NC DEPARTMENT OF HEALTH AND HUMAN SERVICES EIS MANUAL

ELIGIBILITY INFORMATION SYSTEM EIS 4200

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SSI MEDICAID-TERMINATIONS - PART SIX

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EIS 4200 – SSI MEDICAID-TERMINATIONS PART SIX


I. SAA, SAD, and AAF (PAYMENT TYPE 5)

II. MAABD AND HSF - SSI TERMINATION DUE TO DEATH OR MOVING OUT OF STATE

III. MAABD & HSF-OTHER TERMINATIONS OF SSI

IV. EX PARTE ACTIONS

V. SSI IS REAPPROVED.

VI. RETROACTIVE TERMINATION OF SSI


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EIS 4200 – SSI MEDICAID-TERMINATIONS
PART SIX

REVISED 10/01/09 - CHANGE NO. 01-10

SSI TERMINATION

SSA notifies the recipient when SSI will terminate. When the SSI termination processes, SSA transmits this information to EIS via the SDX. The Medicaid Eligibility Code displayed on the online SDX indicates ineligibility for SSI Medicaid when the code is R, D or W. (EXCEPTION: WHEN THE MEDICAID ELIGIBILITY CODE IS R AND THE PAYMENT STATUS CODE IS E02, THE INDIVIDUAL IS ELIGIBLE FOR SSI MEDICAID.) The Medicaid Eligibility Code displays under the Change Month. The Change Month is the month the change is effective, and could be retroactive.

When the Medicaid Eligibility Code is C, G, Q, P, or N (with Payment Status Code N24) SSI ends, but SSI Medicaid continues.

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I. SAA, SAD, and AAF (PAYMENT TYPE 5)

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II. MAABD AND HSF - SSI TERMINATION DUE TO DEATH OR MOVING OUT OF STATE

REVISED 10/01/09 - CHANGE NO. 01-10

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III. MAABD & HSF-OTHER TERMINATIONS OF SSI

    A. When the SSI Medicaid is MAABD or HSF, and SSI terminates for some reason other than death or moving out of state, Medicaid continues until an “ex parte” case review is done and the review result entered in EIS. The action may be a redetermination, transfer to another Medicaid program, or a termination is entered into EIS.

      If the county has a DSS-8125 pending at the time the SSI Termination processes, the form is placed on hold. This action is reported on the Error and Attention Report with a message-ON HOLD DUE TO SSI UPDATE. The form does not process and continues to display on the report until the county deletes the action.

      1. When the SSI termination processes in EIS the case changes effective the current cycle month to a Non-SSI case in the weekly update.
      2. The SSI indicator on the case and in the Common Name Database changes from Y to N according to 1 above.
      3. The Medicaid Effective Date changes to the current cycle month.
      4. The Cert From Date changes to match the Medicaid Effective Date. The Cert Thru Date remains 12/31/9999.

REISSUED 02/01/11 - CHANGE NO. 03-11

III. A. (CONT’D)

      5. The EIS Medicaid Classification will:
        a. Change from C to N

          OR

        b. Remain Q.
      6. A CAP code displayed on the case remains if an END DATE is not entered.
      7. EIS updates the RSDI amount from the SDX.
      8. EIS deletes the SSI amount.
      9. Carolina Access and HMO remains on the case.
      10. The district number, county case number, and the worker number remain the same as on the case at the time of the SSI termination.
      11. CITIZEN/ID code remains the same as on the case at the time of the SSI termination.

    B. EIS generates a notice of redetermination to the client.

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IV. EX PARTE ACTIONS

    A. When the aid program is MAABD or HSF, SSI=N and Cert Thru Date is 12/31/9999, EIS only allows redeterminations, terminations, or reapplications into MAF, MIC, SA, or AAF.

      EIS does not allow changes to any demographic data including district number, worker number, address, and/or county number until a redetermination, termination, or reapplication is entered into EIS on the case.

      1. Redetermination
        a. The county must redetermine eligibility in the Medicaid aid program categories of MAABD, MQB, MPW, MSB, IAS, or HSF.
        b. The Medicaid effective date is the first day of the EIS processing month.
        c. The Certification From Date is the first day of the EIS processing month.
        d. The Certification Thru Date may be one to twelve months after the Cert From Date according to the policy and system edits for redeterminations. The Certification Thru Date for MQB-E is December 31st of the current calendar year.

REVISED 02/01/11 - CHANGE NO. 03-11

IV. A. 1. (CONT’D)

e. When suspending an individual’s Medicaid due to incarceration or residence in an Institution for Mental Disease (IMD), enter the Certification Thru Date as twelve months after the Cert From Date according to the policy and system edits for suspension at redetermination for an ex parte case.
        f. EIS allows authorized or deductible status.
        g. EIS allows adequate or timely change codes.
        h. Manual or system generated notices are issued when the redetermination is completed depending on whether the notice override is entered.
        i. EIS will not allow a county number change at redetermination.
        j. EIS generates a case profile.
      2. Case Termination.
        a. The Medicaid case can be terminated for any reason, including death or moving out of state.
        b. EIS allows manual or system generated notices based upon the termination code entered.
        c. EIS allows adequate or timely change codes.
        d. EIS generates a case profile.
      3. Reapplications.
        a. If MAB, MAD, or HSF and the individual qualifies as MAF or MIC, a reapplication is required.
          (1) You may enter the casehead payee as a non recipient on line 1 on the 8124.
          (2) The usual edits apply depending on the aid program entered on the 8124.
        b. Refer to the WFFA or Special Assistance Manual for instructions related to Money Payment reapplications.

REVISED 10/01/09 - CHANGE NO. 01-10

IV. (CONT’D)

    B. PML

      A PML can be posted to a case using the DB/PML transaction.

    C. Aid program transfers.

      EIS automatically transfers a case from MAD to MAA when an individual turns age 65.

    D. Benefit issuance.

      EIS issues Medicaid benefits as appropriate.

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V. SSI IS REAPPROVED.

    If SSI is reapproved, EIS modifies the existing case.

    A. The SSI indicator on the case and in the Common Name Database is changed from N to Y.

    B. The case displays on the SDX/EIS UPDATES REPORT and the SSI TERMINATION REPORT. If there is a pending application, the case displays on the SSI INDIVIDUAL ON EIS PENDING APPLICATION REPORT.

    C. EIS will automatically re-open TPR for an individual who is deleted from an active case or whose case terminates because they are approved for SSI Medicaid when the individual’s TPR is active at the time SSI is approved.

EXAMPLE:

      On June 3, EIS process an on-going SSI Medicaid approval for an individual currently active in EIS. On the night of June 3, EIS deletes the individual from the active case (or closes the case if it is a single-person case) effective June 30 and terminates TPR at the same time. EIS will automatically re-open the TPR at the same time it opens the SSI Medicaid case and will update the individual segment to indicate TPR coverage.

REISSUED 10/01/09 - CHANGE NO. 01-10

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VI. RETROACTIVE TERMINATION OF SSI

    SSI may terminate retroactively. When this occurs, MAABD SSI Medicaid is not terminated retroactively, but continues with a Cert Thru Date of 12/31/9999, unless the termination is due to death or the individual moves out of state.

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