Federal changes include cost of living adjustments (COLAs) and other mass changes to the following benefits:
Social Security (Retirement, Survivor's and Disability Insurance (RSDI), including the deduction for Medicare
Note: If an increase in Social Security benefits makes an individual ineligible for SSI, the CAO will decide on eligibility for extended coverage under the Pickle Amendment. (See Chapter 387, Supplemental Security Income.)
Veterans Administration (VA) benefits.
Black Lung benefits.
Railroad Retirement benefits.
Other federal benefits.
When there is a change in income, including a COLA or other mass change in federal benefits, the individual will report the change by the tenth day of the month after the change. The individual does not have to verify the change unless the CAO is unable to confirm it. The CAO will first check various reporting systems before requiring the individual to verify any changes that are reported. 55 Pa. Code ยง 133.84 (d)
Exception: This does not apply to individuals living in a long-term care facility. For those individuals, a change in income will be reported within ten days of when the income is received.
DHS will let the CAO know the effective date of a benefit increase that is federally funded and how it will be carried out. When information is provided in advance, the CAO will complete a case review to decide what effect the increased income will have on eligibility for MA. The review will be completed within five days of the expected change. A new PA 600 form does not need to be filled out. See Appendix A for information about the current COLA procedure.
Cost of Living Adjustment (COLA) Disregard: Federal Regulations require that a COLA be disregarded for SSI-related MA budgets (including Long-Term Care) until the month following the month that the Federal Poverty Income Guidelines (FPIGs) are published.
Example: The FPIGS are usually published in January. The disregard month for the affected budgets would be February, and the effective date for updated COLA and FPIGs would be March 1. During the disregard month, (e.g. February) the affected budgets will display the COLA increase as a Type 18 deduction. The Type 18 deduction will be removed by a batch process when the disregard month is over (e.g. March 1.)
The CAO will complete an eligibility review in March using the updated income and FPIGs for these budgets.
The affected categories are:
Healthy Horizons: PH 80, PH 00, and PG 00
MAWD: PW 80, PI 80, PW 66 and PI 66
SSI-related MNO: TA 80, TJ 80, TA 66 and TJ 66
Buy-In budgets: TA 65, TA 67, TJ 65 and TJ 67
All LTC Buy-In budgets with Program Status Code (PSC) 80 and PSC 66 (not PSC 00)
All Waiver budgets with PSC 80 and PSC 66 (not PSC 00)
The CAO will confirm mass changes in RSDI and SSI benefits through BENDEX, the State Data Exchange (SDX), or the Income Eligibility Verification System (IEVS).
Railroad Retirement, Veterans Administration, and Black Lung information is not available through system matches. Individuals who receive these benefits may or may not get the COLA. The individual will report the increase and verify the new amount.
Updated March 27, 2017, Replacing February 14, 2012