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

VII. IN-HOME HEALTH SERVICES AND SUPPLIES

When an ongoing SSI recipient receives assistance with in-home health services and supplies, the county dss will be notified by the recipient, provider, or Medicaid claims contractor that a transfer of resources evaluation is needed. The dss is responsible for establishing eligibility by completing a transfer of resources evaluation. Refer to MA-2240, Transfer of Resources, for procedures.

A request for a transfer of resources evaluation is considered a change in situation that must be reviewed promptly. Refer to MA-2340, Change In Situation, for procedures.

Take the following steps to determine if an ongoing SSI Medicaid recipient is eligible for in-home health services and supplies:

REISSUED 10/01/05 – CHANGE NO. 28-05

(VII.)

A. Establish the County of Residence

Refer to MA-2221, County Residence.

1. If the recipient has established residence in another county, or the SDX shows the incorrect county of residence, the county dss in which the report appears must contact the county of residence immediately to advise them that a transfer of resources evaluation is needed.

Within 5 workdays, the first county must send a copy of the report to the county of residence who must complete the evaluation. The individual will remain on the first county’s report until the transfer of assets evaluation indicator has been updated even if the county of residence is changed in EIS.

2. If there is a conflict in county residency, refer to MA-2221, County Residence.

B. Establish a Case Record

Within 5 workdays of being notified of the need for the evaluation, the county of residence must contact the recipient verbally or in writing to determine if a non-allowable transfer has occurred.

In addition, send a DMA-5049, Referral to Local Social Security Office, to notify SSI of the correct county of residence.

1. If the recipient states there have been no transfers and the investigation does not prove otherwise, document the case record and update the Assets Transfer Tracking Screen to indicate that there is no transfer of resources sanction. Refer to MA-2240, Transfer of Resources, and EIS-3900, Assets Transfer Tracking Screen, for procedures.

2. If the recipient states that a non-allowable transfer has occurred, follow transfer of resources policy. Update the Assets Transfer Tracking Screen and assign sanction, if appropriate, following timely notice. Refer to MA-2240, Transfer of Resources, and EIS-3900, Assets Transfer Tracking Screen, for procedures.

3. If the recipient fails or refuses to respond to the request for information regarding transfer of resources, complete the EIS Assets Transfer Tracking Screen and impose an indefinite sanction following timely notice. Refer to MA-2240, Transfer of Resources, and EIS-3900, Assets Transfer Tracking Screen, for procedures.

REISSUED 11/01/11 - CHANGE NO. 17-11

(VII.)

C. Individual Eligible for In-Home Health Services and Supplies

When it is established that the recipient is eligible for payment of in-home health services and supplies, send the recipient a manual approval notice to continue assistance with these services.

D. Individual Ineligible for In-Home Health Services and Supplies

1. If the individual is ineligible for assistance with in-home health services and supplies due to a transfer of resources sanction, send the recipient a manual DSS-8110/DSS-8110S, Notice of Change In Benefits, to terminate assistance with these services. Refer to MA-2240, Transfer of Resources, for procedures.

2. Medicaid assistance continues for other covered services.

E. Assets Transfer Tracking Screen

When the transfer of resources evaluation is completed, update the evaluation indicator and/or sanction period in EIS. Refer to MA-2240, Transfer of Resources and EIS-3900, Assets Transfer Tracking Screen, for procedures.