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Document these changes. All appropriate changes must be completed

within 30 days of the agency learning of the change.

B. Determining Eligibility When Applying for SA from SAIH

1. If an SAIH beneficiary moves to a residential facility, explain to the

beneficiary that he/she can apply for SA.

2. If the beneficiary applies for SA, obtain a signed DSS-8190 SSI/Non-SSI Application Workbook as a reapplication. Verify eligibility according to the SA policy.

3. Notify the adult services case manager when the beneficiary applies

for SA via DSS-0031 SAIH Program Interagency Referral Form. Keep

the case manager informed regarding the status of the application.

4. If the beneficiary is found eligible for SA, terminate the SAIH case

effective the last day of the month. Send a DSS-8110, Your Benefits

Are Changing, adequate notice because the beneficiary has requested

the SAIH be terminated and the change is beneficial to the beneficiary.

5. Provide written notification via DSS-0031 SAIH Program Interagency

Referral Form, to the Adult Services Case Manager the day the SA

is approved so the case manager can close the case management

assessment. Verify the case manager has received the DSS-0031.

6. Approve the SA with an effective date the month following the

determination of the SAIH case. Enter the full SA payment beginning

with this month.

7. If the individual enters the residential care facility after the first day of

the month, calculate a partial SA payment for that month, following

instructions in SA-3220, Budgeting.

8. Do not count the individual’s income, including the SAIH payment, in

determining the SA partial payment.

9. If the beneficiary does not apply for SA or if SA is not approved,

terminate the SAIH case effective the last day of the month. Send the

appropriate notice to terminate the SAIH case. See SA-3330: Notices.

SA-5200 VIII.