Reexaminations on Appealed DDSD Denials

A Medi-Cal applicant has the right to appeal a DDSD “denial of disability” decision. If the appeal is successful, the applicant, if otherwise eligible, is granted Medi-Cal benefits. The basis for linkage to the Medi-Cal program is the state hearing decision determining that the individual is, in fact, disabled.
Document the hearing decision in CalSAWS and scan a copy of the decision in the Imaging System.

State hearing decisions do not, however, establish whether or not a disability reexam is necessary and, if so, when it will be scheduled. To correct this, the Department of Health Care Services has established the following procedures:

STAGE	WHO	ACTION
1	State Hearing Officer or EW	Sends a copy of the hearing decision to DDSD whenever a state hearing overrules a DDSD “denial of disability” determination.
2	DDSD	Determines whether or not a reexam is necessary based on the findings of the hearing decision, and, if so, the date of the reexam.
3	DDSD	Communicates to the responsible EW via an MC 221 that a reexam is required (if DDSD so determines) along with the date of the reexam. If DDSD determines that a reexam is not necessary, no MC 221 will be sent to the EW. Note: This step in the process may change in the future. It is anticipated that, in the future, an MC 221 will be issued on every DDSD disability denial “overrule”. Staff will be advised if this change is made.
4	EW	Follows regular procedures and enters the reexam date in CalSAWS.

Reexaminations on Appealed DDSD Denials

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