Effective Dates: 7/28/2022 - Present

Identification Number:
EM-22010 REV
Intended Audience:All RCs/ARCs/ADs/FOs/
TSCs/PSCs/OCO/WBDOC/SAU
Originating Office:ORDP OISP
Title:Special Processing Instructions - Applying Medicare Part D Extra Help Low Income Subsidy (LIS) Income and Resource Exclusions to Coronavirus Disease 2019 (COVID-19) Related Disaster Assistance
Type:EM - Emergency Messages
Program:Medicare
Link To Reference:See References at the end of this EM
 
Retention Date: August 31, 2024

This EM replaces a prior version issued on February 16, 2022. This revision updates the procedure for documenting Unemployment Insurance Benefits (UIB) exclusions. In addition, minor edits were made throughout.

Section B: Added a NOTE at B.4 regarding the treatment of UIB received after the pandemic UIB end month but falls within the UIB pandemic period. An additional NOTE was added at B.4 stating that we will update the incident period end date for the COVID-19 emergency when it is announced by FEMA.

Section C: Clarified that disaster assistance resource exclusions are not time-limited exclusions. Retained disaster assistance is excluded from resources indefinitely.



A. Purpose and Background

The COVID-19 pandemic resulted in Federal, State and Tribal governments issuing a wide variety of assistance payments or other relief to affected individuals. Most LIS claimants and their families received some form of assistance, and we have determined that many forms of assistance qualify as disaster assistance. Special development and documentation procedures apply to disaster assistance paid to LIS claimants on account of the pandemic.

Due to the number of pandemic-related assistance programs and the varying end dates for the assistance types, more instructions will be forthcoming.

B. Income Policy for Pandemic-related Disaster Assistance

Many types of assistance received during the pandemic are excluded from income in accordance with disaster assistance procedures.

1. Procedure for identifying disaster assistance

See EM-20018 REV 6 for updated information on sources of COVID-19 pandemic-related assistance and the policy treatment for identified assistance types. For any assistance classified as disaster assistance in the chart in section C.1 of EM-20018 REV 6 follow the special processing instructions in this EM.

NOTE: Contact your Regional Office for help with alleged disaster assistance that is not listed in the chart in EM-20018 REV 6.

2. Procedure for documenting income exclusions for pandemic-related disaster assistance from March 2020 until the end of the disaster period in each State, Territory, and Tribal area

Follow these steps when documenting receipt of pandemic-related disaster assistance received from March 2020 through the end of the pandemic period. Refer to the chart in section B.4. of this EM for the COVID-19 pandemic period by State, Territory, or Tribal area. As of the publication date of this EM, the disaster declaration remains in effect in all States, five territories, and 32 Tribal areas.

NOTE 1: Any pandemic assistance received after the end of the applicable pandemic period is not subject to special processing instructions. Such assistance may still be considered disaster assistance but would be subject to normal income and resource procedures for disaster assistance. More information will be forthcoming at the end of the disaster period.

NOTE 2: Instructions are forthcoming regarding any case that has been terminated due to pandemic-related disaster assistance.

How to Document the Initial Disaster Assistance Allegation
Step
Action
1
When developing income during initial claim and post-eligibility (PE) events, review the LIS application data and agency data to see if the individual reported or received any of the types of pandemic-related assistance identified in EM-20018 REV 6 or any other type of pandemic-related assistance.

If No, follow normal policies to process the application or post-eligibility event.


If YES and unemployment is involved, proceed to Step 2.

If YES and unemployment is not involved, proceed to Step 3.
2
Follow instructions in section B.3. in this EM to document unemployment income.

If other assistance was also received (e.g. Economic Impact Payments (EIPs)), continue to Step 3.
3
Document the individual’s allegation regarding receipt of COVID-19 related pandemic assistance.
      o Document the report of contact DWRC screen following existing instructions in HI 03035.006D and MS 03206.003. Include ALL of the following:
      -” The President has declared a major disaster for the relevant State, territory, or Tribe due to the COVID-19 pandemic emergency. As of (enter date) the declaration is still in effect.”

