TN 34 (07-24)

SI 02302.320 Sample Notices - 1611(e)(1)(E) Extended Payment Provisions (Institutionalized Recipients)

Situation #1

 

An individual who moves into a public medical care institution is not normally eligible for Supplemental Security Income (SSI) payments if Medicaid is not paying over half of the cost of care. However, if the individual was eligible under 1619 for the month of the move, checks would continue at the same rate (subject of changes in income) for the first 2 full months at the new address.

(See Situation #3 for public medical care institution where Medicaid is paying over half of the cost of case.)

Sample Case:

In this example, an individual moves into a Veterans Administration hospital on August 21, 1987. This is a public medical care institution, so normally they would not be eligible for any SSI payments while living there. However, they were eligible under 1619 (a) for the month of August.

They will continue to receive checks for the first 2 full months they are in the hospital (September and October). The payment rate will be calculated as if they were still living alone in their apartment. Income for July and August will be used to calculatetheir payments for September and October, respectively.

(In most of these examples, the payments calculation is based on a retrospective monthly accounting cycle of 2 months. This means that the recipient's SSI payment is reduced by income received 2 months in the past.)

 

Situation #1

 

Supplemental Security

Income Notice

 

                   Date: August 24, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

We are writing to you because you moved into the Memorial Veterans Hospital on August 21, 1987, you will still receive Supplemental Security Income (SSI) checks for the first 2 full months you are there. For September you will receive $140.00 and for October you will receive $160.00.

This letter also explains why your move may affect your SSI checks in the future.

Why We Can Still Pay You

We usually cannot pay you any SSI while you live in a public institution such a Memorial Veterans Hospital. However, because you were working before you entered the hospital, we can pay you SSI checks for the first 2 full months you live there.

We can do this by using special rules which help people who work while they receive SSI. Because you qualify under these rules, you will receive a $140.00 SSI check in September, and a $160.00 check in October.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

• •

  In July your earnings were $$$¢¢, and in August your earnings were $$$¢¢.

   

  SEE NEXT PAGE

   

Enclosure

TURN THIS OVER IF YOU THINK WE ARE WRONG

 

Situation #1 (Back)

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

HOW TO APPEAL

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical condition. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

1. 1. 

   CASE REVIEW

   You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medical condition.

2. 2. 

   INFORMAL CONFERENCE

   You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless you do not agree with what we decided about your medical condition.

   REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAL IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING.  Be sure to tell us your name, Social Security number, and why you think we are wrong. Also tell us what kind of appeal you want—CASE REVIEW OR INFORMAL CONFERENCE.  If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if you want the names of these groups.

You have other rights because you are eligible under the supplemental security income program. There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.

 

Situation #1 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

 

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. In you case, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in Memorial Veterans Hospital throughout the months of September and October, your SSI checks will stop beginning in November 1987. This will happen because the law does not allow us to pay you any further money while you live in such a public institution.

We will write to you again before we do anything to stop your checks.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

Situation #2

 

This example is only slightly different from Situation #1. The facts are the same as in Situations #1, except that the individual received the same amount of money in July and August 1987. Therefore the language in the first paragraph is modified to account for the fact that the two special checks will be issued in the same amount ($140.00).

Situation #2

 

Supplemental Security

Income Notice

 

                   Date: August 24, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

We are writing to you because you moved into the Memorial Veterans Hospital on August 21, 1987, you will still receive Supplemental Security Income (SSI) checks for the first 2 full months you are there. For September and October you will receive $140.00 per month.

This letter will also explain how your move may affect your SSI in the future.

Why We Can Still Pay You

We usually cannot pay you any SSI while you live in a public institution such as Memorial Veterans Hospital. However, because you were working before you entered the hospital, we can pay you SSI for the first 2 full months you live there. We can do this by using special rules to help people who work while they receive SSI. Because you qualify under these rules, you will receive checks for $140.00 for both September and October.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

• •

  In July and August your earnings were $$$¢¢ each month.

   

   

  SEE NEXT PAGE

   

Enclosure

TURN THIS OVER IF YOU THINK WE ARE WRONG.

 

Situation #2 (Back)

 

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

HOW TO APPEAL

 

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical conditions. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyers, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

1. 1. 

   CASE REVIEW

   You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medical condition.

