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

V. COUNTY DSS RESPONSIBILITY WHEN SSI TERMINATES FOR INDIVIDUALS IN LTC

When SSI terminates due to the recipient entering long term care, the county dss will often have established eligibility for LTC before the SSI payment terminates according to procedures in IV. above. In that case follow procedures in V.A., below. If eligibility for LTC has not been established, follow procedures in V.B., below.

A. SSI Terminates - Eligibility for LTC Already Established

Take the following steps if the procedures in IV. above have been followed and LTC eligibility has been previously established within the past 6 months:

1. Contact the recipient or representative to determine whether there has been a change in income or assets. If there has been a change, reverify. Also verify status of the homesite and explain estate recovery provisions.

2. Review the Adult Medicaid Applications. The recipient or the representative does not have to sign the application form.

3. Begin the "ex parte" redetermination according to procedures in MA-1000, VII, SSI Medicaid-Automated Process.

REISSUED 10/01/05 – CHANGE NO. 28-05

(V.A.)

4. If the individual remains eligible:

a. The certification period begins the current processing month in EIS.

Example: Review completed September 27. The ongoing EIS month is November. The certification period is November 1 through April 30.

b. Adjust the PML if necessary.

5. Follow EIS instructions to post eligibility.

6. If there has been a change which makes the recipient ineligible, terminate the case.

B. SSI Terminates - Eligibility for LTC Not Established

There may be some situations in which the county does not know a recipient has entered LTC until the "ex parte" redetermination has begun.

If eligibility for payment of cost of care has never been established,

1. Follow procedures in MA-2230, Financial Resources, MA-2231, Community Spouse Resource Protection, MA-2240, Transfer of Resources, and MA-2270, Long Term Care Need and Budgeting, to establish financial eligibility for cost of care and patient liability.

2. Until it is determined that the recipient is eligible for nursing home cost of care and a PML is established the recipient may receive Medicaid continuation for PLA only (according to MA-1000, VII, SSI Medicaid-Automated Process.)

3. If the recipient is eligible for cost of care follow EIS instructions to post eligibility.

4. If the recipient is eligible for Medicaid but ineligible for nursing home cost of care for any reason, follow policy in MA-2270, Long Term Care Need and Budgeting, for PLA budgeting procedures.