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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 13

SSI MEDICAID – AUTOMATED PROCESS

(VII.C.2.c) Current also means that the case is active. Information obtained from a closed or terminated program is not considered current even if verified during the appropriate time frames. A case in suspense is considered active. For SSI terminations, information on the SDX is no longer current as the SSI case is no longer active. Income, resources and other information subject to change must be verified. The former SSI recipient is exempt from citizenship/identity requirements. Use citizenship/identity code 50, permanently exempt. For example, if the recipient is being evaluated for MAF Medically Needy and the certification period is 6 months, the information must have been verified within the last 6 months. If the recipient is being evaluated for MIC and the certification period is 12 months, the information must have been verified within the last 12 months. In both situations the case in the other program must be currently active. 3. Whose Information to Review a. Check all possible sources of information in the SSI recipient's name. b. If the names of immediate family members (spouse, parents and stepparents, adult or minor children, and siblings) who live with the recipient are known, check all records in their names. See DMA-5138, Ex Parte Review Checklist (Non-MIC/NCHC Re-Enrollments), for a suggested checklist to document family members.

D. Continuation of MAD When SSI Disability Termination is in Appeal Status - Ex Parte Procedures When the SSI disability benefit of an active MAD recipient is terminated for no longer being disabled, he or she may continue to be considered disabled while pursuing appeal of the SSI termination. The recipient has only 65 days to request an appeal with Social Security/SSI unless SSA accepts a late appeal for good cause. 1. The case will appear on the SSI Termination Report. Begin the ex parte review process in five work days. a. If the recipient appeals the SSI termination within 65 days or SSA accepts the appeal with good cause and the recipient meets other non-disability criteria for MAD, the ex parte review is complete. Flag the case and continue to track the SSI appeal according to MA-2525, Disability. Determine if the recipient is receiving Medicare Part B. Contact the Social Security Administration to determine if the recipient will continue receiving Medicare Part B while the SSI termination is being appealed. If necessary, change the classification code from Q or B to N or M when the Medicaid is continued but the recipient no longer receives his Medicare benefit.