Disability Advocacy Program (DAP) Changes, OPS180302 (Published March 13, 2018)
At application or any other eligibility review, the CAO worker will determine if the individual is potentially eligible for disability benefits and should be referred to DAP and SSA. A referral may be appropriate based on the following:
an Employability Assessment Form (PA 1663) or Employability Re-assessment Form (PA 1664) indicates that the recipient is permanently disabled; or
a Medical Assessment Form (PA 635) indicates that the recipient is incapacitated; or
the recipient meets the characteristics in the SSI/SSDI profiles. See Appendix A. Some recipients may provide a PA 1663 or PA 1664 indicating a temporary disability that is expected to last less than 12 months. In these instances, a DAP referral should be completed regardless of the number of months indicated on the form.
Reminder: An individual who has applied for SSA disability benefits and is cooperating with the SSA in the eligibility process is not required to submit an updated medical or employability assessment form until SSA makes a final decision. A new employability assessment form is not required while the recipient’s case is in the application/appeal process. See Cash Assistance Handbook, Section 129.31 Verification of Incapacity or Medical Assistance Eligibility Handbook, Section 305.26, Presumptive Eligibility – PH/PJ/TJ. This applies to cash and Medicaid recipients.
NOTE: If the sole diagnosis is drug addiction or alcoholism, do not refer the case to DAP. These individuals are not eligible for SSI/SSDI.
If the CAO worker is unable to make a clear-cut decision about whether a recipient should be referred to DAP, he should make the referral.
The DAP Referral Form (PA 731) and telephone contacts with SSA are used to follow the progress of the recipient's SSI/SSDI application and appeal.
1. Discuss the SSI/SSDI benefits and the advantage of applying for them.
Reminder: The cash or Medicaid recipient must apply for SSI/SSDI benefits and cooperate with SSA as a condition of eligibility.
55 Pa. Code §§ 141.21(n)(1) 55Pa. Code 181.1(d) 55 Pa. code 183.13(b)
NOTE: If the recipient's income or resources would make him ineligible for SSI/SSDI, the CAO worker should make a DAP referral for an MRT disability determination so assistance can be authorized in a federal category to ensure federal financial participation.
2. Determine if the recipient has applied for or received SSI/SSDI benefits in the past.
3. Reserved
4. Advise the recipient that the DAP advocate can help him with his SSI/SSDI application and appeal.
NOTE: The CAO should refer terminally ill (including AIDS/HIV+) individuals to the DAP advocate for the initial application.
5. Update the Agreement of Mutual Responsibility (AMR) by noting that the recipient has been referred to DAP to apply for SSI/SSDI benefits. Also note on the AMR that if the application for SSI/SSDI benefits is denied for medical reasons, the recipient must agree to appeal the decision. The DAP advocate will assist the recipient with the appeal process.
6. Encourage all recipients to sign the PA 731 because SSA accepts the postmark date or date received stamp date as the filing date (effective date) for SSI/SSDI benefits.
The CAO worker will use the PA 731 to refer a recipient to DAP. The form contains a statement of recipient intent to cooperate with both the CAO and SSA in seeking SSI/SSDI benefits. The cash or Medicaid applicant who has signed the agreement does not have to go to SSA before the CAO authorizes cash or Medicaid.
NOTE: If the cash or Medicaid recipient does not want to sign the PA 731, the CAO worker advises him that he must verify that he has applied for SSI/SSDI in order for the CAO to authorize or continue cash or Medicaid.
7. Complete the PA 731 without the recipient's signature if he chooses not to sign.
8. Indicate on the PA 731 if the recipient has requested the DAP advocate's help in his initial SSI/SSDI application.
NOTE: If the recipient appears to be severely handicapped or unable to apply for SSI/SSDI on his own, the CAO worker may determine that the DAP advocate's help is needed. The CAO worker should note on the PA 731 that he is requesting help for the recipient.
9. Inform the recipient that the CAO will forward the PA 731 to SSA, and that SSA will contact the recipient to schedule the initial SSI/SSDI application appointment.
10. Tell the recipient to contact the DAP advocate as soon as SSA notifies him of the scheduled appointment, if he wants the DAP advocate to help with the initial application.
11. Give the recipient a DAP Contact Card (PA 736) which provides the name, address, and phone number of the DAP advocate.
12. Distribute the four copies of the PA 731 as follows:
Original to SSA. Process according to CAO procedure as quickly as possible to protect the filing date. Attach as much medical evidence as is available to help the SSA interviewer to define the recipient’s impairment.
NOTE: Attach reimbursement form FAIR 176-SSI for a GA recipient.
NOTE: Do not send to SSA if the CAO needs a disability determination by the MRT only.
First copy to DAP advocate. Attach photocopies of any social history, medical records, or employment history that is available.
Second copy to the recipient.
Third copy in the case record.
When SSA receives the PA 731, it will contact the recipient within five to seven days to arrange for an SSI/SSDI application interview.
When the eligibility worker refers a recipient to DAP, the CAO will assign a program status code of 50 to category D cases or change the category to PH, PJ, or TJ in category TD or PD cases. The program status code is used with state-funded category D to identify and allow for Federal financial participation. The CAO will use the program status code until the final SSA determination is made.
For Medicaid recipients who require only a disability determination by the Medical Review Team (MRT), to determine eligibility for Medicaid category PH (Healthy Horizons), PJ, TJ or PW, the CAO will:
1. Refer the recipient to the CAO MRT coordinator with a PA 731. Indicate on the form that only a disability determination is needed. Attach all available medical information.
2. Assign category PH (Healthy Horizons), PJ, TJ or PW, if the recipient meets all other program requirements. Do not use a DAP program status code.
3. Change the category when the initial determination is made if the individual is not certified as disabled by the MRT.
PMA15088319 Eligibility for Healthy Horizons and Applying for Potential Social Security Income (Linked February 22, 2010)
Updated August 21, 2018, replacing February 5, 2013