When you lose your Aged Blind Disabled (ABD) benefits for medical reasons

Maybe.

The ABD program provides medical coverage and a small monthly cash grant if any of these apply to you:

• Age 65 or over
• Blind or have a disability.

You should read I applied for benefits. DSHS said no. if DSHS denies you ABD because you have too much income or resources, or for any other non-medical reason.

Read DSHS Help for People with Disabilities: Necessary Supplemental Accommodations if you need help getting or keeping DSHS because you:

• Have a disability
• Have problems reading or writing, speaking, or understanding English
• Have a history of drug or alcohol use, and/or
• Other problems

It has general information about what kind of help may be available to you.

You can do any or all of these:

• Ask for a hearing.
• Ask a DSHS supervisor to review and explain the decision.
• Reapply.

We recommend you ask for a hearing while also pursuing either the second or third option. You can try more than one option at the same time.

You can ask for this hearing when you get benefits through a state program, and you disagree with a verbal or written decision the agency has made about your benefits, including the decision to deny or stop terminate your benefits. It is like a court hearing, but less formal.

Representing yourself at an administrative hearing has more information. Read it to learn about such things as your deadline to ask for a hearing and how to get ready for the hearing.

Probably.

DSHS has 45 days after you apply to decide if you should get ABD. If they do not send you a notice within 45 days, you should ask for an administrative hearing for a decision about whether you can get ABD.

• Contact the Administrative Hearing Coordinator (AHC) at the local DSHS office. The AHC represents DSHS in the hearing. Your case might settle beforehand if you can show that DSHS made a mistake or if you can give DSHS more complete medical information.
• Make an appointment with the AHC to look at your file and discuss your case. Get copies of all medical reports and other documents DSHS used and created in making and explaining its decision.
• The DSHS notice denying or terminating ABD should give at least one Washington Administrative Code (WAC) rule supporting their decision. Ask the AHC for any other rules they relied on. The ABD rules are in WAC Chapter 388-449.
• Ask the AHC to explain anything that you do not understand about DSHS’s decision.
• What evidence would change DSHS’ decision. If you get them that evidence, DSHS may give you ABD without a hearing. You should also give a copy of any of this evidence to the ALJ before the hearing.
• Why your current medical information is not enough to prove you have a disability and cannot work, and what other information you need to prove it.

You can ask to talk to the supervisor or administrator.

If DSHS still does not agree with you that you should get or keep getting ABD, you will need to go to the hearing.

After you apply for ABD, DSHS reviews your medical and vocational information. It is usually on DSHS evaluation forms from doctors who examined you.

DSHS uses a 5-step “Sequential Evaluation Process” (SEP) form. You must figure out what parts of the evaluations, and what step of the SEP, show why DSHS is denying or terminating your benefits.

If you think any doctor who did an evaluation for DSHS may help you on any point DSHS told you is important to the decision, ask the doctor for a letter of support. You might be able to get proof DSHS needs from your regular doctor, psychologist, nurse practitioner, or mental health worker.

If you are a client of the Department of Vocational Rehabilitation (DVR), ask for copies of medical or vocational information in your DVR file that may help.

If you believe more medical evaluations would prove your case, you can ask DSHS to approve and pay for another evaluation.

You must give a good reason for needing it.

DSHS might not have gotten evaluations of all your medical problems that they know about.

You might have a past medical problem you believe still keeps you from working, that no one has evaluated yet. Maybe an evaluation mentions medical problems outside the doctor’s expertise or recommends evaluations DSHS did not get.

Call the OAH. Ask for a pre-hearing conference. At that conference, you can ask the ALJ to order DSHS to pay for a second evaluation.

If the ALJ will not do this, try to get one from another doctor yourself. Try a doctor you have seen before. Ask your doctor to use DSHS’s evaluation form.

Ask DSHS for blank forms to bring to your doctors or print them yourself. Form 13-021 is for physical conditions. Form 13-865 is for mental health conditions.

You can also ask the ALJ at the hearing to order DSHS to pay for more evaluations. Getting more evaluations may help you eventually settle or win.

You should testify at the hearing about how your medical problems limit what you can do.

Give examples from your daily life. You should especially give examples of situations where you worked or tried to work.

You can have people who know you well testify to what you can and cannot do.

You can ask your DSHS worker to explain more about the decision before or after asking for a hearing. You may learn DSHS had incorrect information or was missing information. If so, try to give them the right information.

Ask the DSHS worker for any help you need getting it. If you have to pay to get it, ask DSHS to pay or if they will accept other proof.

You can also ask the DSHS worker’s supervisor for a meeting to review the decision. If you write the supervisor, they must write back within 10 days.

If that does not change the decision, write to the head administrator of the local DSHS office. They also must write back in 10 days.

No. There is no more appeal unless you also ask for an administrative hearing. The 10- and 90-day deadlines for continued benefits and appeal run while you work with DSHS.

Even if it seems like DSHS will fix your case, ask for a hearing just in case. You can withdraw the hearing request if things work out.

Yes. You can reapply for benefits any time. You can reapply even if you asked for a hearing.

You should reapply if either of these is true:

• You think DSHS correctly denied you. Your situation has since changed. You think you are eligible to get benefits now.
• You have more information that might change DSHS’ decision. Your worker or supervisor will only consider it if you reapply. You can reapply while also trying to use the new information in your hearing.

The approval of a new application probably will not go back to the date you first applied or DSHS first denied you.