SI CHI01730.010 Wisconsin State Cash Supplement And Medicaid Eligibility (RTN 419 - 06/2011)

A. General

SSI recipients residing in Wisconsin are usually eligible for a State administered cash supplement and Medicaid. More information is available on the state’s web site at: http://www.dhfs.state.wi.us/ssi and Medicaid at http://dhfs.wisconsin.gov/medicaid/ . Inform SSI claimants (1) that the SSI application is also an application for a State administered cash supplement and Medicaid (2) that the decision notice of State cash supplement and Medicaid eligibility comes from the State; and (3) that denial of the SSI claim precludes a state cash supplement but does not preclude Medicaid eligibility if the requirements of any other Medicaid coverage group can be met, but they will have to file for these with the State.

NOTE: SI 01730.035B refers to other requirements that must be met in order for SSA to make the Medicaid eligibility determination. Since January 1, 1996, the State of Wisconsin has also adapted the Medicaid eligibility procedures to administer their state SSI cash supplement. If SSI eligibility is met for Medicaid it is also met for State cash supplement purposes.

Medicaid applications by persons not eligible for SSI are made online at http://www.access.wisconsin.gov or at the county department of human or social services in the county in which they reside or at one of the tribal offices. Information about the application procedure may be obtained from that office. Locate a Medicaid office by calling the Recipient Services Hotline at 1-800-362-3002. Inquiries about the State cash supplement and Medicaid benefits, billing, prior authorization, etc., should be referred to the Recipient Services hotline at (800) 362-3002.

B. Public Information Material

Inquiries about the State cash supplement and Medicaid in Wisconsin are best answered by calling Recipient Services hotline at (800) 362-3002. Updated printed materials are available from that source.

C. Issuance of State Cash Supplement and Medicaid Cards

The State Data Exchange (SDX) is updated after each SSR run. An update file of changes is sent to the State after each run. The SDX daily updates are used to issue the State cash supplement and Medicaid cards, known as Forward Health cards, to SSI recipients who have not been on Medicaid before. The State has contracted with HP Enterprises to issue its State cash supplement and Medicaid cards. State cash supplement payments and Medicaid card eligibility for a new SSI recipient will be received within approximately 7 to 10 days of the field office systems input.

NOTE: Unless there is a systems problem or an urgent immediate need, HP Enterprises should not be asked to manually issue a State cash supplement or Medicaid card on an initial claim or reinstatement. If there are problems with receipt or use of the SDX, they should be brought to the attention of the MOS-RSI/SSI Branch.

When manual issuance of a State cash supplement or Medicaid card (e.g., lost, stolen or systems limitation) is necessary, the SSI recipient should contact the Recipient Services hotline at (800) 362-3002.

FO’s written requests typically are made via fax to (608) 221-0991 for State cash supplement issues and (608) 221-8815 for Medicaid issues with an SSI2 printout of the PRSN, PMTH, REPY, CMPH, DRDP, and ADDR fields.

NOTE: Ensure that the CMPH field contains the pertinent dates for State cash supplement and Medicaid coverage. Although HP Enterprises has access to the SDX for verification, certain SDX systems limitations prevent all SSI eligibility information from being sent via SDX.

SDX Systems Limitations

  1. No more than two years of payment and computations history are sent via SDX. Retroactivity eligibility determinations beyond two years are not communicated to the State via SDX.

  2. The SDX sends retroactive eligibility data only up to the first break in eligibility. If the up to two-year period of retroactivity is interrupted by at least a single month of ineligibility, only the most recent period of eligibility is communicated via SDX.

    Example: A hearing determination grants 3 years of retroactive eligibility back to 02/08 and the SSI record shows a single month of excess income for 02/10. The Federal SSI payment system will properly calculate a retroactive payment that excludes the one month of N01 (excess income) and calculate a payment for the remaining 3 year period, 02/08 through 01/10 and 03/10 up to the present. However, the SDX will inform the State that SSI eligibility exists only for the period beginning the month after the month of the excess income (i.e., N01) or 3/10 to the present. The history prior to that nonpayment month is not communicated to the State by SDX.

  3. One Time Payments (see SI CHI01730.010D — Attachment 1 - Pay Flag One) do not get transmitted over the SDX. Any SSI One time Payment data will not be sent to the State for either State cash supplement or Medicaid eligibility.

D. Completion of the SSI2 Printout

Normally, the State of Wisconsin will obtain State cash supplement and Medicaid eligibility information from the SDX daily updates. They update their system once each week, at the start of business on Thursday, with data from SSA that was updated as of the previous Tuesday.

NOTE: Unless there is a systems problem or an urgent immediate need, HP Enterprises should not be asked to manually issue a State cash supplement or Medicaid card on an initial claim or reinstatement.

Use these fax numbers: State SSI cash supplement at (608) 221-0991 and manual issuance of the Medicaid card at (608) 221-8815 with the SSI2 method only when the conditions listed above are present. If both State SSI Cash and Medicaid are requested, send just one fax but circle both. Use the enclosed Fax Cover Sheet to send the SSI2 or a simulated SSID. Give the SSI recipient or caller the HP Enterprises Recipient Services Hotline number (800) 362-3002 for any follow-ups or future calls or questions. This staff can answer both Medicaid Card and State cash supplement questions.

