Special Assistance SA-3110 APPLICATION PROCESS

IX. REOPENING A DENIED SA APPLICATION DUE TO APPEAL REVERSAL

A. SA Appeal Reversal

When an SA application was denied but is subsequently approved as the result of a state appeal, reopen the original application within 5 work days of the date the Notice of Decision is final and process the reversed decision.

B. SSA Appeal Reversal

If an SA application is denied based on a decision by SSA but the SSA denial is reversed on appeal, the reversal of the SSA decision is considered a reversal of the SA decision. The applicant is not required to make a separate SA appeal. This applies to determinations of eligibility based on disability or as well as other eligibility factors such as resources or transfers.

1. Administratively reopen the SA application if:

a. The applicant or the representative notifies the county dss within 60 days of the date of the reversal decision and requests SA, and

b. The onset date for disability or blindness (or the beginning date of eligibility) is the same as or prior to the date of the SA denial, and

c. There is a period of cost of care that SA can cover.

2. It is recommended that you periodically check to determine if the appeal process has been completed, through the SDX or contact with SSA or the applicant. If you learn of the appeal decision through some source other than the applicant, contact the applicant to determine if he/she wishes to reopen the SA application based on these criteria.

3. Approve assistance based on the original date of application if all other eligibility factors are met. Payment can begin no earlier than the month of SSI approval. Refer to Item X below for the effective date of payment.

4. Request For Override

If the applicant is authorized for more than 12 months prior to disposition, send a letter to the Payment Benefits Section. Also, if Medicaid is authorized more than 12 months prior to disposition, request an override of the 12 months Medicaid claims processing time limit. Follow instructions in MA-2395, Corrective Actions and Responsibility for Errors, to complete the Request For Claims Override.