9043 - SSI/SSP APP Denied - County Medi-Cal Determination Needed - Urgent

This alert is generated when an individual’s SSI/SSP application is denied based on excess income. The alert will be generated only when the client is not currently eligible for full scope Medi-Cal. When the client is already receiving full scope benefits, an alert message has already been generated advising the case carrying worker of the change in SSI/SSP status.

Action Required

Follow the steps below to determine if the SSI/SSP denied individual is eligible for Medi-Cal and take the appropriate actions to approve or deny the application.

Obtain all five State Date Exchange (SDX) Inquiry screens from MEDS and determine if sufficient information is available to process the application.
Refer to MEDS HB Chapter 1: MEDS/CDB Overview, Section ISDX - SSI/SSP Client SDX Inquiry Request.
Request additional information and verification about identity, citizenship, income, property and/or disability evaluation, if necessary.
If the client is determined ELIGIBLE, approve Medi-Cal using the appropriate application date.
If the client is determined NOT ELIGIBLE, deny Medi-Cal and issue an appropriate denial Notice of Action (NOA) to the client.

To determine the appropriate application date and other information, refer to MC HB Chapter 9: Denials Discontinuance Suspensions, Section SSI/SSP Discontinuances and Denials Due to Excess Income.

9043 - SSI/SSP APP Denied - County Medi-Cal Determination Needed - Urgent

Action Required

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