Adult Medicaid Manual MA-1000 SSI MEDICAID AUTOMATED PROCESS

IV. SSI APPROVAL

When SSI is approved for an individual, the information on the SDX is matched to EIS to determine if the SSI individual is already in EIS. The purpose of matching is to prevent duplicate EIS individual ID's and benefits. If the individual is not in EIS, EIS creates a new case. If the individual is found in EIS, EIS creates a new case for the individual and closes or deletes him from the existing case, or in some cases modifies the existing case. Refer to EIS 4200, Part 3 for information. Also follow instructions in MA-1100, SSI Medicaid/County DSS Responsibility for county dss responsibility when an active Medicaid recipient or applicant in EIS is approved for SSI.

When the Social Security Number of an individual on the SDX matches with an individual in EIS but one of the other criteria does not match or the social security number is found more than once in EIS, EIS creates an exception report called the "SDX Exception List" which is online in EIS. The county dss must determine if the individuals are the same. It is very important to work the exception report weekly. See EIS 4200, Part 2 for instructions to resolve the discrepancies. UNTIL THE DISCREPANCY IS RESOLVED, EIS CANNOT PROCESS THE SSI MEDICAID CASE AND/OR ISSUE MEDICAID.

A. Reports

To assist with case management, EIS generates the report "SSI Medicaid Created/Modified in EIS" when a current EIS case or individual is modified as a result of an SSI approval, and when an SSI Medicaid case transfers into a county. These reports are displayed in NCXPTR. The last six versions are kept on-line. Each situation is identified separately. The EIS county number, district, aid program/category, casehead, case number, case id, SSI recipient name, and individual ID number are listed for each case. Any pending action deleted by EIS as a result of a case termination is also listed.

Refer to EIS 4200, Part 8 for instructions for this report.

See below for a chart of all the SSI Medicaid reports.

REVISED 11/01/11 – CHANGE NO. 17-11

(IV. A.)

SSI REPORTS

Name of Report	What It Lists	Sorted By	Online or Paper
SSI Medicaid Cases Created/Modified by EIS	Cases created/modified/terminated by EIS due to SDX Updates 1) Case Terminated 2) Individual Delete 3) SSI Medicaid 4) Review 5) New Individual 6) County Transfer 7) Inactive	County, District, message type, and alpha by last name	NCXPTR – last 6 versions
SSI Individual In EIS Pending Application	SSI Individual who had a pending application in EIS but now authorized for SSI Medicaid	County, District, and date of application (oldest first)	NCXPTR – Applications listed are retained on the report until dispositioned
SSI/Medicaid ID Registers SSI Medicaid Straggler Run/Register	Cards generated for SSI Medicaid recipients 1) Annual Run 2) Daily/Weekly Straggler	Alpha by name	NCXPTR – last 25 versions
SSI Approval-Medicaid Denied (TPR Refusal)	Denied due to failure to provide TPR info – SDX code - R	County, alpha by name	NCXPTR – last 8 versions
Medicaid Terminated – (TPR Refusal)	Medicaid terminated due to failure to provide TPR info – SDX code – R	County, District, program, and alpha by name	Paper mailed to the county
SSI Individual Receiving SAA/SAD/HSF	List of cases where client failed to provide TPR info, SDX code – R	District, program, alpha by name	Paper mailed to the county
SSI Exempt	Persons exempt from participation in Carolina Access	Exempt #, alpha by name	Paper mailed to the county
SSI Termination Report	Termination due to redetermination, death, moving out of state	District, post date, type action	NCXPTR - Case continues to display until the county processes the termination and deletes the case
SSI Termination Alert Report	The county has not redetermined eligibility, terminated the case, SSI has not been reapproved or a reapplication has not been dispositioned.	County, post date, alpha name	NCXPTR – Case continues to display until the county processes a redetermination.

REVISED 11/01/11 – CHANGE NO. 17-11

(IV.)

B. Approval Notice

When SSI is approved and an SSI Medicaid case is created in EIS, an automated Medicaid approval notice is generated that night. See DMA-5101, SSI Approval Notice.

C. Medicaid Card Issuance

1. For new SSI approvals, EIS issues Medicaid cards for SSI Medicaid approvals the same night the case is created in EIS. The State mails the cards from Raleigh the next work day. EIS generates the SSI Medicaid Straggler Register daily in NCXPTR.

2. Ongoing SSI Medicaid recipients are issued a yearly Medicaid card by EIS. An SSI/Medicaid Regular Run Register is generated in NCXPTR for identification. Regular run is the 11th work night from the end of the month.