      - Document the type of disaster assistance income received and note:

          o Who received the income (name and relationship to the LIS individual);
      o How much income was received; and

      o The month(s) in which the income was received.



      - If any of the disaster assistance was retained, document how much was retained and identify the financial account that contains the retained income.
NOTE: Follow these documentation steps for each type of disaster assistance received from the C.1 chart in EM-20018 REV 6.

Proceed to Step 4.
4
Exclude from income all pandemic-related disaster assistance identified in the chart in section C.1 of EM-20018 REV 6 that was received from March 2020 through the end of the pandemic period, based on the individual’s reasonable allegation.

(See chart in section B.4. in this EM for end dates.)
      o Use the VRAI screen to exclude the amount received following existing instructions in HI 03035.006D and MS 03206.006.

      o Input the type of pandemic-related disaster assistance received, the amount received, the date(s) received, and the rationale for the determination.



Important: In EM-20018 REV 6, we have provided additional program information about the various types of assistance and we will continue to update the chart as we obtain more information. Use your best judgment when assessing the reasonableness of a person’s allegation and obtain detailed explanations when needed. If you have reason to question the person’s allegation or if you suspect fraud, follow normal verification and documentation policy in HI 03035.006 to request evidence in support of the individual’s allegation.


For example, a couple alleging $5,900 for their first EIP may be reasonable if they have 7 dependent children in their household. It would be questionable for a single person with no dependents to allege that amount for their first EIP.

Proceed to Step 5.

NOTE: The LIS eligibility process is an automated and paperless process. Do not photocopy evidence for the file. Record all development and evidence received on the verification screens.
5
If the individual alleges retaining any pandemic-related assistance amounts, continue to section C in this EM for instructions on how to handle pandemic-related resource exclusions.


3. Procedures for documenting Unemployment Insurance Benefits (UIB) exclusions

If the LIS individual answered yes to receiving UIB at any point from March 2020 through the pandemic UIB end month provided in the chart in B.4. below, and the record is active (subsidy determination is pending):


    · Enter the allegation regarding unemployment payments in the Medicare Application Processing System (MAPS).

    · On the DWRC screen, type the following, “Unemployment Insurance Benefits excluded due to COVID-19 disaster assistance from March 2020 through xx/xx/xxxx (Fill in end date based chart in B.4.).”

    · If the LIS individual retained any of the UIB received during the pandemic, document the retained amount on the DWRC following Step 3 in the chart in B.2. above. Continue to instructions in section C of this EM for the resource exclusion procedures.

    · On the issue verification screen (VRAI), exclude the alleged unemployment payment amounts.


If the LIS individual answered yes to receiving UIB from March 2020 through the pandemic UIB end month provided in the chart in B.4. below, and the record is not active (subsidy determination is adjudicated):

      · Follow HI 03050.045 Manual Correction Process for the Extra Help Application.

        IMPORTANT: The 60-day processing limitation is temporarily lifted to correct excludable pandemic-related financial assistance.


      · Exclude the UIB payment(s) from countable resources on the VRAI following existing instructions in HI 03035.006D and MS 03206.006.


      · On the DWRC document the issue and the resolution, and type the following, “Unemployment Insurance Benefits excluded due to COVID-19 disaster assistance from March 2020 through xx/xx/xxxx (Fill in end date based chart in B.4.).”

        NOTE 1: When using the manual correction process, an increase in the subsidy amount must be effective with the first month of Extra Help eligibility. To accomplish this, be sure that the “Report Date” field on the MCOR screen is equal to the month prior to the first month of Extra Help eligibility. A change to a lower subsidy amount is effective with the month after the month shown in the “Event Report Date” field of the MCOR.

        NOTE 2: MAPS processes manual corrections cases as new applications. As a result, the system will request updated IRS data, which may create new verification issues and delay processing. To avoid this, show income and resources as verified. For additional MAPS instructions see MS 03206.006.


