Long Term Care for SSI Individuals

Authorizing Vendor Payments for SSI

Recipients

Eligibility for SSI Individuals

SSI Recipients already meet all technical, resource, and income eligibility requirements for LTC.

Since SSI Recipients already receive a Medicaid Card, the only additional LTC benefit is the vendor payment.

Confirmation Notices

For SSI Individuals you will receive either: Automated certification – LTC, HCBS MAP-374 – Hospice MAP-24 – SCL MAP-24B – ABI

SSI Individuals will also be on the RDS report titled “PRO Certifications Not Matched to KAMES”

Categories for SSI Individuals

Aged - category A Blind - category B Disabled - category D

All LTC cases for SSI individuals are now entered on the KAMES system.

SSI Individuals in LTC

Upon receipt of “confirmation” for an SSI recipient receiving LTC or Waiver Services:– Immediately authorize a vendor payment

on the KAMES system– Set up a case file using A, B or D category– Enter all information on the KAMES

system and work as normal– Send a PAFS-5.1 to notify SSA of

institutionalization

The next few slides have more details...

“SSI Only” or “SSI Alert”?

SSA determines ongoing SSI amount using a $30 standard, and $20 of any other income is excluded. So, if the individual has other income, and it is: $50 or more - case is “SSI Alert”

• SSI will be discontinued, if individual is institutionalized.

Less than $50 - case is “SSI Only”• SSI Payment will equal $50, less other

income amount, if institutionalized.

Income Consideration

If no income besides SSI, count $30 SSI.If there is “other” income, besides the SSI: – Count the entire amount of the “other” income.– Determine the amount of SSI to consider, by using

the following formula$50 – “other” income = SSI ongoing amountIf this is a negative number, the SSI will be discontinued.

Always enter a spot-check for 3 months to check on the new SSI amount.

For “SSI Alert” Cases

Send PAFS-5.1 to SSA to “alert” them if the individual is in an LTC facility

Spot check the case for 3 months, to see if SSI has been discontinued

Once SSI stops, it will discontinue the A,B or D Case and issue Exparte eligibility for 2 months

Individual will be advised to come into the DCBS office to re-apply for AMA in the J, K or M category

“SSI Only” Cases

If no income received other than SSI:– Count $30 continuing SSI– Patient Liability is zero

If other income is less than $50:– Adjust SSI amount to $50 minus the

amount of other income sources– Patient liability is zero

In both of these situations, we would send PAFS-5.1 to SSA

Wrap Up

SSI Individuals who meet Patient Status and Level of Care are eligible for LTC.

Upon receipt of a Confirmation Notice, immediately authorize payments on KAMES system.

Send form PAFS-5.1 to SSA to notify them of the individual’s LTC admission.