SSI Facilitation - Post-Application
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SSI Facilitation - Post-Application

Revised April 2, 2009


Approval Process

Reconsideration

Hearing

Appeals Council Review

Termination of Facilitation Services

Reopening Past Denials

Death of a Client

Links


Approval Process

  1. DDS sends notice that a person meets disability criteria to the SSADO.

  2. Disability Quality Branch (DQB) reviews a percentage of DDS approvals and denials for quality assurance and has the authority to overturn DDS decisions.

  3. SSADO conducts a financial eligibility review before final approval of SSI benefits.

    1. This usually involves an interview with the person.

    2. Social Workers may need to provide persons approved SSI assistance with this part of the process.

    3. Sanction persons who fail to participate in the SSA financial eligibility review without good cause.

  4. SSA sends the person written notice of approval of benefits.

  5. Office of Financial Recovery (OFR)

    1. SSA sends notice of approval to OFR with the interim assistance reimbursement.

    2. OFR sends any excess reimbursement to the person within 10 days.

    3. OFR sends a copy of the person notice to the CSO.

    4. Notify OFR at 1-800-562-6114 whenever a person receives the entire retroactive SSI payment. This number is available for persons approved for SSI and staff.

    5. OFR may pay up to 25% of the retroactive payment for attorney's fees. OFR reduces the attorney payment by the amount SSA has already given to the attorney. We do not issue money to an attorney that they have already received from Social Security.


EXAMPLE

Attorney's fees are $4,000 for John Doe. For this case, SSA deducts $3,000 from John's $16,000 reimbursement. OFR will pay a maximum of $1000. This is the difference between the money paid to the attorney by SSA and the attorney's fee. GAU grants for that time period were $8000.


1. Social Security Retroactive Amount $16,000
2. Attorney bills for $4000, but Social Security gives the attorney $3000 directly. -3000
3. Subtotal $13,000
4. OFR can pay up to 25% of the $13,000 (up to $3250). However, the attorney's fees are $4000 and the attorney has already received $3000 from Social Security. OFR gives $1000 to the attorney. -1000
5. DSHS issued $8000 in cash GA grants to John during this time period. -8000
6. John gets the rest ($13,000 - 9000) $4000


EXAMPLE

Attorney's fees are $3,000 for Sally Smith. For this case, SSA deducts $3,000 from Sally's $16,000 reimbursement. OFR does not issue anything to the attorney because Social Security has already paid the full attorney's fees.

  1. Verify that financial services have terminated GAU benefits.

 

Reconsideration

Reconsideration is the first level of appeal when a SSI application is denied.

  1. Always request a reconsideration of a SSI application denial for GA-X cases. For other cases (e.g, GA-U or GA-D), review the medical documentation and facilitate if the person appears to meet SSA disability criteria.

    1. If a person receiving GA-U appears to meet SSA disability criteria, request GA-X following submission of the reconsideration request.

  2. A reconsideration request must be filed within 60 calendar days of the denial unless there is good cause for missing the deadline.

  3. Review information sent to the person with the notice of denial.

  4. The official form is SSA-561-U2, Request for Reconsideration. However, SSA will accept any written format. When new information exists include:

    1. SSA-3441-F6, Reconsideration Disability Report

    2. Updated Personal Observations

    3. Additional medical evidence

  5. Include a signed and dated SSA-827, Authorization for Source to Release Information to Social Security with the Request for Reconsideration.

Hearing

  1. A hearing request is filed when a request for reconsideration is denied.

  2. Recommend that the person contact a legal representative.

    1. CSO staff should not recommend a specific attorney. Attorneys specializing in SSI claims are listed in the Yellow Pages.

    2. When SSI is approved, the ALJ may award up to 25% of the retroactive lump sum payment, or $4000, whichever is less to the legal representative.

    3. The DSHS Office of Financial Recovery (OFR) may pay 25% of the interim assistance reimbursement to the attorney. See Approval Process for details.

    4. Legal representatives may charge the person for expenses incurred while representing the client.

  3. When a person chooses not to obtain legal representation:

    1. SSI Facilitators may assist the person with filing the hearing request but do not act as a legal representative.


NOTE:

SSI Facilitators do not represent the client at the hearing. A person has a right to choose to have an attorney, friend, or other person represent their claim. They may also choose not to have a representative. Do not endorse or recommend attorneys.

  1. A written request for a hearing must be filed within 60 days of the reconsideration denial. When the person obtains legal representation, the attorney may file the hearing request forms including SSA-1696-UH, Appointment of Representative. The forms used to request a hearing are:

    1. HA-501-U5, Request for Hearing by Administrative Law Judge

    2. HA-4486, Claimant’s Statement When Request for Hearing is Filed and the Issue is Disability

    3. SSA-827, Authorization for Source to Release Information to Social Security Administration. Send three signed and dated copies

    4. Any new medical records or reports

 

Appeals Council Review

  1. When a hearing upholds the SSI denial the person is no longer eligible for GAX, unless they provide proof of an appeal with SSI Appeals Council.

  2. Notify financial services to make a program change from GAX to GAU if the person does not provide proof of an appeal within 60 days of the SSI hearing denial.

  3. The legal representative may request an Appeals Council review.

  4. Input the post appeal filing date on the ICMS SSI Tracking screen.

  5. A legal representative may file a further appeal in Federal Court of an Appeals Council denial.

Termination of Facilitation Services

  1. The client may no longer appear potentially eligible for SSI when:

    1. There is a change in the person's resources or income,

    2. The person becomes employed, or

    3. The person's medical condition improves.

  2. Terminate facilitation services when the person no longer appears to meet SSI criteria:

    1. Explain the person's right to pursue a SSI application without our assistance,

    2. Give the client DSHS 14-343, SSI Facilitation Program Medicaid Decision,

    3. Authorize a program change from GA-X to GA-U with an incapacity review date in 60 days.

Reopening Past Denials

  1. When there is new evidence of the severity of the impairment or of the onset date, a request to reopen a past denial may be indicated.

  2. A person may request a reopening of a denial:

    1. Within one year for any reason, or

    2. Within two years for good cause. Good cause includes new evidence not available at the time of the initial application.

  3. Attach a written request to “Reopen prior denial of benefits” to the application packet.

  4.  When a request to reopen a past denial is denied the person may request a reconsideration and hearing.

Death of a client

  1. Pursue the SSI application process when a person dies and SSA has a signed:

    1. Initial application, and

    2. DSHS 18-235, Interim Assistance Reimbursement Authorization.

  2. Send written notice of death and intent to pursue the application with a copy of the IARA to SSA and DDS.

  3. When the application is at hearing or post appeal:

    1. Notify the Office of Hearing and Appeals that the state has a lien on the claim, and

    2. Include a copy of the IARA.

  4. Continue to monitor the application/appeal until SSA approves or denies the claim.

 

Links

Social Security:

DSHS:


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Modification Date: April 2, 2009
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