      · If the LIS individual retained any of the UIB received during the pandemic, document the retained amount on the DWRC following Step 3 in the chart in B.2 above. Continue to instructions in section C of this EM for the resource exclusion procedures.

    4. Disaster Assistance Income Exclusion Periods by State or Territory

    The following chart lists the period in which pandemic-related disaster assistance income exclusions apply by State or Territory. Assistance received after these dates is not pandemic disaster assistance subject to the special processing instructions in this EM. Instead, follow normal processing instructions for income received after the disaster end date in the chart. For unemployment income, the end date is determined differently. Unemployment received after the “Pandemic UIB End” date in the chart is subject to normal income counting rules.

    NOTE 1: Document, post, and exclude UIB from March 2020 through the pandemic UIB end month provided in the chart in B.4 below, for months that fall within the pandemic UIB period, but are issued after the end of the pandemic UIB end month.

    NOTE 2: The disaster end date in the chart below refers to the end of the FEMA-specified “incident period.”

    At this time, FEMA has not announced the incident period end date for the COVID-19 emergency. We continually check the FEMA website and monitor the news for any information on the incident period end date. We will update this chart as situations change.

    For Tribes, SSA will consider March 2020 as the starting month for the pandemic disaster period. To determine period end dates for Tribes, consult FEMAs disaster assistance declaration page at https://www.fema.gov/disaster/declarations.

    Pandemic Disaster Assistance by State and Territory
    State or Territory Name
    Disaster Begin Date
    Pandemic UIB End
    Disaster End Date
    State or Territory Name
    Disaster Begin Date
    Pandemic UIB End
    Disaster End Date
    Alabama3/20206/2021currentMontana3/20206/2021current
    Alaska3/20206/2021currentNebraska3/20206/2021current
    Arizona3/20207/2021currentNevada3/20209/2021current
    Arkansas3/20206/2021currentNew Hampshire3/20206/2021current
    California3/20209/2021currentNew Jersey3/20209/2021current
    Colorado3/20209/2021currentNew Mexico3/20209/2021current
    Connecticut3/20209/2021currentNew York3/20209/2021current
    Delaware3/20209/2021currentNorth Carolina3/20209/2021current
    Washington D.C.3/20209/2021currentNorth Dakota3/20206/2021current
    Florida3/20206/2021currentOhio3/20206/2021current
    Georgia3/20206/2021currentOklahoma3/20206/2021current
    Hawaii3/20209/2021currentOregon3/20209/2021current
    Idaho3/20206/2021currentPennsylvania3/20209/2021current
    Illinois3/20209/2021currentRhode Island3/20209/2021current
    Indiana3/20209/2021currentSouth Carolina3/20206/2021current
    Iowa3/20206/2021currentSouth Dakota3/20206/2021current
    Kansas3/20209/2021currentTennessee3/20207/2021current
    Kentucky3/20209/2021currentTexas3/20206/2021current
    Louisiana3/20207/2021currentUtah3/20206/2021current
    Maine3/20209/2021currentVermont3/20209/2021current
    Maryland3/20209/2021currentVirginia3/20209/2021current
    Massachusetts3/20209/2021currentWashington3/20209/2021current
    Michigan3/20209/2021currentWest Virginia3/20206/2021current
    Minnesota3/20209/2021currentWisconsin 3/20209/2021current
    Mississippi3/20206/2021currentWyoming 3/20206/2021current
    Missouri3/20206/2021currentNorthern Mariana Islands3/20209/2021current

    C. Resource Policy for Pandemic-related Disaster Assistance

    Many types of assistance received during the pandemic and retained into (the) month(s) following receipt are excluded from resources.

    Resources exclusions for pandemic-related disaster assistance are not time-limited exclusions. Retained disaster assistance is excluded from resources indefinitely. See the chart in in section C.1 of EM-20018 REV 6 for types of pandemic related disaster assistance.

    Given the administrative complexities involved in processing pandemic-related resource exclusions at such a large scale, special processing applies to resource determinations involving pandemic-related disaster assistance.

