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North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL
MA-1100 AGED, BLIND AND DISABLED
SSI MEDICAID – COUNTY DSS RESPONSIBILITY
11 REVISED 11/01/11 – CHANGE NO. 17-11 (IV.) B. Establish a Case Record
When county residency has been established prepare a county case record. Include in the record all forms and documents identified in this section.
C. Establish Level of Care. (Refer to MA-2270, Long Term Care Need and Budgeting.)- Not applicable to PRTFs.
1. Request a completed FL-2/MR-2. Use the MR-2 to request the level of care for ICF-MR and CAP-MR/DD.
2. Send the FL-2 to the Claims Processing Contractor Prior Approval Unit and forward the MR-2 to the Murdock Center, Specialized Services, to obtain prior approval.
3. If the recipient does not have an approved FL-2/MR-2 for the correct level of care, do not authorize payment for cost of care.
D. Complete the Adult Medicaid Applications and Supplement B - LTC Budgeting
1. It is not necessary to complete sections already verified by SSI eligibility (i.e. citizenship, age, disability, etc.).
2. Evaluate for transfer of resources.
Transfer of Assets reports are received by DMA from SSA and sent to the counties to evaluate an SSI individual for transfer of resources. SSA enters a payment status code of N04 to indicate excess resources, but not necessarily due to a transfer. Additional investigation may be necessary to ensure it was not a transfer that created a period of ineligibility. React to reports upon receipt. Refer to MA- 2240, Transfer of Resources.
a. If a non-allowable transfer has occurred, follow transfer of resources policy. Assign sanction, if appropriate.
b. Do not authorize cost of care during sanction period.
3. If the recipient has a community spouse, determine spousal and dependent family member allowance.
4. Establish that reserve is within allowable limits. If countable assets exceed the reserve limit for one and cannot be reduced by the burial exclusion, do not authorize cost of care. (If resources have not been reported to SSA, use the DMA- 5049, Referral to Local Social Security Office, to advise SSA.)