SSI Categorically Needy Medical (S01)

Created on: 
Jul 14 2017

See ACES Screens and Online pages for an example of pages or screens used in this chapter.

Who is eligible to receive SSI Categorically Needy (S01) medical?

A person who receives federal cash benefits under the Supplemental Security Income (SSI) program is automatically eligible to receive S01 medical. There is no income or resource limit for S01 medical eligibility as long as the client is SSI eligible. For more information, see EA-Z Manual - WAC 182-510-0001 What is supplemental security income (SSI) and who can get it?

Can a client receive SSI Categorically Needy (S01) medical coverage while incarcerated?

When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).

If the client is AUTO closed though the State Data Exchange (SDX) interface, see Online Processing - Does a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO close when a client is incarcerated?.

Online Processing

How is SSI Categorically Needy (S01) medical 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 Social Security Number (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 ACES and the SDX interface on the client’s name, date of birth and SSN. At the time of the auto open the following occurs:

  • The address in the SDX interface is used for clients not currently active on any Assistance Unit (AU).
  • The current address in ACES is used for clients who are currently active.
  • Any existing medical or cash AU is closed if the Supplemental Security Income (SSI) client is the only active member.
  • If applicable to the client’s current situation, Categorically Needy Foster Care / Adoption Support / Juvenile Rehabilitation Medical (D01/D02/D26) medical 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 Financial Responsibility code on the AU Details page is changed to SSI Parent (SI) and benefits are recalculated for the remaining AU members.
  • Basic Food benefits are recalculated to include SSI income.

What happens when ACES does not auto-open SSI Categorically Needy (S01) medical?

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 State Data Exchange (SDX) interface.
  • 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. For more information, see How do I screen SSI Categorically Needy (S01) medical?

What is the begin date for SSI Categorically Needy (S01) medical?

ACES uses the earlier of the Supplemental Security Income (SSI) Eligibility Date or the SSI Medicaid Effective Date from the client’s State Data Exchange (SDX) record when determining the appropriate S01 begin date.

  • The SSI/Eligibility Date field on the SDX page is the date the client was issued the first SSI payment.

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

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 SSI Categorically Needy (S01) medical 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 Medicaid Eligibility Code field on the SDX page. 

How do I screen SSI Categorically Needy (S01) medical?

To screen S01 medical, take the following steps:

  1. From the Welcome Back page in aces.online, click the Screen New Application link at the top of the page.
  2. On the Applicant page, take the following steps:
  • Applicant Name field - Enter the [applicant’s name].
  • Primary Language field - Select the client's primary language from the drop down menu.
  • Interpreter Needed field - Select the check box if the client is requesting an interpreter.
  • Residential Address section - Enter the [client’s residential address].
    • If the applicant has a mailing address, click the box next to Mailing Address same as above field to remove the checkmark and enter the applicant’s mailing address.
  • To add an Authorized Representative, follow the steps in How do I add an authorized representative (AREP) during screening?
  1. On the Address Validation page take the necessary steps to complete the address validation process. For additional information, see Screening - Address Validation.
  2. On the Programs page, take the following steps:
  • In the Programs sections, click on the checkbox next to Medical.
  • In the Program Determination Criteria section, click the checkbox next to SSI Eligible.
  • Click Next.
  1. Complete the screening process. For more information, see Screening an Application.

How do I process a pending SSI Categorically Needy (S01) Assistance Unit (AU)?

To process a pending S01 AU, take the following steps:

  1. On the AU Details page, select Applicant (PN) from the Financial Responsibility field drop down menu.
  • An S01 AU can only have one Applicant (PN) coded on the Financial Responsibility field.
  1. On the Unearned Income page, select SSI Benefits (SI) from the Source field drop down menu and enter the unearned income information.
  2. Complete the interview following instructions in the Interview chapter.
  3. After committing the interview data, follow the instructions in the Process Application Months chapter for all pending months.
  4. After all pending months have been processed; follow the instructions in the Finalize Application chapter to complete the S01 eligibility determination.

When is a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO closed?

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

When the SDX record indicates a client’s Supplemental Security Income (SSI) benefits have terminated, ACES takes the following actions:

  • Updates the client’s SSI income amount on the Unearned Income page to $0. The SSI Benefits (SI) income code remains in order to keep the S01 AU open while the client’s eligibility for any other medical programs is determined.
  • The Ever Received SSI radio button is marked Yes on the Unearned Income page.
  • The following fields are updated on the Other Agency Application/Benefit page:
    • Type field is updated to SSI (SI).
    • Status field is changed to the appropriate code.
  • Alert 248 - SSI TERMINATED, REDETERMINE MEDICAL ELIGIBILITY is generated.
  • Letter 022-05 (Redetermination for Medical) with an eligibility review (ER) is sent to the client. 
  • When the SDX record indicates a client’s SSI is suspended, LTR 022-05 and the review form are not sent for up to 60 days. 
    • If a client’s status changes from suspended to terminated, the ER form is sent when we receive a SDX record with the termination data. 
    • If the client’s status changed from suspended back to a pay status, all tracking is stopped and no ER form is sent.
    • If the client’s status remains suspended, the ER form is 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 checks the ER Received field on Case Actions page for all active S01 AUs.
    • If there is a Yes (Y)Alert 251 - SSI TERM 60 DAYS AGO / COMPLETE MEDICAL REDETERMINATION is generated and the AU remains active.
    • If there is not Yes (Y), the AU is terminated with Reason Code 235 - Review Not Complete. If the termination occurs during the 10-day notice period, adverse action rules are applied to the termination.
    • Users can manually enter Yes (Y) in the ER Received field at any time during the tracking periods to prevent the AUTO termination.

