426-5 PROCESSING SSI DENIALS; THE SSI APPEAL PROCESS

426-5 PROCESSING SSI DENIALS; THE SSI APPEAL PROCESS

Interim Assistance continues until Social Security issues its final SSI eligibility decision regarding disability. Which of the four possible SSI levels of decision is final depends upon whether a denied applicant chooses to appeal an SSI decision, and how far the applicant chooses to continue in the SSI appeal process.

There are four possible SSI decision levels in the Social Security administrative process:

1. Initial Determination

The initial determination is handled by an SSA Field Office Claims Representative. However, the Claims Representative does not make the initial medical determination; these are done by Disability Determination Service agencies. In Alaska, initial medical determinations are done by the Disability Determination Service of the Division of Vocational Rehabilitation.

2. Reconsideration

A reconsideration or "recon" decision is the first step in the SSI appeals process. Any person who has received an adverse initial decision on his or her SSI application or open case is entitled to ask for a reconsideration.

3. Administrative Law Judge Hearing

If dissatisfied with the reconsideration decision, the individual may ask for a hearing before an Administrative Law Judge;

4. Appeals Council Review

A request to have the Appeals Council review the decision made by the Administrative Law Judge is the next step if applicant is dissatisfied with the decision of the Administrative Law Judge.

Like the DPA hearing process, a client may withdraw in writing from the SSI appeals process at any point. The appeal process ends upon failure to appear without good cause, or it ends if the client does not timely request the next level of review without good cause. Occasionally, an individual may claim good cause for not filing an appeal in a timely manner. Such individuals are still considered to be in the SSI appeal process while seeking a good cause waiver for an untimely appeal. Once an individual has exhausted the SSI appeal process, he or she may choose to appeal the SSI decision to the federal district court; Interim Assistance is not available pending an appeal to the court.

Once Interim Assistance is approved, it is continued until the client is approved for SSI , receives an adverse SSI decision and does not appeal it to the next appeals level, withdraws or abandons an appeal at any level, or receives an adverse decision from the Appeals Council. However, if DPA discovers or receives clear evidence that the client is not eligible for APA on grounds other than those being appealed through the SSA system, the Interim Assistance case will be closed.

If the IA case is closed because of countable income that exceeds the APA need standard, the APA /Medicaid application is held in pended status until an initial decision on eligibility for SSI benefits is made.