Identification Number:
EM-16012
Intended Audience:All RCs/ARCs/ADs/FOs/TSCs/PSCs/OCO/OCO-CSTs/ODAR
Originating Office:ORDP OISP
Title:Guidelines on issuing manual notices for individuals determined ineligible because of excess resources that include a countable trust
Type:EM - Emergency Messages
Program:Title XVI (SSI)
Link To Reference:See Reference at the end of this EM.
 
Retention Date : September 02, 2017

Retention Date : September 02, 2016

A. Purpose

This emergency message (EM) provides additional requirements for issuing a manual notice when notifying an individual of ineligibility due to excess resources that include a countable trust.

B. Background

We are issuing guidance to field office (FO) technicians on providing additional information in manual notices about the reason an individual is determined ineligible due to excess resources that include a countable trust.

Current manual notices sometimes provide incomplete information about ineligibility due to excess resources that include a countable trust. This guidance will help provide a standardized approach to providing information on trust issues, clarify the message sent to individuals, and allow us to provide better public service.

C. Policy for using a manual notice to notify an individual of ineligibility due to excess resources that include a countable trust

POMS SI 01120.204 provides instructions on when a manual notice is required for trusts established with an individual’s assets on or after 01/01/00. The POMS requires that FO technicians issue a manual notice whenever an individual:

    · is ineligible due to excess resources and those resources include a trust;
    · has excess resources, but is eligible for SSI based on an undue hardship waiver; or
    · has a change in eligibility or payment status due to trust or undue hardship involvement.
Use the instructions and notice paragraphs in POMS SI 01120.204 to prepare manual notices for trust cases. Prepare these notices using the Document Processing System (DPS).

D. Procedures for drafting manual notices for individuals determined ineligible because of excess resources that include a countable trust

Continue to use the required paragraphs outlined in POMS SI 01120.204, depending upon the specific individual’s circumstances. In addition, using free form text, for each reason the trust is countable (that is, why it does not meet the exception or other requirements in POMS), you must cite:
    · the applicable section of the trust (or any joinder agreement, if applicable) containing the problematic language or issue;
    · the POMS citation that contains the policy requirements on that subject; and
    · the following language indicating where the POMS can be found on-line – “You can find the Program Operations Manual System (POMS) on the Social Security website at https://secure.ssa.gov/poms.nsf/Home?readform.”


E. Examples of manual notice language

The following examples (1) describe various scenarios where an individual’s trust would be a countable resource because it does not comply with all of the requirements for exception and (2) provide sample notice language technicians could include in a manual notice. The examples are not all inclusive.

    1. Situation - Section VII.A.2. of the trust does not allow Medicaid payback to all States providing medical assistance in the event of the beneficiary’s death.

      Sample Language - Section VII.A.2. of the trust does not comply with Program Operations Manual System (POMS) SI 01120.203B.1.h.

    2. Situation - Section 3.a. of the trust violates the sole benefit requirement by allowing for payment of third party travel expenses not permitted by POMS SI 01120.201F.2.

      Sample Language - Section 3.a. of the trust does not comply with Program Operations Manual System (POMS) SI 01120.201F.2.

    3. Situation - Section III.B.2. of the trust does not require that the State(s) receive all amounts remaining in the trust at the time of early termination up to an amount equal to the total amount of medical assistance paid on behalf of the individual under the State Medicaid plan.

      Sample Language - Section III.B.2. of the trust does not comply with Program Operations Manual System (POMS) SI 01120.199F.1.

    4. Situation - Under Section 1 of the trust, the parent did not have legal authority to establish the trust with his adult child’s assets.

      Sample Language - Section 1 of the trust does not comply with Program Operations Manual System (POMS) SI 01120.203B.1.g.

    5. Situation – Under Section I of the trust, the establishment of the trust occurred after the beneficiary turned 65. Also, Section V.A.2. of the trust does not allow Medicaid payback to all States providing medical assistance in the event of the beneficiary’s death.

      Sample Language – Section I of the trust does not comply with Program Operations Manual System (POMS) SI 01120.203B.1.b. Section V.A.2. of the trust does not comply with Program Operations Manual System (POMS) SI 01120.201B.1.h.

    6. Where to locate POMS on-line
F. References

SI 01120.199 Early Termination Provisions and Trusts
SI 01120.200 Trusts – General, including Trusts Established Prior to 1/1/00, Trusts Established with the Assets of Third Parties and Trusts Not Subject to Section 1613(e) of the Social Security Act
SI 01120.201 Trusts established with the assets of an individual on or after 1/1/00
SI 01120.202 Development and Documentation of Trusts Established on or After 01/01/00
SI 01120.203 Exceptions to Counting Trusts Established on or after 1/1/00
SI 01120.204 Notices for Trusts Established on or after 1/1/00
SI 01120.225 Pooled Trusts Management Provisions
SI 01120.227 Null and Void Clauses in Trust Documents

Direct all program–related and technical questions to your RO support staff or PSC OA staff. RO support staff or PSC OA staff may refer questions or problems to their Central Office.



EM-16012 - Guidelines on issuing manual notices for individuals determined ineligible because of excess resources that include a countable trust - 03/02/2016