California Department of Social Services - State Hearings Division
Notes from the Training Bureau - June 17, 2002

Subject: SSI/SSP Presumptive Disability Determinations and Continuation of Medi-Cal

When the Social Security Administration grants presumptive disability to an SSI/SSP applicant, and then subsequently denies disability when making a formal disability determination, the applicant is entitled to receive SSI/SSP based Medi-Cal throughout the entire SSI/SSP appeals process if he/she filed a timely appeal of the disability denial.

Assume a county becomes aware that a person was granted presumptive disability by the Social Security Administration, but that the Social Security Administration subsequently determined him/her to be not disabled. If the individual appeals that denial, the county should contact the CDHS immediately in order to determine whether SSI/SSP based Medi-Cal should be restored.

If the Social Security Administration denial decision becomes final, (i.e., when the individual chooses not to appeal to the next level or the Appeals Council renders an unfavorable decision) the individual is no longer eligible for SSI/SSP based Medi-Cal.