Special Assistance Administrative Letters

Administrative Letter No. DAAS-07-22 - COLA 2008 (Obsolete 03/12/08, Change Notice 01-08)

Division of Aging and Adult Services - Adult Services Section

Date:	November 6, 2007
Subject:	Social Security Cost-of-Living Adjustment (COLA 2008) and VA Cost-of- Living Adjustment (COLA 2008) for Special Assistance Program
Distribution:	County Directors Special Assistance Supervisors
Effective Date:	January 1, 2008

I. SOCIAL SECURITY and VETERAN’S CHANGES DUE TO COLA ADJUSTMENT

A. RSDI/SSI

Effective January 1, 2008, recipients of RSDI and/or SSI will receive a 2.3% cost-of-living increase in their monthly benefits.

B. SSI Federal Benefit Rate (FBR)

Effective January 1, 2008, the SSI FBR for an individual will increase to $637 per month.

C. Veteran’s Benefits (VA)

Effective January 1, 2008, most recipients of Veteran’s Benefits will receive a 2.3% cost-of-living increase in their monthly benefits.

II. RECIPIENT NOTICE OF COLA

All SA recipients who are authorized as of the November regular run (November 19) will be sent a notice with the December 2007 SA checks. This notice satisfies the notice requirements in SA-3330. Please see Attachment 1.

III. ONGOING CASES AUTOMATICALLY UPDATED IN EIS

EIS will automatically calculate the January 2008 Special Assistance payments to reflect the 2.3% COLA increase in RSDI/SSI benefits. SA cases in EIS with correct information will be updated on the night of November 27, 2007. The payment effective date will be January 1, 2008.

Note: EIS will not automatically calculate the January 2008 Special Assistance payments to reflect the COLA increase in VA benefits. IMC’s will need to evaluate these cases to recalculate the SA payment.

The SA CASE UPDATED - AUDIT RPT is a list of all updated cases and will be available in XPTR on November 28, 2007, under the name ‘DHREJA SA CASE UPDATED-AUDIT RPT’.

This report will show the recipient’s name, listed in alphabetical order by district number, the county case number, the case ID number, the old and new SA payment amounts, the old and new RSDI/SSI amounts, and the adult care home rates. The $20 General Income Exclusion will be included in the new payment calculation for these cases.

Case profiles for each updated case listed on the Audit Report will be generated and displayed in NCXPTR under the name ‘DHREJA SA RSDI COLA PROFILES’. No paper reports will be generated for any other report, but will be displayed in NCXPTR.

A. Cases Updated in EIS

Within 30 days of the update, verify the new RSDI amount through SOLQ. If the amount is different from that on the SA CASE UPDATED-AUDIT RPT, revise the payment amount as soon as the action can be taken and the appropriate notice can be sent.

B. Cases Updated in EIS, But Changes Occur After November 27, 2007 That Affect the Payment

1. Recompute the SA payment amount. When computing the new payment, use the case profile information to determine the revised RSDI/SSI amounts. These cases will have the $20 General Income Exclusion given automatically; do not give another $20 exclusion.

2. Send an adequate notice if the recipient received the notice with the December check.

3. Key the DSS-8125 no later than December 21, 2007 to reflect the correct payment amount effective January 1, 2008 or termination.

4. Verify the new benefits through SOLQ with those shown on the SA CASE UPDATED-AUDIT RPT. If the amounts are different, revise the payment amount as soon as the action can be taken and the appropriate notice can be sent.

IV. ONGOING CASES NOT UPDATED IN EIS

A. Reports of Cases Not Updated

The following reports identify cases that were not automatically updated by EIS. You must manually update all cases listed on these reports following instructions in B. below.

These reports will be available in XPTR on November 28, 2007. No paper copies will be generated.

