
Discontinued for Reasons Other than “Cessation of Disability”
Clients under age 65 who are discontinued from SSI/SSP for reasons other than “cessation of disability” (i.e., excess income or resources) and who are not receiving Social Security Disability benefits must be referred to DDSD to determine if the disability established by SSA still exists. (This can also include individuals who are in LTC).
Before making a referral to DDSD, the EW must first make a diligent attempt with SSA, MEDS and/or IEVS to verify the reason why SSI was discontinued. If a referral must still be made, annotate on the County Worker Comments section of the MC 221 why the SSI case status was unobtainable. Packets without this information will be returned as code Z56 by DDSD.
These individuals fall under the Craig v. Bonta court settlement, which entitles them to an extension of Medi-Cal after the SSI discontinuance, pending a determination of ongoing Medi-Cal eligibility.
DDSD Referral
Send a limited packet to DDSD after diligent attempt to obtain SSI case status is unsuccessful. Annotate on the MC 221 County Worker Comments section:
- SSI/SSP discontinued for reasons other than cessation of disability, and
- The steps taken to obtain SSI case status and the reason why the information was unobtainable.
- Client continues to receive MC under the pending SB-87 redetermination Aid Codes (1E, 2E, and 6E). Do not approve MC until DDSD decision is received.
DDSD Approval
DDSD may be able to adopt SSA's disability approval and onset date by querying SSA records. If so, the MC 221 will be returned to the EW with disability approval indicated.
No Decision
If SSA's reexam date has passed or if SSA's disability decision cannot be verified, DDSD will return the MC 221 to the EW with decision code Z56. A full DDSD packet must be sent.
Discontinued Due to “Cessation of Disability”
Clients under the age 65 who are discontinued from SSI/SSP due to “cessation of disability” are entitled to receive zero share of cost extended MC throughout the:
- Social Security Administration (SSA) appeal process, including the 65 day period in which an appeal may be filed (Aid Code 6N), and
- County MC redetermination process (Aid Code 6E).
When the SSA decision becomes final, the individual’s Aid Code will be changed from 6N to 6E and his/her name added to the Exception Eligibles Report. The EW must determine ongoing MC under another linkage factor (e.g., AFDC-MN) by completing the SB 87 Redetermination Process.
DDSD Referral
Due to the 1990 federal disability regulations, the Social Security disability decision is binding. DDSD is not allowed to make an independent disability decision if the applicant claims the same disabling condition previously considered by Social Security within the past 12 months.
Therefore, a DDSD referral is required only when the individual alleges a new disabling condition not already considered by Social Security.
The EW must:
- Send a full packet to DDSD.
- Write “Former SSI Payment Status N07 Recipient, Alleges New Impairment” in the Worker Comments Section of the MC 221.
- Record client’s disability conditions and referral detail in CalSAWS.
No Decision
DDSD will query MEDS for SSA appeal information upon receipt of a DDSD referral. DDSD will return to the EW all referrals with an SSA disability appeal pending. The MC 221 will be marked “Z56” (no decision made). The EW must deny the case due to the receipt of extended MC.
Note: The final SSI decision, and, if applicable, the hearing status, is posted on the MC Eligibility Data System (MEDS).
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