2. 2. 

   INFORMAL CONFERENCE

   You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless yo do not agree with what we decided about your medical condition.

   REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAR IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING.  Be sure to tell us your name, Social Security number, and why we are wrong. Also tell us what kind of appeal you want—CASE REVIEW OR INFORMAL CONFERENCE.  If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if want the names of these groups.

You have other rights because you are eligible under the supplemental security income program. There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.

 

Situation #2 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. In your case, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in Memorial Veterans Hospital throughout the months of September and October, your SSI checks will stop beginning in November 1987. This will happen because the law does not allow us to pay you any further money while your live in such a public institution.

We will write to you again before we do anything to stop your checks.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. If will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #3

 

If an individual moves into a public or private medical care institution, and Medicaid pays for over half the cost of care, Supplemental Security Income (SSI) payment is limited to a maximum of $25.00 (plus, in some cases, an optional State supplement). However, if the individual was eligible under 1619 for the month of the move, the checks for the first 2 months would not be subject to the $25.00 payment limit.

Sample Case:

In this example, an individual moves into a nursing home on August 21, 1987. Medicaid pays for over half of their care, so they normally would only be eligible for $25.00 per month while living there. However, because they were eligible under 1619(a) for August 1987, they will continue to receive their checks at the old rate for September and October.

The payment rate will be calculated using the full Federal benefit rate rather than the $25.00 limit. Income from July and August will be used to calculate their payments for September and October, respectively.

 

Situation #3

 

Supplemental Security

Income Notice

 

                   Date: August 24, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

We are writing to you because you moved into the Shady Lane Nursing Home on August 21, 1987. You will receive Supplemental Security Income (SSI) payments of $71.50 each month for September and October, the first 2 full months you are there.

This letter also explains how your move may affect your SSI in the future.

Why We Can Still Pay You

We usually cannot pay more than $25.00 in SSI money each month while you live in a medical care center such as the Shady Lane Nursing Home and while Medicaid pays for more than half of your expenses. However, because you were working before you entered the nursing home, we can pay you more than $25.00 for the first 2 full months you live there.

We can do this by using special rules which help people who work while they receive SSI. Because you qualify under these rules, you will receive checks for $71.50 for both September and October.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

• •

  In July and August your earnings were $$$cc each month.

   

  SEE NEXT PAGE

   

Enclosure

 

TURN THIS OVER IF YOU THINK WE ARE WRONG.

 

Situation #3 (Back)

 

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

HOW TO APPEAL

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical condition. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

1. 1. 

   CASE REVIEW

   You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medical condition.

2. 2. 

   INFORMAL CONFERENCE

   You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless you do not agree with what we decide about your medical condition.

   REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAR IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING.  Be sure to tell us your name, Social Security number, and why you think we are wrong. Also tell us what kind of appeal you want —CASE REVIEW OR INFORMAL CONFERENCE.  If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if you want the names of these groups.

You have other rights because you are eligible under the supplemental security income program. There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.

 

Situation #3 (Page 2)

 

XXX-XX-XXX DI                     Page 2 of 2

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. In your case, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in the Shady Lane Nursing Home throughout the months of September and October, we will have to lower your SSI check for November to no more than $25.00. This will happen because the law does not allow us to pay you more than $25.00 while you live in such a nursing home. If you have other income, you may receive less than this.

We will write to you again before we make any changes to your SSI check.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #4:

 

 

The new legislation affects individuals who were eligible under 1619(b) as well as 1619(a) for the month of the move to the institution. Most of the language in the preceding samples can be used for 1619 (b) cases. However, certain modifications are necessary because these individuals were not receiving Supplemental Security Income (SSI) checks before they moved. In some cases, they may not have been receiving checks for several years.

Sample Case:

In this example, an individual moves into a nursing home on August 4, 1987. Medicaid pays for over half of their care, so they normally would only be eligible for $25.00 per month while living there. However, because they were eligible under 1619(b) for August 1987, they will receive checks at the full rate for September and October.

Because they were not eligible for checks in July or August, their payment for September and October is based on their income for the month of September under the retrospective monthly accounting rules. Since they had no countable income in September, they will therefore receive checks at the full Federal benefit rate ($340.00) for the 2 months.

