2578 SSI Recipients | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

SSI Recipients

Effective Date:

July 2019

Chapter:

2575

Policy Number:

2578

Previous Policy Number(s):

MT 49

Updated or Reviewed in MT:

MT-56

Requirements

An individual who receives SSI prior to admission to a nursing home (NH) has already had Medicaid eligibility established. A NH vendor payment can be authorized.

Basic Considerations

A NH vendor payment can be authorized for the SSI recipient entering a NH if all the following conditions are met:

The A/R is a resident of Georgia.
The A/R has an approved Level of Care (LOC).
The A/R has not transferred a resource for less than fair market value within 60 months prior to the month of application.

Individuals entering a NH who receive SSI only will have their SSI payment amount reduced to $30.00 the month following the month of NH admission. They will also receive a State Supplement. Please see effective dates and amounts below:

Effective Date	State Supplement Amount
7/1/2006	$20.00
7/1/2018	$35.00
7/1/2019	$40.00

Individuals entering a NH who receive SSI and any other income from another source will have their SSI terminated and changed automatically to ABD Medicaid on the DMA Recipient Data Base.

Authorization of a vendor payment for an SSI recipient should not be delayed pending receipt of the SSI/DMP to MAO list.

Procedures

Follow the steps below to authorize a NH vendor payment for an SSI recipient:

Step 1

Complete and submit Form 107 to the SSA District office to report the SSI recipient’s new living arrangement and address.

Step 2

Step 3

Obtain A/R’s or PR’s statement regarding ownership of resources and possible transfer of assets. If a SSI A/R’s countable resources exceed the SSI resource limit, notate on Form 107 and forward to SSA. Unless/until SSA takes action, there is no effect on authorizing the vendor payment. If, however, the SSI A/R (SSI only and SSI/MAO) had assets which have been transferred, compute and impose a transfer penalty. Do not authorize the vendor payment. Refer to 2342 Transfer of Assets. Verify income at the twelve-month review for A/Rs whose SSI will be terminating.

Step 4

Inform A/Rs and their representatives of Estate Recovery and provide them Form 315. Refer to 2398 Estate Recovery for ABD Medicaid.

Step 5

Determine patient liability for the month of admission to LA-D using ALL income available to the A/R that month, INCLUDING SSI. Determine patient liability for the month(s) following the month of admission to LA-D using only the amount of SSI to which the recipient is entitled in LA-D (if any) plus all other income.

The month of admission to LA-D means the first month of continuous confinement in LA-D, including situations where the SSI recipient entered the NH from a hospital or other LA-D.

Step 6

Do not delay in authorizing the vendor payment on the system and notifying the A/R, PR and the NH, even if you are still waiting on information regarding resources or transfers.

Use the Admission date or Effective Date on Form DMA-59, whichever is later, as the Payment Authorization date in the system.

Special Considerations

SSI Recipient is not a Resident of Georgia

Follow the procedures below if the SSI recipient entering a NH is not a resident of Georgia:

Do not authorize a vendor payment.
Notify DMA via Form 951 that the A/R is not a Georgia resident and therefore not eligible for Medicaid.
Notify SSA via Form 107 of the A/R’s correct state of residence.
Notify the SSI recipient of his/her ineligibility for a vendor payment.

SSI Recipient is not approved for Level of Care

Follow the procedures below if the SSI recipient entering a NH, Swing Bed, or a facility for the mentally retarded is not approved for a LOC:

Do not authorize a vendor payment.
Notify the SSI recipient of his/her ineligibility for a vendor payment.

Reviews

Annual reviews are completed by SSA on SSI only NH recipients. Although it is not necessary for DFCS workers to complete a full annual review on these A/R’s, workers should check annually to confirm that recipients continue to receive SSI and remain a resident of the NH while authorizing an annual renewal in the eligibility system for the purposes to extend the Period of Eligibility.

For the AR’s that lose their SSI payment DFCS must obtain all the necessary verification and forms (this would include the Declaration of Citizenship form) to determine eligibility at the next review or interim change.