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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

7 REISSUED 10/01/05 – CHANGE NO. 28-05 (II.B.) d. The applicant or spouse, child, or parent, or representative of applicant is hospitalized for an extended period of time.

3. DO NOT TAKE AN APPLICATION FOR RETROACTIVE SSI MEDICAID WHEN THE REQUEST IS NOT TIMELY.

C. Establish the Retroactive Period

1. The retroactive period is the 1, 2, or 3 month period prior to the SSI month of application.

2. Always use the date in the SSI Application Date field to verify the retroactive period. It is located on screen two of the on-line SDX.

D. Register a DSS-8124

1. The application date entered on the DSS-8124 is the date the retroactive application is signed at the county dss. This is a new application, not a reapplication.

2. Enter the exact first and last name, Social Security number, and birth date as listed on the SDX.

IMPORTANT: EIS DATA MUST MATCH SDX DATA TO PREVENT FUTURE DISCREPANCIES.

3. Use the EIS individual ID number assigned to this individual.

4. The application must be MAA, MAD, or MAB.

5. On the retro date screen, place an S beside RSDI Or SSI Appeal Reversal/SSI APPL to indicate this is an SSI Retroactive application.

NOTE: Using the date screen allows retro Medicaid to be authorized based on the SSI date of application and application processing time to be based on the date the DSS-8124 is signed.

6. Enter the SSI date of application beside ORIG DTE OF APPLI on the date screen. Refer to EIS 2400 for further instructions.

E. Determine Eligibility In the Retro Period

1. Evaluate eligibility using categorically needy criteria. When the individual does not meet categorically needy income and/or resources limits evaluate under any Medicaid program (Medically needy, MAF, MIC, etc.)