The field office will suppress the computer-generated notice, and issue a manual notice, which will explain that two checks will be issued in each of the months affected by the special rules. This is because the computer system recognizes that the individual is due $25.00 each month, and will send them a check in that amount. The field office will then pay the balance by issuing automated one-time payments.

 

Situation #4:

 

Supplemental Security Income

Notice of Change

 

                   Date: August 7, 1987

                   Claim Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

We have received information that affects your payments (or those of the individual named above, on whose behalf you applied to receive payments).  Based on this information, we are taking the following action:

We are writing to you because you moved into the Shady Lane Nursing Home on August 4, 1987. You will receive Supplemental Security Income (SSI) checks for the first 2 full months you are there. We will pay you $340.00 in SSI money for September and for October. We will send you two checks each month, one for $315.00 and one for $25.00

This letter also explains how your move may affect your SSI in the future.

Why We Can Still Pay You

We usually cannot pay more than $25.00 in SSI money each month while you live in a medical care center such as the Shady Lane Nursing Home, and while Medicaid pays for more than half of your expenses. However, because you were working before you entered the nursing home, we can pay you more than $25.00 for the first 2 full months you live there.

We can do this by using special rules which help people who work while they receive SSI. Because you qualify under these rules, we will send you $340.00 for both September and October.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that the are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

 

Enclosure:

SEE NEXT PAGE

TURN THIS OVER IF YOU THINK WE ARE WRONG

 

Situation #4 (Back)

 

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

HOW TO APPEAL

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical condition. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

1. 1. 

   CASE REVIEW

   You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medical condition.

2. 2. 

   INFORMAL CONFERENCE

   You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless you do not agree with what we decided about your medical condition.

   REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAR IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING. Be sure to tell us your name, social security number, and why you think we are wrong. Also tell us what kind of appeal you want—CASE REVIEW OR INFORMAL CONFERENCE.  If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if you want the names of these groups.

You have other rights because you are eligible under the supplemental security income program There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.

 

Situation #4 (Page 2)

 

XXX-XX-XXX DI                     Page 2 of 2

 

• •

  You have no income for September and October other than your SSI checks of $340.00

Things To Remember

If you continue to live in the Shady Lane Nursing Home throughout the months of September and October, we will have to lower your SSI check for November to no more than $25.00. This will happen because the law does not allow us to pay you more than $25.00 while you live in such a nursing home. If you have other income, you may receive less than this.

We will write to you again before we make any changes to your SSI check.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

 

                  Manager's Name

                  Title

Situation #5

 

As explained under Situation #1, when an individual moves into a public medical care institution, payment can continue for 2 months. However, the State where the individual lives may choose not to make optional supplemental payments under the new provision. If so, the supplemental payment is stopped even though Federal payment will continue for 2 months.

 

Sample Case:

In this example, an individual moved into a Veterans Administration hospital on August 4, 1987. This is a public medical care institution, and Medicaid is not paying for over half of the cost of care. Therefore, their checks would normally be stopped effective September 1987 (the first full month at the new address). However, since they were eligible under 1619(a) for August 1987, their payments for September and October will still be computed using the full Federal benefit rate.

The individual was also receiving an optional State supplemental payment. Since they live in a State which chooses not to supplement recipients who live in an institution under the new provision, the supplemental payment is stopped for September and October even though Federal payment continues. Therefore the notice must explain why payment can continue and why it will be decreased.

 

Situation #5

 

Supplemental Security Income

Notice of Planned Action

 

                   Date: August 7, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are reducing your Supplemental Security Income (SSI) check from $148.91 to $88.00 starting in September 1987. We plan to reduce the amount of your check because you moved into the Memorial Veterans Hospital on August 4, 1984.

Why Your Payments Changed

We usually cannot make any SSI payments while you live in a public institution such as the Memorial Veterans Hospital. However, because you were working before you entered the hospital, we can pay you for the first 2 full months you live there.

We can do this by using special rules which help people who work while they receive SSI. Because you qualify under these rules, you will receive $88.00 for both September and October.

You will receive less money than we paid you before you entered the hospital, because you cannot receive money from your State while you are in the hospital. Since your old SSI payment included $60.91 that came from your State, your check has been reduced by that amount. As a result, your next SSI check will be for $88.00.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

SEE NEXT PAGE

We won't change your check if you appeal within 10 days  after getting this notice.

