IM-10 01/30/97 TERMINATION OF
SOCIAL SECURITY (SS) AND SUPPLEMENTAL
SECURITY INCOME (SSI) PAYMENTS WHERE DRUG ADDICTION AND/OR
ALCOHOLISM (DA&A) IS THE CONTRIBUTING FACTOR FOR DISABILITY
|TERMINATION OF SOCIAL SECURITY (SS) AND SUPPLEMENTAL SECURITY INCOME (SSI) PAYMENTS WHERE DRUG ADDICTION AND/OR ALCOHOLISM (DA&A) IS THE CONTRIBUTING FACTOR FOR DISABILITY|
|Public Law 104-121 revised the definition
of disability for Social Security, SSI and Medicaid effective immediately.
The Law states, in part, An individual shall not be considered to be disabled
for purposes of this title if alcoholism or drug addiction would be a contributing
factor material to the determination that the individual is disabled.
The Social Security Administration (SSA) notified all Drug Addiction and/or Alcoholism clients that their benefits were terminating and that they could reapply if they believed that they were disabled even if they stopped using drugs and/or alcohol.
The following DA&A clients lost their SS/SSI eligibility effective January 1997:
Individuals who received SSI and fit into one of the above categories received their last SSI check in December 1996. The SDX printout for January 1997 will identify a DA&A client who is determined no longer eligible for a SSI payment with a payment status code N07.
SOCIAL SECURITY DISABILITY PAYMENTS
Individuals who received regular SS disability benefits and fit into one of the above categories received their last SS check in January 1997. The BENDEX printout for February 1997 will identify a DA&A client who is determined no longer eligible for a regular SS disability check with a payment status code of T8.
Re-evaluate food stamp households that include an individual who loses SSI for the following: work registration requirements for the individual; budget adjustment due to loss of income; possible loss of a medical deduction; and categorical eligibility of the household or the individual. Any action that adversely affects the household requires an IM-80.
TEMPORARY ASSISTANCE FOR NEEDY FAMILIES
Individuals in families receiving TANF (formerly AFDC) who lose SSI eligibility must be evaluated to determine if they are now to be included in the assistance group. A person who lost SSI eligibility is mandatory without the SSI exclusion and must be included in the TANF case effective January 1997. Optional inclusions in the assistance group must have their options explained to them if they contact the DFS office. If they choose to be included in the assistance group, their beginning date of inclusion would be the month they request to be included, if they are found eligible.
If including an individual who formerly received SSI and is now a mandatory member of the assistance group causes the family to be ineligible for TANF, or reduces the grant amount, send an IM-80 with wording as follows: Because (name of former SSI recipient) no longer receives Supplemental Security income, all of his/her income and resources must be included in determining your eligibility or amount of grant. This is in accordance with 13 CSR 40-2.120.
If the former SSI recipient is a parent and the factor of deprived of parental support was established by accepting Social Security’s determination that the parent was disabled, immediately redetermine incapacity, as with any case with deprived of parental support based on incapacity.
Individuals who lose their SS/SSI benefits based on the determination they are no longer considered disabled under the new standards for DA&A are not eligible for Medical Assistance, unless they are re-determined disabled by the Medical Review Team (MRT). Identify these individuals using the SDX/BENDEX printouts and determine if they are eligible for Medicaid under another type of assistance (TOA) which is not based on disability. If eligible under another TOA, the MA case should be closed and the other TOA opened. The only TOA eligibility could be established for, without contacting the client, is TANF.
If the individual is not eligible for TANF, staff must immediately take action to close the Medicaid case by sending an IM-80. The IM-80 must state You are no longer considered permanently and totally disabled as the Social Security Administration (SSA) stopped your Social Security Disability and/or Supplemental Security Income benefits because you no longer meet the disability requirements. If you feel you are eligible for Medicaid under a different program, contact this DFS office. If an individual requests a hearing after receiving an adverse action notice, staff should immediately request medical information and submit the medical reports to MRT for a disability determination.
If an individual reapplies for Medical Assistance after a determination that they are no longer disabled based on DA&A, staff must obtain the medical information and submit it to MRT using standard procedures.
RETROACTIVE SS/SSI PAYMENTS BASED ON DA&A
Certain individuals whose principal factor contributing to their disability determination was DA&A may continue to receive retroactive SS/SSI payments after they are no longer determined disabled. The BENDEX/SDX printout will show the individual’s benefits have been terminated but will continue to show an amount in the monthly benefit field until all retroactive benefits have been paid. These individuals are NOT considered to be determined disabled for Medical Assistance without a determination by the Medical Review Team. The payments are to be budgeted as income.