SSI

CalFresh joint application processing with Social Security Administration

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The California Department of Social Services (CDSS) has provided guidance about joint processing of CalFresh applications by the Social Security Administration (SSA) and county welfare departments for SSI recipients.

SSI recipients will be eligible for CalFresh beginning June 1, 2019.  Households that include only SSI recipients may apply for CalFresh at a SSA office.  SSA must inform SSI applicants or recipients of their right to apply for CalFresh at the SSA office or their right to apply at the county welfare department whenever a member of a household consisting of only SSI applicants or recipients conducts business with SSA. SSA will not assist households with both SSI and non-SSI members.

SSA will screen all households for CalFresh eligibility.  Based on the screening, SSA must give the household the opportunity to apply for CalFresh.  If a household with only SSI applicants or recipients agrees, SSA will assist the household in submitting and completing a CalFresh application.  These household may also complete their annual recertification at the SSA office.

SSA can use the GetCalFresh.org online application starting June 1, 2019.  If the application is submitted using GetCalFresh.org, the county must not require an additional signature from the household.  If a household wants to submit a paper application, SSA will assist the household in completing the written application and will submit it to the county within one business day of receipt of the signed application.

For either type of application, SSA then will provide the following information to the household in writing: 1) contact information for the county; 2) remaining actions to be taken to complete the application; 3) a statement that the household should be notified of their CalFresh eligibility determination within 30 days; 4) the household’s rights and responsibilities; and 5) information about how to get an EBT card.

The expedited service timeframe will begin the date the county receives the application.  SSA will prescreen the application for entitlement to expedited service.

If the household chooses to apply with the county, SSA will inform the household of their option to apply online or take the paper application to the county.

Households in which all members receive or are authorized to receive SSI are categorically eligible for CalFresh unless the entire household is institutionalized or disqualified from receiving CalFresh.  In determining categorical eligibility, the county must verify that each member of the household receives or is authorized to receive SSI.  For persons who are categorically eligible, no additional verification is needed for resources, gross and net income, social security number, sponsored immigrant information, and residency.  Although identity must be verified, verification of identity in MEDS is sufficient and counties must check MEDS prior to requesting verification of identity.  Counties can verify SSI benefits through the State Data Exchange or the Beneficiary Data Exchange.

Households whose applications are processed using SSA joint processing will not be required to go to a county welfare department office or otherwise be subject to a county interview.  The county will not contact the household to obtain information unless the application is improperly completed, mandatory verification is missing or the county determines that information in the application is questionable.  Counties may contact the household to determine whether the household has expenses which can be deducted from income including shelter and medical expenses.

Counties must certify households processed under SSA joint processing for 24 months because all members of the household will be elderly or disabled.  If the household has no earned income, certification will be for 36 months under the Elderly Simplified Application Project.  (ACL 19-44, May 9, 2019.)

Failure to follow prescribed treatment

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The Social Security Administration (SSA) has issued a new ruling about the effect of failure to follow prescribed treatment.  In general, an individual who is otherwise disabled is not entitled to Social Security Disability or Supplemental Security Income benefits if they do not follow prescribed treatment that would be expected to restore the ability to perform substantial gainful activity without good cause.

SSA determines whether an individual has failed to follow prescribed treatment when:

1)  The individual would otherwise be eligible for benefits

2)  There is evidence that the individual’s own medical source prescribed the treatment for the impairment upon which the disability finding is based.  Prescribed treatment means medication, surgery, therapy, use of durable medical equipment or use of assistive device.  Prescribed treatment does not include lifestyle modifications such as dieting, exercising or smoking cessation.  SSA considers any evidence of prescribed treatment including prescription forms and medical records.

3)  There is evidence that the individual did not follow the prescribed treatment.

If all these conditions exist, then SSA determines whether the prescribed treatment, if followed, would be expected to restore the individual’s ability to perform substantial gainful activity, and whether the individual has good cause for not following the prescribed treatment.  Good cause includes religion, cost, incapacity that means the individual is unable to understand the consequences of failure to follow prescribed treatment, medical disagreement among individual’s own medical sources, intense fear of surgery, prior unsuccessful major surgery, high risk of loss of life or limb, or risk of addiction to opioid medication.  Good cause does not include the individual’s allegation that they were unaware of the prescribed treatment unless the individual shows incapacity.  If either of these criteria is met, then SSA will not find failure to follow treatment.