TURN THIS OVER if you think we're wrong

Situation #5 (Back)

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review our decision. We'll change mistakes. Do you have other questions? If so, get in touch with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lost your appeal, you might have to a pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decided your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT. We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #5 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

• •

  You are living in the State of (State Name).

• •

  In July and August your earnings were $$$¢¢ each month.

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. In your case, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in Memorial Veterans Hospital throughout the months of September and October, we will have to stop your SSI checks beginning November 1987. This will happen because the law does not allow us to pay you any further money while you live in such a public institution.

We will write to you again before we do anything to stop your checks.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

 

Situation #6

 

This example is only slightly different from Situation #5. The facts are the same as in Situation #5, except that the State is still making an optional supplement to the Federal payment, though at a reduced rate. Therefore, the language has to show that the State supplement is being reduced (though not stopped altogether).

 

Situation #6

 

Supplemental Security Income

Notice of Planned Action

 

                   Date: August 7, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are reducing your Supplemental Security Income (SSI) check to $148.91 to $128.91 starting in September 1987. We plan to reduce the amount of your check because you moved into the Memorial Veterans Hospital on August 4, 1987.

Why Your Payments Changed

We usually cannot make any SSI payments while you live in a public institution such as the Memorial Veterans Hospital. However, because you were working before you entered the hospital, we can pay you for the first 2 full months you live there. We can do this by using special rules which help people who work while they receive SSI.

You will receive less money than you did before you entered the hospital, because you are due less money from your State. The SSI money that you receive from (State Name) is being reduced from $60.91 to $40.91. As a result, your next SSI check will be for $128.91.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount.

 

SEE NEXT PAGE

 

We won't change your check if you appeal within 10 days  after getting this notice.

TURN THIS OVER if you think we're wrong

 

Situation #6 (Back)

 

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review out decision. We'll change mistakes. Do you have other questions? If so, get in tough with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT.   We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #6 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

• •

  You are living in the State of (State Name).

• •

  In July and August your earnings were $$$¢¢ each month.

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. For example, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in Memorial Veterans Hospital throughout the months September and October, we will have to stop your SSI checks beginning in November 1987. This will happen because the law does to allow us to pay you any further money while you live in such a public institution.

We will write to you again before we do anything to stop your checks.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #7:

As explained under Situation #3, when an individual moves into a medical care institution, and Medicaid is paying for over half of the cost of care, payment can continue at the old Federal rate for the first 2 months at the new address. However, the State where the individual lives may choose not to make optional supplemental payments under the new provision. If so, the supplemental payment is stopped even though Federal payment continues at the old rate.

Sample Case:

In this example, an individual moved into a nursing home on August 4, 1987. Medicaid paid for over half of their care, so their checks normally would be reduced to $25.00 in September. However, because they were eligible under 1619(a) during August, their payments for September and October will be computed using the full Federal rate.

However, their State has chosen not to supplement institutionalized recipients under the new provision (and does not supplement the $25.00 rate). Therefore the notice explains that the Federal rate continues for 2 months, but the checks will be reduced because there will be no optional State supplementation.

 

Situation #7

Supplemental Security Income

Notice of Planned Action

 

                   Date: August 7, 1987

                   Social Security Number:

Beneficiary Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are reducing your Supplemental Security Income (SSI) check from $150.91 to $90.00 starting in September 1987. We plan to reduce the amount of your check because you moved into the Shady Lane Nursing Home on August 24, 1987.

Why Your Payment Changed

We usually cannot pay more than $25.00 each month while you live in a medical care center such as the Shady Lane Nursing Home and while Medicaid pays for more than half of your expenses. However, because you were working before you entered the nursing home, we can pay you the higher amount of $90.00 for the first 2 full months you live there. We can do this by using special rules which help people who work while they receive SSI.

You will receive less money than you did before you entered the Shady Lane Nursing Home, because you cannot receive money from your State while you are in the nursing home. Since your old SSI payment amount included $60.91 that came from your State, your check has been reduced by this amount. As a result, your next SSI check will be for $90.00.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please call us.

 

SEE NEXT PAGE

We won't change your check if you appeal within 10 days after getting this notice.

