The Arkansas Department of Human Services (DHS) entered into an agreement under Section 1634 of the Social Security Act with the Social Security Administration (SSA) for SSA to make Medicaid eligibility determinations. Supplemental Security Income (SSI) recipients who receive an SSI cash payment, are in N24 payment status (GN 02604.405 &. GN 02604.440), or are Section 1619(b) recipients automatically have Medicaid eligibility unless:

• •

  They fail to meet the Assignment of Rights (AOR) provisions and Third Party Liability (TPL) requirements; or

• •

  The State has determined ineligibility under the Medicaid trust provision.

See SI 01730.040-SI 01730.048 for a discussion of the Medicaid eligibility limitations, including transfer of resources (TOR).

An essential person, who is the spouse of a converted individual, regardless of the State of conversion, is eligible for Medicaid in Arkansas until becoming potentially eligible for SSI (e.g., age 65).

When an individual files for SSI, the SSA interviewer will provide the claimant with the following information regarding Medicaid:

• •

  If the claimant is found eligible for SSI payments and meets all other requirements in SI 01730.040-SI 01730.048, the claimant will also be eligible for Medicaid.

• •

  The SSI recipient will receive a DCO-55 client notice from DHS advising the SSI recipient of the Medicaid approval and Medicaid begin date. Within a week of approval on the Medicaid system, the recipient will receive a separate letter instructing the recipient to take the letter to either the local DHS office or Department of Finance and Administration Revenue Office to obtain a photo Medicaid Identification (ID) card. The photo Medicaid card should be retained since no monthly replacement card will be issued. If the letter to obtain the photo Medicaid ID card is not received timely, the SSI recipient should contact the Client Assistance Unit at 1-800-482-8988.

• •

  The SSI recipient should report all address changes to SSA in order to receive the letter for the Medicaid ID card on time and so that DHS will have an up-to-date address for mailings to recipients advising of changes in services.

• •

  If the claimant has unpaid medical expenses in the 3 months prior to the month of application (shown in the AP field) for SSI, refer the SSI applicant to the local DHS office. Medicaid eligibility for this 3-month period requires a Medicaid application with the county DHS office. The eligibility decision will be made by DHS (SI 01715.001C.3.).

• •

  DHS is responsible for determining what services are covered by Medicaid and for processing bills for services charged to Medicaid. Under the Automated Eligibility Verification and Claims Submission (AEVCS) system, Medicaid service providers have electronic equipment that reads the plastic Medicaid card and provides immediate Medicaid eligibility information.

Although SSA determines Medicaid eligibility for most SSI recipients, DHS is responsible for administering the Medicaid program (e.g., the State issues Medicaid cards, determines what medical services are covered, and pays providers) and making Medicaid eligibility determinations for certain other categories. DHS also makes the Medicaid determination on TOR, AOR, TPL, and Medicaid trust cases.

Medicaid eligibility notices (DCO-55) for SSI recipients who are Arkansas residents are issued by DHS based on the eligibility information given the State DHS office by SSA on the SDX tape. The DCO-55 and the letter to obtain the photo Medicaid ID card are usually sent 10 days after the individual is in C01/M01 pay status or Section 1619(b) on the SSR. The plastic photo Medicaid ID card for new recipients will be obtained at the local DHS or Revenue Office, depending on the county. A monthly Medicaid Identification card is not issued.

Recently re-entitled SSI recipients will also receive a DCO-55, but not a new plastic Medicaid card.

If the SSI recipient is not on the SSR/SDX or the information is incomplete, see manual Medicaid certification (MMC) procedures in E. below.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 provides that SSI payments may only begin as of the first day of the month following the later of (1) the date the application is filed or (2) the date the individual becomes eligible for such benefits (SI 00601.009). As a result of this policy, cash SSI payments are not paid for the first month of SSI eligibility (i.e., the E02 month). Since no SSI cash payments are paid for the E02 month, no Medicaid certification is made to DHS by SSA. If death occurs in the filing month, curtail development, input death termination, and refer any inquiry about medical expenses to DHS (SI 00601.010E.4.).

