Supplemental Security Income (SSI) provides cash and Medical Assistance (MA) benefits to an individual who meets the age, blindness, or disability requirements. The benefit is based on a federal payment plus a State Supplemental Payment (SSP). SSI is administered by the Social Security Administration (SSA).
SSI recipients can get Nonmoney Payment (NMP) MA and Buy-In of Medicare premiums. The CAO is responsible for keeping an MA record so that SSI recipients can get medical services. Eligibility for SSI MA is decided on by SSA, because Pennsylvania is a “1634” state. That is, when the SSI program was started in January 1974, states were given the choice of entering into an agreement with SSA under Section 1634 of the Social Security Act.
The 1634 agreement says that MA eligibility is based on the individual’s claim to SSI benefits. SSA sends information on SSI cash benefits and MA eligibility to the (Department of Human Services DHS) When SSA updates its SSI files, a record of changes is created and transferred to DHS as the State Data Exchange (SDX) file. This data is posted to IEVS Exchange #6, SDX Information. It shows new SSI records and changes to existing SSI records.
SSA information received on IEVS is identified on the IEVS screen as “8036.” The data exchange replaced the paper “8036” exchange of information from SSA to DHS See Using IEVS, Exchange #6 – SDX Information.
SSI replaced the state cash assistance programs of Old Age Assistance (OAA), Aid to the Blind (AB), and Aid to the Disabled (AD). Before January 1, 1974, DHS ran these programs with financial help from the federal government.
Any individual who qualifies for SSI and also qualifies for Healthy Horizons or a TANF-related category of MA or State Blind Pension (SBP)-related category of MA may choose which benefit he or she will receive.
Any individual who qualifies for General Assistance (GA) or GA-related MA because of disability may be eligible for SSI and must apply for SSI as a condition of eligibility.
The CAO will:
Identify applicants and recipients who are possibly eligible for SSI, and refer them to SSA and to the Medical Review Team (MRT) coordinator of the Disability Advocacy Program (DAP).
Give SSA pamphlets to people who are referred to SSA, and let them know about the need to show proof of the disability.
Authorize and maintain MA benefits for SSI recipients.
Keep case records on SSI recipients.
Give information to SSA when it is requested.
Tell the local SSA field office, by telephone, fax, e-mail, or letter, of changes in an individual’s situation that may affect the individual’s SSI eligibility. See Section 387.12, Notifying SSA of Changes to an SSI Recipient’s Situation.
NOTE: There are no exact guidelines for deciding what information should be reported to SSA. The CAO should know what issues affect eligibility for cash assistance, MA, or SNAP programs and should let SSA know about those issues. Information that should be reported includes changes in income, new or newly shown resources, and changes in living arrangements, such as entering prison or a Long-Term Care (LTC) facility.
Tell the SSI recipient that he or she must report changes directly to the SSA.
Stop MA when notified by SSA through IEVS Exchange #6, SDX Information. Decide whether the individual can get MA for other reasons. If the SDX MA eligibility code shows the individual’s MA eligibility continues, change the category.
Reminder: The CAO will get an IEVS alert. The reason code tells why a disposition was set.
NOTE: When an individual’s SSI benefits are held by SSA for one month and restarted in the following month, the CAO will not take any action to close or change the SSI MA benefits.
When the CAO learns that an SSI recipient's situation has changed enough to affect his or her SSI cash benefits, the CAO will:
Tell the local SSA field office by telephone, fax, e-mail, or letter.
NOTE: The CAO can use the sample letter to the SSA in Appendix C. The Executive Director (or someone named by the Executive Director) must approve the type of notice and sign all letters to SSA. The CAO must name the recipient, explain how that individual’s income or resources has changed, and tell about anything else that has changed.
Keep a copy of the information in the case record.
Update the case record narrative.
Stop MA when notified by SSA.
Decide on the individual’s continued eligibility for all other benefits he or she is getting, and decide whether the individual can get MA for other reasons.
Updated February 14, 2012, Replacing December 17, 2008