To develop failure to follow prescribed treatment, SSA can contact the medical source. SSA can purchase a consultative examination or obtain testimony from a medical expert but is not required to do so.

For listings, if SSA finds failure to follow prescribed treatment without good cause, SSA continues by evaluating residual functional capacity.  For listings, SSA will not find failure to follow prescribed treatment if disability is based on a listing that requires only the presence of laboratory findings, or the listing requires consideration of whether the individual was following a specific treatment.

For residual functional capacity, SSA will find that the individual is disabled if they would be unable to perform substantial gainful activity even if they had followed prescribed treatment.

SSA can reopen a favorable determination or decision if it discovers that it did not apply failure to follow prescribed treatment correctly.

For continuing disability reviews, SSA will make a failure to follow prescribed treatment finding when the individual’s medical source prescribes a new treatment since the last favorable determination without good cause.  SSA also will find failure to follow prescribed treatment for a new impairment alleged during the continuing disability process and there is evidence that the individual did not follow prescribed treatment without good cause.

For drug and alcohol cases where SSA finds that drugs and alcohol are not material to the disability determination, a failure to follow prescribed treatment, SSA does failure to follow prescribed treatment determination only for impairments other than drugs and alcohol.  (SSR 18-03, October 29, 2018.)

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Determining onset date for disability claims

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The Social Security Administration (SSA) has issued a new ruling about determining the onset date for Social Security Disability and Supplemental Security Income claims.  The established onset date is the earliest date that the claimant meets the both the definition of disability and the non-medical requirements for benefits eligibility.

SSA first determines the potential onset date, which is the earliest date that the claimant meets non-disability requirements.  If the claimant meets the statutory definition of disability on the potential onset date, that date is used as the established onset date.

For impairments that result from a traumatic injury or other traumatic event, the onset date is the date of the traumatic event even if the claimant worked on that date.

Non-traumatic impairments are impairments that are not expected to change in severity over time, impairments that are expected to improve over time, or impairments that are expected to worsen over time.  For non-traumatic or exacerbating and remitting impairments, SSA determines the first date that the claimant meets the definition of disability.  SSA reviews the evidence and considers the nature of the impairment, the severity of signs, symptoms and laboratory findings, the longitudinal history and course of treatment, the length of the impairments exacerbations and remissions if applicable, and any statements by the claimant.  The onset date can predate the earliest recorded medical examination.

SSA considers evidence from other non-medical sources such as family, friends or former employers only if SSA cannot obtain other medical evidence and SSA cannot reasonably infer the onset date from the medical evidence in the file.

At the hearing level, the Administrative Law Judge (ALJ) may call upon a medical expert but the decision to call a medical expert is entirely in the ALJ’s discretion.  The claimant cannot require the ALJ to call a Medical Expert.

If the claimant has both a traumatic and non-traumatic impairments, SSA considers all of the impairments in combination when determining the onset date.

Generally, the claimant’s established onset date is not before the last day the claimant performs substantial gainful activity.  However, SSA can determine the established onset date to be before or during an unsuccessful work attempt.

The established onset date can be in a previously adjudicated period if the claimant meets the definition of disability and applicable non-medical requirements during the previously adjudicated period.  However, it is in the adjudicator’s discretion whether to reopen a prior claim.  (SSR 18-01p, October 2, 2018.)

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Transitional Nutrition Benefit Program

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Transitional Nutrition Benefit Program

The California Department of Social Services has issued instructions implementing the Transitional Nutrition Benefit (SNB) Program.  TNB is part of the end of SSI cash-out.  As a result of eligibility of previously excluded SSI/SSP recipients, some households will have their CalFresh terminated.  TNB will provide state-funded nutrition benefits for households that include at least one SSI/SSP recipient and will become ineligible for CalFresh benefits when the SSI/SSP recipient is added to the household. A household that becomes ineligible for CalFresh for any other reason is not eligible for TNB.

TNB eligibility is determined on the effective date of the addition of the SSI/SSP recipient to the CalFresh household.

Households will be certified for TNB for one 12-month period, and then may be recertified for additional six month periods.

