 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||||
| |||||||||||||
Administrative Letter No. 13- 03 - End of the 2013 Social Security Cost of Living Adjustment Disregard for Special Assistance In-Home Cases and the Effect of the New 2013 Federal Poverty Level on SA/IH Cases
N. C. Division of Aging and Adult Services Adult Services Section
Date: |
February 18, 2013 |
Subject: |
End of the 2013 Social Security Cost of Living Adjustment Disregard for Special Assistance In-Home Cases and the Effect of the New 2013 Federal Poverty Level on SA/IH Cases |
Distribution: |
County Directors Special Assistance Supervisors Adult Services Supervisors |
Effective Date: |
Upon Receipt |
The disregard of the Social Security RSDI/SSI Cost of Living Adjustment (COLA) for Special Assistance In-Home (SA/IH) applicant/recipients (a/rs) ends effective April 1, 2013. April 1, 2013 is also the effective date for implementing the new federal poverty level (FPL) of $958.00 as the total countable monthly income (TCMI) limit for categorically needy (CN) Aged, Blind and Disabled (ABD) Medicaid a/rs.
Based on these two changes income maintenance caseworkers (IMCs) must assess each SA/IH recipient’s TCMI to determine if they remain eligible for ABD Medicaid as CN. This letter provides instructions to IMCs to implement these changes for SA/IH cases.
I. Procedures for Manually Updating Ongoing SA/IH Cases
A. Report of Current SA/IH Recipients as of December 31, 2012 Receiving RSDI, SSI or Both
A report has been created in Client Services Data Warehouse under the name: “SA/IH Active Cases with SSA, SSI, or Both by District”. This report identifies all Special Assistance cases that contain an ambulation capacity code ‘H’ as of the report month entered, receiving RSDI, SSI or both. Use this report to help identify SA/IH cases to review for the end of the COLA disregard.
B. To Access the report and update it for your county DSS take the following steps.
1. Log in to CSDW Public Folders/DHHS Main Document/DAAS/Shared/State Sanctioned folder.
2. Find the report entitled “SA/IH Active Cases with SSA, SSI, or Both by District”.
3. Change the Report month to January 2013 (201301).
4. Enter the correct county number. Click on “Run Query”.
II. Implementation Instructions for SA/IH Ongoing Cases
A. Effective April 1, 2013, begin counting the full RSDI/SSI amount, including the 2013 COLA. Continue to disregard the COLA for January, February, and March 2013.
1. Treat the end of the COLA disregard as a change in income effective April 1, 2013.
2. Verify the 2013 RSDI/SSI benefits using SOLQ.
B. Determine if the SA/IH a/r is eligible for ABD Medicaid as Categorically Needy (CN)
SA/IH recipients must first qualify for CN Medicaid.
1. Compute the a/r’s total countable monthly income (TCMI). This is the amount of countable income after all allowable deductions and exclusions. See SA-3210 for instructions on calculating TCMI. Compare the changed income to the 2013 FPL for recipients who are not Medicaid passalong to see if they would still qualify for Adult Medicaid as CN.
2. While most SA/IH recipients’ income must be at or below the FPL in order to qualify for CN Medicaid, there are exceptions.
a. SA/IH a/rs eligible for Medicaid as passalong;
b. Recipients who reside with a legal spouse, in which case SSI counts the income of the couple.
C. If eligible for CN Medicaid, calculate the new maximum SA/IH payment
1. Subtract the a/r’s TCMI from the basic SA maintenance amount, $1,228 ($1,182 + $46 personal needs allowance).
2. Round to the nearest whole dollar $.49 or less, round down;
$.50 or more, round up).
3. The result is the maximum allowable SA/IH payment.
4. The actual payment may be less than the maximum allowable payment, based on the needs assessment by the case manager. Allow enough time to coordinate with the SA/IH case manager for his/her decision of the appropriate SA/IH payment for each recipient.
5. Send a DSS-8110, timely notice to notify the recipient if the SA/IH payment decreases.
6. Key a DSS-8125 to update income and the correct payment amount effective April 1, 2013. Must be keyed by:
• March 11, 2013 if using an automated DSS-8110 timely notice,
• March 12, 2013 if completing a manual DSS-8110 timely notice.
D. Cases Ineligible Due to the End of the COLA Disregard
For SA In-Home Program cases no longer eligible for full Medicaid based on the FPL of $958.00, send a manual timely notice to terminate the SA/IH benefit. Continue to assess the recipient for continued Medicaid under other classifications.
III. Implementation Instructions for SA/IH Applications
A. Pending SA/IH Applications Dated Prior to April 1, 2013
1. For the months prior to April 2013, budget RSDI/SSI amounts prior to the 2013 COLA. For months effective April 2013 and later, budget current RSDI/SSI income to include the 2013 COLA.
2. Always verify whether the a/r is eligible for CN ABD Medicaid.
B. Applications Dated April 1, 2013 and Later
1. Beginning April 1, 2013, budget current RSDI/SSI when calculating total countable monthly income (TCMI).
2. Always verify whether the applicant is eligible for CN ABD Medicaid.
If you have any questions regarding this information, please contact your Special Assistance Program Representatives at SpecialAssistance@dhhs.nc.gov
Sincerely,
Dennis W. Streets, Director
DWS/SPM/cu
|
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
| |||||||||||||