403.12 Terminated SSI Benefits

(Eff. 03/01/25)

Beneficiaries that lost SSI benefits but have continued to receive coverage in PCAT 86 must be evaluated through the SDX Ex Parte Process.

NOTE Eligibility Specialist will receive a task in Workload Pro indicating an ex parte determination is needed for PCAT 86. Eligibility Specialist will leave the beneficiary in the PCAT 86 until an ex parte decision is made. If a beneficiary is found ineligible for another PCAT with income information only and the Eligibility Specialist cannot complete the SDX Ex Parte, then the manual DHHS Form 1233-EXP-SDX— SDX RFI Form—will need to be completed by the Eligibility Specialist and sent to the member. Follow MPPM 702.03.03 for further instructions or guidance on the SDX Ex Parte process for 86. A DHHS Form 3401, or 3400-B is not required to be sent out with the manual DHHS Form 1233-EXP-SDX . Note: The 90-day period will start on the date the manual DHHS Form 1233-EXP-SDX is sent to the member. For PCAT 86 (SSIOSS), the Eligibility Specialist must explore the OSS Pass-Along Program (PCAT 85) (MPPM 404.04). If a beneficiary is denied for failure to return requested information, the Eligibility Specialist will end-date coverage 90 days from the date the manual DHHS Form 1233-EXP-SDX was sent to the beneficiary (Adverse Action Rules Apply) and terminate the vendor payment (FM CRCF-01 for PCAT 86). 90-day Notice Period Note: The 90-day period will start on the date the Manual SDX RFI is sent to the member. First 30 days: Due Date of the Manual SDX RFI from the date the form was sent. 60 days from the date the Manual SDX RFI was sent: Manual Reminder Notice that the SDX RFI is due.

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403.12 Terminated SSI Benefits

Official source

(Eff. 03/01/25)

Beneficiaries that lost SSI benefits but have continued to receive coverage in PCAT 86 must be evaluated through the SDX Ex Parte Process.

NOTE Eligibility Specialist will receive a task in Workload Pro indicating an ex parte determination is needed for PCAT 86. Eligibility Specialist will leave the beneficiary in the PCAT 86 until an ex parte decision is made. If a beneficiary is found ineligible for another PCAT with income information only and the Eligibility Specialist cannot complete the SDX Ex Parte, then the manual DHHS Form 1233-EXP-SDX— SDX RFI Form—will need to be completed by the Eligibility Specialist and sent to the member. Follow MPPM 702.03.03 for further instructions or guidance on the SDX Ex Parte process for 86. A DHHS Form 3401, or 3400-B is not required to be sent out with the manual DHHS Form 1233-EXP-SDX . Note: The 90-day period will start on the date the manual DHHS Form 1233-EXP-SDX is sent to the member. For PCAT 86 (SSIOSS), the Eligibility Specialist must explore the OSS Pass-Along Program (PCAT 85) (MPPM 404.04). If a beneficiary is denied for failure to return requested information, the Eligibility Specialist will end-date coverage 90 days from the date the manual DHHS Form 1233-EXP-SDX was sent to the beneficiary (Adverse Action Rules Apply) and terminate the vendor payment (FM CRCF-01 for PCAT 86). 90-day Notice Period Note: The 90-day period will start on the date the Manual SDX RFI is sent to the member. First 30 days: Due Date of the Manual SDX RFI from the date the form was sent. 60 days from the date the Manual SDX RFI was sent: Manual Reminder Notice that the SDX RFI is due.