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DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 10

SSI MEDICAID – AUTOMATED PROCESS

(V.A.4.d.) (2) When the SSI Medicaid case is created, complete the DMA-2041, Third Party Health and Accident Resources Information, and enter the insurance information in EIS.

The individual will not receive SSI Medicaid until the corrected information is transmitted to EIS via the SDX. EIS will then automatically create an SSI Medicaid case and issue a notice and card effective the month SSI is effective. B. Trusts

Certain trusts are not a countable resource in determining SSI eligibility. They may be a countable asset for Medicaid, and therefore affect Medicaid eligibility. When the SDX indicates the individual has a certain trust, EIS will generate a report to DMA.

The DMA Medicaid Eligibility Unit will send notification to the county along with a copy of the EIS report. The county will evaluate the report for effect on eligibility.

VI. SSI DENIAL

A. SSI Denial/Medicaid Denial

When SSI is denied, SSI Medicaid is automatically denied. EIS sends an automated Notice of Medicaid Denial. See DMA-5102, SSI Denial Notice. There is no notice register for denials.

B. Appeals for Medicaid Denial

When SSA denies SSI and Medicaid, the individual must contact Social Security to appeal the denial of his SSI and Medicaid. The Notice of Medicaid Denial advises the individual to contact SSA to appeal and advises him to contact dss if he wants to be evaluated under another coverage group.

VII. SSI TERMINATIONS

Caseworkers must refer to MA-2320, Recertification, and ensure that all policy requirements are followed for SSI Exparte reviews.

When SSI terminates, evaluate ongoing eligibility for Medicaid in all aid program/categories. The individual remains authorized after SSI is terminated while the evaluation is completed.

When the SSI termination processes in EIS, the termination appears on the SSI TERMINATION REPORT. The SSI indicator changes to "N." The case remains open with a Medicaid through date of 12/31/9999. Within 5 workdays the county dss must initiate an ex parte review to determine whether the recipient qualifies for Medicaid under any other coverage group, including Family and Children's Medicaid which includes pregnant woman coverage, family planning waiver, North Carolina Health Choice for Children, or Work First Family Assistance. For SSI terminations for disability reasons, see D. for ex parte procedures.