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Official source

DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 3

SSI MEDICAID – AUTOMATED PROCESS

(III.B.) 5. Terminate Medicaid when an SSI recipient dies or moves out of state. 6. Change to SSI status when SSI stops. C. SSI Medicaid Recipients In EIS An SSI Medicaid case is in EIS just as a regular Medicaid case is in EIS, with case and individual data and history. 1. SSI Status a. SSI Medicaid Recipients - The SSI status is "Y" for SSI recipients. EIS/SDX controls most of the data on these cases. See III.D., below or refer to the EIS Manual, Section 4200, Part 5. b. SSI Medicaid Recipients In Ex Parte Review Status - The SSI status is "N" and the “Certification Thru Date" is 12/31/9999. Do not make changes to the case in EIS until the ex parte review is completed. c. Non-SSI Medicaid Recipients - The SSI status is "N" for non-SSI recipients. The county dss controls all data on these cases. 2. Aid Program/Category The aid program/category is always MAA, MAB, or MAD except for the following situations: a. SSI recipients who also receive Special Assistance are SAA or SAD. b. SSI children in foster care are HSF. c. SSI recipients in a single person Transitional Medicaid case (payment type 5) remain AAF. 3. Classification SSI recipients are always Categorically Needy. The classification code in EIS is: a. “C” for SSI recipients who do not have Medicare, or b. “Q” for SSI recipients who are entitled to Medicare. 4. Individual Eligibility History (IE) a. The IE segment indicates the individual is an SSI Medicaid recipient beginning with the first month of SSI. b. The certification thru date is always 12/31/9999.

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Page 3

Official source

DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 3

SSI MEDICAID – AUTOMATED PROCESS

(III.B.) 5. Terminate Medicaid when an SSI recipient dies or moves out of state. 6. Change to SSI status when SSI stops. C. SSI Medicaid Recipients In EIS An SSI Medicaid case is in EIS just as a regular Medicaid case is in EIS, with case and individual data and history. 1. SSI Status a. SSI Medicaid Recipients - The SSI status is "Y" for SSI recipients. EIS/SDX controls most of the data on these cases. See III.D., below or refer to the EIS Manual, Section 4200, Part 5. b. SSI Medicaid Recipients In Ex Parte Review Status - The SSI status is "N" and the “Certification Thru Date" is 12/31/9999. Do not make changes to the case in EIS until the ex parte review is completed. c. Non-SSI Medicaid Recipients - The SSI status is "N" for non-SSI recipients. The county dss controls all data on these cases. 2. Aid Program/Category The aid program/category is always MAA, MAB, or MAD except for the following situations: a. SSI recipients who also receive Special Assistance are SAA or SAD. b. SSI children in foster care are HSF. c. SSI recipients in a single person Transitional Medicaid case (payment type 5) remain AAF. 3. Classification SSI recipients are always Categorically Needy. The classification code in EIS is: a. “C” for SSI recipients who do not have Medicare, or b. “Q” for SSI recipients who are entitled to Medicare. 4. Individual Eligibility History (IE) a. The IE segment indicates the individual is an SSI Medicaid recipient beginning with the first month of SSI. b. The certification thru date is always 12/31/9999.