TURN THIS OVER if you think we're wrong

 

Situation #7 (Back)

 

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review our decision. We'll change mistakes. Do you have other questions? If so, get in touch with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to a add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT. We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We give your names of these groups.

 

Situation #7 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

• •

  You live in the State of (State Name).

• •

  In July and August your earnings were $$$¢¢ each month.

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. In your case, we used income from July to figure your payment for September, and your income from August to figure your payment for October.

Think To Remember

If you continue to live in the Shady Lane Nursing Home throughout the months of September and October, we will have to reduce your check again. This will happen because the law does not allow us to pay more than $25.00 while you live in such a nursing home.

We will write to you again before we do anything to reduce your check.

If You Have Any Questions

If you have any questions you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #8

 

For this example, the basic facts are similar to Situations #7. The individual moved into a nursing home on August 4, 1987, and is eligible under the special rules for September and October. The State supplement is stopping. The difference is that the amount of the wages for August was less than for July. The effect is that the September payment (based on the July income) will be less than the August payment, and the October payment will be greater than the September payment.

This example also illustrates how the notice must account for the way in which the computer system processes these cases. It is possible that for one of the months affected by the new rules the individual can get one check, and then for the second month they can get two checks.

In this situation, the system computed that the individual was due the money for September because of their July income. However, the field office recognized that under the special rules they were due $19.00. The office therefore suppressed the notice generated by the computed system, and issued an automated one-time payment of $19.00 for September.

Because the individual's wages were lower in August, they were due more money for October. Because the system will compute that they are due $25.00 in October, it will send them a check for $25.00 on October 1. However, the field office recognizes that the actual payment due for October under the special rules will be $66.00. The office will therefore issue a second automated one-time payment of $41.00 in October.

This notice therefore must contain all the following information:

• •

  An explanation of the special rules.

• •

  An explanation of why payment is reduced (because of the termination of the State supplement).

• •

  The effect on SSI payments of the earnings for July and August.

• •

  The fact that payment for October will be made in two checks instead of one.

   

Situation #8

Supplemental Security Income

Notice of Planned Action

 

                   Date: August 7, 1987

                   Social Security Number:

Beneficiary Name           XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are reducing your Supplemental Security Income (SSI) from $150.91 to $19.00 in September 1987. We plan to reduce the amount of your check because you moved into the Shady Lane Nursing Home on August 4, 1987. We will increase your check to $66.00 in October. We will send you two checks for October, one for $25.00 and one for $41.00.

Why Your Payment Changed

We usually cannot pay more than $25.00 each month while you live in a medical care center such as the Shady Lance Nursing Home and while Medicaid pays for more than half of your expenses. And because of money you made while you were working, we normally could not pay you any money for the month of September.

However, because you were working before you entered the nursing home, we can pay you some money for September and October. We can do this by using special rules which help people who work while they receive SSI. Because you qualify under these rules, we will send you a check for $19.00 in September, and two checks for a total of $66.00 in October.

We will be paying you less money than we did before you entered the Shady Lane Nursing Home, because you cannot receive money from your State while you are in the nursing home. Since your old SSI payment amount included $60.91 from you State, your check has been reduced by this amount. As a result of this change, and because of the money you made while you were working, your next SSI check will be for $19.00.

 

SEE NEXT PAGE

We won't change your check if you appeal within 10 days after getting this notice.

 

TURN THIS OVER if you think we're wrong

 

Situation #8 (Back)

 

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review our decision.We'll change mistakes. Do you have other questions? If so, get in touch with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT. We'll help you fill it out

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #8 (Page 2)

XXX-XX-XXX DI                     Page 2 of 2

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for September and October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

• •

  You live in the State of (State Name).

• •

  In July your earnings were $$$¢¢ and in August your earnings were $$$¢¢.

We use the amount of your income from 2 months earlier when we figure your SSI payment for a given month. For example, we used your income from July to figure your payment for September, and your income from August to figure your payment for October.

Things To Remember

If you continue to live in the Shady Lane Nursing Home throughout the months of September and October, we will have to reduce your check again. This will happen because the law does not allow us to pay you any more than $25.00 while you live in such a nursing home.

We will write to you again before we do anything to reduce your check.

