2636 Loss of Recipient Status

When an individual loses SSI recipient status due to an action taken by SSA to suspend, stop payment or terminate benefits, the following provisions apply.

If the individual timely appeals the SSI eligibility decision by SSA to suspend, stop payment or terminate benefits, SSI recipient status continues. The appeal is timely if filed within 60 days of notification of the SSA action. If the appeal is filed within 10-days of the notification, the recipient can choose to continue SSI benefits throughout the entire appeal process (disability related action) or through the first level of appeal (non-disability related action. The recipient shall continue to be eligible for SI medical assistance (if otherwise eligible) throughout the appeal process. Verification from SSA that the appeal was timely filed is required.

If the individual does not appeal the SSA decision to suspend, stop payment or terminate SSI benefits, or the decision is no longer under appeal, SI medical assistance shall continue while eligibility under another medical assistance program (if any) is determined. Once that determination is complete, SI medical assistance shall be discontinued giving timely and adequate notice. Continued SI medical assistance provided pending the eligibility determination in most instances is not considered overstated eligibility subject to a claim. See 11121.1 (5) and 11122 (7) .

In addition, there may be instances where the suspension or stop payment of SSI benefits is temporary. If contact with SSA verifies that benefits will be reinstated within the next two months, SI medical assistance may continue. Otherwise, eligibility under another medical assistance program must be determined as indicated above. See Policy Memo 2018-10-01, re: SSI Termination and Verification of Resources for further guidance.

NOTE : If the agency has information that the SSI recipient has resources, including income, which the SSA verifies will make the individual ineligible for SSI, EATSS SDX information will be disregarded, and the individual would no longer be considered an SSI recipient. The process to determine eligibility under another medical assistance program described above would apply.