SI BOS02003.002 Maine Interim Assistance Reimbursement Agreement (TN 5-245 - 10/2015)

See SI 02003.000

A. Introduction

On February 3, 1992, the Maine Department of Human Services (DHS) entered into an Interim Assistance Reimbursement (IAR) Agreement with the Social Security Administration (SSA). This agreement was updated and renewed on September 25, 2010, and modified November 20, 2012 to include the new electronic IAR (eLAR) process. The IAR Agreement covers both initial and posteligibility situations.

On April 28, 1989, the Maine Department of Mental Health, Mental Retardation and Substance Abuse Services entered into an IAR Agreement with SSA for postentitlement situations only. This agreement was terminated effective January 29, 2001.

B. Policy

1. Initial and Posteligibility Periods Covered

The IAR Agreement with the Maine Department of Human Services provides for reimbursement to DHS for General Assistance provided to the SSI recipient for initial claims and posteligibility situations. For initial claims the reimbursement covers the General Assistance paid for the interim period while the SSI application is pending. For posteligibility situations the reimbursement covers the General Assistance paid by DHS to an individual for the interim period while his or her SSI benefits are suspended or terminated if the individual is subsequently found to be eligible for SSI during those months. SI 02003.001 describes the interim period.

2. Protective filing

The IAR authorization serves as a protective filing for an initial SSI claim. The date that DHS receives a signed IAR authorization establishes a 60-day protective filing period for SSI eligibility. If an individual does not file an SSI application within the 60-day protective filing period, the IAR authorization does not serve as protective filing for SSI purposes.

3. Life of the Authorization

For initial SSI claims the IAR authorization is binding on the State of Maine and an individual for one calendar year beginning with the date SSA receives a signed authorization. If the State of Maine does not notify SSA within thirty (30) calendar days of the date that the individual signed the authorization, the authorization is no longer binding. In such a situation, SSA will release a retroactive SSI payment to the individual and the State of Maine will be responsible for pursuing recovery of IAR from the individual without assistance from SSA. If an individual applies for SSI within the one calendar year period covered by the IAR authorization or has already applied for SSI before the State received an authorization, the period for the life of the authorization will be extended beyond the one year period, until such time as:

  • SSA makes the first payment of SSI retroactive benefits on the individual’s claim; or

  • SSA makes a final determination on the claim and no timely request for review is filed; or

  • The State and the individual agree to terminate the authorization.

For posteligibility cases the IAR authorization is binding for one calendar year beginning with the date SSA receives a signed authorization. If the State does not notify SSA within thirty (30) calendar days of the date that the individual signed the authorization, the authorization is no longer binding. In such a situation, SSA will release the retroactive SSI payment to the individual and the State of Maine will be responsible for pursuing recovery of IAR from the individual without assistance from SSA. If a timely request for administrative or judicial review is filed the IAR authorization remains in effect until such time as:

  • SSA makes the first posteligibility payment of retroactive SSI benefits following the suspension or termination of the individual’s benefits; or

  • SSA makes a final determination on the claim and no timely request for appeal is filed; or

  • The State of Maine and the individual agree to terminate the authorization.

The Maine Department of Human Services must obtain another initial claim or posteligibility authorization if the authorization is no longer in effect and the State wants reimbursement for General Assistance payments made.

C. Process

Maine DHS uses one multipurpose IAR authorization form, covering either initial payment or posteligibility payment (Exhibit 1). On every IAR authorization either the Initial Payment Only block or the Initial Posteligibility Payment Only block must be checked. The same authorization form cannot be used for both an initial claim and posteligibility situation. Each time an individual files for SSI or his or her benefits are suspended or terminated another initial claim or posteligibility authorization is required.

The State of Maine adopted an amended version of the national authorization model. It uses a question and answer format to lead the individual and the State through the IAR process. If a claimant is found eligible for SSI, and by mistake the first SSI retroactive payment is sent to the claimant instead of the State, the State of Maine can demand that the claimant repay to the State the amount that would have been deducted if the retroactive check had been sent to the State. If the recipient does not repay the State, then the State of Maine can seek to collect the amount due to the State through court action or other legal remedy.

D. Procedure

When SSA receives an IAR authorization, input the Grant Reimbursement (GR) code for the Maine Department of Human Services to the SSR.

   GR Code DHS: 20050

SSA deactivated the GR code for the Maine Department of Mental Health, Mental Retardation and Substance Abuse Services (20010) January 29, 2001, when we terminated the IAR Agreement.