If You Have Any Questions

If you have any questions you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

Situation #9

 

After an individual moves to a public medical care institution, and receives payment at the old rate for 2 months because of 1619, payment will stop in the third full month at the new address. A Notice of Planned Action will explain this determination.

In this example, a recipient moved into a Veterans Administration hospital on July 15, 1987. After they received checks for August and September under the new provision, payment was stopped in October. The notice explains why the checks are being stopped and why they were not stopped at an earlier date.

 

Situation #9

 

Supplemental Security Income

Notice of Planned Action

 

                   Date: Septebmer 7, 1987

                   Social Security Number:

Recipient Name             XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we plan to stop your Supplemental Security Income (SSI) in October 1987. We plan to stop your checks because you can no longer receive SSI while you live in the Memorial Veterans Hospital. Your last SSI check will be the one you received on September 1, 1987.

Why We Are Stopping Your Check

As we told you in an earlier letter, we have paid you while your live in Memorial Veterans Hospital under special SSI rules. These special rules apply only for the first 2 full months you live there.

Regular SSI rules now apply. Under the regular SSI rules we cannot pay people who live in a public institution for an entire month. This means we have to stop your SSI checks. There are two reasons for this.

• •

  You are living in Memorial Veterans Hospital, which is a public institution.

  AND

• •

  Medicaid pays for half or less than half of the cost of your care.

Things To Remember

In the future you may qualify again for SSI payments. If you think you meet the rules for receiving SSI checks again, please contact us right away. This is important, because if we can start your SSI checks by September 1988, you will not have to file a new claim.

 

SEE NEXT PAGE

We won't change your check if you appeal within 10 days after getting this notice.

TURN THIS OVER if you think we're wrong

 

Situation #9

 

 

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review our decision. We'll change mistakes. Do you have other questions? If so, get in touch with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some of all of this money back.

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT.   We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #9 (Page 2)

XXX-XX-XXX DI                    Page 2 of 2

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #10

 

After an individual moves to a medical care facility, and receives payment at the old rate for 2 full months because of 1619, payment will be reduced in the third month if Medicaid still pays for over half the cost of care. A Notice of Planned Action will explain this determination.

In this example, a recipient moved into a nursing home on July 15, 1987. After they received checks for August and September under the new provision, payment was reduced to $25.00 in October. The notice explains why the checks are being reduced, and why they were not reduced at an earlier date.

 

Situation #10

Supplemental Security Income

Notice of Planned Action

 

                   Date: September 7, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are reducing your Supplemental Security Income (SSI) from $90.00 to $25.00 starting in October 1987. We plan to reduce your check because you are still living in the Shady Lane Nursing Home.

Why Your Payments Changed

As we told you in an earlier letter, for 2 months we have paid you a higher amount of SSI under special SSI rules. But these special rules can apply only for the first 2 full months you live there.

The regular SSI rules now apply to you. Under the regular SSI rules we can only pay people up to $25.00 if they live in a medical care facility and Medicaid pays more than half the cost of their care. This means we have to reduce your SI checks to $25.00 starting in October. There are two reasons for this.

• •

  First, you are living in a medical care facility.

  AND

• •

  Second, Medicaid pays for more than half the cost of your care.

   

   

  SEE NEXT PAGE

   

We won't change your check if you appeal within 10 days after getting this notice.

TURN THIS OVER if you think we're wrong

 

Situation #10 (Back)

 

YOUR RIGHT TO APPEAL

Do you think we're wrong? If so, you have the right to appeal. If you appeal, we'll review our decision. We'll change mistakes. Do you have other questions? If so, get in tough with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people to come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can question these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT.   We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #10 (Page 2 of 2)

 

 

XXX-XX-XXX DI                  Page 2 of 2

 

If You Have Any Questions

 

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #11

 

The preceding situation explained how an individual's checks could be reduced in the third full month of living in a nursing home, where Medicaid provides over half of the care. However, in some situations a recipients payment might increase rather than decrease in the third month.

An increase is possible because of the accounting cycle using in Supplemental Security Income (SSI) to determine a recipient's benefits. This cycle is know as retrospective monthly accounting, or RMA. Under RMA, current benefits are based on the income received 2 months in the past. Thus, for the first 2 months of residence in the institution, the recipient's SSI payment was being reduced by income earned 2 months in the past (e.g., August's SSI was based on June's income, etc.).

