Adult Medicaid Manual MA-1000 SSI MEDICAID AUTOMATED PROCESS

REISSUED 10/1/05 – CHANGE NO. 29-05

I. INTRODUCTION TO SSI MEDICAID

North Carolina contracted with the Social Security Administration (SSA) under Section 1634 of the Social Security Act to determine Medicaid eligibility for aged, blind, and disabled individuals who receive SSI. This contract is called a “1634 Agreement” and was effective January 1, 1995. Under this agreement, an application for SSI is also an application for Medicaid. Individuals who are eligible for SSI also qualify for Medicaid. Eligibility for Medicaid begins with the first day of the month in which eligibility for SSI begins and continues as long as the individual remains eligible for SSI.

The SSA determination of SSI Medicaid eligibility includes assessment of categorical requirements, citizenship, income and assets, identification of third party resources and fraud notification. The Eligibility Information System (EIS) issues Medicaid cards and automated notices for these recipients. This is done independently from the issuance of the SSI check. The majority of SSI recipients receive Medicaid without any county dss action or intervention. However, there are special situations which require the county dss to explain and provide services and assistance to SSI Medicaid recipients.

When the SSI terminates, Medicaid may continue without a separate application. The SSI termination appears on the SSI TERMINATION REPORT and the Medicaid remains open. The county department of social services (dss) is responsible for initiating an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, such as Family and Children's Medicaid (including pregnant woman coverage), North Carolina Health Choice for Children, Work First Family Assistance, or Medicaid for the Aged, Blind and Disabled.

The purpose of this section is to explain the automated process which generates Medicaid eligibility based on SSI.