Transitional CalFresh recipients may be eligible for TNB if their benefits are terminated by adding a previously excluded SSI/SSP recipient to the household.

Pending CalFresh applications with a beginning date of aid in the month prior to the implementation date of CalFresh eligibility for SSI/SSP recipients can be eligible for TNB.

TNB eligibility will continue as long as the household continues to include at least one of the previously excluded SSI/SSP recipients, the same individual continues to receive SSI/SSP and the household is ineligible for CalFresh.  When TNB is terminated it cannot be reestablished except for when documentation required for redetermination is provided within 30 days of the discontinuance.

Counties are not required to act on information received during the TNB certification period except for the household being granted CalFresh.

Form notices for the TNB program are attached to ACL 18-107.

Because TNB are nutrition benefits, they are not considered income for purposes of other means-tested programs.

TNB are subject to intercounty transfer policies and procedures. (ACL 18-92, July 31, 2018.)

Supplemental Nutrition Benefit Program

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The California Department of Social Services has issued instructions implementing the Supplemental Nutrition Benefit (SNB) Program.  SNB is part of the end of SSI cash-out.  As a result of eligibility of previously excluded SSI/SSP recipients, some households will have their CalFresh reduced.  SNB will provide state-funded nutrition benefits for households that include at least one SSI/SSP recipient and will have their CalFresh benefits reduced when the SSI/SSP recipient is added to the household to compensate for this CalFresh benefit reduction.

SNB eligibility is determined on the effective date of the addition of the SSI/SSP recipient to the CalFresh household.

SNB eligibility will remain linked to the household.  The exception is SNB eligibility transfers to a new household for a domestic violence survivor who creates a separate household.

Transitional CalFresh recipients may be eligibile for SNB if their benefits are reduced by adding a previously excluded SSI/SSP recipient to the household.

Pending CalFresh applications with a beginning date of aid in the month prior to the implementation date of CalFresh eligibility for SSI/SSP recipients can be eligible for SNB.

SNB eligibility will continue as long as the household continues to receive CalFresh and the at least one of the previously excluded SSI/SSP recipients remains in the household.

SNB eligibility will be redetermined at the household’s CalFresh recertification. Counties must give separate notices of action regarding the SNB program.  Form notices for the SNB program are attached to ACL 18-108.

Because SNB are nutrition benefits, they are not considered income for purposes of other means-tested programs. (ACL 18-91, July 31, 2018.)

The end of SSI cash-out

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The California Department of Social Services has issued instructions implementing the end of SSI cash-out.  SSI/SSP recipients are ineligible for CalFresh.  Instead, SSI/SSP recipients receive an extra $10 per month in SSP benefits.  AB 1811 Sections 38-41 end the SSI cash-out.  When implemented, this change will make SSI/SSP recipients eligible for CalFresh. The change will be implemented on June 1, 2019.  If automation cannot be completed implementation can be delayed until August 1, 2019. Newly eligible households, that is new applicants in which all members are SSI/SSP recipients, will be eligible for CalFresh as of the implementation date.  If a newly-eligible SSI/SSP only household submits an application within the calendar month prior to implementation, the county must process the application but will not issue benefits until the implementation date.

SSI/SSP recipients in ongoing households will be eligible for CalFresh at the household’s next periodic report, annual recertification, or when voluntarily requested by the household.  A new application will not be required to add an SSI/SSP recipient to an ongoing household.

Grants under the Cash Assistance Program for Immigrants increase by $10 per individual and $20 per couple.  SSI/SSP recipients will be eligible for the Food Distribution Program on Indian Reservations.

All SSI/SSP recipients will be considered elderly and/or disabled household members for CalFresh purposes.

Income, resources and deductions of the SSI/SSP recipient will be considered when determining CalFresh eligibility.  Households in which all members of household receive SSI/SSP will be considered categorically eligible for CalFresh. This means that no additional verification is needed for resources, gross or net income, Social Security Number, sponsored immigrant information or residency.

Households will not be required to report termination of SSI/SSP mid-period.  However, if termination of SSI/SSP becomes known to the county it must take action mid-period.

Transitional CalFresh cases will be treated like other ongoing CalFresh cases.

Counties must provide reasonable accommodations for the disabilities of newly eligible SSI/SSP recipients. (ACL 18-90, July 31, 2018)