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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

15 REISSUED 10/01/05 – CHANGE NO. 28-05 (VI.A.) 2. Plan of Care (The county dss or CAP lead agency) in the record,

3. Complete a DMA-5008, to evaluate for transfer of resources. Refer to MA-2240, Transfer of Resources.

a. If a non-allowable transfer has occurred, follow transfer of assets policy. Assign sanction, if appropriate.

b. Do not authorize cost of care during sanction period.

4. Assess Community Spouse Resource Protection (CSRP), if applicable.

B. Continue to follow all rules and procedures in MA-2280, Community Alternatives Programs Medicaid Eligibility, to authorize CAP coverage for an individual who is already eligible for Medicaid. In addition, consider the following information for SSI recipients who are also eligible for CAP.

1. Deductible

SSI Medicaid recipients do not have a deductible under CAP.

2. EIS

a. The SDX will continue to control all elements in EIS for SSI recipients who are eligible for CAP except for the CAP indicator and effective date.

b. The county dss is responsible for:

(1) Entering in EIS the CAP indicator and effective date.

(2) Terminating CAP coverage in EIS.

3. Refer to EIS 3101 for instructions on posting CAP.

VII. IN-HOME HEALTH SERVICES AND SUPPLIES

When an ongoing SSI recipient receives assistance with in-home health services and supplies, the county dss will be notified by the recipient, provider, or Medicaid claims contractor that a transfer of resources evaluation is needed. The dss is responsible for establishing eligibility by completing a transfer of resources evaluation. Refer to MA-2240, Transfer of Resources, for procedures.

A request for a transfer of resources evaluation is considered a change in situation that must be reviewed promptly. Refer to MA-2340, Change In Situation, for procedures.

Take the following steps to determine if an ongoing SSI Medicaid recipient is eligible for in- home health services and supplies: