If SSA finds the client "not disabled," the client remains eligible for P3 MA if they appeal the SSA determination. There are 3 stages to SSA's appeal process:
- Administrative Law Judge (ALJ)
- Appeals Council
NOTE: When a noncitizen, age 65 or older, who was residing in the U.S. on 08/22/96, is denied SSI due to a finding of "not disabled," determine eligibility for Category 01 assistance. If the noncitizen meets the
immigration requirements for medical assistance and all other AABD Cash eligibility requirements are met, they are eligible for Category 01 assistance whether or not they appeal the SSI denial.
The Department accepts the determination of the ALJ as final. If the client files an appeal and is otherwise eligible, authorize P3 MA until:
- the client withdraws the appeal with SSA, or
- the determination of "not disabled" is upheld at the reconsideration level and the client does not file an appeal to the ALJ level, or
- the determination of "not disabled" is upheld by an ALJ.
When proof is received that the client filed an appeal of SSI's decision of "not disabled" (the initial decision or at the reconsideration level), restore P3 MA retroactive to the month/year of the termination.
If the Appeals Council or District Court sends the case back to the ALJ for a new decision, P3 MA eligibility may exist. However, a new medical assistance application is required. A new CAU disability decision is not required unless the review date on
the last decision is passed.