DATE: JANUARY 3, 2003
SUBJECT: Potential DAC or Widow(er) Passalong Eligibles
DISTRIBUTION: County Directors of Social Services
Many disabled and elderly Social Security recipients are eligible to have all or a part of their Social Security benefits disregarded under the four different passalong provisions in federal law when determining eligibility for Medicaid. Some individuals eligible for passalong may have lost Medicaid eligibility incorrectly. New manual instructions were issued with Change Notice 16-03 on November 12, 2002.
The purpose of this letter is to provide instructions that require each county DSS to take steps to identify and reinstate individuals who are passalong eligible as a Disabled Adult Child (DAC) or Widow (er) s. On January 3, the State will provide a report of individuals in NCXPTR who must be evaluated for Medicaid under the passalong provisions. This process must be completed within 30 days of receipt of this administrative letter.
A report will be provided in NCXPTR that identifies individuals potentially eligible for DAC or Widow (er) s passalong. The NCXPTR selection name is “DHREJ PASSALONG POT ELIGS-D & W. The report title is “Individuals Potentially Eligible for Passalong-DACs/Widow(ers).” You may print a paper copy of the report, if needed.
Individuals were selected for this report based on the following SDX and EIS criteria:
The report is sorted by county and Medicaid status.
Individuals are assigned to a county for review based on their Medicaid status. Active individuals and individuals on pending applications are assigned to their current county. Terminated individuals are assigned to the county in which the Medicaid termination occurred.
Within each county, individuals are displayed in the following order: terminated, deductible status or MQB, and active (Medicaid status is A in any category other than MQB).
Each county is responsible for evaluating all individuals listed on the report for passalong eligibility. This evaluation process is to be completed within 30 days from receipt of this letter.
Refer to MA-2110, Passalong, to determine if those individuals identified on the report qualify for Medicaid under passalong provisions. Follow instructions in MA-2110 on how to disregard all SSA income and/or COLAs when determining passalong eligibility.
Use MA-2110, Attachment 2, to document the individual’s eligibility or ineligibility for passalong and file as a permanent document in the case record. For each individual determined to be passalong, enter in EIS the appropriate Individual Special Use code (PC for COLA, PD for Disabled Adult Child or PW for Widow (er).) Do this for all individuals identified below.
If you determine an individual on the report is passalong eligible, take the appropriate action based on the individual’s Medicaid status as instructed below.
Individuals terminated from Medicaid within the last 12 months for whom you can establish passalong eligibility must be reinstated back to the first month of eligibility after the termination occurring after January 1, 2002. Complete an unsigned administrative application to reinstate the individual. For any eligibility authorized so late that providers have less than 60 days to file claims at disposition, you must complete an override request. Check the box for county administrative error. Do the override request at the same time you authorize the case.
Determine the individual’s current address prior to reinstatement. If the individual is no longer in the county where his Medicaid terminated, the county in which the Medicaid terminated is still responsible for reinstating that individual for Medicaid. Once the county authorizes the individual for Medicaid, transfer the individual to the correct county.
Once the county transfer has processed, request adjustment of responsibility for claims in months that the individual resided in the second county. Identify any claims charged in error to their county by reviewing the "Recipient Payment Register." Once claims are identified, notify the Claims Analysis Section of DMA in writing of the charges. Include the recipient's name, individual identification number, and dates of service.
Individuals who lost Medicaid eligibility longer than 12 months ago but are passalong eligible cannot be automatically reinstated. Determine the individual’s current address and send a notice to the individual. Inform him that he is potentially eligible for Medicaid and that he must apply at the dss in the county where he now resides. If the individual applies, determine eligibility from the date of application and up to 3 months retroactive to the date of application, following application processing policy in MA-2300 – MA-2304.
When you send a notice to an individual who is now living in another county, send a copy of that notice to the dss in the individual’s new county of residence.
Evaluate MQB recipients and individuals in deductible status who qualify as passalong for full Medicaid. Authorize full Medicaid back to the beginning of the certification period.
MQB recipients have 12 months certification periods. For any eligibility authorized so late that providers have less than 60 days to file claims at disposition, you must complete an override request. Check the box for county administrative error. Do the override request at the same time you authorize the case.
The only action needed for active passalong eligible recipients is to enter the appropriate Special Use code in EIS and document passalong eligibility in the case record.
If you have questions, please contact your Medicaid Program Representative.
Nina M. Yeager
[This material was prepared by Cinnamon Narron, Policy Consultant, Medicaid Eligibility Unit.]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.