Family and Children's Medicaid MA-3120 SSI MEDICAID

III. COUNTY DSS RESPONSIBILITY WHEN SSI IS APPROVED

A. Exception Processing

When SSI is approved for an individual, the information on the SDX is matched to EIS to determine if the SSI individual is in EIS. This is necessary in order for EIS to know whether to create a new SSI Medicaid case or modify an existing EIS case to SSI Medicaid.

1. Match Criteria

In order to make the decision, the SDX matches with EIS on four criteria:

a. Social Security Number

b. First Name

c. Last Name

d. Date of Birth

REISSUED 11/01/09 – CHANGE NO. 14-09

(III.A.)

2. Partial Match

When SSI is approved for an individual, the information on the SDX is matched to EIS to determine if the SSI individual is already in EIS. The purpose of matching is to prevent duplicate EIS individual ID's and benefits. If the individual is not in EIS, EIS creates a new case. If the individual is found in EIS, EIS creates a new case for the individual and closes or deletes him from the existing case, or in some cases modifies the existing case. Refer to EIS 4200, Part 3 for information. Also follow instructions in MA-1100, SSI Medicaid/County DSS Responsibility for county dss responsibility when an active Medicaid recipient or applicant in EIS is approved for SSI.

When the Social Security Number of an individual on the SDX matches with an individual in EIS but one of the other criteria does not match or the social security number is found more than once in EIS, EIS creates an exception report called the "SDX Exception List" which is online in EIS. The county dss must determine if the individuals are the same. It is very important to work the exception report weekly. See EIS 4200, Part 2 for instructions to resolve the discrepancies. UNTIL THE DISCREPANCY IS RESOLVED, EIS CANNOT PROCESS THE SSI MEDICAID CASE AND/OR ISSUE MEDICAID.

B. SSI Approval with Pending Family and Children’s Medicaid Application

1. Each individual in a pending application in EIS who begins to receive SSI is identified to the county dss on the report: SSI IND IN EIS PENDING APP. This report is generated in NCXPTR 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 automatically creates an SSI Medicaid case for the individual and authorizes MAABD 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 this application.

c. Continue to follow application processing requirements in MA-3215, Processing the Application.

3. Single Person Application

a. Process the application for the period of time covered by the application (ongoing and retroactive) prior to SSI Medicaid authorization.

REVISED 10/1/05 – CHANGE NO. 23-05

(III.B.3)

b. If the individual has a deductible, recalculate the ongoing deductible based on the number of months beginning with the month of application through the last month prior to SSI Medicaid authorization.

c. Use the DMA-5097, 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-3215, Processing the Application.

4. Multiple Person Application (MAF, MIC, AAF)

a. Continue to process the application for the remaining individuals in the application.

b. Delete the SSI individual from the assistance unit, the budget unit and needs unit effective the month of SSI Medicaid authorization.

c. Adjust the maintenance allowance for the remaining applicants effective the month the SSI individual is deleted.

d. Recalculate the deductible, if applicable, for the months in the certification period prior to SSI authorization and for the ongoing case.

C. SSI Approval With Active Case in EIS (other than HSF or AAF)

1. Each SSI approval who is in an active case in EIS is identified to the county dss on the SSI MED CREATED/MODIFIED Report. 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. Single Person Case

a. When an authorized individual in any aid program/category except HSF or AAF is approved for SSI, no further action is required.

b. When an individual in deductible status is approved for SSI, take the following steps:

REVISED 10/1/05 – CHANGE NO. 23-05

(III.C.2.b.)

(1) Recompute the six month deductible based only on the income and the number of months in the certification period prior to SSI Medicaid authorization.

(2) Notify the individual of the revised deductible.

(3) If the revised deductible is met, authorize for the period of time prior to SSI Medicaid authorization.

3. Multiple Person Case (MAF, MIC)

a. React to the non-SSI case within 30 days.

b. Delete the SSI individual from the budget unit/needs unit effective the month of SSI Medicaid authorization.

c. Recalculate the six month deductible, if applicable, based on the number of months the SSI individual was in the certification period.

d. Notify the ongoing MAF case of the amount of the new deductible.

e. If the change causes the case to have a deductible, send a timely notice.

f. Refer to MA-3410, Terminations and Deletions, for instructions on deleting an assistance unit member.

D. SSI Approval with Active HSF Case in EIS

Special provisions were made to allow SSI children in county custody to remain in HSF. This allows the county dss to continue to update certain data elements in EIS. This is necessary because children in dss custody may have an address and county number on the SDX other than the Medicaid county of residence. Also, this allows the State to identify children in dss custody for federal reporting purposes.

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 SDX/EIS Updates Report.

2. If the HSF case was in deductible status, the case is automatically authorized. Individuals in HSF who go from deductible status to authorized are identified in the SDX/EIS Updates Report. Follow instructions in C., above to recompute the deductible for the time prior to SSI Medicaid authorization, if applicable.

REVISED 10/1/05 – CHANGE NO. 23-05

(III.)

E. SSI Approval for Individual in Transitional Medicaid Case

Because of EIS system constraints an individual receiving transitional benefits (single person AAF payment type 5) who becomes eligible for SSI remains authorized as a transitional case.

1. When a single person Transitional Medicaid case is approved for SSI the case remains AAF (payment type 5).

2. EIS sets the SSI status to “Y.” The individual will receive automatic Medicaid.