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COMAR 10.09.24.03

354 State of Maryland Medical Assistance Manual Revised July 2012 This information is not always transmitted accurately or timely by SSA. Upon discovering that a DAC was denied or terminated for MA eligibility due to an SDX or CM error, the CM must certify the individual as MA-eligible retroactive to the date that MA eligibility was erroneously denied or terminated. Anyone who meets the DAC criteria must be certified as eligible for MA without a lapse in coverage from the time that SSI cash payments ended. Even though a DAC may have income in excess of the MA medically needy income limit (MNIL), the individual is eligible as a DAC. They are not required to complete a MA application form. A financial eligibility determination is not conducted. Eligibility Upon Employment If a DAC becomes employed, the earned income or accumulated resources may make the individual financially ineligible for the deemed status of SSI eligibility. When SSA‟s database indicates that a DAC is no longer SSI-eligible, the individual is no longer categorically eligible for MA as an SSI recipient. The MA eligibility CM must then redetermine the individual‟s eligibility for the most appropriate coverage group. The policies and procedures followed in section 12 and its CARES supplement for “Redeterminations for Former SSI recipients.” Eligibility must be redetermined before MA coverage may be terminated, with a notice of adverse action issued at least 10 days before any closure. Although a DAC may have received SSI benefits as a child, this is not a requirement. An individual is eligible for SSI payments as a child if the individual: Qualifies for SSI based on disability and financial eligibility is either: Under 18 years old, or Under 22 years old and regularly attending school, college, or training that was designed to prepare the individual for a paying job; Is not married; and Is not the head of household CARES Procedures The following procedures are used to certify a DAC as eligible in coverage group S02 on CARES: Delete the SSI income from the UINC screen effective the month that the SSI payments ended. Enter the SSA income effective the month that the Social Security payments began. (These months should be the same.) At the bottom of the UINC screen, enter “SI” in the “Appl type” field, and enter “S” in the “Stat” field, Enter the date the SSI cash payments were terminated.