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NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4200

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SSI MEDICAID-INTRODUCTION - PART ONE

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EIS 4200 – SSI MEDICAID-INTRODUCTION PART ONE


I. STATE DATA EXCHANGE (SDX)

II. MATCH PROCESS

III. EMERGENCY MEDICAID

IV. EXCEPTIONS TO AUTOMATIC MEDICAID ELIGIBILITY-REFUSAL TO PROVIDE TPR


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EIS 4200 – SSI MEDICAID-INTRODUCTION
PART ONE

REVISED 10/01/07 - CHANGE NO. 02-08

1634 BACKGROUND

Effective January 1, 1995, individuals who receive SSI are automatically eligible for Medicaid. Medicaid eligibility begins with the first month of eligibility for SSI, but not prior to January 1, 1995. Medicaid benefits for these individuals are issued automatically by the Eligibility Information System (EIS). SSI Medicaid cases are in EIS, just as other regular cases. SSI Medicaid recipients are found in Name Search, and have all the usual case and individual data and history as other cases in EIS. EIS will automatically insert a Relationship To Payee indicator of “L” for self when the SSI Medicaid case is built.

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I. STATE DATA EXCHANGE (SDX)

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II. MATCH PROCESS

REISSUED 10/01/07 - CHANGE NO. 02-08

II.(CONT’D)

1.

SSN IS NOT IN EIS

     

EIS CREATES SSI MEDICAID CASE

2.

SSN MATCHES ONLY ONE PERSON IN EIS AND

SDX NAME AND DATE OF BIRTH ALSO MATCH IN EIS

 

EIS USES INDIVIDUAL ID FROM NAME CLEARANCE

EIS CREATES SSI MEDICAID CASE

3.

SSN MATCHES ONLY ONE PERSON IN EIS AND

SDX NAME AND/OR DATE OF BIRTH DO NOT MATCH IN EIS

SDX EXCEPTION LIST

EXCEPTION RESOLVED (CASE IS NOT CREATED AND BENEFITS NOT ISSUED UNTIL EXCEPTION RESOLVED.)

EIS CREATES SSI MEDICAID CASE

4.

SSN MATCHES MORE THAN ONE PERSON IN EIS

 

SDX EXCEPTION LIST

EXCEPTION RESOLVED (CASE IS NOT CREATED AND BENEFITS NOT ISSUED UNTIL EXCEPTION RESOLVED.)

EIS CREATES SSI MEDICAID CASE

Refer to SSI MEDICAID-PART TWO for EXCEPTION PROCESSING instructions.

REISSUED 07/01/06 - CHANGE NO. 01-07

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III. EMERGENCY MEDICAID

REVISED 07/01/06 - CHANGE NO. 01-07

III.D.3.(CONT'D)

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IV. EXCEPTIONS TO AUTOMATIC MEDICAID ELIGIBILITY-REFUSAL TO PROVIDE TPR

ISSUED 01/01/95 - CHANGE NO. 1-95

IV.(CONT’D)

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