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

III. COUNTY DSS RESPONSIBILITY FOR SSI APPLICANTS WHO DIE PRIOR TO DISPOSITION

This section only applies to deceased individuals who applied for SSI prior to their death.

A. Policy Rules

1. The county dss can protect the SSI date of application for retroactive Medicaid and ongoing Medicaid when an SSI applicant dies before SSA establishes eligibility for SSI.

2. The representative must request Medicaid within 60 days (90 days with good cause) from the date of the SSI disposition notice.

B. Establish Timely Application

Follow instructions in II.B. to establish the application is timely.

C. Establish the Retroactive and Ongoing Period

1. The retroactive period is 1, 2, or 3 month period prior to the SSI month of application. Verify this date on screen two of the on-line SDX.

2. The ongoing period begins with the month of SSI application and continues through the month of death.

D. Register a DSS-8124

1. Enter the exact first and last name, social security number, and birth date as listed on the SDX or SSA record. This is a new application, not a reapplication.

REISSUED 10/01/05 – CHANGE NO. 28-05

(III.D.)

IMPORTANT: EIS DATA MUST MATCH SDX DATA.

2. If the deceased individual never applied for SSI, the application date entered on the DSS-8124 is the date the application is signed by the representative. Eligibility can be established no earlier than three calendar months prior to this date. Do not use the date screen when there is no SSI application date to protect.

3. When the individual applied for SSI, the SSI date of application is protected for Medicaid. Use the date screen and:

a. Place an S beside RSDI Or SSI Appeal Reversal/SSI APPL.

Note: Using the date screen allows 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.

b. 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

1. Complete a full determination of eligibility. If the individual does not qualify as categorically needy, evaluate in any Medicaid coverage group.

2. If it is an MAD application and disability has not been established, follow instructions in MA-2525, Disability, to send required information to Disability Determination Services (DDS).

3. If eligible in any Medicaid coverage group, approve the application as open/shut through the month of death. Refer to EIS 4200 to authorize assistance when eligibility is established in a Family and Children's coverage group.

4. Follow procedures in MA-2395, Corrective Action and Responsibility for Errors, to request an override when the 365 day limit for filing claims has expired or less than 45 days remain before the time limit expires.

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

REISSUED 10/01/05 – CHANGE NO. 28-05