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CHANGE NOTICE FOR MANUAL
DATE: May 16, 2003
Manual: State/County Special Assistance for Adults
CHANGE NO: 01-03, SPECIAL ASSISTANCE PROGRAM MANUAL UPDATES
To: County Directors of Social Services
Effective: June 1, 2003
I. Content of change
A. SSI Eligibility Requirements
SA-3100, Eligibility is revised to clarify that to be eligible for Special Assistance, an individual must be eligible for SSI, or ineligible for SSI solely based on income. Special Assistance is a state supplemental payment under federal SSI regulations.
The eligibility requirements are separated for SSI and non-SSI recipients. SSI recipients automatically meet most eligibility requirements (citizenship, income, resources) for SA and these do not require separate verification. You must establish that the SSI recipient meets non-SSI criteria (North Carolina residency, age for SAA and SAD, residence in an SA facility, current FL-2).
The eligibility requirements for non-SSI recipients are updated to include reference to the transfer of resources requirements that were implemented in November 2002.
B. Establishing Disability for SAD Applicants
SA-3110, Application Processing now provides expanded instructions for establishing disability when an individual applies for Special Assistance for the Disabled and disability has not been established. The applicant must apply for disability with the Social Security Administration. Do not submit SAD applications to Disability Determination Services to establish disability, unless SSA will not determine disability and the applicant meets all other eligibility criteria for Special Assistance. If the applicant makes a separate application for MAD, follow the procedures in the Medicaid manual for submitting the Medicaid application to DDS.
If SSA denies or terminates benefits due to not being disabled, the individual is not eligible for Special Assistance. If the Social Security decision is appealed and the denial is overturned, the denied SA application or terminated case may be reopened if certain criteria are met. The individual is not required to request a separate appeal for the SA if the denial or termination is based on a Social Security decision.
C. Time Standards and Pending Applications
SA-3110, Application Processing is also revised to eliminate pending applications while awaiting information from the applicant or a third party (other than Social Security). Continue to pend applications while awaiting a Social Security decision.
The time standard for processing applications remains 45 days for SAA and 60 days for SAD. To deny an application for information not provided by the applicant or a third party, you must request the information at least twice with at least 12 calendar days between each request.
If you deny an application or terminate an ongoing case due to a Social Security decision, advise the applicant/recipient that he may appeal the Social Security decision and that the SA application/ongoing case may be reopened if the decision is overturned. Advise the applicant/recipient or representative that he must contact the county dss within 60 days of the Social Security decision to request the Special Assistance be reopened.
This section now includes instructions for processing applications when the applicant must spend down resources.
D. Temporary Absence
SA-3100, Eligibility Requirements and SA-3310, Change In Situation are revised to expand the definition of temporary absence. To be eligible for Special Assistance, an individual cannot be a resident of a state institution or an institution for the treatment of mental disease. However, there is now a provision for temporary absence due to medical or psychiatric treatment. If an individual is temporarily absent from an SA approved facility and the absence is expected to last less than 30 consecutive days, the Special Assistance may continue during the temporary absence. This includes temporary absence in state mental hospitals, private psychiatric facilities, nursing homes or rehabilitation centers as well as for acute hospital care.
There is no provision for temporary absence when the recipient is incarcerated in a jail or prison. Terminate Special Assistance with adequate notice when the recipient is incarcerated. SA funds paid to a recipient during an unreported incarceration are an overpayment.
E. Change In Situation
1. Change In Income/Resources for SSI Recipients
Instructions are revised to clarify that you do not react to changes in income or resources for SSI recipients. Those changes must be reported to SSA. For pending applications, you may pend the application awaiting a determination by SSA of the effect of the change on SSI eligibility.
2. Passalong
A section is added for SA terminations. When the SA payment is terminated, always evaluate for Medicaid eligibility. This includes evaluating whether the recipient is eligible for ongoing Medicaid under passalong provisions.
II. Implementation instru`ctions
Apply these changes to all applications taken on or after June 1, 2003. Apply these changes to all redeterminations in process on or started on or after June 1, 2003.
III. Maintenance of Manual
Remove: |
SA-3100 |
Insert: |
SA-3100, effective 6/1/03 |
Remove: |
SA-3110 |
Insert: |
SA-3110, effective 6/1/03 |
Remove: |
SA-3310 |
Insert: |
SA-3310, effective 6/1/03 |
Online Manual: SA-3100, SA-3110 and SA-3310 revisions are in red.
If you have any questions regarding this information, please contact your Adult Programs Representative, or Jackie Franklin, Special Assistance Program Coordinator.
John T. Tanner, Chief
Adult and Family Services
Attachments
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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