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 amount plus a State Supplemental Payment (SSP). SSI is administered by the Social Security Administration (SSA).
SSI recipients receive MA and can receive Buy-In of Medicare premiums. The CAO is responsible for maintaining an MA record for each SSI recipient so that SSI recipients can get medical services. Eligibility for SSI MA is determined by SSA, because Pennsylvania has an agreement with SSA under Section 1634 of the Social Security Act (a “1634” state).
The 1634 agreement says that MA eligibility is based on the individual’s claim to SSI benefits. SSA sends information on individuals’ 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 on Exchange 6. The SSI records are identified as “8036 Pend” files on the SDX Match Summary Screen and they show new SSI records and changes to existing SSI records.
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 they
will receive.
The CAO will:
Identify applicants and recipients who are possibly eligible for SSI, and refer them to the Disability Advocacy Program (DAP) via an SSA referral generated through the Disability screen in eCIS.
Authorize and maintain MA benefits and records for SSI recipients.
Provide information to SSA when it is requested.
Communicate
with the local SSA field office, by telephone, fax, e-mail,
or letter, regarding
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:
Information that should be reported to SSA
include but
are not limited to: changes in income, new or newly shown resources,
and changes in living arrangements, such as entering a
correctional or Long-Term
Care (LTC)
facility or
moving out of Pennsylvania.
Tell the SSI recipient that they must report changes directly to the SSA.
Review the individual for other MA before terminating
the SSI MA, when notified by SSA through the SDX on
Exchange 6 that SSI benefits have terminated. If needed, contact the
individual to request more information needed to determine ongoing
eligibility.
Reminder: In most cases, the CAO will get an Exchange 6 hit or an alert when there is a change in the SSI record, to include termination of SSI benefits. The hit reason code or alert description will explain why it was generated.
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 their 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 individual, explain how
that individual’s residence, income or resources
has changed, and anything else that has changed.
Keep a copy of the information in the case record.
Narrate the information that was shared with SSA and include details on how that information was communicated.
Review the individual for other MA before terminating the SSI MA, when notified by SSA that SSI benefits have terminated for the individual, If needed, contact the individual to obtain needed information if eligibility cannot be determined after an ex-parte review.
Determine the individual’s continued eligibility for all other benefits they are receiving.
Updated May 14, 2024, Replacing February 14, 2012