    1. Procedures for developing resource exclusions for retained pandemic-related disaster assistance

    Pandemic-related disaster assistance exclusions must be considered during initial claims, redeterminations, and any other post-eligibility (PE) event involving resource verifications. Manual actions will likely be required to apply pandemic-related resource exclusions.

    Develop and exclude from resources pandemic-related disaster assistance identified in EM-20018 REV 6 only when an individual alleges retaining an amount that may affect eligibility.

    Accept the individual’s reasonable allegation regarding how much assistance was retained and how the funds were held following the below steps.

    How to Document the Allegation about Retained Amounts
    Step
    Action
    1
    		Document the individual’s allegation about how much assistance was retained and how the funds were held in the Medicare Application Processing (MAPS) System using the DWRC established for income documentation. (See Step 3 in the chart in section B.2 above.)
    2
    		Document the alleged exclusion amount on the appropriate resource page (i.e., VRAI screen) following instructions in the chart below.

    When an individual alleges retaining any excludable funds and the retained amount affects LIS eligibility do the following:

    How to Develop and Document Excluded Resource Amounts
    Step
    Action
    1
    		For all months during the period of review in which the individual alleged retaining pandemic disaster assistance and excess resources are involved:

    Compare the account balances to the alleged pandemic assistance received. Check for allegations on the DWRC screen and the VRAI screen created in secton B of this EM.
    2
    		When fact patterns and bank balance information align with the initial allegation:
        · Apply resource exclusions based on the individual’s allegation.
        · If excluded amounts are commingled with countable funds in an account, assume countable funds are spent first. See SI 01130.700 for more information on commingled funds.

    When fact patterns and bank account balances do not align with the initial allegation:
        · Contact the person and verify whether the excess resource balances are attributable to saved pandemic assistance;
        · Exclude only those amounts attributable to retained pandemic assistance (unless another exclusion applies, e.g., early deposits or Federal tax returns). If excluded amounts are commingled with countable funds, assume countable funds are spent first per SI 01130.700;
        · Record discrepancies, updated disaster assistance allegations, and any other information material to the resource determination on a DWRC. To change the amount retained, update the VRAI screen.
        · If you discover other income during the investigation, develop according to normal policies.
        · Use your best judgment when assessing the reasonableness of a person’s allegation and obtain detailed explanations when needed. If you have reason to question the person’s allegation or if you suspect fraud, follow normal resource verification and documentation policy in HI 03035.010, HI 03035.020 and HI 03035.006 to request evidence in support of the individual’s allegation.

    NOTE: The resource exclusion for pandemic unemployment only applies to unemployment paid during the timeframe outlined in the chart in section B.4. of this EM. Regular unemployment benefits paid outside of that period retained into the month after the month of receipt are countable resources.
    3
    		Exclude from resources all retained pandemic-related disaster assistance identified on the chart in EM-20018 REV 6 received from March 2020 through the end of the pandemic based on the individual’s reasonable allegation. (See chart in section B.4. in this EM for end dates.)

    Apply exclusions to the appropriate field on the VRAI screen and enter “disaster assistance” as the reason. On the DWRC screen, document the type of pandemic assistance received and the excluded amount. Additionally, note the source of each exclusion if there are multiple exclusions involved (e.g., we also had to exclude an early SSI payment or some of the account funds were from a Federal tax return).

    NOTE: For continuing resource exclusion amounts, advise individuals to save documentation of disaster assistance. We may request evidence for individuals who continue to save disaster assistance long-term.

    2. Example of applying pandemic-related resource exclusions.

    At the 8/2021 redetermination, the technician documents the following on a DWRC:

    “Recipient and spouse received all three EIPs, each in a single deposit to their checking account ($2,400 in May 2020; $1,200 in January 2021; and $2,800 in April 2021.) Recipient alleges saving some of the money in their joint checking account in the months after they received the EIPs, but that all of the money was spent down within a few months each time.”

    Since account balance patterns follow the EIP payment schedule captured on the chart in section C.1 of EM-20018 REV 6 and align with the allegation from the VRAI screen, the technician applies the pandemic assistance exclusion when MAPS would otherwise calculate ineligibility.

