Special Assistance SA-3120 EIS Instructions for SA

IX. CHANGE IN AMBULATION

A. “B”, “C”, ”E” or “M” TO “H” OR “H” TO “B”, “C”, “E” or “M”)

Do not transfer cases from SA/IH (“H”) to SA (“B”, “C”, “E” or “M”) or from SA (“B”, “C” ,“E” or “M”) to SA/IH (“H”). If an SA/IH recipient chooses to enter an SA facility and requests SA, a new application is required. The same is true for SA recipients residing in a SA facility who choose to return home and request SA/IH.

No new “E’ cases are allowed to be keyed after December 1, 2009.

B. “B”, “C”, “E” or “H” to “M” or “M” to “B” or “C”.

Do not transfer “B”, “C”, “E” or “H” cases to “M”. A transfer is allowed from “M” cases to “B” or “C”.

No new “M” cases are allowed to be keyed after September 30, 2010.

Key the DSS-8124, Application Processing screen, in EIS as a reapplication.

Use the DMA-5022 screen in EIS to issue supplemental payments when a recipient changes living arrangement and ambulation capacity. The paper version of the DMA-5022 is available online at the following link: http://info.dhhs.state.nc.us/olm/forms/dma/dma-5022-ia.pdf

Use the DB/PML screen to request retroactive or replacement Medicaid cards.

See EIS-3105 for instructions.