426-5        PROCESSING SSISupplemental Security Income DENIALS; THE SSISupplemental Security Income APPEAL PROCESS

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

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

1. Initial Determination

The initial determination is handled by an SSASocial Security Administration 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 SSISupplemental Security Income appeals process.  Any person who has received an adverse initial decision on his or her SSISupplemental Security Income 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 DPADivision of Public Assistance hearing process, a client may withdraw in writing from the SSISupplemental Security Income 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 SSISupplemental Security Income appeal process while seeking a good cause waiver for an untimely appeal.  Once an individual has exhausted the SSISupplemental Security Income appeal process, he or she may choose to appeal the SSISupplemental Security Income 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 SSISupplemental Security Income, receives an adverse SSISupplemental Security Income 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 DPADivision of Public Assistance discovers or receives clear evidence that the client is not eligible for APAAdult Public Assistance on grounds other than those being appealed through the SSASocial Security Administration system, the Interim Assistance case will be closed.

If the IAInterim Assistance case is closed because of countable income that exceeds the APAAdult Public Assistance need standard, the APAAdult Public Assistance /Medicaid application is held in pended status until an initial decision on eligibility for SSISupplemental Security Income benefits is made.