"Extra Help" benefits terminated. Must I go to federal court?

Luke Turner

New Member
Jurisdiction
Washington
MY PROBLEM

SSA terminated my “Extra Help with Prescription Drugs” benefits because my money supply was $16,348, which is $2,338 over the limit.

I appealed the termination by claiming about $11,000 of my money supply is earmarked for dental treatment.

SSA rejected my appeal because I gave no evidence that I had spent any of the earmarked money for dental treatment yet.

I have since then spent enough of that earmarked money on dental treatment to again qualify for “Extra Help” benefits.

My only recourse at this point seems to be taking the SSA to federal court.

QUESTIONS

1. Is going to federal court really my only means of getting the “Extra Help” benefits back?

Going to court seems like a waste of legal resources in response to such a trivial, temporary technicality.

2. If I don’t go to court or win my case, how long must I wait before re-applying for the “Extra Help” benefits? 1 year? 2 years?

3. How can I find out how much the “Extra Help” has benefited me? How much has it been saving me per month or year?

MY ARGUMENT

If I were to argue my own case, I think I’d argue as follows:

By making their termination decision final, the SSA has violated it’s own mission and purpose. That mission, as I see it, is to provide assistance to people who have difficulty taking care of themselves. The finality of their termination decision needlessly denies me access to their help, as I now (and likely always will) meet the requirements for that help. As such, the SSA’s permanent termination of help to someone who qualifies for their help places the SSA squarely in violation of their own mission and purpose.

I want to be clear on this. I do not object to the SSA’s termination decision. It seems a reasonable protection against possible fraud. But I do object to the permanence of that termination. The permanence fails to account for changing conditions.

To more efficiently execute their mission and purpose, I think the SSA should have replied to my appeal as follows:

“We regret that we must stand by our decision to terminate your ‘Extra Help’ benefits because you have too much money and have offered no evidence for having spent the money you claim is earmarked for a purpose. But we also see from the evidence you did supply, that you may begin spending that earmarked money in the near future. If you ever do spend that earmarked money as intended and enough to bring your money supply below the limit, send us proof of such, and we will reinstate your benefits.”
 
The SSA did no wrong.

You will lose because of this:

If you ever do spend that earmarked money as intended and enough to bring your money supply below the limit, send us proof of such, and we will reinstate your benefits.”

Now that you've spent the money, just send the receipts for the treatment, show that you are below the limit and you'll get your benefits back.
 
The SSA did no wrong.

You will lose because of this:



Now that you've spent the money, just send the receipts for the treatment, show that you are below the limit and you'll get your benefits back.

To clarify: Your answer to my first question is "No." I do not have to go to federal court (even though the final termination decision letter they sent me says I can only go to court). I can instead ignore that procedure and just send them proof of my spending.

If this is so, I like that.
 
The SSA did no wrong.

You will lose because of this:

Reread the OP's initial post, Jack. The OP was not quoting a reply from SSA. He/she was stating how he or she would have responded if the OP were the SSA.

My only recourse at this point seems to be taking the SSA to federal court.

You must first exhaust all administrative remedies before you may file in federal court. I have no idea if you've done that or not.

Even though the agency has said its determination is final and assuming no more administrative appeals are available, you still have nothing to lose by submitting a request for reconsideration providing the new evidence. The worst the agency can do is say no and then off to court you go.
 
Reread the OP's initial post, Jack. The OP was not quoting a reply from SSA. He/she was stating how he or she would have responded if the OP were the SSA.

Oops. Yeah, I see that.

Still, it makes sense to re-apply for "Extra Help" benefits now that the money is gone even if it's just a new claim and not retroactive.
 
Back
Top