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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

13 REVISED 10/01/05 – CHANGE NO. 28-05 (IV.) G. Review

As long as the recipient continues to receive SSI, the county dss does not have to redetermine eligibility. If the dss learns of a change that might affect eligibility for cost of care or the PML, treat as a change in situation. If the change affects eligibility for SSI, use the DMA-5049, Referral to Local Social Security Office, to report the information to SSA. Examples of when the dss must react to an SSI recipient in LTC: individual leaves the facility, changes level of care, COLA increase, change in income other than SSI, or a countable asset is discovered that was not previously considered.

H. SSI Recipient in LTC Returns to PLA

If an SSI recipient leaves LTC and returns to a private living arrangement, change the living arrangement code in EIS to reflect pla living arrangement. EIS will use the county and address on the SDX.

I. SSI Recipient in LTC Transfers to Domiciliary Facility

If an SSI recipient in LTC transfers to a domiciliary care facility, refer to the Special Assistance Manual to authorize the SA payment.

V. COUNTY DSS RESPONSIBILITY WHEN SSI TERMINATES FOR INDIVIDUALS IN LTC

When SSI terminates due to the recipient entering long term care, the county dss will often have established eligibility for LTC before the SSI payment terminates according to procedures in IV. above. In that case follow procedures in V.A., below. If eligibility for LTC has not been established, follow procedures in V.B., below.

A. SSI Terminates - Eligibility for LTC Already Established

Take the following steps if the procedures in IV. above have been followed and LTC eligibility has been previously established within the past 6 months:

1. Contact the recipient or representative to determine whether there has been a change in income or assets. If there has been a change, reverify. Also verify status of the homesite and explain estate recovery provisions.

2. Review the Adult Medicaid Applications. The recipient or the representative does not have to sign the application form.

3. Begin the "ex parte" redetermination according to procedures in MA-1000, VII, SSI Medicaid-Automated Process.