Special Assistance SA-3110 APPLICATION PROCESS

III. EXPLAINING ELIGIBILITY REQUIREMENTS AND APPLICATION PROCESS

A. Explain that SA benefits cannot begin prior to the month in which an application is signed. There are no retroactive benefits for SA prior to the month of application.

B. Discuss the applicant’s current as well as retroactive medical needs. Explain retroactive Medicaid benefits in addition to Medicaid benefits provided ongoing with SA eligibility. Advise the applicant that he/she may make a separate Medicaid application. Document the offer for the Medicaid only application and make a referral to the appropriate Medicaid staff as applicable. If the applicant does not request, or is clearly not eligible for Medicaid retroactive to the SA application month, document the SA case file with the offer of Medicaid for the 1, 2, or 3, month retroactive period and the reason that no retroactive application was taken.

C. Explain that when the applicant accepts Medicaid, he/she assigns his/her right to third party insurance benefits to the state. Inform the applicant that it is a misdemeanor to fail to disclose the identity of any person or organization against which he/she has the right to recovery of medical expenses paid by Medicaid.

D. Explain that if an applicant must be referred to SSA, SA benefits cannot begin until SSA has made a determination of eligibility for benefits including disability for a person under age 65.

NOTE: Because SA is a state supplement to the federal SSI program, to be eligible for SA an individual must apply and be eligible for SSI or be found ineligible for SSI solely due to income. For additional information on SSI and the SA application see SA-3110, VIII Establishing Disability for SAD below.

E. Explain that the application may pend up to 12 months if awaiting a decision from SSA.

F. Explain the annual redetermination process. Refer to SA-3320, Redetermination of Eligibility.

G. Complete the DSS-8124, Application Processing Form, following the instructions in the EIS User’s Manual. The date of the application is the date the applicant or authorized representative signs the DSS-8124, Application Form, under penalty of perjury.

NOTE: If applicant is currently residing in a state institution, a properly completed referral, DMA-5010, Referral for Inpatient Hospital and Intermediate Care Facilities, may serve as an application document. The date the referral is received by the agency will be used as the date of application

H. If the applicant requests assistance by mail, send a follow-up letter to the applicant within three workdays after the request is received, asking the applicant to come to the Department of Social Services for an interview or to contact the agency so that other arrangements can be made. Offer to make a visit or to provide transportation, if needed. Explain that an application must be signed to initiate the application process.

Explain that a delay in signing an application may result in the loss or delay of benefits. Refer to DAAS-3000 Appointment Follow-up Letter Regarding SA Assistance Request. The letter shall specify that the agency shall, if it does not hear from the applicant within 15 days of the date of the letter from the agency, consider that the applicant is no longer interested in receiving assistance.

I. If the applicant requests SA by phone, explain that applications cannot be accepted over the phone. Explain application options. See H. above.

J. If a DMA-5000 Mail-in Application for Medicaid is received and in talking to the client or representative it is found the client needed to apply for SA, explain that the DSS-8124, DAAS-8190NS or DAAS-8190S and other required application documents will need to be completed as appropriate in an intake interview. Schedule an intake appointment for the client and/or representative to come into the Department of Social Services to complete the SA application. Once the DSS-8124 application form has been signed, the date of application entered on the DSS-8124 application form will be the same as the date on the mail-in application.

K. Discuss other available services and make appropriate referrals.