However, DHS has decided to provide Medicaid coverage for the SSI E02 month. If SSA becomes aware that the client did not receive coverage for the E02 month automatically, refer the client to the local DHS county office for authorization. Please note that this is a DHS agency decision and does not affect or change the SSI program policy or procedures.

An Arkansas DHS Certification for Medicaid Eligibility, SS-RVI-304, should be routinely prepared for situations listed below when SSA makes the Medicaid eligibility determination, but a correct or complete SSI record cannot be provided to DHS:

1. 1. 

   Systems limitation cases;

2. 2. 

   Closed period(s) of SSI entitlement;

3. 3. 

   Intervening period(s) of SSI entitlement;

4. 4. 

   SSI claimant dies (see F.4. below for qualifying circumstances); or

5. 5. 

   SSI claimant/reinstated recipient moves out of Arkansas before payment is initiated.

SSA should never certify Medicaid coverage for any month of SSI ineligibility (e.g., N04), the E02 month, the 3-month prior period, or a month of non-SSI cash payment (e.g., E01, N01) unless the non-cash month is a Section 1619(b) month or is PSY N24. For months of SSI ineligibility for a cash payment/1619(b), refer the client to the local DHS office for possible coverage under another Medicaid category administered by DHS.

For the situations listed in E. above, the DO should complete Parts I and III of the SS-RVI-304 (See Exhibit 1) and mail the original form to the Arkansas Department of Human Services, Division of County Operations, Client Assistance Section, P. O. Box 1437, Slot S340, Little Rock, Arkansas 72203.

Certify to DHS only for the period the SSI recipient is/was a resident of Arkansas and received an SSI payment or was eligible for 1619(b), or was in PSY N24. If the recipient resided outside of Arkansas anytime during the period of eligibility and SSA determines Medicaid eligibility in that State (i.e., a 1634 State), call the servicing DO for the out-of-State residence. Have the former DO certify Medicaid to their respective State agency using their State-specific procedures.

A copy of the SS-RVI-304 should be placed in the SSI folder (if available). A third copy may be placed in a central FO location to facilitate control per 1.a. below.

In addition, take the following actions, as appropriate:

Upon receipt of the SS-RVI-304, the State DHS will issue a letter explaining how to obtain a photo Medicaid ID card. DHS will also establish eligibility on the State Medicaid eligibility system and issue a DCO-55 client notice concerning Medicaid coverage. If a photo Medicaid ID card is needed, the SSI recipient can obtain it as instructed on the DCO-55.

Note: If the letter to obtain the plastic photo Medicaid ID card is not received within two weeks, DOs can call the Client Assistance Unit at 1-800-482-8988 for status.

Once a systems limitation case is manually certified for continuing Medicaid eligibility, DHS will continue eligibility to Medicaid under the MMC process until:

• •

  DHS receives an SDX record that matches the SSN in Item 3 of the SS-RVI-304; or

• •

  DHS is notified by SSA via the SS-RVI-304 that the named SSI recipient is no longer entitled to SSI or has moved out of Arkansas; or

• •

  The record has been in manual certification status for 4 months. DHS will automatically suspend Medicaid eligibility.

If SSI eligibility continues past the 4 months, but the record is still not accreted to the SSR, another SS-RVI-304 needs to be sent by the servicing FO.

DHS will routinely issue a DCO-55 and a letter to obtain a plastic photo Medicaid ID card to new SSI recipients within a week of the time the individual is in C01/M01 pay status and is authorized on the Arkansas Medicaid system. If the SSI recipient has been in C01/M01 SSI pay status for less than 30 days while in Arkansas but a medical emergency exists, follow the procedure in I. below to provide certification of current month Medicaid eligibility only.

A medical emergency is a situation that would endanger a person's life if medication or medical attention is not provided immediately.

Note: A request for Medicaid certification for a retroactive period is not considered a medical emergency.

If the emergency criteria in H. above is met, the DO should:

1. 1. 