    D. Correcting Excludable Payments

    If an individual reported a payment that meets criteria for exclusion and the payment was counted as income or resources, the individual does not have to file an appeal. Technicians must take action to exclude the payment(s) via the manual correction process explained in HI 03050.045, Manual Correction Process for the Extra Help Application.

    NOTE: LIS pandemic-related financial assistance outreach mailer inquiries should be handled by field offices (FOs). For more information about the LIS pandemic-related financial assistance outreach mailer see, EM-22033 REV Instructions for Reviewing Medicare Part D Low Income Subsidy (LIS) Claims Partially Awarded or Denied due to COVID-19 Disaster Assistance.

      If the excludable payment was previously counted as income or a resource for LIS purposes but the payment should be excluded,
                - Accept the individual’s reasonable allegation regarding payment(s) received.
                - Follow HI 03050.045 Manual Correction Process for the Extra Help Application.

                  IMPORTANT: The 60-day processing limitation is temporarily lifted to correct excludable pandemic-related financial assistance.
                - Remove the payment(s) from countable income and resources by documenting the DWRC and VRAI screens in MAPS following existing instructions in HI 03035.006D, MS 03206.003, and MS 03206.006. Be sure to capture the type of payment and the payment amount, and note the payment(s) as “excludable disaster assistance”.

      NOTE: MAPS processes manual corrections cases as new applications. As a result, the system will request updated IRS data, which may create new verification issues and delay processing. To avoid this, show income and resources as verified. For additional MAPS instructions see MS 03206.006. Additionally, when using the manual correction process, an increase in the subsidy amount must be effective with the first month of Extra Help eligibility. Be sure that the “Report Date” field on the MCOR screen is equal to the month prior to the first month of Extra Help eligibility. A change to a lower subsidy amount is effective with the month after the month shown in the “Event Report Date” field of the MCOR.

      E. Additional Information

      For more information about the LIS income verification process see, HI 03035.010 Income Verification Process.

      For more information about the LIS resource verification process see, HI 03035.020 Verification Process for Liquid Resources.

      See EM-20014 REV 6 for guidance on how common types of COVID-19 related assistance will be treated for purposes of determining Supplemental Security Income (SSI) eligibility.

      Direct all program-related and technical questions to your Regional Office (RO) support staff or Program Service Center (PSC) Operations Analysis (OA) staff. RO support staff or PSC OA staff may refer questions, concerns, or problems to their Central Office contacts.

      F. References

      2/24/2021 White House Announcement: Continuation of the National Emergency Concerning the Coronavirus Disease 2019 (COVID-19) Pandemic

      EM-20014 REV 8 Effect of COVID-19-Related Financial Assistance on SSI Income and Resources

      EM-20018 REV 6 Medicare Part D Low Income Subsidy (LIS) – Effect of Coronavirus Disease 2019 (COVID-19) Related Assistance

      EM-22033 REV Instructions for Reviewing Medicare Part D Low Income Subsidy (LIS) Claims Partially Awarded or Denied due to COVID-19 Disaster Assistance

      MS 03206.003 MAPS Report of Contact (DWRC)

      MS 03206.006 MAPS - Development Worksheet- Issue Verification (VRAI)

      HI 03035.006 Verification and Documentation Process for Medicare Application Processing System (MAPS)

      HI 03035.010 Income Verification Process

      HI 03035.020 Verification Process for Liquid Resources

      HI 03050.045 Manual Correction Process for the Extra Help Application

      SI 00830.620 Disaster Assistance – Presidentially-Declared Disaster

      SI 01130.620 Disaster Assistance

      SI 01130.700 Identifying Excluded Funds That Have Been Commingled With Nonexcluded Funds


      EM-22010 REV - Special Processing Instructions - Applying Medicare Part D Extra Help Low Income Subsidy (LIS) Income and Resource Exclusions to Coronavirus Disease 2019 (COVID-19) Related Disaster Assistance - 7/28/2022