Supplemental Security Income and Medi-Cal Advocacy Program (SSIMAP) provides advocacy services to help physically and mentally disabled General Relief (GR) participants apply for Supplemental Security Income (SSI), obtain early SSI approval, and become self-sufficient. If approved, individuals are eligible for up to $889.40 on SSI versus $221 on GR. Additionally, SSI recipients are entitled to Medi-Cal. There are several steps in SSI advocacy.
To be automatically eligible for the GR SSIMAP, GR participants must meet one of the following referral criteria:
- Have a Permanent Unemployable or Permanent Needs Special Assistance (NSA) status; or
- Have a temporary physical and/or mental disability 12 out of 18 months or longer status. The number of months with the status does not need to be consecutive.
While automatic referrals are triggered through the computer system, there are other ways a GR participant may be referred to GR SSIMAP.
- Eligibility Worker (EW) Referral – The EW may refer an applicant/participant to GR SSIMAP if:
- During the GR application process, the EW determines that the applicant/participant is potentially eligible for SSI, the EW will refer the participant to the SSIMAP Advocate to be seen on the same day as a walk-in.
- The EW at any time determines that a participant is potentially eligible for SSI.
- The applicant/participant does not meet the automatic referral criteria but requests to see a SSIMAP Advocate.
- Department of Mental Health (DMH) Referral – DMH co-located staff may refer an applicant/participant to SSIMAP based on DMH’s assessment of the applicant/participant.
GR SSIMAP staff will assist the participant throughout the SSI application process.
During the initial interview, the participant will meet with a SSIMAP Advocate to discuss the following:
- The participant's potential eligibility for SSI (e.g., technical requirements, such as residence and immigration status, are met);
- The participant's current SSI status (e.g., there may already be an application in process);
- If the participant is already in the SSI process, whether he/she has another representative or would like the advocate to be the representative;
- Sources of medical records (e.g., doctors and hospitals) to document the disability; and
- Sources of non-medical information about the participant's ability to function (e.g., third party documentation).
If there is no pending SSI claim or a SSI disability determination has not been made in the last 90 days, an SSI application is initiated if the applicant/participant is determined to be potentially eligible. The SSIMAP Advocate will:
- Assist the applicant/participant to complete all the required forms;
- Explain the participant's reporting responsibilities;
- Inform the participant about the availability of transportation funds for any medical or SSI-related appointments; and
- File the SSI application with the Social Security Administration (SSA).
Under federal regulations, applicants/participants are eligible for SSI benefits effective with the first day of the month following the SSI application date. To prevent loss of SSI benefits, SSIMAP Advocates will assist in protecting the SSI application date.
Throughout the application process, the SSIMAP Advocate will remain in regular contact with the participant, SSA, and the Disability Determination Service (DDS), which determines the participant's disability. This way, the SSIMAP Advocate can assist the participant to remain in compliance with the SSI claim requirements, as well as liaison with SSA and DDS on behalf of the participant.
If the participant informs the SSIMAP Advocate that he/she has or will have other/self-representation during the SSI application stage, he/she is required to provide verification that an SSI application was filed and provide periodic updates on the status of his/her SSI application.
Filing an Appeal
If the SSI application is denied, participants have a right to appeal the decision with SSA. SSA requires the request for an appeal to be submitted within 60 days from the date the participant receives the SSI denial letter. Generally, SSA has four levels of appeal. They are:
- Hearing by an Administrative Law Judge;
- Review by the Appeals Council; and
- Review by the Federal Court.
However, in Los Angeles County, SSA is gradually phasing out the request for reconsideration, which SSA calls the appeal redesign. SSA offices part of the redesign will grant participants a hearing with an Administrative Law Judge (ALJ) when an appeal request is filed. SSA offices not part of the redesign will grant participants a reconsideration.
The following Department of Public Social Services offices are affected by the SSA appeal redesign and participants from these offices are not granted reconsiderations as the first level of appeal:
Request for Reconsideration
If the SSI application is denied, the first appeal level is known as the request for reconsideration. The request for reconsideration must be filed within 60 days of receipt of the application denial notice. Reconsideration is only the next step of appeal if the SSI application is taken by a SSA office that is not an appeal redesign office. If the request for reconsideration is granted, then it is the next level of appeal. If the SSI denial decision is upheld at the reconsideration level, a subsequent request for appeal will give participants a hearing with an ALJ. The SSIMAP Advocate will assist the participant in filing the request.
The reconsideration consists of SSA and Disability Determination Service staff (not involved in the first decision) reviewing the medical documentation already on file plus any additional evidence.
If the participant informs the SSIMAP Advocate that he/she has or will have other/self-representation during the reconsideration stage, he/she is required to provide verification that a request for reconsideration was filed and provide periodic updates on the status of his/her reconsideration request.
Hearing with an Administrative Law Judge
If the request for reconsideration is denied, the next level of appeal is to request a hearing from the initial application date with SSA's Office of Hearings and Appeals. As previously mentioned, appeal redesign offices will grant participants a hearing with an ALJ when an appeal request is filed. This request must be filed within 60 days after either the initial application or the reconsideration denial date, as appropriate.
After the initial application and/or reconsideration is denied, unless the participant chooses other/self-representation, the SSIMAP Advocate refers the participant to the County's contracted SSI hearing representative. The contractor meets with the participant, completes all required forms, requests the hearing with SSA, and represents the participant at the hearing. There is no charge to the participant for these services.
If the participant informs the SSIMAP Advocate that he/she has or will have other/self-representation during the SSI hearing stage, he/she is required to provide verification that a hearing request was filed and provide periodic updates on the status of his/her SSI hearing.
Supportive services are provided to assist participants to overcome barriers in completing the SSI process. Supportive services include:
- Referrals to medical and mental health care;
- Transportation issuances for any medical or SSI-related appointment;
- Clothing issuances;
- Shower issuances; and
- Haircut issuances.
Individuals are tracked through each step of SSIMAP. Physically disabled participants who fail to comply with any required activity (e.g., miss SSIMAP Advocate appointments, refusal to apply for SSI) become ineligible for GR and benefits will be terminated.
NOTE: Mentally disabled participants who refuse to comply with SSIMAP requirements do not have their GR benefits terminated. However, attempts will be made to locate mentally disabled participants who fail to appear to their scheduled SSIMAP appointments. Mentally disabled participants who fail to attend their third SSIMAP appointment have their GR benefits terminated for whereabouts unknown.
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