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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 11

SSI MEDICAID – AUTOMATED PROCESS

(VII.) A. Automated Recipient Notice

When the SDX indicates a recipient is being terminated from SSI, EIS generates an automated notice to the recipient. See DMA-5100, Notice of Medicaid Redetermination.

The notice advises the recipient:

1. To contact the local SSA if he wants to appeal the SSI termination.

2. The county dss must determine whether he may continue to be eligible for Medicaid as a non-SSI recipient.

3. The county dss will contact him if further information is needed.

When the determination is completed, a timely notice will be sent to inform the recipient of the Medicaid decision.

B. Time Frames for Completing the Evaluation of Ongoing Medicaid Eligibility (Ex Parte Review)

1. Initiate the evaluation of ongoing eligibility within 5 workdays of the date the termination appears on the SSI TERMINATION REPORT. This is essential to ensure enough time to evaluate for ongoing eligibility.

Use the Adult Medicaid Applications or the DMA-5007, MAABD Redetermination Document, as the base document for the evaluation for ongoing eligibility. The SSI recipient's signature is not required for the evaluation, nor can the recipient be required to come into the agency.

Within 4 months of the month the SSI terminated, the county dss must complete the evaluation of ongoing eligibility and notify the recipient about his ongoing eligibility for Medicaid. The four month period begins the month the case appears on the SSI TERMINATION REPORT.

For example, the case appears on the SSI TERMINATION REPORT in July. July, August, September and October are continuation months. Complete the evaluation of eligibility and send the timely notice to make the decision effective no later than October 31.

2. Federal financial participation for up to four months is available for Medicaid during the evaluation. Counties may be liable for charge backs of Medicaid expenditures for ineligible cases if the Medicaid must be extended longer than 4 months to complete an evaluation and/or send timely notice of termination.

3. Recipient Lives In A County Different From That On The SSI TERMINATION REPORT.