TN 16 (09-95)

GN 02610.065 How to Correct Cases When The Title II Benefits Are Paid First In The Third Circuit - Offset

A. Policy

SSA adjudicates and pays the title XVI claim before paying retroactive title II benefits for all claimants in the Third Circuit whose claims are adjudicated on or after January 10, 1992, the date the Mazza AR was published in the Federal Register. If a claimant requests application of the Mazza AR to a claim adjudicated between May 17, 1990, (the date of the court of appeals decision), and January 10, 1992 (the date the Mazza AR was published) follow the procedure in GN 02610.065B.

EXAMPLE: A claimant may request application of the AR by alleging that he/she was denied Medicaid eligibility because his/her title II benefits were paid before the title XVI claim was adjudicated.

B. Procedure

If a claimant demonstrates that application of the AR could change the adjudication and payment of title XVI benefits (including any effect on Medicaid eligibility), the FO will follow this procedure.

1. Query the SSR

Confirm that title XVI offset did take place by querying the SSR.

2. Determine Title XVI Eligibility

Determine title XVI eligibility without considering the title II income paid retroactively.

3. Beneficiary Ineligible for Title XVI

If the beneficiary is still ineligible for title XVI in the months title II benefits were paid retroactively for some nonmedical reason, issue an appropriate manual denial notice (see NL 00802.020).

4. Beneficiary Eligible for Title XVI

If the beneficiary is eligible for title XVI without considering the title II income:

  1. Make a one-time payment of $1 for each month of title XVI eligibility (see SM 01901.130 ff.). Input an N TAC for any overpayment the system does not address. See SI 02260.030 for guidelines for the system process and tolerances.

  2. Input “Mazz” in the CG field on the SSR for later identification of Mazza cases.

  3. Issue a manual notice of title XVI payment for the closed period to the beneficiary to take to the appropriate Medicaid agency. See NL 00802.010, “Initial Award Notice — SSA-L8025, SSI Notice of Award,” for how to do the award notice. If you use a preprinted form (see NL 00802.015, “Completion of the SSA-L8025”), the following should be put immediately after the payment chart which lists amounts due (see GN 02610.067 for model notice):

    • Caption 1915, “Information About Medicaid” — See NL 00802.015A.2.g. and

    • The following paragraph:

      “Since you are not eligible now for SSI, you are also not eligible for Medicaid based on SSI. However, if you need help with medical bills, you may still be eligible for medical assistance. Also, you may be eligible for Medicaid for the months