Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 20 - Division of County Operations
Rule 016.20.95-010 - Changes in Medical Services Policy Manual to Extend Medicaid Eligibility to Certain Recipients who have lost SSI Benefits
Current through Register Vol. 49, No. 9, September, 2024
27. Pregnant Women found presumptively eligible by a Qualified Provider for ambulatory prenatal care. Re. MS 5600;
28. Individuals eligible for the U-18 category. Re. MS 6000;
29. Title IV-E and other Foster Children. Re. MS 6000 and 7000;
30. Non-Title IV-E Adoptive Children with Special Needs, Re. MS 6590;
31. Individuals eligible for the Medically Needy Program, Re. MS 7000;
32. Refugees eligible for Medicaid under "special eligibility period" criteria of Refugee Resettlement Program; and
33. Drug addicts and alcoholics who lose their SSI, provided that they meet certain requirements. Re: MS 2055.
2005 Date Specific Eligibility
With date specific eligibility, for most Medicaid categories an individual's or family's eligibility may begin or end on any day of a month.
When eligibility is established, eligibility will begin on the day the application was registered, unless retroactive coverage is needed. If retroactive coverage is needed and if eligibility is established for a retroactive period, eligibility can begin up to 3 months prior to the date of application (but not on the first day of the third retroactive month unless the application was filed on the first day of a month).
Eligibility for most Medicaid categories under date specific eligibility may be terminated at any time. The end date of eligibility will be the last day of the 10 day advance notice period, unless a recipient requests a hearing within the advance notice period,
There are some Medicaid categories in which eligibility may not begin or end on any day of a month. These categories are: QMB (MS 2047), SMB (MS 2051), QOWI (MS 2048), and TM (MS 2061), Information about the begin and end dates for these categories is found in the eligibility section for each category.
2010 Supplemental Security Income fSSI) Eligibles
Individuals who have been determined eligible for SSI benefits by the Social Security Administration (SSA) are eligible for Medicaid (i.e., recipients of straight SSI benefits, Mandatory State Supplements, SSI conditional payments and SSI presumptive disability payments).
The County Office is notified of SSI eligibles by printout as SSA makes information available to the Office of Information Systems (CIS). OIS will mail Medicaid ID cards to all SSI eligibles at certification.
SSA will notify OIS via the State Data Exchange system of changes for this group of eligibles. The County Office will notify the local SSA District Offices by means of a lead form, RVI-302, regarding current changes reported by/for individuals within this group (e.g., SSl recipient enters a nursing home).
2010.1 National Correction Procedure
The National Correction Procedure is a process for notifying the Social. Security Administration (SSA) of changes that could affect SSI/Medicaid eligibility and/or the amount of State supplementation payments.
When information is received that is not reflected on the latest "SSI Recipient" printout, the County Office will submit the information to SSA via the SSA-391i, Report of Change-SSI Data. The following information can be reported:
|
Recipient's Name |
Resources |
|
Sex |
Unearned Income Type |
|
Date of Birth |
Unearned Income Stop Date |
|
Payee Name, Hailing Address, Zip Code |
Unearned Income Amount |
|
SSI Living Arrangement |
Unearned Income Frequency |
|
Date of Death (month, year) |
Unearned Income Claim/ID Number |
|
Marital Status |
Earned Income Period |
|
Residence Address, Zip Code |
Earned Income Wage Estimate |
|
State, County of Jurisdiction |
Net Self-Employment Income Estimate |
In addition, the County Office will properly identify the recipient and/or any other individual, the reason for submittal, and the Service Representative requesting the change. Supporting documentation will be submitted if available.
The Service Representative will complete Parts I and II of the SSA-3911. Completion and routing are self-explanatory with the following exceptions:.
Item 8. - Enter Bureau of Supplemental Security Income, 1200 Main Tower Bldg., Dallas, TX 75202,
Item 10. - Enter the information from the "SSI Recipients" printout that needs correction,
2051.6 Changes
The SSA COLA increases which are received in January of each year will be disregarded for SRB applicants and recipients until the month after the new Federal Poverty Levels are issued to counties. The new FPLs are usually issued in March with an effective date of April 1st.
When Counties receive the new SMB income limits, effective April 1, the individual's income, including the January COLA increase, will be compared to the new SMB income limit to determine if eligibility will continue for April and later months.
If an individual or couple is ineligible due to the COLA increase, an EMS-700 will be sent as advance notice of closure, and case will be closed when the notice expires.
SMB reevaluations will be conducted annually. All eligibility factors will be redetermined. Completion of Forms EMS-777, EMS-707, and EMS-769 are needed at each reevaluati on. Form EMS-662 wi 11 be completed, i f necessary.
