DATE: DECEMBER 29, 2000
Manual: Aged, Blind and Disabled Medicaid
To: County Directors of Social Services
Effective: February 1, 2001
Make the following change(s)
Federal regulations require that states conduct an ex parte review of ongoing eligibility when an SSI recipient ceases to be eligible. The ex parte process avoids excessive requests for information from recipients and unnecessary loss of Medicaid coverage.
The Health Care Financing Administration (HCFA) has recently issued new guidance for conducting ex parte reviews for individuals who are terminated from SSI. The ex parte procedures have been expanded to require that Medicaid evaluations for ongoing eligibility rely wherever possible on information already available to the agency. "Available to the agency" includes on-line sources such as SDX or ESC and other program records such as Food Stamps. It also includes records in the names of family members living with the recipient. Expanding sources of acceptable information will ensure that all possible avenues of continuing Medicaid eligibility are explored when SSI is terminated.
MA-1000, SSI Medicaid - Automated Process is updated to incorporate these ex parte requirements.
To facilitate documentation of the ex parte review, a checklist is included as an attachment to this section. This checklist should be used to document all sources of information which are reviewed and the names of the individuals whose records were checked for potential eligibility information.
Many of the detailed EIS instructions for SSI cases have been deleted from this section as they are found in the EIS manual.
Please note that there are instances in which an SSI recipient no longer receives a cash payment but is still considered to be SSI eligible. An example is a "1619(b)" recipient. These recipients continue to be authorized for Medicaid. They will not show up on the SSI termination report nor do they require an ex parte review.
These changes are effective for all SSI terminations appearing on the SSI Termination Report on or after February 1, 2001, including all cases on the report whose reviews are currently in progress.
Remove MA-1000, pages 1-14
Insert MA-1000, pages 1-17, effective 2/1/01
Insert Attachments 9 and Attachment 10
If you have any questions regarding this information, please contact your Medicaid Program Representative.
Paul R. Perruzzi
[This policy material was researched and written by Jackie Franklin, Policy Consultant, Medicaid Eligibility Unit.]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.