PM 03-18-01-c

At Intake:

  1. At Intake:
  2. Active Cases:
    1. Central Suspensions
    2. Central Cancellations
      1. TA 22/TAR 73
      2. TA 22/TAR 55
    3. Follow-up to Central Suspensions/Cancellations
      1. Appeal Pending at Reconsideration or ALJ Level
      2. Resumptions
      3. Restored Assistance
      4. Discrepancy Referral (Form 1925)
      5. Appeal Pending at Appeals Council
      6. Client's Request for Review of Other Transitional Assistance Eligibility
    4. Family Community Resource Center Suspensions/Cancellations

At Intake:

  1. (FCRC) If CAU finds the client disabled, review the case file and SOLQ information to find if the client has applied for SSI.
  2. (FCRC) If there is no SSI application pending, send Form 267 to the client, advising the client to:
    • apply for SSI, and
    • take their copy of Form 2199 with them to the SSA office, and
    • provide verification of the SSI application within 10 calendar days.
    1. If SOLQ shows the client has applied for SSI, the application has been denied within the past 60 days, and there has been no appeal filed, send Form 267 to the client, advising the client to:
      • appeal the SSI denial, and
      • provide verification of the appeal within 10 calendar days.
  3. (FCRC) When the client has been found disabled by CAU, has an SSI application or appeal pending, and meets all other eligibility requirements, approve P3 TA.
  4. (FCRC) If the client has been found disabled by CAU and fails to apply for SSI, the client is not eligible for Category 07 eligibility under any of the other not employable criteria.

Active Cases:

For all active P3 TA cases, an SDX crossmatch is completed centrally each month to verify the status of the SSI application. When the crossmatch shows that a client has been denied SSI and there is no appeal pending, P3 TA is centrally suspended or canceled.

Central Suspensions

The case is centrally suspended with Type Action (TA) 21, Type Action Reason (TAR) 73 when:

  • the SSI denial date is within 65 days of the date of the crossmatch and the Appeal Code field is blank, or
  • new codesthe SSI denial date is subsequent to the SSI application date and the SSI denial has been upheld at the reconsideration level (the Appeal Code = R and Appeal Decision Code = UF in PASDX).
  • With the TA 21/TAR 73 action, Notice to P3 Transitional Assistance Client (Form 2509C), is sent to the client. Form 2509C informs the client that assistance will be restored without interruption if the client appeals the SSA decision.

A suspended P3 TA case is centrally canceled the 2nd month following the month of suspension.

Central Cancellations

TA 22/TAR 73

The case is centrally canceled with TA 22/TAR 73 when the SSI denial date is more than 65 days from the date of the crossmatch and the Appeal Code field is blank. Notice of Change - P3 Transitional Assistance (Form 157TAC) is sent to the client. Form 157TAC advises the client of:

  • the P3 TA ineligibility, and
  • the right to request a review of other TA eligibility.

Important Notice Regarding Eligibility for Transitional Assistance Program (Form 3404) is attached to Form 157TAC.

TA 22/TAR 55

The case is centrally canceled with TA 22/TAR 55 when:

  • revised codethe SSI denial date is subsequent to the SSI application date and the SSI denial has been upheld at the ALJ level (the Appeal Code = H and Appeal Decision Code = UF in PASDX), or
  • revised codethe SSI denial date is subsequent to the SSI application date and the appeal process has gone beyond the ALJ level (the Appeal Code = A)

Form 157TAC and Form 3404 are centrally sent to the client.

Follow-up to Central Suspensions/Cancellations

Action on a P3 TA suspended or canceled case is dependent on the status of the SSI application.

Appeal Pending at Reconsideration or ALJ Level

If the client responds to Form 2509C or Form 157TAC by stating that an appeal is pending at the reconsideration or ALJ level, check SOLQ information. If SOLQ does not confirm the client's statement, request proof from the client. A written statement from SSA verifying the pending appeal must be dated within the previous 90 days. Upon receipt of proof that an appeal is pending at the reconsideration or ALJ level, resume or restore P3 assistance without any further action by the client.

Resumptions

Use TA 13/TAR 74 to resume assistance. Resume assistance retroactive to the date of suspension.

With the Family Community Resource Center entry of TA 13, the system will centrally enter Item 80 code 373 RESUM with the month and year of resumption in the AMOUNT field. Item 80 code 373 identifies the case as a P3 client with an SSI appeal pending. Matching federal funds for the medical assistance are not available when the case is coded with code 373.