   Fully prepare an SS-RVI-304, Parts I and III, with the required information. All items on the SS-RVI-304 must be completed or answered ?None.? If information is omitted, there may be delays. Describe the life-threatening nature of the emergency in detail, and explain why routine procedures cannot be used in Item 18, Remarks.

2. 2. 

   Obtain approval from an operations supervisor/MSS (or above) for use of the emergency procedure. The SSA official authorizing the appropriateness of the emergency certification should sign in Part III; and

3. 3. 

   Inform DHS in the following manner:

   • •

     FAX the fully completed and authorized SS-RVI-304 to the State DHS at (501) 682-8978, or

   • •

     If the FAX machine is inoperable, mail the fully completed SS-RVI-304 to the State DHS office.

• •

  Within 2 days of receipt of the FAX/mailed SS-RVI-304, the Client Assistance Unit will:

  • –

    Issue an DCO-55 client notice, and

  • –

    Establish Medicaid eligibility on the State Medicaid eligibility file for the current month only.

• •

  Arkansas DHS will call the servicing DO to confirm that the SS-RVI-304 was received.

If an individual did not file an SSI application with SSA before death, but an oral inquiry/protective writing exists, and an underpayment would be due a parent/spouse or IAR State, then pursue an application and complete development for payment of the underpayment and Medicaid eligibility (GN 00204.005). See E. above for manual Medicaid certification instructions.

If an oral inquiry/protective writing does not exist or one exists but no underpayment would be due (e.g., death in the E02 month), or no one is eligible for an underpayment (if one were to exist), immediately refer an interested party inquiring about Medicaid coverage for the decedent's unpaid medical expenses to the county DHS office. The 3-month period of retroactivity for Medicaid coverage ends with the date an application for Medicaid is filed with DHS on behalf of the deceased individual, not with the date of death.

When an SSI recipient in C01, M01, M02 with cash payments, Section 1619(b), N24, or protected payment status contacts the SSA office alleging (1) non-receipt of the initial letter to obtain the plastic Medicaid ID card in 30 days of receipt of the first SSI check and no manual Medicaid certification is required per E. above; or (2) that Medicaid coverage is not on DHS records, then:

Verify that the correct address, zip code and State/County code are on the SSR. The State/County code in the ADDR and CMPH segments of the SSR should start with ?04? for Arkansas residents. If protected payments are being paid using the G-K systems procedures, the SCR field in the DUPR segment should have 5 zeros (SM 01305.640 and MSS 98N084, dated 04/23/98).

1. 1. 

   If the address date on the SSR is incorrect, transmit the correct information to the SSR. This information will be sent to DHS via the SDX. Also, take action to complete whatever additional development (e.g., LA) is required by SSI.

2. 2. 

   If the SSR is correct, refer the recipient to the Client Assistance Unit at 1-800-482-8988 or (501) 682-8233.

DHS issues the DCO-55 client notice and the letter to obtain the plastic Medicaid ID card from the local DHS or Revenue Office at initial entitlement in Arkansas. The plastic Medicaid ID card should be retained by the recipient and used when medical services are provided. The AEVCS system for SSI recipients is updated from information on the SDX. However, no new Medicaid card is automatically issued as long as the State Medicaid number remains the same, even if the SSI recipient's name changes or SSI eligibility is lost for a short period of time.

If the plastic Medicaid card is lost or identifying information on the card changes:

• •

  Review the SSR to see if identifying information changes are needed and transmit any necessary changes; then

• •

  Refer the SSI recipient to the Client Assistance Unit at 1-800-482-8988 who will handle the inquiry.

If the SSI applicant has unpaid medical expenses in the 3 months prior to the date of application for SSI, refer the applicant to the county DHS office. Medicaid eligibility for this 3-month prior period requires a Medicaid application with DHS, and the eligibility decision will be made by DHS.

As discussed in A. above, SSA makes Medicaid eligibility determinations for most SSI recipients. Only DHS makes Medicaid ineligibility determinations for SSI claimants/recipients.

