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EAZ
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Revised October 20, 2009 |
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SSI REDETERMINATION When a client loses eligibility for Supplemental Security Income (SSI) cash assistance, the department must redetermine their eligibility for Medicaid. The State Data Exchange (SDX) interfaces with ACES and provides us with information regarding the termination or suspension of SSI cash assistance. (The automated ACES redetermination process does not apply to any client where the SDX medical eligibility code is indicated as A, C, G, N, Q or Y on the SDX). When the medical eligibility code is 'R' Referred to State, the ACES system takes the following steps depending on whether the SSI is in non-pay status or is in suspended status. Suspended Status ACES checks the SDX to determine the client's payment status code. If the code is a payment suspense code (S01, S04, S05, S06, S07, S08, S09 or S10) ACES waits and does not generate the 22-05 Redetermination letter and Alert 248 - SSI Terminated, Redetermine Medical Eligibility for 60 days. Social Security uses the suspense codes when updating a client's address, changing a payee or budgeting fluctuating income and in many cases the SSI cash starts again within a short period of time. If, at any time during the 60 days wait period, the client's status changes from suspended to non-pay status, then the 22-05 Redetermination letter is generated along with the 248 Alert. If the client's status changes from suspended back to a pay status, then all tracking is stopped and no 22-05 Redetermination letter is sent. ACES automatically removes the SSI closure information from the bottom of the UNER screen when this happens. After 60 days, if the status on the SDX has not changed, then ACES generates the 22-05 Redetermination letter to the client and the 248 Alert to the worker. Non-Pay Status When the SSI closes for a client who is not in a suspended status with Social Security Administration, ACES populates the bottom of the UNER screen with the SSI closure date and generates the 22-05 Redetermination letter and Alert 248. The client is given 60 days in which to complete and return the eligibility review form to the department. Both suspended and terminated clients have 60 days from the review is sent to return the form. At the end of 60 days, if the S01 AU is still active, ACES will check for Y-Yes in the ELIG RVW RCVD field on the MISC screen to indicate the review has been received. A barcode to ACES interface automatically populates theis field if an eligibility review form is received in the Document Management System (DMS). If there is a 'Y' on the MISC screen, Alert 251-SSI TERM'D 60 DAYS AGO, COMPLETE MED REDETERMINATION generates and the AU remains active until the review is intitiated in the system. If there is not a 'Y' on the MISC screen, the S01, L01 or C01 (with SSI income) AU's will automatically close with reason code 235 - Review Not Complete and ACES generates the correct termination letter allowing advance notice. At this point, the redetermination process is complete. The ACES tracking process automatically stops if an SDX record is sent indicating the client has started receiving SSI again. When SSI closes, it is important to remember that a redetermination of the client's disability status is also required, in addition to reviewing income and resource criteria. If SSI has closed because the client has started to receive Title II Social Security Disability benefits, a new disability determination is not required, however a referral needs to be made to DDDS to determine the disability review date if the client is under the age of 65. If SSI has closed for some other reason, a new referral to DDDS for a disability determination will need to be made. Follow directions under the Ex-Parte review process by screening in an S02 and setting the end date 4 months out to allow time for the disability decision to come back. Set a barcode tickler to review the case again at that time if no disability decision has been made. | ||
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If the client receives long term care services under a Home and Community Waiver (HCBS) program (COPES or DDD waiver), it is important to coordinate closely with the social worker or case manager during this process to ensure medicaid coverage is not closed for these vulnerable clients. If the client has an NSA representative, guardian or designated authorized representative, ensure copies of all letters are sent to them so they can respond on behalf of the client. See Chapter 388-472 WAC for more information in Equal Access Services. If the client is on services with HCS or DDD, attach a copy of the latest client assessment to the NGMA referral packet. | ||