Does a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO close when a client is incarcerated?

If the State Data Exchange (SDX) record indicates a client is incarcerated the S01 AU remains active and ACES takes the following steps:

  • Updates the client’s Living Arrangement field on the Client Details page to Jail (JL).
  • Updates the Inmate or Resident of a Public Institution? field to Yes (Y) on the Client Details page in ACES 3G and the Shelter page in ACES.online.
  • An indicator is sent to ProviderOne (P1) and medical coverage could be limited based on the client’s incarceration status. 

When the client's State Supplemental Income (SSI) benefits terminate, the system continues the current redetermination process. For more information, see When is a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO closed? 

Mainframe Processing

How is SSI Categorically Needy (S01) medical 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 Social Security Number (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 ACES and the SDX interface on the client’s name, date of birth and SSN. At the time of the auto open the following occurs:

  • The address in the SDX interface is used for clients not currently active on any Assistance Unit (AU).
  • The current address in ACES is used for clients who are currently active.
  • Any existing medical or cash AU is closed if the Supplemental Security Income (SSI) client is the only active member.
  • If applicable to the client’s current situation, Categorically Needy Foster Care / Adoption Support / Juvenile Rehabilitation Medical (D01/D02/D26) medical 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] - SSI Parent and benefits are recalculated for the remaining AU members.
  • Basic Food benefits are recalculated to include SSI income.

What happens when ACES does not auto-open SSI Categorically Needy (S01) medical?

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 State Data Exchange (SDX) interface.
  • 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. For more information, see How do I screen SSI Categorically Needy (S01) medical?

What is the begin date for SSI Categorically Needy (S01) medical?

ACES uses the earlier of the Supplemental Security Income (SSI) Eligibility Date or the SSI Medicaid Effective Date from the client’s State Data Exchange (SDX) record when determining the appropriate S01 begin date.

  • The SSI/Elig Date field on the SDX1 screen is the date the client was issued the first SSI payment.

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

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/Elig Date field on the SDX record.

How long is the SSI Categorically Needy (S01) medical 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. 

How do I process a pending SSI Categorically Needy (S01) Assistance Unit (AU)?

To process a pending S01 AU, take the following steps:

  1. From the AMEN screen, select [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] - Applicant coded on the Finl Resp field. See <F1> Help to determine financial responsibility codes for other AU members.
  1. On the UNER screen, in the Srce field enter [SI] - SSI Payment and enter the unearned income information.
  2. Complete the interview following instructions in the Interview chapter.
  3. After committing the interview data, follow the instructions in the Process Application Months chapter for all pending months.
  4. After all pending months have been processed, follow the instructions in the Finalize Application chapter to complete the S01 eligibility determination.

When is a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO closed?

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

When the SDX record indicates a client’s Supplemental Security Income (SSI) benefits have terminated, ACES takes the following actions:

  • Updates the client’s SSI income amount on the UNER screen to $0. The [SI] - SSI Payment income code remains in order to keep the S01 AU open while the client’s eligibility for any other medical programs is determined.
  • The following fields on the UNER screen are updated:
    • Ever Received SSI field is changed to [Y] - Yes.
    • Application/Benefit Type field is updated to [SI] - SSI.
    • Application/Benefit Stat field is changed to the appropriate code.
  • Alert 248 - SSI TERMINATED, REDETERMINE MEDICAL ELIGIBILITY is generated.
  • Letter 022-05 (Redetermination for Medical) with an eligibility review (ER) is sent to the client. 
  • When the SDX record indicates a client’s SSI is suspended, LTR 022-05 and the review form are not sent for up to 60 days. 
    • If a client’s status changes from suspended to terminated, the ER form is sent when we receive a SDX record with the termination data. 
    • If the client’s status changed from suspended back to a pay status, all tracking is stopped and no ER form is sent.
    • If the client’s status remains suspended, the ER form is 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 checks the Elig Rvw Rcvd field on MISC screen for all active S01 AUs.
    • If there is a [Y] - YesAlert 251 - SSI TERM 60 DAYS AGO / COMPLETE MEDICAL REDETERMINATION is generated and the AU remains active.
    • If there is not [Y] - Yes, the AU is terminated with Reason Code 235 - Review Not Complete. If the termination occurs during the 10-day notice period, adverse action rules are applied to the termination.
    • Users can manually enter [Y] - Yes in the Elig Rvw Rcvd field at any time during the tracking periods to prevent the AUTO termination.

Does a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO close when a client is incarcerated?

If the State Data Exchange (SDX) record indicates a client is incarcerated the S01 AU remains active and ACES takes the following steps:

  • Updates the client’s Liv Arng field on the DEM1 screen to [JL] - Jail.
  • Updates the Inmate or Resident of a Public Institution? field to Yes (Y) on the Client Details page in ACES 3G and the Shelter page in ACES.online.
  • An indicator is sent to ProviderOne (P1) and medical coverage could be limited based on the client’s incarceration status. 

When the client's State Supplemental Income (SSI) benefits terminate, the system continues the current redetermination process. For more information, see When is a SSI Categorically Needy (S01) Assistance Unit (AU) AUTO closed?.

 

See ACES Screens and Online pages for an example of pages or screens used in this chapter.