Adult Medicaid Manual MA-1100 SSI MEDICAID-COUNTY DSS RESPONSIBILITY

II. COUNTY DSS RESPONSIBILITY FOR RETROACTIVE SSI MEDICAID

This section applies ONLY to individuals requesting retroactive Medicaid based on an SSI date of application. Individuals can also apply for retroactive Medicaid based on the Medicaid date of application at the dss. Refer to MA-2301, Conducting A Face To Face Intake Interview, for procedures when accepting and processing non-SSI retroactive Medicaid applications.

A. Policy Rules

1. The retroactive period for SSI Medicaid is the 1, 2, or 3 month period prior to the SSI month of application. This date is protected for any Medicaid coverage group.

2. An individual cannot apply for retroactive SSI Medicaid until his SSI application is disposed.

3. The a/r must apply for retroactive SSI Medicaid within 60 days (90 days with good cause) from the date of the SSI Medicaid approval or denial notice in order to protect the SSI retroactive period.

B. Establish Timely Application

1. Verify that the request for retroactive Medicaid is within 60 days of the date of the SSI Medicaid disposition notice generated by EIS:

a. View applicant's Medicaid approval or denial notice. The 60 day period begins with the Date Mailed on the Notice, or

b. Verify the case create date on the case data (cd) screen in EIS. This is the date the Medicaid notice is mailed. The 60 day period begins with the date the Medicaid notice was mailed,

or

c. Verify via the on-line SDX the date of SSI denial. The 60 day period begins with the date of the first Saturday after the SSI denial. This is the date the Medicaid notice is mailed. (Use this method to establish the date of the notice only when the applicant cannot provide his SSI Medicaid denial notice).

2. When more than 60 days but less than 90 days have elapsed, determine if good cause exists for failure to apply timely. Good cause is limited to:

a. The applicant states he did not receive the SSI Medicaid notice; or

b. The applicant dies; or

c. The applicant is incapacitated, incompetent, or unconscious and there is no representative acting on his behalf; or

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(II.B.)

d. The applicant or spouse, child, or parent, or representative of applicant is hospitalized for an extended period of time.

3. DO NOT TAKE AN APPLICATION FOR RETROACTIVE SSI MEDICAID WHEN THE REQUEST IS NOT TIMELY.

C. Establish the Retroactive Period

1. The retroactive period is the 1, 2, or 3 month period prior to the SSI month of application.

2. Always use the date in the SSI Application Date field to verify the retroactive period. It is located on screen two of the on-line SDX.

D. Register a DSS-8124

1. The application date entered on the DSS-8124 is the date the retroactive application is signed at the county dss. This is a new application, not a reapplication.

2. Enter the exact first and last name, Social Security number, and birth date as listed on the SDX.

IMPORTANT: EIS DATA MUST MATCH SDX DATA TO PREVENT FUTURE DISCREPANCIES.

3. Use the EIS individual ID number assigned to this individual.

4. The application must be MAA, MAD, or MAB.

5. On the retro date screen, place an S beside RSDI Or SSI Appeal Reversal/SSI APPL to indicate this is an SSI Retroactive application.

NOTE: Using the date screen allows retro Medicaid to be authorized based on the SSI date of application and application processing time to be based on the date the DSS-8124 is signed.

6. Enter the SSI date of application beside ORIG DTE OF APPLI on the date screen. Refer to EIS 2400 for further instructions.

E. Determine Eligibility In the Retro Period

1. Evaluate eligibility using categorically needy criteria. When the individual does not meet categorically needy income and/or resources limits evaluate under any Medicaid program (Medically needy, MAF, MIC, etc.)

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(II.E)

2. If it is an MAD application and disability has not been established for the retroactive period, follow instructions in MA-2525, Disability. This is an MAD-Y application. Send the required information to Disability Determination Services (DDS).

3. If eligible under any Medicaid coverage group in the retro period, approve the application as open/shut. Refer to EIS 4200 for instructions to authorize when eligibility is established under a Family and Children's coverage group.

4. Follow procedures in MA-2395, Corrective Actions and Responsibility For Errors, to request an override when the 365 day limit for filing claims has expired or less than 60 days remain before the time limit expires.

5. If the individual is not eligible in any Medicaid coverage group in the retro period, deny the application per MA-2304, Processing the Application.