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VI. DETERMINING ELIGIBILITY WHEN APPLYING FOR SAIH FROM A RESIDENTIAL FACILITY

Individuals living in residential facilities may choose to move to a PLA and apply

for SAIH. It is critical that the SA facility beneficiary or representative, the IMC,

the adult services case manager and others involved with the beneficiary work

together and communicate effectively. Moving from a facility to PLA requires

advance planning and timing of all activities needed for this change so that it

does not pose health or safety risks for the beneficiary.

NOTE: For individuals who are in a residential facility or are being diverted from

entering a residential facility and have been identified as being approved

for Supported Housing Slots and/or Transition to Community Living

through the US Department of Justice (DOJ) Settlement with North

Carolina, refer to DAAS Administrative Letter 13-07: Instructions for

Special Assistance In-Home Approvals for Individuals with Verified

Supported Housing Slots

A. When the SA facility beneficiary or representative inquires

about SAIH, an inquiry (DMA-5095) must be completed for

documentation.

Explain that the beneficiary is automatically eligible for Medicaid, and

explain the SAIH requirements.

B. If the beneficiary wants to apply for SAIH, obtain a signed DSS-8190 SSI/Non-SSI Application Workbook as a reapplication.

Verify income and any other eligibility criteria that are necessary to

determine if the beneficiary is eligible for SAIH.

C. If the beneficiary is eligible for SAIH, they are

automatically eligible for Medicaid.

D. Refer the SAIH applicant to the adult services case

manager for a case management assessment, following

time standards for applications.

E. The Adult Services Case Manager follows the State-County Special Assistance In-Home Case Management Manual. SA-5200 VI.