1. SA Error Report – Cases Not Updated – These cases could not be automatically updated by EIS due to errors in the case data in EIS. This is displayed in NCXPTR under the name ‘DHREJA SA ERROR: CASES NOT UPDTE’. The error messages include:

a. MAINT NOT $1,219, $1,561 or $1,277: Cases with the Maintenance Amounts that are not equal to $1,219, $1,561 or $1,277.

b. PAYMT NOT EQUAL DIFF: The Maintenance Amount minus the Total Countable Monthly Income minus the Grant Recoupment Amount does not equal the Monthly Payment Amount.

c. SSI AND RSDI = ZERO: There are no entries for SSI and RSDI in EIS.

d. UNEARN INC = ZERO: Either the Net Unearned Income amount or the Total Countable Monthly Income amount is zero.

e. TOT MO INC NOT BAL: The total of the RSDI, SSI plus other unearned income and case level net earned income does not equal the Total Countable Monthly Income amount plus $20.

f. SSI NOT $623: The SSI amount, which is present in EIS, is not $623, and there is no RSDI amount present.

g. SSI IND Y – NO SSI: The SSI indicator is Y and no SSI amount is entered.

h. RSDI & SSI AMOUNT INVALID: The total of the RSDI and SSI amounts exceeds allowable limit of $637.

i. TOT UNEARN IS < RSDI & SSI: The total unearned income is less than RSDI and/or SSI.

j. CASE PENDING: These are cases that contained a pending DSS-8125 at the time of the mass change.

2. SA Potential Terminated Cases – These are cases in which the Monthly Payment Amount is less than $1.00 as a result of the increased RSDI/SSI. This is displayed in NCXPTR under the name ‘DHREJA SA POTENTIAL TERMINA CASE’. These recipients potentially have income that exceeds the allowable income limit based on their ambulation capacity, and the cases may require termination.

Instructions for Medicaid Passalong for Terminated Cases – Evaluate cases terminated due to the COLA increase for eligibility for continued Medicaid under passalong provisions. Refer to MA-2110, Passalong for instructions for determining if Medicaid passalong applies. Use Attachment 2 in MA-2110 to document whether the recipient is eligible for Medicaid passalong. If the recipient is eligible for Medicaid passalong, take the following actions in EIS:

a. Key a DSS-8125 to transfer the case to Medicaid. The classification is always “N”.

b. Enter the code “PC” in the Individual Special Use field on the individual level in EIS.

c. You will get an error message. Put the form on hold and call an EIS consultant at 919-855-4000. EIS will contact DIRM to process the case.

d. If changes later occur in a passalong case, follow the same procedure. Key the DSS-8125, put it on hold and call EIS to process the case.

3. SA Potential Zero-Pay Cases

These are cases whose Monthly Payment Amount is $1.00, $2.00, $3.00, or $4.00 as a result of the increased RSDI/SSI increase. This is displayed in NCXPTR under the name ‘DHREJA SA POTENTIAL ZERO PAY CAS’.

It is important when manually updating these cases to record the actual Total Countable Monthly Income in the case record for future budgeting purposes. Enter the ACTUAL payment amount ($1.00, $2.00, $3.00 or $4.00) in the Monthly Payment Amount field. Enter a payment effective date of 012008.

4. Disenfranchised Cases (Ambulation Capacity Code “A” and “S”)

This report identifies disenfranchised cases:

a. DHREJA SA A&S CAP DISENFRANCH - This is a list of all disenfranchised cases that contain an ambulation capacity code “A” or “S”. These cases must be manually updated if EIS was unable to automatically update.

These disenfranchised recipients who have a Total Countable Monthly Income of $1,276.51 or greater should be terminated, unless they meet the income and eligibility criteria for the SA Special Care Unit (SCU), ambulation capacity code ‘C’. The SCU total countable monthly income limit is $1,560.50. Follow instructions in DAAS Admin Letter 05-08 to evaluate for SCU eligibility.

Some of the originally disenfranchised recipients may have, at some point since October 1, 1995, met the income limit for Basic SA (ambulation capacity ”B”) due to either a decrease in income or an increase in the Basic Adult Care Home rate. If so, these individuals could have been switched to the Basic SA group. If the Total Countable Monthly Income is now between $1,218.50 and $1,276.50, do not terminate. As long as a disenfranchised recipient’s Total Countable Monthly Income does not exceed $1,276.50 and he/she meets all other eligibility requirements, SA eligibility continues.

When manually updating these cases, the following special instructions apply:

a. Review the case carefully to confirm that the recipient was in the original disenfranchised group “A” or “S”.

b. Verify the Ambulation Capacity indicated on the latest FL-2.

c. Recalculate the budget using the appropriate Adult Care Home rate ($1,231 for “A” or “S”) and the Maintenance Amount ($1,277 for “A” or “S).

d. If the SA Payment Amount after rebudgeting is $1.00, $2.00, $3.00 or $4.00, the case will become Zero-Pay.