Issue A-OTPs and mail correspondence to:

Department of Human Services
For ACCT of (Client’s name)
ATTN: Dave MacLean
19 Union Street
Augusta, ME 04333

FAX manually prepared SSA-L8125s and SSA-L8125-F6s to: 207-287-3455.

Phone Number: 207-624-4164

E. Exhibits

The following exhibits consist of an example of the Maine Department of Human Services Reimbursement Authorization form (Exhibit 1) and a copy of the apportionment notice sent by the State of Maine (Exhibit 2).

    

AUTHORIZATION FOR REIMBURSEMENT OF INTERIM ASSISTANCE

   

INITIAL CLAIM OR POSTELIGIBILITY CASE

    

      

Name__________________________________ Social Number______________________________

Address______________________________________ City/Town/Zip Code _________________________________

   

    

The term “state” means the Maine Department of Human Services.

        

What actions am I authorizing when I sign this authorization and I check the “Initial Claim Only” block?

    

[ ] Initial Claim Only

   

You are authorizing the Commissioner of the Social Security Administration (SSA) to reimburse the state for some or all of the money the state pays towards your basic needs. This money helps you while SSA decides if you are eligible to receive SSI benefits. If you become eligible, SSA pays the State from the retroactive SSI benefits due you. The reimbursement covers the time from the first month you are eligible to receive SSI benefits through the first month your monthly SSI benefit begins.

If the state cannot stop the last payment made to you, SSA can reimburse the state for this additional payment amount.

         

What actions am I authorizing when I sign this authorization and I check the “Posteligibility Case Only” block?

      

[  ]  Posteligibilty Case Only

  

You are authorizing the Commissioner of the Social Security Administration (SSA) to reimburse the state for some or all of the money the state pays towards your basic needs. This money helps you while SSA decides if your SSI benefits can be reinstated after being terminated or suspended. If your SSI benefits resume, SSA pays the state from the retroactive SSI benefits due you. The reimbursement covers the time from the day of the month the reinstatement is effective through the first month your monthly SSI benefit resumes.

If the state cannot stop the last payment made to you, SSA can reimburse the state for this additional payment amount.

    

How can the state use this form when blocks for initial claims and posteligibility cases are part of the form?

     

The state can use this form for one case situation at a time, either an initial claim or a posteligibility case. If both blocks are checked the form is not valid. You and the state must sign and date a new form with only one block checked.

     

What kind of state payment qualifies for reimbursement by SSA?

    

SSA can reimburse a state for a payment that is paid only from state or local funds. The state cannot be reimbursed for payments made wholly or partially from Federal funds.

   

How does SSA determine how much of my SSI money to pay the state?

    

SSA decides the amount of payment based on two considerations. First, SSA looks at the amount of money claimed by the state, and second, SSA looks at the amount of your retroactive SSI money available to pay the state. SSA can reimburse the state for a payment made in the month only when you receive a state payment and an SSI payment for the same month. SSA will not pay the state more money than you have for the SSI retroactive period.

        

How long is this authorization effective for the state and me if I checked the “Initial Claims Only” block?

         

This authorization is in effect for you and the state for twelve (12) months. The 12 months begin with the date SSA receives the authorization from the state and ends 12 months later. You and a state representative must sign and date the authorization for the authorization to be valid.

Exceptions apply to this rule. The state must send SSA the authorization within a certain time frame. SSA must receive the form within 30 calendar days of the date you signed the authorization. If the form is late, SSA will not accept the form as a valid authorization. SSA will not pay any of your retroactive SSI benefits to the state. SSA will send you any SSI money that may be due you based on SSA’s regular payment rules.

      

Can the authorization stay effective longer than the 12-month period? Can the authorization end before or after the 12-month period ends?

      

The authorization can stay effective longer than the 12-month period, if you

  • apply for SSI benefits before the state has the authorization form, or

  • apply within the 12-month period the authorization is effective, or

  • file a valid appeal of SSA’s determination on your initial claim.

The period of the authorization can end before the 12-month period ends, or end after the 12-month period ends when any of these actions take place:

  • SSA makes the first SSI payment on your initial claim; or

  • SSA makes a final determination on your claim; or

  • the state and you agree to terminate this authorization.

The authorization period will end with the day of the month any of these actions take place.  

   

How long is this authorization effective for the state and me if I check the “Posteligibility Case Only” block?

    

This authorization is in effect for you and the state for twelve (12) months. The 12 months begin with the date SSA receives the authorization from the state and end 12 months later. You and a state representative must sign and date the authorization for the authorization to be valid.