With the third month of residence in the institution, income received prior to the change of address no longer counts against the SSI check. If the recipient receives no income while in the institution, the full benefit (usually $25.00) is payable in the third month.

The advantage offered by the new 1619 rule is that some benefit, even if less than $25.00, may be payable for the first 2 months of residence in the institution. Under old rules, the results of RMA frequently meant that no benefit could be paid for the these months, even though the recipient's earnings stopped upon entering the institution.

Sample Case:

An individual was working in July 1987, and eligible under 1619(a). They entered a nursing home on July 15, and stopped work. Under RMA, their earnings for June and July were used to compute their payments for August and September, respectively. Because of the earnings, they would normally have been due no checks for August and September while in the nursing home living arrangement. However, because of the special rules we were able to pay them $11.50.

Since they had no income in August, no deduction due to income was made from the October check. Therefore, the individual is due the full $25.00 for October. Since this check is larger than the $11.50 per month they got for August and September the notice must explain the increase.

 

Situation #11

Supplemental Security Income

Notice of Change

 

                   Date: September 9, 1987

                   Claim Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

We have received information that affects your payments (or those of the individual named above, on whose behalf you applied to receive payments). Based on this information, we are taking the following action:

Starting in October 1987, we will increase your Supplemental Security Income (SSI) check from $11.50 to $25.00. Your check is being increased because you no longer have other income that counts against your SSI. The rest of this letter will tell you more about this.

Information About Your Payment

• •

  Your regular monthly check of $25.00 will be sent to you about the first day of October 1987.

• •

  This is the first check you will receive that is at your newly increase rate.

Your Payment Is Based On These Facts

We used the following facts to figure the amount of your SSI for October. Please check these facts carefully to make sure that they are right. If we have the facts right, then your checks will be in the right amount. If there is a mistake, please contact us.

• •

  Your earnings stopped in July 1987.

• •

  You are living in the Shady Lane Nursing Home.

• •

  Medicaid pays for more than half the cost of your care.

   

  SEE NEXT PAGE

   

Enclosure:

 

TURN THIS OVER IF YOU THINK WE ARE WRONG

 

Situation #11 (Back)

 

YOUR RIGHT TO APPEAL

If you think we are wrong, you have the right to appeal. If you appeal, we will review our decision. If we made a mistake, we will fix it. If you have any questions, get in touch with us. Please bring this notice with you if you come to a Social Security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

HOW TO APPEAL

There are two different kinds of appeals. You can pick the one you want unless you do not agree with what we decided about your medical condition. Then, the only appeal you can have is a case review. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the two kinds of appeals:

1. 1. 

   CASE REVIEW

   You can give us more facts to add to your file. Then, we will decide your case again. You will not meet with the person who will decide your case. This is the only kind of appeal you can have if you do not agree with what we decided about your medial condition.

2. 2. 

   INFORMAL CONFERENCE

   You will meet with the person who will decide your case. You can tell that person why you think you are right. You can also give us more facts to help prove you are right. You can bring other people to help explain your case. You can pick this kind of appeal unless you do not agree with what we decided about your medical condition.

   REMEMBER, YOU PICK THE KIND OF APPEAL YOU WANT. BUT, IF YOU APPEAL IN PERSON, IT MAY HELP US TO DECIDE YOUR CASE.

TO APPEAL, YOU MUST MAKE A REQUEST IN WRITING. Be sure to tell us your name, social security number, and why you think we are wrong. Also tell us what kind of appeal you want—CASE REVIEW OR INFORMAL CONFERENCE. If you cannot write to us, call our office or come in and someone will help you.

There are groups that can help you with your appeal. Some groups may be able to give you the name of a lawyer who will help you for free. Let us know if you want the names of these groups.

You have other rights because you are eligible under the supplemental security income program. There are also some things you must do. The enclosed booklet tells you what you should know. Please read this booklet and keep it in case you have questions later.

 

Situation #11 (Page 2)

 

XXX-XX-XXX DI                  Page 2 of 2

 

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title

 

Situation #12

 

This situation provides an illustration of how a notice would look when information about an individual's living arrangement is discovered after the fact. The language must be modified to show that the new rules under 1619 were applicable in the past, but not any longer.

