EPN-Arbitrary Termination

If a child’s Social Security benefits are altered or terminated:

1. Request a Reconsideration within 60 days using Form SSA-561-U2.

2. Gather and submit updated information on:

   • School enrollment status

   • Any changes in living arrangements

   • Income or resources, if applicable

3. If the Reconsideration is denied, request a hearing with an Administrative Law Judge within 60 days.

4. Consider seeking representation from a disability advocate or attorney for the hearing.

5. If necessary, pursue Appeals Council review and Federal Court review.

Survivors Benefits

For alterations or terminations of survivors’ benefits:

1. File a Request for Reconsideration (Form SSA-561-U2) within 60 days of receiving the notice.

2. Provide updated information on eligibility criteria, such as:

   • Marital status changes

   • Age-related changes

   • Disability status updates, if applicable

3. For child survivors, submit current school enrollment information if relevant.

4. If the Reconsideration is unsuccessful, request an Administrative Law Judge hearing within 60 days.

5. Consider obtaining representation for the hearing process.

6. Pursue Appeals Council review and Federal Court action as final steps in the appeals process if needed.

For both benefit types, it’s crucial to act promptly within the given timeframes and keep detailed records of all communications with the Social Security Administration throughout the appeals process.

Family Benefits

Family benefits under Social Security provide financial support to the dependents of workers who are retired, disabled, or deceased. These benefits can be altered or terminated under certain circumstances, and understanding the process is essential for beneficiaries.

Alteration or Termination of Family Benefits:

1. 
   Benefit Changes:  Family benefits may be adjusted if there are changes in the primary beneficiary’s status or other family member’s eligibility.

2. Termination Reasons: Benefits for family members (such as disabled widow(er)s and disabled adult children) can be terminated due to:

   • Marriage

   • Entitlement to a larger benefit

   • Death of the primary beneficiary

3. Appeal Process: If family benefits are altered or terminated unfavorably, the beneficiary can appeal the decision through the following steps:

   • Request for Reconsideration: File within 60 days using Form SSA-561.

   • Hearing by Administrative Law Judge:  If reconsideration is unsuccessful, request a hearing.

   • Review by Appeals Council: If necessary, pursue a review of the decision.

   • Federal Court Review: As a final step, you can appeal to the Federal Court.

4. Continuation of Payment: During the appeal process, beneficiaries may sometimes request continuation of payments.

5. Representation: Beneficiaries have the right to appoint a representative to help with the appeal process.

Medicare

If you are removed from the Medicare program, it’s crucial to take prompt action to ensure continuous healthcare coverage and appeal the decision if necessary. Here are the steps you should consider:

1. Review the removal notice carefully to understand the reason for your disenrollment.

2. Contact the Social Security Administration (SSA) immediately to clarify your status and discuss reinstatement options.

3. If you believe the removal was in error, file an appeal. You have 60 days from the date of the decision to request a reconsideration. You can:

   • Fill out a “Medicare Redetermination Request” form (CMS Form 20027)

   • Submit a written request to the Medicare Administrative Contractor (MAC)

   • Follow the appeal instructions provided in your Medicare Summary Notice (MSN).

4. If you need to disenroll voluntarily:

   • For Part B: Contact SSA and complete form CMS-1763.

   • For Part D: Enroll in another plan, send a written request, or call 1-800-MEDICARE.

5. Explore alternative coverage options:

   • If eligible, enroll in a Medicare Advantage plan during the Annual Election Period (October 15 – December 7) or Medicare Advantage Open Enrollment Period (January 1 – March 31).

   • Consider Medicaid if you meet income requirements

6. Seek assistance from your State Health Insurance Assistance Program (SHIP) for free, personalized counseling on your options.

7. If your appeal is denied, you can request further review through the multi-level appeals process, potentially up to the Federal District Court level.  If you have questions related to Medicare or Medicaid, here is a great place to state:  Free Medicare help:  352-841-0632.

Remember, acting quickly to avoid gaps in your healthcare coverage is crucial. If you’re unsure about any step, consult with a Medicare specialist or your healthcare provider for guidance. 

Medicaid

If you are removed from the Medicaid program, it’s crucial to take prompt action to ensure continuous healthcare coverage and appeal the decision if necessary. Here are the steps you should consider:

1. Review the removal notice carefully to understand the reason for your disenrollment.

2. Contact your state Medicaid agency immediately to clarify your status and discuss reinstatement options.

3. File an appeal if you believe the removal was in error. You typically have 30-90 days from the date of the decision to request an appeal, depending on your state. Some states require appeals to be filed within 10 days to continue receiving benefits during the appeal process.

4. Submit your appeal request in writing, even if not required by your state. Include your name, contact information, and a statement like “I want to appeal the denial notice dated [date]”.

5. If possible, submit your appeal request in person at your local Medicaid office and have it date-stamped to prove timely submission.

6. Prepare for a fair hearing, which is your opportunity to explain why you disagree with the decision about your Medicaid eligibility.

7. Gather all relevant documentation to support your case, including medical records, income statements, and other evidence demonstrating your eligibility.

8. Consider seeking assistance from legal aid organizations or advocacy groups that can help you navigate the appeals process.

9. If your appeal is denied, explore other healthcare coverage options, such as Marketplace plans or employer-sponsored insurance.

Remember, the appeals process can be complex, but it’s designed to protect your rights. Act quickly and thoroughly to ensure the best chance of maintaining your Medicaid coverage.

Important Considerations

It is crucial to act promptly within the given timeframes and keep detailed records of all communications with the Social Security Administration throughout the appeals process. Understanding your rights and responsibilities can help ensure that you receive the benefits you are entitled to as a family member of a Social Security beneficiary.