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7. To report within 5 calendar days any change in situation that may

affect SA eligibility. Explain the meaning of fraud. Notify the applicant

they may be suspected of fraud if the applicant/beneficiary fails to

report a change in situation. Explain that in such situations, the

applicant/beneficiary may have to repay assistance received in error

and that they may also be tried by the courts for fraud.

8. To provide information about any person or organization from which

Medicaid has a right to recovery of medical expenses that were paid

by Medicaid.

9. To sign a DMA-5052SA, State/County Special Assistance Beneficiary

Estate Subject to Medicaid Recovery Notice because Medicaid is

automatic for SA facility beneficiaries, inform applicants of the

potential for estate recovery for the cost of PCS paid by Medicaid for

beneficiaries age 55 and older. Regardless of age at application,

have the applicant or their representatives sign the DMA-5052SA,

State/County Special Assistance Beneficiary Estate Subject to

Medicaid Recovery Notice. Provide a signed copy to the applicant

and/or representative and retain a copy of the case file. 10. To report within five business days to the county DSS the receipt of a

payment, which the SA beneficiary knows to be erroneous, such as

two payments for the same month, or a payment in the wrong

amount. Failing to report such payments may result in the SA

beneficiary being required to repay any overpayments.

VIII. ELIGIBILITY DETERMINATION PROCESS The following steps shall be followed in determining eligibility. Review each

eligibility factor following the policy in the appropriate manual sections.

Document all factors of eligibility on the DSS-8190 SSI/Non-SSI Application

Workbook. Date-stamp all information with date of receipt in DSS including

electronic date received stamps. Document in the case record all applicant,

collateral, and telephone contacts, including the full name and title of who

provided the information and what they verified.

NOTE: SSI Recipients automatically meet the categorical, financial and

resource requirements.

A. Verify and document each eligibility factor SA-3110 VIII.