315.09 APTD Verification Requirements for SSA Denial (AAM)

SR 13-12 Dated 07/13

Previous Policy

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Aid to the Permanently and Totally Disabled (APTD) applicants and recipients who are denied Social Security Administration (SSA)-related benefits due to not meeting SSA medical disability criteria are not eligible for an APTD cash grant if the SSA denial

. occurred within the 12 months prior to the individual's application date for APTD cash; or

�        occurs any time after the individual's application date for APTD cash.

Eligibility for APTD medical assistance remains unchanged.

This policy is applied differently based on the individual's APTD cash recipient status as of June 30, 2011.

For individuals who were not recipients of APTD cash assistance on June 30, 2011, - which means individuals who were pending APTD cash assistance before July 1, 2011, individuals who applied on or after July 1, 2011, or individuals who began to receive APTD cash assistance on or after July 1, 2011 - APTD cash assistance is denied or terminated:

. upon the first denial of SSA-related benefits due to not meeting the SSA medical criteria, if that denial occurred within 12 months prior to the individual's application for APTD cash assistance, or any time after the individual's application date for APTD cash; or

. if the individual fails to provide the required proof of the SSA denial, as described below, within timeframes.

For individuals who were open and receiving APTD cash assistance as of June 30, 2011, APTD cash assistance is terminated:

. upon the second denial of SSA-related benefits due to the APTD recipient not meeting SSA medical criteria, when the following criteria are met:

- only one denial from prior to July 1, 2011 may be used, as long as that denial occurred between the 12 months prior to the individual's application date and June 30, 2011; and

- at least one denial must be made any time after July 1, 2011. Note: If no denials occurred between the 12 months prior to the individual's application date and June 30, 2011, then both denials must come on or after the July 1, 2011 date before APTD cash may be terminated; or

. if the individual fails to provide the required proof, as described below, within timeframes.

Verification Requirements for Individuals Who Apply for APTD Cash Assistance On or After July 1, 2011 or Begin to Receive APTD Cash Assistance On or After July 1, 2011

All individuals who are pending APTD cash assistance before July 1, 2011, apply for APTD cash assistance on or after July 1, 2011 or begin to receive APTD cash assistance on or after July 1, 2011 must provide a copy of the SSA letter which describes why the individual was denied SSA-related benefits by SSA, if their application for those benefits is subsequently denied. If the SSA-related benefits are approved, the individual must provide proof of the benefit amount that they will be receiving, per current policy.

Verification Requirements for Individuals Who Were Open and Receiving APTD Cash Assistance on June 30, 2011

Individuals who were open and receiving APTD cash assistance on June 30, 2011 must provide the following proof:

. the reason SSA denied their application for SSA-related benefits;

. how many times the individual has appealed SSA's decision to deny the SSA-related benefits; and

. the reason SSA has denied each of the appeals, if there has been more than one appeal.

Terminate APTD cash assistance if verification is not received within timeframes.

Verification requirements applicable to all APTD-eligible individuals whose APTD cash grant is denied or terminated because SSA denied SSA-related benefits due to the individual not meeting SSA medical criteria, or because the individual failed to provide required proof within timeframes.

If the Department has denied or terminated an individual's APTD cash grant due to the individual not meeting the SSA medical criteria, or because the individual did not give the Department the required verification timely, the individual may reapply for APTD cash, BUT they are to be denied for APTD cash assistance each time they apply until the individual provides the proof described below.

. APTD applicants or recipients whose APTD cash benefits have been denied or terminated because SSA denied SSA-related benefits due to the individual not meeting SSA medical criteria, may have their eligibility for APTD cash benefits reconsidered only if the APTD cash applicant or recipient provides proof that their appeal of the SSA decision denying the SSA-related benefits due to not meeting the SSA medical criteria, has been successful. This proof should be apparent in that the individual has been determined by SSA to have met their medical criteria and the individual will now be receiving an SSA-related benefit. Individuals are ineligible for APTD cash assistance until proof that a SSA-related benefit has been approved is provided.

. For those individuals who were denied APTD cash for failing to provide the required proof within timeframes, eligibility for APTD cash benefits may be reconsidered only if the APTD cash applicant or recipient provides proof that they were denied SSA-related benefits for another reason other than not meeting the SSA medical criteria. In this case, the individual must still provide all required proof described above and in PART 315 in total (as the regular Developing Potential Sources of Income policy still applies), including why the individual was denied SSA-related benefits, proof they have appealed the SSA decision, and that they are complying with all SSA application requirements (including the SSA application or process requirement that resulted in their denial), before eligibility for APTD cash assistance can be reconsidered. Individuals are ineligible for APTD cash assistance until this proof is provided.

 If the individual provides all required proof after being terminated or denied APTD cash, and is then determined eligible for APTD cash based on the proof provided, the APTD cash grant is issued:

- according to the policy in Section 109.09, Reuse of Forms 800, 800HR, and 800Q After Denial or Closing; or

- the next semi-monthly payment period in which APTD cash eligibility was determined from the submitted proof.

 

315.09 APTD Verification Requirements for SSA Denial (AAM)