Once entered, code 373 will remain on Form 552 throughout subsequent suspension(s)/resumption(s). Code 373 cannot be deleted by the Family Community Resource Center. When the case is canceled or changed to category 03 or 93 assistance, code 373 is centrally deleted.

Restored Assistance

P3 assistance was centrally canceled if SDX shows that the client did not file an appeal within 65 days of the SSI denial date. If the client provides proof that an appeal is pending at the reconsideration or ALJ level, the case was canceled in error. Restore assistance effective the date of cancellation.

With TA 12, enter code 373 RESUM in Item 80. In the AMOUNT field of code 373, enter the month and year assistance was restored. Code 373 identifies the case as a P3 client with an SSI appeal pending. Matching federal funds for the medical assistance are not available while the case is coded with code 373.

Discrepancy Referral (Form 1925)

When the client provides proof that an appeal is pending at the reconsideration or ALJ level and the appeal status is not reflected in the Appeal Code field on SDX or SOLQ within 4 weeks of the date the appeal was filed, complete Discrepancy Referral (Form 1925). Forward Form 1925 and a copy of the proof of appeal provided by SSA to the SSA Programs Control Unit, Bureau of Operations Support. The Appeal Code field will be centrally updated to reflect the client's actual appeal status.

Appeal Pending at Appeals Council

If in response to Form 157TAC or Form 2509C, the client provides proof that an appeal is pending with the Appeals Council, the termination of P3 assistance is valid. The client is not eligible for P3 TA. If the client contacted the Family Community Resource Center before the last day of the last months of eligibility, review eligibility for Category 07 TA. Do not require the client to reapply. If the client meets a different criterion for TA, authorize Category 07 assistance.

If the client contacts the Family Community Resource Center after the last day of the last month of P3 TA eligibility and has an appeal pending with the Appeals Council, require a new Category 07 TA application.

Once an SSI appeal has been filed with the Appeals Council, do not consider eligibility for P3 TA unless:

  • the client files a new SSI application while the appeal is pending with the Appeals Council, or
  • the Appeals Council remands the SSI case back to the ALJ level.

If the Appeals Council remands the SSI case back to the ALJ level, require a new P3 application. Do not require a new CAU decision.

If the client files a new SSI application, require a new P3 application and a new CAU decision. (CAU will not find the client disabled unless there has been a change in the client's medical condition, other factors, or available medical evidence.)

Client's Request for Review of Other Transitional Assistance Eligibility

If the client responds to Form 157TAC by requesting a review of other Category 07 TA eligibility, review SOLQ information and determine the status of the client's SSI application. If the SSI application has been denied at the initial or reconsideration level within the past 60 days, advise the client to appeal the SSI denial and provide proof of the appeal. With proof of the SSI appeal, restore P3 TA. If the client fails to provide proof of an appeal, the client is not eligible for other Category 07 TA.

When the SSI application has been denied at the initial or reconsideration level more than 60 days prior, or if the SSI application has been denied at the ALJ level:

  • When the client contacts the Family Community Resource Center before the last day of the last month of P3 eligibility, review eligibility for other TA. If eligible, authorize Category 07 TA. Do not require the client to reapply.
  • When the client contacts the Family Community Resource Center after the last day of the last month of P3 eligibility, require a new TA application.

Family Community Resource Center Suspensions/Cancellations

When the Family Community Resource Center learns that a P3 client has been found "not disabled" by SSA, has not filed an appeal, and there has been no central action, take action to cancel or suspend P3 TA based on the central action criteria:

  • new codeIf the SSI denial date is within 65 days of the day of the Family Community Resource Center action, or if the SSI denial has been upheld at the reconsideration level (Appeal Code = R and Appeal Decision Code = UF in PASDX), suspend assistance. Send Form 2509.
  • If the SSI denial date is more than 65 days from the date of the Family Community Resource Center action, cancel assistance using TA 22/TAR 73. Form 157TAC will be centrally sent.
  • new codeIf the SSI denial has been upheld by the ALJ (Appeal Code = H and Appeal Decision Code = UF in PASDX), cancel assistance using TA 22/TAR 55. Form 157TAC will be centrally sent.

When the Family Community Resource Center takes action to suspend or cancel P3 TA due to the client's SSI denial, the procedures for resuming or reinstating assistance are the same as the follow-up procedures to central suspensions and cancellations.