Sample Case:

In this example, an individual moved to the Veterans Memorial Hospital on July 23, 1987. Because they were eligible under 1619 in July, they were due checks for August and September. Payment should have stopped in October.

The field office was not notified of the change of address when it occurred. On November 1, the hospital told the office about the change. On November 2, a notice was prepared to explain how the change affected payment.

The checks issued for August and September were correct because under the special rules the change of address did not affect payment. However, the October and November checks constituted an overpayment. A more detailed explanation of the overpayment would be provided in a separate notice. Finally, no payment will be issued in December because the individual still lives in the hospital.

 

Situation #12

Supplemental Security Income

Notice of Planned Action

 

                   Date: November 2, 1987

                   Social Security Number:

Recipient Name            XXX-XX-XXXX DI

Street Address

City/State/Zip Code

 

 

Your payments (or those of the individual named above) will be changed as follows:

We are writing to tell you that we are stopping your Supplemental Security Income (SSI) checks in December 1987. In additional, you were not due the SSI checks you received for $295.00 in October and November. We will send you another letter about the money you were not due.

We plan to stop your checks because you can no longer receive SSI money while you live in Memorial Veterans Hospital.

Why Your Payments Changed

Usually we cannot pay you any SSI while you live in a medical facility such as Memorial Veterans Hospital. However, because you were working before you entered the hospital, you were due checks for the first 2 full months you were there. These checks were due under special rules which help people who work while they receive SSI. You qualified under these special rules because you were working in July 1987.

Beginning in October, however, the regular SSI rules applied to you. Under these rules, we cannot pay people who live in a public institution for an entire month. This means we have to stop your checks. There are two reasons for this.

• •

  First, you are living in Memorial Veterans Hospital, which is a public institution.

  AND

• •

  Second, Medicaid pays for half or less than half of the cost of your care.

   

  SEE NEXT PAGE

   

We won't change your check if you appeal wihtin 10 days after getting this notice.

TURN THIS OVER if you think we're wrong.

 

Situation #12 (Back)

 

YOUR RIGHT TO APPEAL

Do you think we're wrong. If so, you have the right to appeal. If you appeal, we'll review our decision. We'll change mistakes. Do you have other questions? If so, get in touch with us. Please bring this notice with you if you come to a social security office.

You have 60 DAYS TO APPEAL after you get this notice. If you wait more than 60 days, you must have a good excuse.

 

APPEAL IN 10 DAYS TO KEEP GETTING YOUR SAME CHECK

We won't change your check if you appeal within 10 days after getting this notice. You'll keep getting your same check until we decide your appeal. If you lose your appeal, you might have to pay some or all of this money back.

 

HOW TO APPEAL

There are three different ways to appeal. You can pick the one you want. The people in our offices can explain how these appeals work. You can have a lawyer, friend, or someone else help you with your appeal.

Here are the three ways to appeal:

1. 1. 

   CASE REVIEW:

   You can give us more facts to add to your file. Then we'll decide your case again. You don't meet with the person who decides your case.

2. 2. 

   INFORMAL CONFERENCE:

   You'll meet with the person who will decide your case. You can tell that person why you think you're right. You can give us more facts to help prove you're right. You can bring other people to help explain your case.

3. 3. 

   FORMAL CONFERENCE:

   This is a meeting like an informal conference. Plus, we can make people come to help prove you're right. We can make them bring important papers about your case. We can do this even if they don't want to help you. You can questions these people at your meeting.

To appeal, you must fill out a form at one of our offices. It is called a Request for Reconsideration, SSA-561. On the form, YOU PICK THE KIND OF APPEAL YOU WANT.   We'll help you fill it out.

There are groups that can help you with your appeal. Some can give you a free lawyer. We can give you names of these groups.

 

Situation #12 (Page 2)

XXX-XX-XXX DI                  Page 2 of 2

As a result, September was the last month we could pay you any SSI. We will be in touch with you later about the payments we sent you for October and November.

Things To Remember

In the future you may qualify again for SSI payments. If you think you meet the rules for receiving SSI checks again, please contact us right away. This is important, because if we can start your SSI checks by November 1988, you will not have to file a new claim.

If You Have Any Questions

If you have any questions, you should call, write or visit any Social Security office. If you visit an office, please bring this letter. It will help us answer your questions.

 

                  Manager's Name

                  Title