IM-133 12/18/97 CONTINUED MEDICAID
ELIGIBILITY FOR CHILDREN
LOSING SUPPLEMENTAL SECURITY INCOME (SSI) PAY STATUS
|CONTINUED MEDICAID ELIGIBILITY FOR CHILDREN LOSING SUPPLEMENTAL SECURITY INCOME (SSI) PAY STATUS|
|The Balanced Budget Act of 1997 created
a protected Medicaid status for some children who were receiving SSI on
August 22, 1996. The children entitled to this status are those who became
ineligible for SSI because of a change in the definition of childhood disability
in the Personal Responsibility and Work Opportunity Reconciliation Act
(PRWORA). These individuals will be considered as having met the
Permanent and Total Disability (PTD) criteria for Medical Assistance, until
they reach age 18, as long as they continue to meet the childhood disability
definition in effect prior to August 22, 1996.
The Social Security Administration (SSA) is completing disability redeterminations for all SSI recipients under age 18 based on the new childhood disability definition. If the individual did not meet the new definition SSA took action to close their SSI. The first closings took place in July 1997.
The SSA has furnished the Division of Family Services (DFS) a list of children affected by the disability redeterminations. Printouts from this list are being forwarded to the appropriate DFS county offices. On receipt DFS staff must immediately review each case to ensure the child is currently receiving Medicaid coverage under the Medical Assistance program or another type of assistance. If the child is receiving Medicaid no further action is required at the present time, except to file the printout in the case record as directed below. If the child was receiving Medical Assistance and is now in closed status, field staff should immediately review the case record to determine if the case was closed based on loss of disability or closed based on other eligibility criteria. If the case was closed based on loss of disability, immediately cancel-close the case.
DFS field staff should establish a Medical Section in each case record, to include the aforementioned printout, as a reference for future redeterminations/reinvestigations. Since these children are in a protected Medicaid status no medical information will have to be submitted to the Medical Review Team prior to cancel-closing the Medical Assistance case.
Establish a Medical Section even if the child is receiving Medicaid through the Aid to Families with Dependent Children (AFDC) or Medicaid for Children (MC) programs as they have the same protected status. If one of these children applies for Medical Assistance in the future, disability should be based on the rules in effect for children with this protected status.
Continue to follow current MA policy for redeterminations\reinvestigations of these cases on all factors of eligibility except disability. Eligibility on disability will be established based on the pre-PRWORA childhood disability definition until the child reaches age 18. For active MA cases (or those cancel-closed as a result of this memorandum) the first medical re-determination using this standard should be done at the next scheduled reinvestigation. To identify these cases, attach the aforementioned printout to the front of the Medical Section prior to submitting to the Medical Review Team.
The SSA will be furnishing DFS Central Office a copy of the current medical information they have on these children. It will be forwarded to the appropriate DFS county office to be made a part of the medical section in each case record. When completing medical redeterminations contact the Income Maintenance Program and Policy Unit if you have not received this information.