Effective Dates: 8/26/2024 - Present

Identification Number:
SI 02301 TN 76
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Posteligibility Changes
Type:POMS Full Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM

Part SI – Supplemental Security Income

Chapter 023 – Posteligibility Events

Subchapter 01 – Posteligibility Changes

Transmittal No. 76, 08/26/2024

Audience

OCO-OEIO: CR, FCR, FDE, RECONE, RECONR;
FO/TSC: CS, CS TXVI, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

The agency's Goldberg Kelly (GK) policy implements legal requirements arising from the Supreme Court's decision in a case called Goldberg v. Kelly. That case held that Constitutional due process requires that recipients of needs-based benefits receive advance notice and an opportunity to be heard, before a government agency reduces, suspends, or terminates their benefits. As applied to the SSI program, this means that SSI recipients who appeal the advance notice of an initial determination to reduce, suspend, or terminate SSI payments for non-medical reasons must have the option to receive unreduced payment at the protected payment level (GK payment continuation) at the first level of appeal (reconsideration level) until we make a determination on their reconsideration request.

We provide recipients advance notice through the Notice of Planned Action (NOPA). The NOPA explains the right to appeal; the right to continued payment at the protected payment level until a we make a determination for the reconsideration request; and the requirement to file the reconsideration request within 10 days of receipt of the NOPA in order to receive payment at the protected level of payment until we make a determination for their reconsideration request.

Effective October 29, 2021, we implemented EM-21064 Goldberg Kelly Payment Continuation Period (EM-21064). EM-21064 extends eligibility for receipt of payment at the protected payment level during the reconsideration appeal to recipients who file their reconsideration request 11 or more days after, but within 60 days of receipt of a NOPA. This transmittal incorporates EM-21064 into the POMS instructions by adding the requirements to receive and the procedure for payment at the protected level for recipients who file their non-medical reconsideration request 11 or more days after, but within 60 days of receipt of the NOPA.

Summary of Changes

SI 02301.313 Appeal and the Protected Payment Level when a Reconsideration Request is filed 11-60 Days after Receipt of a Notice of Planned Action

Subsection A provides introduction and information about when recipients who file a reconsideration request 11 or more days after, but within 60 days of receipt of a NOPA became eligible to receive payments at the protected payment level while their reconsideration request pends.

Subsection B explains the criteria for receipt of payment at the protected payment level during the reconsideration appeal for recipients who file a reconsideration request 11 or more days after, but within 60 days of receipt a NOPA.

Subsection C provides procedure for paying the protected payment level to recipients who file a reconsideration request 11 or more days after, but within 60 days of receipt of a NOPA.

SI 02301.313 Appeal and the Protected Payment Level when a Reconsideration Request is filed 11- 60 Days After Receipt of a Notice of Planned Action

A. Introduction

As of October 29, 2021, recipients who file a request for reconsideration request 11 - 60 days after receipt of an SSI Notice of Planned Action (NOPA) (SSA-L8155) may receive continued or reinstated payments at the protected payment level (Goldberg Kelly (GK) payment continuation) until we make a reconsideration determination for their reconsideration request.

B. Policy

Recipients who meet the following criteria receive, unless they waive in writing, GK payment continuation until we make a reconsideration determination for their reconsideration request.

1. File a reconsideration request on or after October 29, 2021.

2. File a reconsideration request 11 days or more after receipt, but within 60 days of receipt of a NOPA. We presume that a recipient receives a NOPA five days after the date on it. See SI 02301.310C.

EXAMPLE: We mail a NOPA dated June 12, 2023, to a recipient and presume that the recipient receives the NOPA on June 17,2023. The 60-day count starts June 18, 2023 and ends on August 16, 2023. The recipient has until August 16, 2023, to file a request for reconsideration and receive GK payment continuation until a reconsideration determination is made on their reconsideration request.

C. Reconsideration request filed 11 - 60 days after receipt of a NOPA - Procedure

When a recipient files a request for reconsideration 11 or more days after, but within 60 days of receipt of a NOPA, take the following actions to pay the recipient GK payment continuation until we make a reconsideration determination unless the recipient waives GK payment continuation. Recipients who want to waive receipt of GK payment continuation may do so by completing and submitting to us the form SSA-263 Waiver of Supplemental Security Income Payment Continuation. See SI 02301.310C.6. and SI 0 2301.415 SSA-263-U2, Waiver of Supplemental Security Income Payment Continuation

1. Record the reconsideration request per SI 02301.310C.8.; and

2. On the appropriate MSSICS appeal screen, enter yes (Y) for the recipient's statement explaining late filing and evaluation of the late filing request and enter 1 for established disposition of good cause for late filing continuation request. See MS 04420.015.

3. Make the following system entries to document the good cause statement and evaluation of the good cause finding.

  • •

    Use the following statement to record the recipient’s good cause statement for GK payment continuation. “The reconsideration request was filed timely for receipt of GK payment continuation.”

  • •

    Use the following statement to document the evaluation of the good cause finding. “Recipient’s Name filed the reconsideration request within 60 days of receipt of the NOPA.

4. Pay the PPL per SI 02301.320.


SI 02301 TN 76 - Posteligibility Changes - 8/26/2024