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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
14 REISSUED 10/01/05 – CHANGE NO. 28-05 (V.A.) 4. If the individual remains eligible:
a. The certification period begins the current processing month in EIS.
Example: Review completed September 27. The ongoing EIS month is November. The certification period is November 1 through April 30.
b. Adjust the PML if necessary.
5. Follow EIS instructions to post eligibility.
6. If there has been a change which makes the recipient ineligible, terminate the case.
B. SSI Terminates - Eligibility for LTC Not Established
There may be some situations in which the county does not know a recipient has entered LTC until the "ex parte" redetermination has begun.
If eligibility for payment of cost of care has never been established,
1. Follow procedures in MA-2230, Financial Resources, MA-2231, Community Spouse Resource Protection, MA-2240, Transfer of Resources, and MA-2270, Long Term Care Need and Budgeting, to establish financial eligibility for cost of care and patient liability.
2. Until it is determined that the recipient is eligible for nursing home cost of care and a PML is established the recipient may receive Medicaid continuation for PLA only (according to MA-1000, VII, SSI Medicaid-Automated Process.)
3. If the recipient is eligible for cost of care follow EIS instructions to post eligibility.
4. If the recipient is eligible for Medicaid but ineligible for nursing home cost of care for any reason, follow policy in MA-2270, Long Term Care Need and Budgeting, for PLA budgeting procedures.
VI. COMMUNITY ALTERNATIVES PROGRAM (CAP
A. SSI Medicaid recipients are eligible for services offered under the Community Alternatives Programs. SSA continues to determine Medicaid eligibility. However, the county dss is responsible for establishing eligibility for CAP. County responsibilities include:
1. Level of Care (FL-2/MR-2) in the record,