Sanctions - SSI Applications
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Sanctions - SSI Applications

Revised December 15, 2011

Purpose: Social workers are agents of change who empower our clients to improve their own lives.
WAC 388-449-0200Am I eligible for cash assistance for Aged, Blind, or Disabled (ABD) while waiting for Supplemental Security Income (SSI)?

WAC 388-449-0200
WAC 388-449-0200

Effective November 1, 2011

WAC 388-449-0200 Am I eligible for cash assistance for Aged, Blind, or Disabled (ABD) while waiting for Supplemental Security Income (SSI)?

1.    You may receive ABD benefits while you are waiting to receive Social Security Supplemental Security Income (SSI) benefits only when you:

a.    Have filed your SSI application with the Social Security Administration (SSA), follow through with SSA directions and requirements to process your application including keeping all interview and consultative examination appointments, and do not withdraw your application;

b.    Agree to assign the initial or reinstated SSI payment to us provided under WAC 388-449-0210;

c.    Are otherwise eligible according to WAC 388-400-0060; and

d.    Meet disability criteria listed in WAC 388-449-0001.

2.    To demonstrate your impairments are disabling despite medical treatment, you must participate in medical treatment for the impairments that keep you from working, unless you meet one of the following good cause reasons:

a.    The treatment provider has identified a risk that the treatment may cause further limitations or loss of a function or an organ and you are not willing to take that risk;  or

b.    We determine that treatment is not available because you can't obtain it without cost to you.

 

3.      If you refuse or fail to participate in medical treatment without good cause, your benefits will end until you provide proof you are pursuing treatment as recommended.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

  1.  Compliance with DSHS and SSA is a condition of eligibility for ABD cash.
  2. Individuals who the Department has established don’t meet the definition of “qualified alien” for SSI eligibility aren’t required to pursue SSI. For example: PRUCOLs and people terminated from SSI due to the seven year rule aren’t qualified aliens.
  3. PROCOLs may have enough work quarters to qualify for SSDI and must pursue SSDI.
  4. Non-Citizens must cooperate with the SSI/SSDI application process until it is established by SSA that they don’t meet the requirements for either program.
  5. When cash assistance has been terminated because the person failed to comply with pursuing disability benefits even if they claim good cause, only authorize further ABD cash assistance after the person verifies they have taken action to comply.

Medical Treatment

1.    ABD cash clients must cooperate with SSA requirements. To be eligible for SSI, individuals must provide documentation that their impairments are disabling despite appropriate medical treatment.

 

2.    Clients must follow through with recommended treatment for all potential disabling condition.   The only good cause reasons for failing to cooperate with recommended medical and mental health treatment are:

 

a.    The client provides proof that their treating provider has discussed a treatment risk and the person is pursuing a less dangerous treatment option.

 

b.    The client provides proof there is a direct out of pocket medical cost for the recommended treatment. Transportation or other incidental costs don’t meet the good cause requirement for failing to cooperate with treatment.

WORKER RESPONSIBILITIES

If a person fails to apply for SSI, or follow through with any SSA requirement:

1.    Send form 14-509  Good Cause letter to schedule an appointment with a SSIF.

2.    If the person had good cause for failing to comply with the SSI application process, explain the requirement and coordinate with DDDS or SSA to help the person fulfill the requirement.

3.    If the person failed to file an SSI application, reconsideration, or hearing request, complete the application or request for appeal at the good cause appointment regardless of whether good cause is established.

4.    Use the 14-118 to notify financial services to terminate ABD cash benefits until the person has signed the IARA, filed the SSI application, completed the consultative examination, or any other SSA requirement regardless of whether good cause is established.

5.   If the person complies with signing the IARA or the SSA application process requirement before ABD benefits have terminated, use the 14-118 to notify financial services to reinstate ABD benefits because the person has complied.


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Modification Date: December 15, 2011