Adult Medicaid Admin. Letters
DMA ADMINISTRATIVE LETTER NO: 10-05, APPLICATION PROCESSING AND APPLICATION FOR SOCIAL SECURITY BENEFITS
DATE: July 18, 2005
SUBJECT: Application Processing and Application for Social Security Benefits
DISTRIBUTION: County Directors of Social Services, Medicaid Application Processing Staff
Social Security Administration offices often schedule appointments for completing applications for Social Security benefits. It has been reported to us that these appointments may be scheduled four to six weeks after the individual contacts Social Security asking to apply for benefits. MA-2250, Income, II.A. and MA-3300, Income, III.A.1. require a Medicaid applicant to apply for all benefits for which he may be eligible before his Medicaid eligibility can be determined. A four to six weeks delay between the dates a Medicaid applicant contacts Social Security and an appointment is scheduled can result in the Medicaid applicant being unable to complete his Social Security application within the Medicaid application processing time frame. Through no fault of his own, he could be denied Medicaid.
Additionally, this creates a potential Application Report Card problem for the county. The county cannot begin excluding days from the application processing time until the application is pending solely for one of the reasons listed in MA-2304/3215, Processing the Application, III.B.1.a. As long as the application is pending for the applicant to go to his appointment with Social Security, days cannot be excluded. Like the applicant, the county faces potential harm due to circumstances beyond its control.
II. POLICY PRINCIPLE
If an individual keeps his appointment to complete his Social Security application, Social Security treats the day that the individual contacts them regarding an application as the date of application for benefits. Once he has set up his appointment to complete his Social Security application, the individual has done all he can do until the date of the appointment to meet the Medicaid requirement to apply for Social Security.
Therefore, it is our interpretation of policy that on the date a Medicaid applicant who may be eligible for Social Security benefits contacts the Social Security Administration and makes an appointment to complete his application for Social Security benefits, he has met the requirement to apply for Social Security benefits.
A. Application Processing
Instruct an applicant who may be eligible for Social Security benefits but who has not applied for those benefits at the time he applies for Medicaid to apply for Social Security benefits. Inform him that he cannot be approved for Medicaid until he has done so.
Once it is verified that an applicant who may be eligible for Social Security benefits has made the appointment with Social Security and:
1. All other eligibility requirements have been met, approve the application. Do not wait to determine if the individual keeps his appointment with Social Security and completes his application for Social Security benefits. Flag the case to determine if the applicant kept the appointment and completed his Social Security application. See III.B., below.
2. You have received all other information necessary to determine eligibility except for one of the items listed in MA-2304/3215, Processing the Application, III.B.1.a.,
a. Send the DMA-5098, Your Application for Medicaid is Pending, or DMA-5099, Your Application is Pending for a Deductible, notifying the applicant that his application remains pending for that information, and
b. Key the date screen to stop the application processing clock.
B. Follow-up to Verify That the Social Security Application Was Made
1. The following individuals are eligible for continuous periods of time regardless of changes in income. For these individuals follow-up as part of the re-enrollment process to verify that the individual completed his application for Social Security benefits.
a. Pregnant women eligible under MPW, and
b. Individuals under age 19 who are eligible under MAF-C, MIC-N, or NC Health Choice.
2. Follow-up for Other Individuals
The certification periods for ABD recipients who are potentially eligible for Social Security benefits should always be 6 months, as their income cannot be considered stable. (Refer to MA-2350, Certification and Authorization, II.B.1.a.(1) and MA-2250, Income, II.A.1.d.) Other FC recipients not listed in III.B.1., above (except IAS and Breast and Cervical Cancer Medicaid recipients, for whom the county department of social services does not determine eligibility and who are not subject to the requirement to apply for all benefits to which they may be entitled) have 6 months certification periods. (Refer to MA-3425, Certification and Authorization, II.B.)
a. If the appointment to complete the Social Security application is scheduled for the fourth month of the certification period or later, verify that the individual completed his application for Social Security benefits when completing the first Medicaid re-enrollment or redetermination. (Refer to III.B.3. for instructions on verifying that the Social Security application was completed.)
b. If the appointment to complete the Social Security application is scheduled in the third month of the certification period or earlier, then within a week of the date of the applicant’s appointment to complete his Social Security application, verify that the recipient did keep his appointment and completed the application. (Refer to III.B.3. for instructions on verifying that the Social Security application was completed.)
3. Take the following steps to verify that the individual completed the application for Social Security benefits.
a. If the Medicaid application is still pending at the time of follow-up,
(1) Accept the applicant’s statement. (Refer to MA-2303/3210, Verification Requirements for Applications, II.C. & D., MA-2250, Income, II.A.1., and MA-3300, Income, III.A.1.)
(2) If at the first re-enrollment or redetermination the recipient has yet to begin receiving Social Security benefits, follow procedures in 3.c., below to determine if he did apply for Social Security Benefits.
b. If the Medicaid application was denied, no further action is needed.
c. If the Medicaid application has been approved at the time of follow-up,
(1) Check SOLQ to determine if the recipient has begun receiving Social Security benefits or if he has applied for Social Security benefits.
(2) If SOLQ does not indicate that the recipient has begun receiving or has applied for Social Security benefits,
(a) Send a timely DSS-8110 to the recipient, proposing termination and requesting he provide proof that he has applied for Social Security benefits. Acceptable proof includes:
1) A receipt from Social Security indicating that he made the application,
2) An approval or denial notice from Social Security, or
3) Other documentation from Social Security indicating that he has made the application.
(b) If the recipient contacts you and states he has applied, but has no documentation from Social Security, contact the Social Security office where he states he applied to determine if he has completed his Social Security application.
4. If you verify that he has completed his Social Security application or he completes it by the end of the timely notice period, note this in the case record and advise the recipient to notify you when his Social Security application is disposed. Additionally, you should monitor the case periodically on the SOLQ to determine the status of the Social Security application.
5. If the recipient has not applied for Social Security by the end of the timely notice period, proceed with the termination. Evaluate for any other eligibility.
We will revise the eligibility manuals to incorporate this policy as soon as possible.
If you have any questions, please contact your Medicaid Program Representative.
L. Allen Dobson, Jr., M.D., Assistant Secretary for
Health Policy and Medical Assistance
This material was written by Andy Wilson, Contractor with the Medicaid Eligibility Unit.