DHS makes both eligibility and ineligibility determinations in all other Medicaid categories. Some of these Medicaid categories are listed in SI 01715.005 (Medicaid Groups) and SI 01715.015 (Special Groups of Former SSI Recipients). The information below provides specifics for some of these programs in Arkansas.

When an SSI recipient moves from another State with intent to reside in Arkansas, Medicaid eligibility resulting from SSI payment or Section 1619(b) is effective the month after the month of move to Arkansas (SI 01410.030F.).

Arkansas DHS Certification for Medicaid Eligibility Exhibit 1

TO:Arkansas Department of Human Services                  Date:___________________

Division of County Operations

P. O. Box 1437, Slot S340                                            Attn: Client Asst. Unit

Little Rock, Arkansas 72203

 

I.This individual is eligible for SSI and Medicaid. SSA is unable to establish a record or to provide complete information on the SDX. Please issue a Medicaid card for the period of eligibility indicated below.

1. Reason: (check one) __ Systems Limitation      __ Medical Emergency

   __ Closed/Intervening Period                                 Certification

          of Eligibility or Death

2. Type of Recipient:(circle one) AI AS BI BS DI DS DC

3. Social Security Number: ________________     4. DOB: _____________

5. Name of Recipient: _______________________________________________

6. Mailing Address     ________________________________________

Including Repre.    ________________________________________

Payee & Zip Code:   ________________________________________

7. State/County Code: _________    8. Living Arrangement Code: ________

County of Residence: ________________________

9. Mo/Day/Year of SSI Application: _____________    10. Sex: __________

11. First Month/Year of SSI in Arkansas: _______________________

12. Title II/Medicare Claim #: _____________     13. DOD: _____________

14. TPL Code: _______    15. Transf. RE? ______   16. Medicaid Trust? ____

17. Enter an "E" only for months of SSI payments while in Arkansas:

18. Remarks: ______________________________________________

          ________________________________________________________

II. SSA previously submitted a manual Medicaid certification for the individual and SSN. This individual is no longer eligible for SSI effective: _______. Reason: ____________________________

_________________________________________________

III.Social Security Administration         ______________________________________

    ______________________________                    (CR Print Name)

    ______________________________                    Phone #: _____________________

    ______________________________         ______________________________________

                                                                      (Emerg. Cert. Auth.-OS/MSS or above)

SS-RVI-304 (12/02)

Exhibit 2

TITLE II COLA/DAC/WIDOW(ER) MEDICAID EXTENSION REFERRAL LETTER

To:Arkansas Department of Human Services                        Date:__________

Division of County Operations

Attn: Jack Tiner

P. O. Box 1437, Slot S333

Little Rock, Arkansas 72203

(check 1. or 2.)

1.The following individual was last eligible for Supplemental Security Income (SSI) in ________, 20___, but became ineligible for payment effective with ____________, 20____* because of a title II cost-of-living adjustment (COLA) increase paid to the eligible person or his/her spouse. The person may now be a candidate for preservation of Medicaid eligibility under the provision of:

(check one)

_____ Section 503 (Pickle) of Public Law 94-566, or

_____ Lynch v. Rank court decree.

2.The following individual was eligible for SSI in __________, 20___, but became ineligible in __________, 20___ because of entitlement to or an increase in:

(check one) _______ DAC or ________ widow(er) benefits.

Name and Address    _______________________________________

(Including                 _______________________________________

Representative           _______________________________________

Payee)                      _______________________________________

County of Residence      ____________________________________

Social Security Number      __________________________________

Title II Claim Number      ___________________________________

Gross Title II Payment Prior to COLA      ______________________

                                                               (if applicable)

Current Gross Title II Payment      _______________________________

Other Current Month Income (if any)     __________________________

* If there is a break in entitlement between these two dates, show the months of ineligibility and payment status code for each month: ________________________________________

From:  Social Security Administration         _________________________

         ______________________________ _        Area Code/Telephone

         ______________________________          ________________________

                                                                       Print Name of SSA Employee

Revised 12/02