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

VIII. EMERGENCY CERTIFICATION FOR MEDICAID

A. There may be some instances when an SSI recipient needs a Medicaid card before EIS can automatically issue a card. This may occur when:

1. A newly approved SSI recipient has not received Medicaid due to SSA lag time in updating the SDX or between receipt of SDX and processing of this data by EIS.

2. An SSI recipient recently established residency in North Carolina and is not yet on North Carolina's SDX.

3. The SDX does not verify eligibility due to a problem with the SSA system.

B. Procedures

When an individual requests emergency Medicaid:

1. Document an emergency situation exists.

a. An emergency situation exists when there is an immediate medical need that cannot be met without a current Medicaid card. For example, an individual needs heart medication and the pharmacist will not fill the prescription without a Medicaid card.

REVISED 11/01/11 – CHANGE NO. 17-11

(VIII.B.)

b. When an individual has a Medicaid card from another state, verify if the provider will accept the other state's Medicaid. If not, initiate emergency card procedures.

2. Establish SSI eligibility. SSI eligibility can be established by verifying the individual is on the SDX Exception List, on-line SDX, SOLQ, or by the emergency certification.

a. First, verify whether the individual is on the exception list because data in EIS did not match with data on the SDX. In this situation, do not issue an emergency card. Work the exception report and the card is issued automatically by EIS in the nightly cycle.

b. If the case is not on the exception list, view the on-line SDX. When the individual is on the SDX in current pay status (CO1), SSI eligibility is established.

c. Counties may use SOLQ to verify SSI for emergency Medicaid. Using SOLQ should eliminate the need most often for using the DMA-5050, Emergency Certification for Medicaid.

d. When the individual is not on the exception list, the on-line SDX, or SOLQ, the DMA-5050, Emergency Certification for Medicaid, must be completed by SSA to establish SSI eligibility and North Carolina residence.

e. The DMA-5050, Emergency Certification for Medicaid, may be initiated by DSS or SSA. The completed form:

(1) Verifies that the individual is eligible for SSI in the current month, and

(2) Verifies the individual is a North Carolina resident, and

(3) Provides all the necessary identifying information needed to issue a Medicaid card.

3. When SSI eligibility has been established via the SDX, SOLQ, or the Emergency Certification form:

a. Enter an administrative DSS-8124 (unsigned and untracked). Mark ADMINISTRATIVE.

b. Use exact Social Security number, last name, first name, and date of birth as the SSA record. This ensures the same EIS Individual ID is used when the SSI Medicaid case is created.

REISSUED 11/01/09 - CHANGE NO. 16-09

(VIII.B.3.)

c. The system will set the SSI status to “N”.

d. Approve open/shut for the current month only.

e. Retain the DMA-5050, Emergency Certification for Medicaid, indefinitely.