The procedure for authorizing A, J and M cases will vary depending on whether the individual is eligible to receive SSI/SSP or is an SSP-Only case.
The SDX file received from the SSA contains information on new SSI recipients and changes to existing SSI records. Individual information is matched against information in CIS in order to allow automated opening of A, J, or M cases when possible.
The SDX information is matched with CIS records by Social Security Number (SSN), name and date of birth.
If the individual is not known to CIS, a new case is opened in the appropriate category in the county of residence based on the individual’s address as received from the SSA in the SDX record.
If the individual is known to CIS but is not active, the recipient number on file is used.
If the individual is currently active in CIS, existing information is used for a budget opening.
Information on automated openings can be found in Medical Assistance Eligibility Handbook Chapter 387, Appendix D.
The cases that may be opened using the automated process have these Program Status Codes (PSC):
00 - A, J, or M Standard SSI recipients
31 - J SSI Disabled Foster Child
32 - J SSI Disabled Federal Adoption Assistance
33 - J SSI Disabled State Foster Care
35 - J SSI Adoption/Foster Care – other state
36 - J Out of State Adoption Assistance
37 - J SSI SPLC
44 - A, J, or M SSP-Only
45 - A, J, or M SSI Title XIX Nursing Facility
46 - A, J, or M SSI Essential/Mandatory
60 - A, J, or M SSI Domiciliary Care
62 - A, J, or M SSI Personal Care Boarding Home
64 - A, J, or M SSI Living in Another’s Home
Most of these types of cases are opened through the automated opening process. When the auto-SSI process cannot be completed, the CAO must open the budget manually and generate the appropriate notice. Refer to Appendix C, Reason Code 014, Option A for reason code notice text for the manual opening.
Since SSP-Only recipients are not eligible for a Federal SSI payment, the SDX may not have information on these individuals. Therefore, SSP-Only budgets must be opened manually by the CAO.
Eligibility for SSP-Only is determined by the SSP Central Unit. The CU will receive referrals for SSP-Only cases either from the SSA via a CIS screening program or the CAO. Individuals who would be eligible for SSI, except for income and whose income is less than the Federal Benefit Rate (FBR) plus the appropriate SSP payment will have eligibility determined by the CU. This includes individuals who are SSI recipients who become ineligible for SSI due to income, but may still be eligible for SSP. In these instances, the automated monthly batch run will change the PSC to 44 and establish a redetermination date of three months. The CU will then establish continued eligibility for SSP.
55 Pa. Code § 299.36(b) 55 Pa. Code § 299.36(a)(2)
Individuals denied SSI due to excess income are referred to the CU through the SDX. Those individuals do not have to submit an application. The CU will use available information from the SDX, IEVS and the CAO. If more information is needed the CU will send a request to the individual, as well as a PA-600 so the individual may apply for other benefits or services. The PA-600 will have a return envelope for the local CAO. Refer to Appendix D for the cover letter to be sent with the PA-600.
When the CU has made an eligibility determination for SSP-Only, it will notify the CAO. Immediately after opening the SSP budget, the CAO will authorize the OTI, if applicable, using the stand alone process and reason code 109. The amount of the OTI will be calculated by the CU. For the provisions for continuing eligibility, refer to Section 720.43 Redeterminations.
To maintain integrity of CIS records and CAO control over caseloads, the CU will not have the ability to authorize or change any cases in eCIS. The CU will determine or redetermine eligibility and payment level of all SSP-Only cases. Appendix E illustrates an example of the data CU will provide to the CAO. The CU will email the following information to the CAO SSP liaison:
Date and effective date(s) of action required.
Category and PSC.
Action required (i.e. open budget, close budget, OTI)
Amount of SSP payment or any changes in SSP payment amount.
Demographics for individual case members – name, address, SSN, DOB, etc.
Name and address of Representative Payee, if present, or any alternate address, if needed.
Monthly benefit amount and any OTI information.
All other data needed for the CAO to perform the required action, including dollar amounts and reasons for the action to be performed.
The effective date of SSP-Only eligibility will be either the first day of the month following the month of the SSI application date for individuals who have been denied SSI, or the first day of the month following the month an SSP-Only application is received by DHS.
Reissued September 11, 2012, replacing March 16, 2012