Family and Children's Medicaid MA-3120 SSI MEDICAID

IV. COUNTY DSS RESPONSIBILITY FOR ONGOING SSI RECIPIENTS

A. SSI Child in County Custody (HSF)

1. The county dss continues to be responsible for county custody and placement.

2. The county dss retains the capability to update address, county, district number, and county case number.

3. Only the SDX can update the following fields in EIS:

a. SSI Status

b. Certification Thru

c. RSDI Claim Number

d. First Name, Middle Initial, Last Name

e. SSN

f. Date of Birth

g. Sex

NOTE: The county DSS may discover information on the SDX is incorrect. The information may not affect SSI eligibility, but it is causing a problem with Medicaid claims, buy-in or some other factor that affects Medicaid eligibility. Use the DMA-5049 to report this information immediately to SSA. Use “Other” to specify the problem. In the unusual situation that SSA does not react to changes reported by the client or dss and it is causing a hardship for a recipient or provider, contact DMA, Medicaid Eligibility Unit. A policy consultant will work with you on a case by case basis.

REVISED 10/1/05 – CHANGE NO. 23-05

(IV.)

4. When an SSI child who is in HSF is no longer in county custody, he must be taken out of HSF.

a. As long as he receives SSI his Medicaid cannot be terminated.

b. Enter a DSS-8125 to transfer the HSF case to MAABD. Refer to EIS 4200 for instructions.

5. When an SSI recipient who is receiving Medicaid under MAABD enters county custody, the county dss can transfer the child to HSF.

a. As long as he receives SSI his Medicaid cannot be terminated.

b. Enter a DSS-8125 to transfer the MAABD case to HSF. Refer to EIS 4200 for instructions.

B. SSI Recipient in Single Person Transitional Case (AAF type 5)

1. The county dss retains the capability to update address, county, district number, and county case number.

2. Only the SDX can update the following fields in EIS:

a. SSI Status

b. RSDI Claim Number

c. First Name, Middle Initial, Last Name

d. SSN

e. Date of Birth

f. Sex

3. At the end of the transitional certification period, the individual must be transferred to MAABD.

a. Enter a DSS-8125 to transfer the AAF case to MAABD.

b. Refer to EIS 4200 for instructions.

REVISED 11/01/11 – CHANGE NO. 15-11

(IV.B)

4. An individual authorized for SSI Medicaid under MAABD cannot be transferred to Transitional Medicaid.

C. Reporting Changes

1. The county dss retains the capability to update certain fields in EIS for SSI recipients in HSF or AAF (payment type 5). Therefore, these recipients must report changes that affect Medicaid to the county dss. When changes are reported, treat this as change in situation. Update the allowable fields in EIS.

2. When an SSI recipient reports health insurance information to the dss, complete a DMA-2041. Enter this information in EIS. If the recipient does not have enough information to enable you to complete the DMA-2041, instruct him to obtain the additional information and advise him to contact you with the information as soon as possible.

3. When an SSI recipient also receives Food and Nutrition Services or other services, advise the recipient to report changes to the appropriate dss office.

4. When the dss learns of a change in an SSI Medicaid recipient’s situation that might affect his eligibility for SSI and Medicaid, and the client does not/cannot report the change to SSA, use the DMA-5049, Referral to the Local Social Security Office, to report information to the local SSA office. Use this referral only when SSA is not aware of the change in situation. Examples of when to use the DMA-5049:

a. DSS learns SSI recipient dies,

b. SSI recipient enters a public institution, nursing facility, or rest home,

c. DSS learns information that affects the SSI payment,

d. DSS suspects fraud.

D. Retroactive Medicaid

SSI applicants/recipients are eligible for retroactive Medicaid for the 1, 2, or 3 month period prior to the SSI month of application. The SSI date of application is protected for any Medicaid coverage group. (Individuals can continue to apply for retroactive Medicaid based on the Medicaid date of application at the dss. Refer to MA-3200, Initial Contact, for rules for accepting and processing non-SSI retroactive Medicaid applications.)

The a/r must apply for retroactive Medicaid within 60 days (90 days with good cause) from the date of the SSI Medicaid approval or denial notice in order to protect the SSI retroactive period.

REVISED 11/01/11 – CHANGE NO. 15-11

(IV.D)

The vast majority of SSI recipients will receive retroactive Medicaid under MAABD. Refer to MA-1100 of the Aged, Blind and Disabled Manual. In limited situations an individual can receive retroactive SSI Medicaid under a Family and Children’s aid program/category.

1. Do not evaluate under a Family and Children’s aid program/category unless the individual does not meet the eligibility requirements for MAABD.

2. The application date entered on the DSS-8124 is the SSI date of application. Mark the application “Administrative”. The SSI date of application is located on screen two of the on-line SDX.

3. Enter the exact first and last name, Social Security number, and birth date as listed on the SDX.

IMPORTANT: EIS DATA MUST MATCH SDX DATA TO PREVENT FUTURE DISCREPANCIES.

4. Use the EIS individual ID number assigned to this individual.

5. If eligible in the retro period, approve the application as open/shut.

6. Follow procedures in MA-3530, Corrective Actions and Responsibility for Errors, to request an override when the 365 day limit for filing claims has expired or less than 45 days remain before the time limit expires.

7. If the individual is not eligible in the retro period, deny the application per MA-3215, Processing the Application.