480-5 SUSPENSION AND TERMINATION

480-5 SUSPENSION AND TERMINATION

480-5 A. SUSPENSION

If a recipient becomes ineligible for assistance, and it appears that the period of ineligibility will not exceed three benefit months, the APA case will be suspended. A period of suspension may not exceed three months. Assistance shall be reinstated without a new application if eligibility is again found to exist at any time during the suspension period, or for the month following the suspension period. Benefits for the month following the month of suspension begin the 1st of the next eligible month and are not prorated

During a suspension period, a recipient may sometimes remain eligible for Medicaid even though he or she is not eligible for an APA payment. Medicaid eligibility exists for any month(s) during a period of suspension in which the recipient continues to receive an SSI payment and Medicaid eligibility requirements are still met, see ADLTC MS 530 . This is true even if the Social Security Administration later determines that the recipient was not eligible for the SSI payment. See Aged, Disabled and Long Term Care ( ADLTC ) Medicaid Manual Section 530 .

Note: If we become aware that an APA recipient’s SSI benefits have been suspended using code “S06 Address Unknown,” and it appears likely that the individual’s SSI benefits may be re-instated within three months, we may suspend the APA benefits for up to three months and continue to issue the Medicaid benefits on the same case number. Since SSI is not an eligibility factor for Medicaid, the individual’s Medicaid benefits may continue as long as the individual is otherwise eligible. If the recipient’s SSI suspension ends, and SSI benefits are reinstated, APA must also be reinstated. If it subsequently appears that the individual’s SSI benefits will not be reinstated within the three-month APA suspense period, the APA case must be closed with a 10-day adverse action notice at the end of the three month period.

480-5 B. TERMINATION

If a recipient becomes ineligible for assistance and it appears that the period of ineligibility will exceed three months, or is of uncertain or indefinite duration, APA assistance will be terminated. The individual must reapply for assistance on DPA form GEN 50C and provide any other necessary documentation and/or verification to again become eligible for assistance.

Note: If APA eligibility ends, the caseworker must close the APA case, but continue Medicaid while the individual is receiving SSI . (See ADLTC MS 530 A )