Family and Children's Medicaid MA-3120 SSI MEDICAID

II. OVERVIEW OF AUTOMATED SSI MEDICAID PROCESS

A. State Data Exchange (SDX)

The SDX is how SSA transmits information regarding SSI recipients and applicants to the state. The state uses information on the SDX to create a Medicaid record in EIS for each SSI recipient. The SDX controls Medicaid eligibility for SSI recipients. Except for the situations identified later in this section, only the SDX can update information in EIS for a SSI recipient. This is true even when the county dss has verified information that is inconsistent with data on the SDX.

B. When SSI is Approved EIS Uses Information on the SDX To Automatically:

1. Create a new SSI MAABD case effective the month of SSI approval (but not prior to January 1, 1995) for an SSI recipient who is unknown to EIS or in a pending application in EIS, or

2. Modify an HSF case by setting the SSI status to “Y”. If the case is in deductible status, it is authorized, or

3. Modify a single person AAF case (payment type 5) by setting the SSI status to “Y”, or

4. Close any other single person case in deductible or authorized status in EIS and create an SSI MAABD case, or

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(II.B.)

5. Delete an SSI recipient from any multiple person case (MAF, MIC, etc.) in EIS and create an SSI MAABD case for the individual, and

6. Delete any pending 8125 action for any case terminated in EIS due to SSI approval.

C. Ongoing Automated Maintenance in EIS

For ongoing SSI Medicaid cases, EIS uses information on the SDX to automatically:

1. Update case and individual data in EIS.

2. Issue automated approval, denial, termination and redetermination notices.

3. Issue Medicaid cards for SSI recipients.

4. Change to ex parte status when SSI stops.

D. SSI Medicaid Recipients In EIS

A SSI Medicaid case is in EIS just as a regular Medicaid case is in EIS with case and individual data and history. SSI Medicaid recipient data is also available in Name Search.

1. SSI Status

The SSI status is “Y” for SSI recipients. It is “N” for all other recipients in EIS. The SDX controls the SSI status indicator. When the SSI status is “Y”, Medicaid cannot be terminated by the dss.

2. Aid Program/Category

The aid program/category is always MAA, MAB, or MAD except for the following situations:

a. SSI children in foster care may be HSF.

b. SSI recipients in a single person Transitional Medicaid case (payment type 5) remain AAF.

c. SSI recipients who also receive Special Assistance are SAA or SAD.

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(II.D.)

3. Classification

a. SSI recipients are always Categorically Needy (C) or (Q).

b. EIS controls the class for AAF (payment type 5).

c. The county dss controls the class for HSF and IAS.

4. Individual Eligibility History (IE)

a. The IE segment indicates the individual is an SSI Medicaid recipient beginning with the first month of SSI.

b. The certification thru date is 12/31/9999.

5. ID Cards

All SSI recipients receive a gray Medicaid card. HSF, AAF (payment type 5), SAD, SAA, and LTC cases retain the district number assigned by the county. For MAABD cases in a private living arrangement (pla), the district number is “SDX” on the EIS case and ID card to indicate the individual is an SSI Medicaid recipient.