SSI Medical
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SSI Medical


Revised June 23, 2014



Who is eligible to receive S01 Medical?

How is S01 opened?

What happens when ACES does not auto-open S01?

What is the begin date for S01 Medical?

How long is the S01 certification period?

How do I screen S01 medical?

How do I process a pending S01 AU?

When is an S01 AU AUTO closed?



Who is eligible to receive S01 Medical?

How is S01 opened?

  • S01 medical is usually opened automatically based on information received from the State Data Exchange (SDX) interface. See Interface Data - State Data Exchange.

  • For clients unknown to ACES, all mandatory client data fields such as address, name, date of birth, and SSN are auto-populated using the information on the SDX record.

  • For clients already known to ACES, S01 is auto-opened when there is an exact match between the SDX and ACES on the client’s name, date of birth and Social Security number. At the time of the auto open the following occurs:

    • SDX address is used for clients not currently active on any AU.

    • Current address in ACES is used for clients who are currently active.

    • Any existing medical or cash AU is closed if the SSI client is the only active member.

    • If applicable to the client’s current situation, D01 (SSI Foster Care, Adoption Support or Juvenile Rehabilitation), L01 (SSI Long Term Care) or C01 (Categorically Needy Home Services) may be auto-opened in lieu of S01.

    • If the SSI client is active on a medical or cash AU with other active members, the SSI client’s Finl Resp code on the STAT screen is changed to [SI] - and benefits are recalculated for the remaining members.

    • Basic Food benefits are recalculated to include SSI income.

What happens when ACES does not auto-open S01?

  • S01 is not auto-opened in any of the following conditions:

    • There is a discrepancy in the client’s name, date of birth or Social Security number between ACES and SDX.

    • The SDX record contains too many lines of address preventing ACES from determining what should be used.

    • The client has an existing Third Party Liability (TPL) Non-cooperation sanction.

  • ALERT 245 – AUTO-OPEN NOT POSSIBLE REVIEW FOR MEDICAID/MEDICARE ELIGIBILITY is generated. The second line of this alert identifies the discrepancy for the worker to review and take the appropriate case action.

  • When auto-open is not possible, S01 should be manually opened if appropriate. See How do I screen S01 Medical?

What is the begin date for S01 Medical?

  • ACES uses the earlier of the Medicaid Effective Date or the SSI Eligibility Date from the client’s SDX record when determining the appropriate S01 begin date.

    • The SSI eligibility date on the SDX1 screen is the date the client was issued the first SSI payment.

    • The Medicaid effective date does not currently display on any of the SDX screens.

  • S01 is auto-opened for all months that the client was not receiving Categorically Needy medical on any other AU.

  • ACES can auto-open S01 retroactively up to a maximum of 36 months from the ongoing month.

  • When manually opening S01 medical, use the first of the month listed in the SSI eligibility date field on the SDX record.

How long is the S01 certification period?

  • S01 medical has no review end date and is certified for as long as the client is Medicaid eligible.

  • The Medicaid eligibility indicator displays under the Med Elig field on the SDX1 screen. See <F1> Help.

How do I screen S01 medical?

  1. From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page. The Applicant page displays in a new window.

  2. On the Applicant page:

    • Enter the head of household’s name in the Applicant Name field.

    • Enter the application’s home address under the Residential Address.

    • If the applicant has a mailing address, click the box next to Mailing Address same as above to remove the checkmark and enter the applicant’s mailing address.

  3. Click the Next button and the Address Validation page displays.

  4. Click the Next button and the Programs page displays.

  5. On the Programs page:

    • Click the checkbox next to Medical.

    • Click the checkbox next to Disabled and/or SSI Eligible, depending on the applicant’s eligibility criteria in the Program Determination Criteria section.

  6. Complete the screening process. See Screening a Client.

How do I process a pending S01 AU?

 

  1. From the AMEN, access the pending AU via Option O – Interview.

  2. On the STAT screen, enter [PN] - Applicant in the Finl Resp field for the applicant.

    • An S01 AU can only have one [PN] coded under the Finl Resp field. See <F1> Help to determine financial responsibility codes for other AU members.

  3. On the UNER screen, enter [SI] - SSI Payment under the Srce field and enter unearned income information.

  4. Complete the interview following instructions in the Interview chapter.

  5. After committing the interview data, follow the instructions in the Process Application Month chapter for all pending months.

  6. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S01 eligibility determination.

 

When is an S01 AU AUTO closed?

 

·         If the SDX record indicates that a client has died, moved out of state, or has been incarcerated, any active AUs which the client is the only household member are AUTO closed.

 

·         When the SDX record indicates a client’s SSI benefits have terminated,  ACES takes the following actions:

 

o   Updates the client’s SSI income amount on the UNER screen to $0. The SI income code remains in order to keep the S01 AU open while the client’s eligibility for any other medical programs is determined. See WAC 182-504-0125 Washington Apple Health - Effect of reported changes.

 

o   Updates the Ever Received SSI field on the UNER to [Y]-Yes.

 

o   Updates the Application/Benefit Type field on the UNER to [SI]-SSI.

 

o   Updates the Application/Benefit Status field on the UNER to the appropriate code. See <F1> help.

 

o   Generates Alert 248 – SSI TERMINATED, REDETERMINE MEDICAL ELIGIBILITY.

 

o   Sends LTR 022-05 (Redetermination for Medical at SSI Termination) with an eligibility review (ER) is sent to the client. 

 

·         When the SDX record indicates a client’s SSI is suspended, LTR 002-05 and the review form will not be sent for up to 60 days. 

 

o   If a client’s status changes from suspended to terminated, the ER will be sent when we receive SDX record with the termination data. 

 

o   If the client’s status changed from suspended back to a pay status, all tracking is stopped and no ER is sent.

 

o   If the client’s status remains suspended, the ER will be sent 60 days after we received the first SDX record with the suspension data.

 

·         Both suspended and terminated clients have 60 days from the date it is sent to return their ER form.

 

·         At the end of 60 days, ACES will check the ER rec’d field on MISC screen for all active S01 AUs.

 

o   If there is a Y, Alert 251- SSI TERM’D 60 DAYS AGO, COMPLETE MED REDETERMINATION is generated and the AU remains active.

 

o   If there is not Y, the AU will be terminated with Reason Code 235-Review Not Complete. If the termination occurs during the 10-day notice period, adverse action rules will be applied to the termination.

 

·         Users can manually enter a Y in the ER rec’d field at any time during the tracking periods to prevent the AUTO termination.

Modification Date: June 23, 2014