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

VI. COMMUNITY ALTERNATIVES PROGRAM (CAP

A. SSI Medicaid recipients are eligible for services offered under the Community Alternatives Programs. SSA continues to determine Medicaid eligibility. However, the county dss is responsible for establishing eligibility for CAP. County responsibilities include:

1. Level of Care (FL-2/MR-2) in the record,

REISSUED 10/01/05 – CHANGE NO. 28-05

(VI.A.)

2. Plan of Care (The county dss or CAP lead agency) in the record,

3. Complete a DMA-5008, to evaluate for transfer of resources. Refer to MA-2240,

Transfer of Resources.

a. If a non-allowable transfer has occurred, follow transfer of assets policy. Assign sanction, if appropriate.

b. Do not authorize cost of care during sanction period.

4. Assess Community Spouse Resource Protection (CSRP), if applicable.

B. Continue to follow all rules and procedures in MA-2280, Community Alternatives Programs Medicaid Eligibility, to authorize CAP coverage for an individual who is already eligible for Medicaid. In addition, consider the following information for SSI recipients who are also eligible for CAP.

1. Deductible

SSI Medicaid recipients do not have a deductible under CAP.

2. EIS

a. The SDX will continue to control all elements in EIS for SSI recipients who are eligible for CAP except for the CAP indicator and effective date.

b. The county dss is responsible for:

(1) Entering in EIS the CAP indicator and effective date.

(2) Terminating CAP coverage in EIS.

3. Refer to EIS 3101 for instructions on posting CAP.