2845 SSI Eligible Child

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

SSI Eligible Child

Effective Date:

January 2021

Chapter:

2800

Policy Number:

2845

Previous Policy Number(s):

MT 45

Updated or Reviewed in MT:

MT-63

Requirements

SSI benefits do not affect a child’s IV-E eligibility; a child receiving SSI should always be IV- E eligible if the child meets all the IV-E eligibility criteria.

Basic Considerations

SSI income is exempt (not counted) in determining if the child meets the financial need requirement for AFDC relatedness. If the child receives SSI in the eligibility month, the child meets AFDC relatedness financial need criteria for both income and resources.

As of February 4, 1994, federal policy has allowed the concurrent receipt of SSI and IV-E foster care reimbursement benefits. The RevMax Specialist (RMS) should continue to aggressively determine IV-E reimbursability for all children, including those receiving or eligible to receive SSI benefits. When a child is IV-E reimbursable, the RMS must determine whether to continue the child’s SSI benefits to cover board and care costs or cover the board and care costs under IV-E. It is not in the child’s best interest to lose SSI income while in out- of-home care if it appears the child may be returning home soon or is over the age of 16 yrs and 6 months, due to the need to have SSI income available upon return home or leaving foster care.

The cost of care for a child receiving SSI should not be made IV-E reimbursable unless the monthly federal financial participation (FFP) amount for IV-E reimbursement of the placement cost for that child exceeds the SSI monthly payment. The SSI payment is reduced dollar for dollar by the amount of any Federal Title IV-E reimbursement payments for board and care. In other words, at the point the cost of care multiplied by the FFP amount (the federal Medicaid percentage, FMAP) is more than the SSI amount, the FFP amount should be considered. SSI is a set amount of federal funds. SSI funding is 100% federal dollars while IV-E funding requires a state funds match. SSI is adjusted every January. Title IV-E federal funds are not limited, and will reimburse allowable costs.

Guidelines to follow when considering a child in receipt of SSI:

  • A child who is eligible for SSI and IV-E reimbursability should continue to receive the SSI check if the SSI payments are more than the IV-E reimbursable FFP for the foster care per diem. The child will be IV-E eligible, but not IV-E reimbursable for covering the cost of board and care.

  • The cost of care for a child who is receiving SSI and meets all IV-E reimbursable criteria should be made IV-E reimbursable if the federal IV-E reimbursement for the foster care per diem is more than the SSI payment. In this situation the RMS is responsible for determining the IV-E reimbursability of the child. The SSCM should notify the Social Security Administration (SSA) that the child is receiving a IV-E foster care per diem, including the amount and the effective date. The child’s SSI check would be suspended as required by the dollar for dollar rule, and there would be no concurrent receipt of two federal funding sources.

    The FFP and the SSI payments change annually. It is the responsibility of the SSCM to notify the Social Security Administration of foster care status. The Social Security Administration is responsible for the suspension or reduction in the SSI payment amount.

Programmatic reasons not to discontinue a child’s SSI benefits:

  • If the child is expected to be in out-of-home care a short period of time (i.e., 60 days or less);

  • The child is in the adoption process;

  • The child is approaching age 18 or is in an independent program.

If a child is SSI eligible when entering care, Rev Max will open a Medical Assistance case on Gateway coding the Child in Placement page living arrangement as FC. This will generate the interface update to GAMMIS. The Medicaid case for a foster child will remain open in Gateway and services will be provided through fee-for-service.

Procedures

Revenue Maximization Specialist (RMS) will determine the most appropriate funding source based on the individual child’s circumstances and the determination status on the SHINES Eligibility Summary page.

Verification

Follow verification guidelines found in the appropriate sections of this manual.

Clearinghouse must be checked for information on each member in the removal home family and for child in care.

Standard of Promptness

The standard of promptness for Medicaid is 45 days.

The Medicaid is provided through federal Medicaid and is not reviewed for eligibility.

The SSCM will notify SSA of the change in custody, placement and funding source in sufficient time to allow the SSA to process the request and begin issuing an SSI check to the designated payee.

RMS will code the SHINES Eligibility Summary page with the selected eligibility for SSI when it has been determined that receipt of SSI benefits are in the best interest of the child and the agency. The SSCM has responsibility to contact the Social Security Administration to advise of foster care status and funding determination.