5. VA Error Report

These are all SAA and SAD cases that contain a VA indicator of ‘Y’. You must manually update these cases. The report is displayed in NCXPTR under the name: ‘DHREJA SA VA PAYMENT ERROR CASES’.

SA In-Home Program Recipients

A report has been created in NCXPTR under the name:  DHREJA SA DEMO IN-HOME AS OF. The report is entitled:  SA IN-HOME RECIPIENTS AS OF NOV272007. This report identifies all Special Assistance Cases that contain an ambulation capacity code ‘H’ as of the night of November 27, 2007. To access, it may be necessary to add this report your profile.

These are SAA and SAD In-Home cases with an Ambulation Capacity Code “H.” If your county is one of the SA In-Home Program counties, you must manually update these cases. SA In-Home Program recipients have a case manager and a service plan, and it is important to coordinate with the case managers to ensure that they are aware of changes and can alter service plans as necessary.

SA In-Home Program cases with a Total Countable Monthly Income greater than $851.00 should be terminated. To determine Medicaid income eligibility, do not round income. Use the actual countable income to compare to the income limit of $851.

B. Procedures for Manually Updating Ongoing Cases Not Updated By EIS

1. After November 27, 2007 do not key a change in income for any case with RSDI or SSI until the new RSDI/SSI amount is verified.

2. Verify the new benefits from SOLQ.

3. Send a notice to notify the recipient of the change. An adequate notice is sufficient if the recipient was authorized in November and received the notice with the December check.

4. Key a DSS-8125 no later than December 22, 2007 to reflect the correct payment amount effective January 1, 2008 or termination.

V. APPLICATIONS AND REAPPLICATIONS APPROVED AFTER NOVEMBER 27, 2007

A. Payments Effective Prior to January 1, 2008

Use the previous RSDI, SSI and VA amounts and the $20 General Income Exclusion. Key the DSS-8125 and/or DMA-5022 to approve the case and issue benefits. You may notify the recipient on the approval notice of the payment amounts prior to and after January 1, 2008.

B. Payment Effective January 1, 2008

Use the revised RSDI, SSI and VA amounts and the $20 General Income Exclusion to determine eligibility and payment amounts from January 1, 2008, forward.

C. Zero-Pay Cases

It is important when manually updating these cases to record the actual Total Countable Monthly Income in the case record for future budgeting purposes. Enter the ACTUAL payment amount ($1.00, $2.00, $3.00 or $4.00) in the Monthly Payment Amount field. Enter a payment effective date of 012008.

If you have any questions regarding this information, please contact your Adult Programs Representative or Brenda Porter, Special Assistance Program Coordinator, at 919-733-3818.

Sincerely,

Dennis W. Streets, Director

Attachment

IMPORTANT NOTICE TO

RECIPIENTS OF SPECIAL ASSISTANCE FOR ADULTS (SA) IN ADULT CARE HOMES

December 1, 2007

If you receive a Social Security check and/or Supplemental Security Income (SSI) check, or Veterans Administration (VA) check, your Social Security/SSI check and/ or VA check will increase effective January 1, 2008 due to the yearly Cost of Living Adjustment. This increase in your Social Security/SSI/VA check will have an effect on your SA check because Social Security, SSI, and VA benefits are counted in determining the amount of your SA check. If your Social Security, SSI, or VA check increases, your SA check will decrease.

Hearing Rights: If you disagree with this decision, you have a right to ask for a hearing. To ask for a hearing, call or write your caseworker within sixty (60) days, that is by January 30, 2008. If you do not ask for a hearing by that date, you cannot have a hearing. A local hearing will be held within 5 days of your request unless you ask for it to be postponed for good reason for an additional 10 days. The hearing will establish whether this action was correct. Then, if you think the decision in the local hearing was wrong, call or write your caseworker within 15 days of the local hearing to ask for a second hearing before a state hearing officer.

You may have someone speak for you at your hearing, such as a relative or an attorney obtained at your expense. Free legal services may be available in your community. Contact your caseworker for information on free legal services.

If you ask, your caseworker will show you and the person speaking for you your eligibility record before your hearing. You may ask to see other information used at the hearing.

Attachment 1