Exceptions apply to this rule. The state must send SSA authorization within a certain time frame. SSA must receive the form within 30 calendar days of the date you signed the authorization. If the form is late, SSA will not accept the form as a valid authorization. SSA will not pay any of your retroactive SSI benefits to the state. SSA will send you any SSI money that may be due you, based on SSA’s regular payment rules.

    

Can the authorization stay effective longer than the 12-month period? Can the authorization end before or after the 12-month period ends?

    

Authorization can stay in effect longer than the 12-month period if you file a valid appeal. You must file your appeal within the time frame SSA requires. The period of the authorization can end before the 12-month period ends, or can end after the 12-month period ends when any of these actions take place:

  • SSA makes the first SSI payment on your posteligibility case after a period of suspension or termination; or

  • SSA makes a final determination on your appeal; or

  • the state and you agree to terminate this authorization.

The authorization period will end with the day of the month any of these actions take place.

   

Can SSA use this authorization form to protect my filing date for SSI benefits?

   

SSA can use this form to protect your filing date if you checked the “Initial Claims Only” block. When you sign this form, you are saying that you have the intention of filing for SSI benefits if you have not already applied for benefits.

You have sixty (60) days from the date the state receives this form to file for SSI benefits. Your eligibility to receive SSI benefits can be as early as the date you sign this authorization if you file within the 60-day time period. If you file for SSI benefits after the 60-day time period, this form will not protect your filing date. Your filing date will be later than the date you sign this form.

   

How do I appeal a state’s decision if I do not agree with the decision?

   

You can disagree with a decision the state made during the reimbursement process. You will receive a state notice telling you how to appeal the decision. You cannot appeal to SSA if you disagree with any state decision.

Within 10 working days after the state receives the reimbursement money from SSA, the state must send you notice. The notice will tell you three things: (1) the amount of the payments the state paid you; (2) that SSA will send you a letter explaining how SSA will pay the remaining SSI money (if any) due you, and (3) about your right to a hearing with the state, including how to request the hearing.

If I am found eligible to receive SSI benefits, and by mistake the first SSI retroactive payment is sent to me, what action can the State take to get the money SSA determined is due the state?

If this happens, the State can demand that I pay to it the amount that it would have received if SSI had sent the correct payment to the State. If I do not pay the amount, the State can seek to collect this amount from me through court action or other legal remedy.

    

   

__________________Date ________________ ____________________________ Date ________ GR Code 20050
Signature of Individual Receiving Interim Assistance           Signature of State Representative  

         

   

  

Exhibit 2: State Apportionment Notice Form (balance due paid by SSA)

       

Date

Address

Dear Mr./Ms.

     

The Maine Department of Human Services has received notice from the Social Security Administration that you have been determined eligible for Supplemental Security Income (SSI).

The Interim Assistance Agreement, which you signed, allows the Department of Human Services to receive repayment for General Assistance you received during the time period covering your retroactive award.

The notice of award from the Social Security Administration states the amount of your award is $___________ and the time period covers ____________ through _____________. We have contacted the appropriate municipality and have determined that $___________ has been paid through General Assistance on your behalf during that time period. After the appropriate calculations were made, the Social Security Administration was informed that the amount of $_____________should be returned to the Department for reimbursement.

The remaining balance due you, if any will be issued directly by SSA. It may be issued to you, or your payee, in installments.

ANY BALANCE YOU RECEIVE MAY BE USED AS AVAILABLE INCOME IF YOU SHOULD REAPPLY FOR GENERAL ASSISTANCE WITHIN THE NEXT TWELVE (12) MONTHS. IT IS VERY IMPORTANT THAT YOU KEEP RECEIPTS TO SHOW HOW THIS MONEY WAS SPENT.

If you disagree with this decision, you may request a fair hearing within 30 days of receiving this decision. You must request the appeal in writing to the Department of Human Services, Bureau of Family Independence, 11 State house Station, Augusta, Maine 04333. You may also be eligible for free legal assistance through the Pine Tree Legal Assistance office near you.

                                                           Sincerely,
                                                           Program Manager
                                                      General Assistance Program

F. Reference:

SI 02003.000 Interim Assistance Payments


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0502003002BOS
SI BOS02003.002 - Maine Interim Assistance Reimbursement Agreement (TN 5-245 - 10/2015) - 10/26/2015
Batch run: 10/26/2015
Rev:10/26/2015