If a change occurs that affects eligibility, a ten day advance notice of closure will be issued via the EMS-700 or EMS-55, unless advance notice is not required (Re, MS 3633). Form EMS-57 will be completed for the closure effective the date that the notice expires. With date specific eligibility, eligibility will be terminated when the ten day notice period has ended, unless the recipient requests a hearing within the ten days.
2055 Medicaid for Drug Addicts and Alcoholics fPA&
Section 201 of Public Law 103-296, the Social Security Independence and Program Improvements Act of 1994, mandates that States provide Medicaid to drug addicts and alcoholics who have lost their SSI, provided that they meet certain requirements.
The law which extended coverage for this group became effective March I, 1995. Individuals found eligible under provisions of the law will be entitled to the full range of Medicaid benefits.
2055.1 Social Security Administration Responsibilities
The Social Security Administration will identify those individuals who are:
Disabled, when drug addiction or alcoholism is material to the finding of their disability; and
Their SSI benefits were suspended solely for noncompliance with treatment; or
Their SSI benefits were terminated because of the 36 month limit for SSI benefits provided under the DA&A provisions.
SSA will submit the names of potential DA&A eligibles via the SDX exchange, utilizing a code "P" to the Central Office of Information Systems (OIS). A listing of potential DA&A eligibles will be issued to the appropriate county office by OIS.
These individuals will be identified on WASM by a code "NiO" or "Nll"in the pay status code (PSC) field.
2055.2 County Office Responsibilities
Upon receipt of the listing of potential DA&A eligibles from OIS, the county office will notify the individuals that application will be needed to determine continuing Medicaid eligibility,
2055.3 Eligibility Requirements
When a DA&A application is received, the county office will determine eligibility with the exception of disability. The determination of disability will have already been made by SSA.
|
Individual |
$458.00 |
|
Couple |
$687.00 |
In-Kind Support and Maintenance is considered in DA&A determinations. The general SSI exclusions will be given. Deeming procedures for an ineligible spouse will apply.
|
Individual |
$2,000 |
|
Couple |
$3,000 |
There will be no penalty imposed for transfer of resources.
2055.4 Application Procedures
Application for the DA&A program will be made on form DCO-777. The county office will register the application on WIMA in category 41. Other forms to be completed at the application interview include the DCO-86, DCO-87, DCO-652, DCO-777. DCO-769, and DCO-707.
2055.5 Disposition and System Procedures
2055.6 Changes/Closure
When a change occurs that affects eligibility, a ten day advance notice will be given via DCO-700 or DCO-55, unless advance notice is not required (Re. MS 3633). Form DCO-57 will be completed with a "C" action type effective the date that the notice expires.
2055.7 Reevaluation
Reevaluations will be conducted on an annual basis. At reevaluation, all factors of eligibility will be redetermined (Re. MS 2055.3). Forms DCO-777, DCO-707 and DCO-769 will be completed. Form DCO-662 will be completed, if necessary. The DCO-87, if used by the county, will be coded for the next reevaluation and/or anticipated change.
To complete a reevaluation of an open DA&A case, only the minimum record entries are required (i.e., "0" action, action date, worker number, action reason "201", client notice indicator, and reevaluation date).
2061 Transitional Medicaid (TM) Category 25
The Family Support Act of 1988 ( Public Law 100-485), requires that certain AFDC families (Categories 20 or 21) who lose eligibility April 1, 1990, or later, due to earned income must be given six (6) months of Initial Transitional Medicaid benefits without an application for such assistance. These families may also qualify for an Additional 6 Months Transitional Medicaid Extension.
2061.1 Extent of Services
Individuals approved for Transitional Medicaid will be eligible for the full range of Medicaid services, including services under the Children's Health Services Program.
2061.2 Eligibility Requirements
In addition to the standard Medicaid eligibility requirements of citizenship, enumeration and child support enforcement, the following requirements must be met in determining eligibility for the Initial 6 Months TM Extension period:
In addition to the eligibility criteria stated above, the following eligibility requirements must also be met in the Additional 6 Months TM Extension period:
Resources, deprivation, and unearned income are not eligibility factors for TM.
A rereferral to CSEU is not required.
2061.3 AFDC Case Closure - Due to Earnings
The AFDC case closure must be due solely to increased wages, increased hours of employment, or loss of the 1/3 or $30 earned income exclusion of the parent (or non-parent specified relative); or to loss of the 1/3 or $30 earned income exclusion of any family member who was included in the AFDC grant when the family became ineligible.
