Medical benefits for SSP-Only recipients are the same as those for SSI recipients. Authorization and termination of Medicaid benefits for SSI budgets will remain the same. See Medical Assistance Eligibility Handbook sections 387.5 and 387.53 for more information on Medicaid benefits. The CAO is responsible for opening NMP Medicaid for the SSP-Only recipients in the appropriate A, J or M category/program status code.
Individuals authorized as an A, J or M with PSC of 44 who receive Medicare must be manually enrolled in Buy-In. See Medical Assistance Eligibility Handbook Chapter 388, Medical Assistance Benefits.
When an individual is determined eligible for SSI and the information is received by the CAO via the SDX, the CAO is responsible for reviewing the information and taking appropriate action on Medicaid benefits. Changes to the individual’s status on SDX may necessitate changes in status or category.
For Medicaid recipients who have received medical services billed under a trauma-related code, Third Party Liability (TPL) sends a Medical Services Questionnaire to the payment name and address to identify possible coverage of a third party. If the recipient fails to return the questionnaire within 30 days and the appropriate dollar threshold has been met ($1000), a second questionnaire is sent. If the recipient fails to respond to this questionnaire and the dollar threshold has been met ($5000), a third questionnaire, marked Final Notice, is sent to the CAO with a cover letter explaining that the individual has not responded to two previous requests for information.
The CAO will contact the individual to obtain the requested information. For an SSI/SSP recipient who fails to cooperate by returning the information requested, the CAO must notify the SSA Field Office in writing of non-cooperation. Instructions for SSA notification procedures are located in the Supplemental Security Income (SSI) Chapter of the Medical Assistance Eligibility Handbook section 387.12. This section refers IMCWs to Appendix E, which provides a sample of the letter that is sent to the SSA Field Office. SSA will review the SSI case and inform the CAO if SSI is terminated. The CAO will discontinue Medicaid upon notification from SSA. The case will remain open until SSA provides that notification. For an SSP-Only recipient who fails to provide the information, the CAO must take action to close the budget, including Medicaid, for failure to respond or provide information.
Reissued September 11, 2012, replacing March 16, 2012