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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 2

SSI MEDICAID – AUTOMATED PROCESS

(II.) D. The county dss evaluates Medicaid eligibility for SSI recipients when the SSI benefit terminates. The county dss must explore and exhaust all possible avenues of eligibility in other aid program/categories. When the SSI termination is based on no longer being disabled and the SSI recipient timely appeals the SSI decision, his disability status continues through the SSI appeals process. Continue Medicaid benefits as long as he meets non-disability criteria through the SSA appeal process. Refer to MA-2525, Disability, for timeframes on appeals. Refer to VII.D., Continuation of MAD When SSI Disability Termination is in Appeal Status for ex parte procedures. The recipient also has the right to appeal to a State Hearing Officer on the issue of disability if the ex parte process finds him no longer eligible for Medicaid. If the recipient has a non-disability SSI change that results in ineligibility, he may continue to be eligible as MAD or cease to be eligible as MAD. The county dss must explore and exhaust all possible avenues of eligibility in other aid program/categories. III. AUTOMATION OVERVIEW A. State Data Exchange (SDX) SSA transmits information regarding SSI recipients and applicants to the State using the SDX. The State uses information on the SDX to create a Medicaid record in EIS for each SSI recipient. The SDX controls Medicaid eligibility for SSI recipients. Except for the situations identified later in this section, only the SDX can update information in EIS for an SSI recipient. This is true even when the county dss has verified information that is inconsistent with the data on the SDX. Social Security sends SDX updates to the State several times a week. The updates are compiled and processed once a week for Medicaid issuance for SSI recipients. Generally the updates are run on Friday night. The on-line SDX is updated daily as updates are received from Social Security. Therefore, it is possible for an individual to be on the SDX before he is in EIS. B. EIS Uses Information on the SDX To: 1. Create an SSI MAABD case (or modify an existing Medicaid case in EIS to SSI Medicaid). 2. Update case and individual data in EIS for ongoing SSI Medicaid recipients. 3. Issue automated approval, denial, termination and redetermination notices. 4. Issue Medicaid cards for SSI recipients.