The SSI State Data Exchange (SDX) System provides DHS with case data on SSI applicants and recipients through IEVS Exchange #6, SDX Information. The SSA-SDX database file is on IEVS and is updated several times a week with information from SSA. For details on the information provided by SSA, see “Using IEVS, Exchange #6, SDX information.”
When it gets information from SDX, the CAO must review the information and decide what action to take for MA eligibility.
NOTE: The CAO should contact SSA for more information if the IEVS information is unclear or incomplete.
Reminder: The CAO must review the disposition reason code, the SDX payment status code, and the MA eligibility code. These codes help determine what actions are required on the SSI MA record. (See Section 387.53, End of SSI MA Benefits, for instructions on reviewing other MA benefits when codes indicate that MA should no longer continue in the SSI category.
This code appears in the upper right hand corner of the Detail Inquiry screen of Exchange #6. It tells why a disposition was set. The following codes are used:
01—Non-payment of SSI benefits to a Disabled Adult Child (DAC).
02—Active on SDX, not found or active in the appropriate SSI category in CIS.
03—Incorrect category in CIS.
04—Active A, J, M in CIS. Not found on SDX master file.
Important: The individual is not currently on SDX. This lets the CAO know that the SDX master file could not find an SSI payment for an individual in Pennsylvania. The individual may not be eligible to continue MA in the A, J, or M category.
05—Interstate move. The individual has moved to another state.
NOTE: SDX will process a request to get the out-of-state address.
06—Payment amount change.
08—Intrastate move. The individual has moved to another address in Pennsylvania, or the payment name has changed.
09—Intrastate move. The individual has moved to another address within Pennsylvania or the payment name has changed and there is a change in the payment amount.
10—The record was sent for an SSI opening and failed MCI file clearance.
The first position of the payment status code shows the status of SSI payment eligibility. The second and third positions show the reason for the status. The following codes are used for the first position:
C—The individual is eligible for SSI, a state supplement (SS) payment, or both.
E—The individual is eligible for federal or state benefits (or both) under the eligibility computation, but (a) no payment is due under the payment computation or (b) the benefit is not payable in that month because of a new application date.
H—“Hold” status, final decision pending.
M—Under manual control, called a “forced payment,” although a payment may not be involved.
N—Non-pay. The applicant is not eligible for SSI or SS payments, or a previously eligible recipient is no longer eligible.
P—Suspension with the probability of reinstatement. (This code has not been used since June 1987.)
S—Suspended. The recipient may still be eligible for SSI or SS but is not getting payments.
T—SSI or SS eligibility is stopped. In certain cases, an SSI case record may be stopped and a new case record opened.
See IEVS Exchange #6 for detailed information on SDX payment status codes.
NOTE: Certain SDX payment status codes will create disposition reason codes that must be reviewed and cleared by the CAO.
The following MA eligibility codes show that MA eligibility continues:
B—Deeming waived. Child is under a state home plan. Child was in an institution and covered by MA. Child is now home and enrolled in an MA waiver program. SSA does not use deeming rules to establish eligibility for these children. SSA continues to pay the personal needs allowance.
C—Federally granted MA coverage should be continued no matter what the payment status is. Wages make it not possible for the individual to get any SSI cash benefit, but he or she is eligible for MA under SSA rules.
G—Goldberg/Kelly payment continuation (appeal status). The payment status code may show a reason why the individual is not eligible for benefits. Because the individual appealed the decision, he or she is still considered eligible for MA under SSA rules.
N—Eligible for MA (N24 payment status only)
Y—Eligible for MA
The following MA eligibility codes indicate that the state must review the individual’s case for continued MA eligibility:
A—Refused third-party liability assignment; referred to State; federal decision not possible. The individual answered “no” to the following question on the SSI application: Question 39(a) – Do you agree to assign your rights (or the rights of anyone for whom you can legally assign rights) to payments for medical support and other medical to the State MA agency?
Important: Most SSI applicants and recipients answer “yes” to this question. When the CAO gets an SSI record with MA eligibility code A, the CAO must contact the individual and the SSA office to make sure of the answer. The CAO must tell the individual that SSI recipients in Pennsylvania automatically get MA benefits. If the individual answered “no” to the question, the CAO and the SSA must make sure the individual does not want MA. In most cases, the individual will want MA. The CAO should tell SSA that the individual wants to change his or her answer to the question. If an individual tells the CAO that “No” is the answer he or she meant, the CAO should ask for a Policy Clarification.
D—Disabled adult child. (See Section 387.62, Title II—Social Security Disabled Adult Child (DAC) benefits.)
Q—MA qualifying trusts. If the SSA applicant or recipient uses assets to set up a trust, the trust is counted as a resource for SSI eligibility. Some trusts and trust payments that are not counted as resources for SSI purposes can affect MA eligibility. The DHS must refer SSI trust cases to the following address:
TPL Special Needs Trust Depository
Attn: Manager TPL Section
P.O. Box 8486
Harrisburg, Pennsylvania 17105
Cases should stay open as A, J, or M until the review is completed by the TPL Special Needs Trust Depository. The CAO will
be told when the review is finished.
NOTE: The law does not apply to the following trusts, and MA must continue in the SSI category:
Special-needs trusts—The state gets whatever is left in the trust when the individual dies.
Pooled trusts—The money goes back to the individuals who are part of the trust.
R—Referred to state; a Federal determination is not possible. (See Section 387.53, End of SSI MA benefits.)
S—State determination; not SSA’s responsibility. The state makes the MA decision for SSI recipients.
Exception: Essential persons are coded S. In Pennsylvania, these individuals can get MA benefits. (See Section 387.3, SSI Benefits.) No determination for MA is needed.
W—Widow or widower. (See Section 387.64, Disabled Widows and Widowers.)
The SSI MA case must stay open until the eligibility review for other MA benefits is finished. The review may lead to one of the following decisions:
Keep MA open in the A, J, or M category.
Close the A, J, or M benefits and open MA in another category.
Close MA. (See Section 387.53, End of SSI MA benefits.)
The following codes are no longer used by the SSA:
P—Drug or alcohol addiction; refused treatment, benefit suspended
F—Title VIII recipient
Updated February 14, 2012, Replacing December 17, 2008