    

[Street Address]                            Social Security Administration
[City, ST Zip Code]
[phone]
[fax]
www.socialsecurity.gov

    

 FAX 
 To:   HP Enterprises State SSI Cash Unit    From:
_________________________________________________________________________
 Fax:   Cash–608-221-0991  MA-608–221–8815   Pages:
__________________________________________________________________________
 Phone:                                          Date:
_________________________________________________________________________
 Re: Circle one or both: 1-Cash   2-MA Card      cc:
_________________________________________________________________________

Per SSA Instructions in SI CHI01730.010

  

The attached printout of the Federal SSI record shows the SSI eligibility for a Wisconsin SSI recipient. There is an immediate need or a systems limitation that prevents this SSI recipient’s record from being read by the SDX accurately or timely. If there are any questions on this message please contact the person identified above who has sent this fax. Circle all that apply:

Circle all that apply:

  • Emergency need

  • SDX Systems Limitation

    • Emergency need

    • SDX Systems Limitation

    • SSI eligibility more than 2 years in the past

    • New SSI eligibility exists beyond most recent nonpayment month

    • SSI record has One Time Payments - (see Attachment 1 — Pay Flag One) that is not transmitted over the SDX.

  • SSI applicant died after a signed application was received and before adjudication and no cash underpayment is payable but there are unpaid medical expenses to be covered by MA and a medical allowance determination have been made. SI CHI01730.015

Enclosure – SSI Printout (SSI2 data elements: PRSN, REPY, CMPH, PMTH, DRDP, ADDR)

Attachment 1 - Pay Flag One

Type of check paid or returned check indicator

Code

Definition

0

No payment made

1

Recurring payment dated the first of the month

2

Regular daily payment (underpayment)

3

Supplemental payment dated the first of the month

4

One time payment

5

Advance payment or overpayment recovered (amount recovered shown in check amount column)

E. Changes to Dates of Eligibility for Medical Assistance in Wisconsin

Prior to April 29, 2011, any new application for Wisconsin SSI eligibility limited the start date of Wisconsin Medical Assistance (i.e., MA or Medicaid) if the SSI recipient had a prior period of Wisconsin SSI/MA eligibility. These returning Wisconsin SSI/MA recipients began their Wisconsin SSI/MA on the same date as their SSI eligibility date. There was no retroactivity.

For newly eligible SSI recipients who never had prior Wisconsin SSI/MA, the beginning date for the Wisconsin SSI/MA was retroactive three months prior to the first SSI eligibility date.

Change Effective April 29, 2011

SSI Medicaid: Systems changes were made to backdate Wisconsin SSI/MA eligibility for three months for all recipients who become eligible for SSI again with a new application and after a gap in Wisconsin SSI/MA eligibility.

Other Wisconsin SSI/MA Begin Dates

The Wisconsin SSI/MA program has made changes to the SSI/MA begin date to use the SSI eligibility date in several other situations.

  • Move to Wisconsin – SSI state residency changes to the new state the first day of the month following the month of the move. However, Wisconsin SSI/MA now begins the first day of the month of the move. The Wisconsin State SSI Cash Supplement begins with the residency date change on the SSI record as input by SSA. This change was made in 2010.

  • Payment Status E02 and Start of WI MA – The WI MA Program receives SSI eligibility information from the State Data Exchange (SDX). When a federal SSI eligibility determination of E02 or C01 is communicated through SDX, the WI MA begins with the month containing either one of those payment status codes.

    Examples:

    Newborns – Some newborns have SSI eligibility but only have E02 on their SSI record. This happens in some cases as they move out of the hospital into their parents’ homes and lose SSI financial eligibility before getting a C01 month. In other cases, they may die before the C01 month. In these situations, the Wisconsin SSI/MA begins with the date of birth if the SSI E02 month is within the first three months after the date of birth. The Wisconsin SSI/MA will stop depending on the due process notice sent by the State. This change was effective in 2010.

    Release from jail/prison – The beginning date of Wisconsin SSI/MA is the E02 date that follows a Payment Status N22. The Wisconsin SSI/MA program must see a payment status of N22 followed by E02 for this earlier Wisconsin SSI/MA start date. The State SSI Cash Supplement begins with the first C01 month. This change was made in 2011.

Handling Inquiries

The State of Wisconsin makes all medical assistance beginning date determinations. However, field office staff often are asked to explain why a current or retroactive date was chosen. The response to any Wisconsin SSI/MA inquiry remains the same: the SSI/MA recipient should contact the State of Wisconsin’s SSI/MA Program at 1-800-362-3002.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0501730010CHI
SI CHI01730.010 - Wisconsin State Cash Supplement And Medicaid Eligibility (RTN 419 - 06/2011) - 01/14/2013
Batch run: 01/14/2013
Rev:01/14/2013