EDD denial citing 'facility not certified' for rehab disability claim - but facility says they ARE certified!

You absolutely need to appeal this! EDD has been making these kinds of errors more frequently since they updated their system in 2024. The distinction between 'licensed' and 'certified' for treatment facilities is important - they're looking for facilities certified through DHCS (Dept of Health Care Services) specifically for substance use disorder treatment.\n\nFor your appeal, you need these documents:\n1. A letter from the facility stating their current address and certification number\n2. A copy of their DHCS certification (not just business license)\n3. Documentation showing other patients have received SDI while at this facility (with personal info redacted)\n4. The facility's official NPI (National Provider Identifier) number\n\nSubmit the appeal within 30 days of the denial notice and be very specific that this appears to be a database error on EDD's part.

Thank you for such detailed advice! I didn't realize the DHCS certification was different from their business license. I'll call the facility tomorrow and ask for all these documents. Do you know approximately how long the appeal process takes? We're really struggling financially without this income.

the same thing happened to my cousin last year!!! his rehab was totally legit but edd said it wasnt certified. he had to appeal and it took foreverrrrr but he finally got approved and backpay. the rehab had to write some special letter explaining there certification type or something. dont give up!!

That's so good to hear someone else got through this! How long did the appeal take for your cousin? Did he have to attend a hearing or was it just paperwork?

it took like 2 months i think?? he just had to send in papers no hearing. the rehab director had to get involved and write some official thing. he got all the backpay but it was super stressful waiting

This is a common issue with EDD and treatment facilities. There's a specific certification California requires for substance use treatment facilities to qualify for SDI benefits - it's not just a business license or even a general healthcare facility license. The certification must be current and specifically for substance use disorder treatment through DHCS.\n\nOne critical thing to check: Is the doctor who signed the disability certification properly licensed as well? Sometimes the facility is certified but the specific provider signing the disability forms isn't properly credentialed in EDD's system.\n\nI've helped several clients through this exact situation. In addition to appealing, I strongly recommend calling EDD directly to speak with a claims specialist who can look at the specific certification issue. Regular representatives often can't see or understand these nuanced certification problems.

Good luck calling EDD and actually reaching someone who knows what they're talking about!!! I tried for WEEKS last year when I had certification issues. Either busy signals or 3+ hour waits just to talk to someone who couldn't help!!

I had the same problem trying to reach EDD last month about my certification issue. After wasting days with busy signals and disconnections, I found this service called Claimyr (claimyr.com) that actually got me connected to an EDD agent within 20 minutes. They have a video showing how it works: https://youtu.be/1X-mEsLtbmQ?si=1hcSq3KFtCr4oAmd\n\nIt was honestly worth it because I needed to speak to someone who could see exactly what was wrong with my claim rather than guessing. The agent I spoke with immediately saw the certification code error in my file and fixed it on the spot.

Thank you so much for this tip! After spending all morning getting disconnected by EDD, I'm going to try this service. At this point I just need to talk to someone who can actually see what's happening with the claim and explain exactly what certification they're looking for.

EDD IS THE WORST!!! They denied my claim when I was in treatment too but for a different stupid reason. They said my doctor wasn't authorized to certify my disability EVEN THOUGH HE WAS THE MEDICAL DIRECTOR OF THE FACILITY!!! Took me 4 MONTHS of fighting and calling EVERY SINGLE DAY to get it fixed!\n\nThe system is BROKEN and they make these ridiculous technical denials hoping people will just give up. DON'T GIVE UP!!! Appeal immediately and document EVERYTHING. Every call, every person you talk to, every piece of paper. The burden of proof is on YOU even when THEY make the mistake!!!\n\nIf you can, get your state representative involved. That's what finally worked for me after months of getting nowhere. Good luck!!!

Oh my god, 4 months?? We can't wait that long for this money. I never thought about contacting our representative - that's a great idea. Did you just call their office and explain the situation?

YES! Call your state assembly member (not federal congressman). Most have staff dedicated to EDD issues because SOOO many people have problems. Google \

Question - is this a substance abuse rehab or mental health? Because they have different certification requirements. My husband went to a dual diagnosis place and they had to specifically document both the substance and mental health certifications for his SDI claim to go through. EDD kept denying saying they weren't certified but turns out they just needed different paperwork showing both certifications separately. Worth asking the facility if this could be the issue.

That's a really good point. It's primarily substance abuse treatment but they do provide mental health services too. I didn't realize they might need separate certifications for each. I'll definitely ask the facility about this tomorrow. Thank you!

After reading through all of this, I believe you're dealing with the DHCS certification issue. As of 2025, EDD requires treatment facilities to have an active certification from the Department of Health Care Services to qualify for SDI benefits. This is separate from their general business license or healthcare facility license.\n\nFor your appeal, make sure you include:\n\n1. The facility's current DHCS certification number\n2. The effective date of their certification\n3. Documentation of their current address registered with DHCS\n4. The NPI numbers of both the facility AND the provider who signed the disability certification\n\nIt sounds like there may be a mismatch in their system between the old address and new certification. Your facility's billing department should be very familiar with providing this documentation, as they need it for insurance billing as well.\n\nI'd suggest filing the appeal immediately while simultaneously trying to reach an EDD disability claims specialist who can potentially fix this without waiting for the formal appeal process.

This is incredibly helpful! I just called the facility and spoke with their compliance officer. She confirmed they have an active DHCS certification but said EDD might be confused because they received a new certification number when they changed locations last year. She's preparing all the documentation you mentioned and will email it to me today. I'll file the appeal immediately and also try to reach a specialist. Thank you so much for your expertise!

When I worked at a rehab facility in San Diego we had this EXACT issue with several patients! The problem was that EDD's database hadn't been updated with our facility's new DHCS certification info. We had to fax (yes, FAX in 2025!!) specific documentation to an EDD specialist department. \n\nThe patients who appealed all eventually got approved and received backpay, but it took 6-8 weeks. The most successful appeals included a letter from our medical director explaining the certification status and documenting other EDD claims that had been approved for patients at our facility.\n\nOne thing that helped speed things up was having the patient request an expedited appeal due to financial hardship. There's a specific form for this - I think it's called DE 6315 or something similar.

The expedited appeal form is actually DE 6305, and you're absolutely right that it can significantly speed up the process in cases of financial hardship. OP should definitely include this with their appeal package.

Thank you both for this information! I just downloaded the DE 6305 form and will include it with our appeal. The facility director is also writing a letter explaining their certification status and documenting other patients who have received SDI benefits. This whole system is so unnecessarily complicated!