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NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 3452

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AID PROGRAM/CATEGORY TRANSFERS TO SPECIAL ASSISTANCE PROGRAMS

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EIS 3452 – AID PROGRAM/CATEGORY TRANSFERS TO SPECIAL ASSISTANCE PROGRAMS

I. COMPLETING THE DSS-8125

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

TRANSFERRING FROM S-CD TO S-AD

REISSUED 10/01/07 - CHANGE NO. 02-08

I. COMPLETING THE DSS-8125

NOTE: EIS DOES NOT GENERATE AN AUTOMATED NOTICE FOR SA TRANSFERS.

A. Use the following instructions to complete the DSS-8125. Use the current Case Profile to determine what case and/or individual data must be changed to support the transfer from S-CD to S-AD. If a numeric field requires less digits than spaces available, precede with zeroes.

B. Enter the following required information to perform the aid program/category transfer.

1. Enter the CASEHEAD/PAYEE NAME at the top of the form for filing purposes.

2. Enter the COUNTY NAME.

3. Enter the CASE ID from the Case Profile.

4. Enter your WORKER NUMBER.

5. Enter the COUNTY NUMBER from the Case Profile.

6. Ensure the DISTRICT NUMBER on the Case Profile is correct. If incorrect, enter the appropriate DISTRICT NUMBER.

7. Enter "S" "AD" for AID PROGRAM/CATEGORY.

8. Enter the street address of the domiciliary care facility in ADDRESS LINE 1. Refer to the Mailing Address Appendix to determine the correct address abbreviations.

9. Enter the name of the domiciliary care facility in ADDRESS LINE 2. You must also enter the facility's unique identification code in the last three spaces of ADDRESS LINE 2. Refer to the Special Assistance Manual to determine the appropriate code.

10. Enter the CITY, STATE, and ZIP if different than indicated on the Case Profile. Refer to the Mailing Address Appendix to determine the correct abbreviations.

11. Enter the PAYMENT REVIEW PERIOD FROM and THRU DATES.

a. The PAYMENT REVIEW PERIOD must be twelve months.

b. The PAYMENT REVIEW FROM DATE must be the ongoing month.

12. Enter the MONTHLY PAYMENT AMOUNT.

a. The PAYMENT AMOUNT must be a whole dollar amount.

REISSUED 10/01/09- CHANGE NO. 01-10

I. B. 12. (CONT'D)

b. The PAYMENT AMOUNT must be the MAINTENANCE AMOUNT, minus the TOTAL COUNTABLE MONTHLY INCOME, minus the GRANT RECOUPMENT AMOUNT.

13. Enter the ongoing month for PAYMENT EFFECTIVE DATE.

14. Enter the first day of the ongoing month for MEDICAID EFFECTIVE DATE.

15. Enter a "C" in MEDICAID CLASS for categorically needy individuals. Enter a "Q" in MEDICAID CLASS if the individual is determined dually eligible.

16. Enter the new MAINTENANCE AMOUNT. The amount must be a whole dollar amount and have zeroes indicated in the cents column.

17. Enter the AMBULATION CAPACITY. See the Codes Appendix to determine the appropriate ambulation capacity code.

18. Enter the DOMICILIARY RATE. The amount must be a whole dollar amount and have zeroes indicated in the cents column.

19. Enter the following in INDIVIDUAL DATA:

a. INDIVIDUAL ID; and

b. LIVING ARRANGEMENT. See the Codes Appendix to determine the appropriate living arrangement code.

c. FAMILY PLANNING. See the Codes Appendix to determine the appropriate family planning code.

d. Enter the RELATIONSHIP TO PAYEE code. See the Codes Appendix to determine the appropriate code.

20. Enter the DATE the form is completed.

21. Sign the DSS-8125 in the WORKER'S SIGNATURE field.

22. The county director or his designee must sign the form in the DIRECTOR'S SIGNATURE field.

C. DO NOT ENTER the following information on the DSS-8125 when completing a transfer from S-CD to S-AD.

1. Case Data

a. VERIFICATION INDICATOR

b. CHANGE CODE

REVISED 10/01/09 - CHANGE NO. 01-10

I. C. 1. (CONT'D)

c. NOTICE OVERRIDE

d. APPLICATION NUMBER

e. ONGOING DISPOSITION REASON and DATE

f. RETRO DISPOSITION REASON and DATE

g. CASE TERMINATION REASON and DATE

h. OLD CASE TERMINATION REASON and DATE

i. MONTHLY PAYMENT TYPE

j. PRIOR MONTH PAYMENT 1 and 2 AMOUNT and DATE

k. MEDICAID STATUS

l. MEDICAID CERTIFICATION PERIOD

m. DB/PML CODE

n. DB/PML AMOUNT

o. RETRO MA 1 and RETRO MA 2 fields

p. CHILD/ADULT CARE

q. STEPPARENT INDICATOR

r. GRANDFATHER STATUS CODE and DATE

s. JOBS/WORK REQUIREMENT SAVINGS DATA

t. SPECIAL USE DATA

u. SPECIAL NEEDS DATA

2. Individual Data

a. CASE STATUS

b. FAMILY STATUS

c. WORK REGISTRATION

d. JOBS/WORK REQUIREMENT SAVINGS DATA

e. WORK EXPERIENCE

f. GROSS EARNED INCOME

g. CHILD/ADULT CARE

REVISED 10/01/09 - CHANGE NO. 01-10

I. C. 2. (CONT'D)

h. WORK EXPENSES

i. NET EARNED INCOME

j. EDUCATIONAL LEVEL

k. ISSUE CRD (See EIS 3105 for how to request replacement cards.)

D. Update other information on the DSS-8125 if necessary. Refer to Making Changes To Active Cases, EIS 3102, for instructions.

II. SUBMIT THE DSS-8125 TO DATA ENTRY FOR KEYING.

III. OUTPUTS

When the DSS-8125 processes successfully, the following are received:

A. A Case Profile is produced the night the transfer processes and is mailed to the county the following workday.

B. Benefits are produced in the following manner.

When the DSS-8125 processes by the 4^th workday from the end of the month, an S-AD check is produced for the ongoing month and is mailed to the recipient the last workday of the month.

C. The aid program/category transfer is reported on the Caseworker Supervisor Report. The number of aid program/category transfers completed is determined from the WORKER NUMBER.