Special Assistance SA-3110 APPLICATION PROCESS

V. EXPLAINING THE APPLICANT’S RIGHTS AND RESPONSIBILITIES:

A. Explain in detail, the applicant’s rights:

1. Right to receive assistance if found eligible.

2. Right to be protected against discrimination on the grounds of race, creed, or national origin by Title VI of the Civil Rights Act of 1964. Appeals based on discrimination should be made to the agency director.

3. If approved for SA, the right to spend the SA payment as he/she wishes, but only if in the best interest of the recipient. A substitute payee may be appointed for those individuals who cannot manage the payment. The intent of this requirement is that “best interest” means paying the facility for cost of care.

4.

If approved for SA, the right to receive his/her monthly check in advance until the payment is terminated by appropriate action.

5. Right to have any information given to the agency kept in confidence, in accordance with the federal and state laws and policies.

6. Right to appeal, if:

a. Assistance is denied, changed, or terminated.

b. Applicant believes the payment is incorrect based on the county's interpretation of state regulations.

c. A request for a change in the amount of assistance was delayed beyond 30 days

or denied.

7. Right to reapply at any time, if found ineligible.

8. Right to withdraw from the SA program at any time.

B. Explain the applicant's responsibilities. Specifically, inform applicant that as an SA applicant/recipient that he/she must:

1. Apply for all benefits to which he or she may be entitled, including receiving the maximum benefit for which he or she is eligible. This includes, but is not limited to, SSI. All applicants must apply for SSI if their income is below the SSI Federal Benefit Rate (FBR). SSI recipients receiving less than the FBR must apply to receive the FBR or report changes to Social Security (SSA) which would affect their SSI payment amount. SSI recipients or their payees are responsible for reporting changes to SSA within 10 calendar days. There is a form, SSA-8150-EV that they may use.

Explain that applicants/recipients of SA, who have applied for and receive or are entitled to receive SSI, but whose SSI payment amount is less than SSI FBR, will need to work with SSA to establish SSI FBR income in order to assure having appropriate income to pay toward the SA facility rate.

Explain that beginning with the first month in which the a/r is entitled to SSI FBR, SA payments cannot be issued in an amount to make up for SSI income deficit when the SSI payment amount is reduced for reasons other than SSA overpayment recoupment. Refer to SA-3210, Income for budgeting instructions.

2. Apply for RSDI/SSI within the SA application processing time standard if the applicant does not have a current application or is not currently receiving. Explain that SA cannot be approved until RSDI/SSI eligibility is determined, and that the SA application will pend up to 12 months awaiting the SSA decision.

a. If the applicant has been denied SSI/RSDI, and is not in appeal status and the appeal time frame has lapsed, and if either of the statements in (1) or (2) below applies instruct the applicant via the DMA-5097 to reapply for SSI/RSDI and pend the SA case up to 12 months awaiting a decision.  

(1) If applicant was denied due to resources, and is now within the resources limit, or

(2) If applicant was denied for a valid reason, and the situation has changed.

b. However, if the appeal timeframe has not lapsed and if either of the statements in (1) or (2) below applies, rather than reapplying for SSI/RSDI, instruct applicant to appeal the SSI/RSDI denial. This is crucial because a new application, if approved, would only approve benefits beginning with the new application date. If an appeal is won, benefits would be approved based on initial application date.

Examples of when to instruct an SA applicant to appeal the SSI/RSDI denial are:

(1) The applicant was denied SSI/RSDI due to disability, and they still feel they are

disabled, or

(2) The applicant was denied SSI/RSDI due to resources, etc. and they disagree with

the finding.  

Note: SA does not pend applications while waiting for the SSI/RSDI appeal process. The SA application will need to be denied. Explain to the applicant that if the appeal results in a reversal to approve SSI/RSDI retroactive to the SA denial the SA case can be reopened and benefits approved.

3. Provide the necessary sources from which information needed to determine eligibility can be located. Provide the applicant with a DMA-5097, Request for Information.

4. Report within 5 days any change in situation that may affect SA eligibility. Explain the meaning of fraud. Notify the applicant he/she may be suspected of fraud if the applicant/recipient fails to report a change in situation. Explain that in such situations, the applicant/recipient may have to repay assistance received in error and that he/she may also be tried by the courts for fraud.

5. Provide information about any person or organization against which he/she has a right to recovery of medical expenses paid by Medicaid.

6. Because Medicaid is automatic for SA facility recipients, inform applicants of the potential for estate recovery for the cost of PCS paid by Medicaid for beneficiaries age 55 and older. Regardless of age at application, have the applicant or his/her representatives sign DMA-5052SA, State/County Special Assistance Recipient Estate Subject to Medicaid Recovery. Provide a signed copy to the applicant and/or representative and retain one copy for the case file.

7. Immediately report to the county department the receipt of a check, which he/she knows to be erroneous, such as two checks for the same month, or a check in the wrong amount. If the incorrect payments are not reported the recipient may be required to repay any overpayments.