Adult Medicaid Manual MA-1100 SSI MEDICAID-COUNTY DSS RESPONSIBILITY
REVISED 11/01/11 – CHANGE NO. 17-11
I. COUNTY DSS RESPONSIBILITY FOR SSI APPROVALS
This section provides instructions for situations in which the county dss may have interaction with SSI Medicaid recipients.
A. SSI Approval with Pending Application in EIS
1. Each individual in a pending application in EIS who begins to receive SSI is identified to the county dss on the report: DHREJ SSI IND IN EIS PENDING APP. This report is generated in XPTR at the time of the SDX weekly update. The application remains on the report until it is dispositioned. Refer to EIS 4200 for additional information on the report.
2. When SSI is approved, EIS creates an SSI Medicaid case for the individual and authorizes Medicaid effective the first month SSI is approved.
a. The pending application is not altered in any way.
b. The county dss must approve, deny, or withdraw its application.
c. Continue to follow application processing requirements in MA-2300, Initial Contact, through MA-2304, Processing the Application.
3. Single Person Application
a. Continue to process the application beginning with the month of application (ongoing and retroactive) through the month prior to SSI Medicaid authorization.
b. If the individual has a deductible, recalculate the ongoing deductible based on the income in the months beginning with the month of application through the last month prior to SSI Medicaid authorization.
c. Use the DMA-5097/DMA-5097S, Request For Information, or the DMA-5099/DMA-5099S, Medicaid Application Pending For A Deductible, to notify the individual of the revised deductible.
d. If the application is approved for the period prior to SSI authorization, approve open/shut.
e. If the individual is ineligible for Medicaid prior to SSI Medicaid authorization, deny the application per MA-2304, Processing the Application.
REISSUED 11/01/11 – CHANGE NO. 17-11
(I.A.)
4. Multiple Person Application (MAF, MIC, AAF)
a. Continue to process the application for the remaining individuals in the application.
b. Do not count the SSI individual's needs, income, or resources beginning with the month of SSI Medicaid authorization. Recalculate the deductible, if applicable.
c. Adjust the maintenance allowance for the remaining applicants effective the month the SSI individual's needs are deleted.
B. SSI Approval with Authorized Single Person Case in EIS
1. Each individual in an authorized single person case in EIS (except HSF, SA, AAF payment type 5) who begins to receive SSI is identified to the county dss on the DHREJ SSI MED CREATED/MODIFIED Report. The message is: CAS TRM-EIS has created an SSI Medicaid case. This report is generated in XPTR each time EIS is modified as a result of an SSI approval. Refer to EIS 4200 for additional information on the report.
2. When a single individual who is already authorized in EIS in any aid program/category is approved for SSI no further action is required.
3. For a married individual whose spouse is receiving non-SSI Medicaid:
a. React to the change in 30 days.
b. Treat the spouse as a budget unit of one.
c. Delete the SSI individual's needs, income, and resources from the spouse's budget effective the month of SSI Medicaid authorization. Apply the Maintenance Allowance adjustment.
d. Refer to MA-2340, Change in Situation, for instructions on deleting a budget unit member.
REVISED 10/01/05 - CHANGE NO. 28-05
(I.)
C. SSI Approval With Authorized Multiple Person Case in EIS (MAF, MIC, AAF)
1. Each individual in an authorized multiple person case in EIS who begins to receive SSI is identified to the county dss on the DHREJ SSI MED CREATED/MODIFIED Report. The message is: IND DEL-EIS has created an SSI Medicaid case. This report is generated in XPTR each time a case in EIS is modified as a result of an SSI approval. Refer to EIS 4200 for additional information on the report.
2. React to the non-SSI case within 30 days.
3. Delete the SSI individual's income from the ongoing non-SSI case effective the month of SSI Medicaid authorization.
4. Change the maintenance allowance to delete the SSI individual's need.
5. If the change causes the case to have a deductible, send a timely notice.
6. Refer to the Family and Children’s Manual, MA-3410, Terminations and Deletions for instructions on deleting an assistance unit member.
D. SSI Approval with Deductible Case in EIS (MAABD or MAF)
1. An SSI approval for an individual in a single person MAABD or MAF case in deductible status in EIS is identified to the county dss on the DHREJ SSI MED CREATED/MODIFIED Report. The message is: CAS TRM-EIS has created an SSI Medicaid case. This report is generated in XPTR each time a case in EIS is modified as a result of an SSI approval. Refer to EIS 4200 for additional information on the report.
2. SSI Medicaid is authorized effective the month of approval for SSI, but not prior to January 1, 1995.
a. Recompute the six month deductible based only on the income in the months in the certification period prior to SSI Medicaid authorization.
b. Notify the individual of the revised deductible.
c. If the revised deductible is met, authorize for the period of time prior to SSI Medicaid authorization.
3. If the SSI individual has a non-SSI spouse, review the spouse's case:
REVISED 10/01/05 - CHANGE NO. 28-05
(I.D.3)
a. Treat the non-SSI spouse as a budget unit of one effective the month the SSI individual is authorized for SSI Medicaid. Apply Maintenance Allowance Adjustment.
b. Follow MA-2340, Change In Situation, or Family and Children’s Manual, MA-3410, Terminations and Deletions, for instructions to delete budget unit members.
4. If the SSI recipient is in deductible status in a multiple person MAF case the message is: IND DEL-EIS has created an SSI Medicaid case.
a. Recalculate the six month deductible based on the number of months the SSI individual was in the certification period.
b. Delete the SSI individual from the budget unit effective the month of SSI Medicaid authorization.
c. Notify the ongoing MAF case of the amount of the new deductible.
E. SSI Approval with MQB Case in EIS
1. Each individual in an authorized MQB case in EIS who begins to receive SSI is identified to the county dss on the DHREJ SSI MED CREATED/MODIFIED Report. The message is: CAS TRM-EIS has created an SSI Medicaid case. This report is generated in XPTR each time an MQB case in EIS is terminated and a MAABD case is created as a result of an SSI approval. Refer to EIS 4200 for additional information on the report.
2. If the MQB recipient was on a deductible, follow instructions in D. above, to recalculate the six month deductible for the SSI individual for the period prior to the SSI Medicaid authorization.
F. SSI Approval with Existing HSF Case
1. When an authorized HSF recipient is approved for SSI, the SSI status is set to "Y". The case remains in HSF. This situation is not identified on the DHREJ SSI MED CREATED/MODIFIED Report.
2. If the HSF case is in deductible status, the SSI status is set to "Y" and the case is automatically authorized effective the month of SSI approval. Individuals in HSF who go from deductible status to authorized are identified on the DHREJ SSI MED CREATED/MODIFIED Report. The message is: SSI MED-Non-SSI EIS cases that change to SSI Medicaid. Follow instructions in D., above to recompute the deductible for the time prior to SSI Medicaid authorization, if applicable.
REVISED 10/01/05 – CHANGE NO. 28-05
(I.F.)
REISSUED 10/01/05 – CHANGE NO. 28-05
