When there is a medical allowance for concurrent title II/title XVI disability claims
and SSI presumptive disability (PD) payments have been made, the title II claim is
often adjudicated before the final allowance is posted to the SSI claim. If a PD payment
has been made for a month in the title II windfall offset period, a title II offset
computation may be processed based on an MBR/SSR interface. This offset computation
is correctly applied because all requirements for title II offset are met. When the
final allowance is posted to the SSI claim, if the title II monthly benefit amounts
are large enough, no additional SSI benefits would be payable for the retroactive
months. If the SSI recipient were found ineligible for some months in the retroactive
period they would lose potential Medicaid eligibility inappropriately.
Example: The SSI date of eligibility is 1/00, a PD decision is made in 2/00, and PD payments
are made for 3/00 - 4/00. A final allowance results in a title II CMA of $600 being
paid in 5/00 and retroactive benefits of $600 per month being withheld. The windfall
period is 1/00 – 6/00. An automated title II offset computation processes before the
SSI claim is finally adjudicated. Following the offset computation, the SSR shows:
1/00 - PS S21 (zero offset*)
2/00 - PS E02 (zero offset*)
3/00 - PS C01 ($512 SSI paid and $512 title II offset)
4/00 - PS C01 ($512 SSI paid and $512 title II offset)
5/00 - PS N01 (zero offset*)
6/00 - PS N01 (zero offset*)
*See SI 02006.010A.4 for definition of zero offset.
Final adjudication of the SSI claim results in the following on the SSR:
1/00 - PS E02
2/00 - PS C01 and nothing payable due to zero offset (CMPH FMA shows $512 payment,
but WFA and WFO are 0 and there is no WFX in WCMP.)
3/00 - 4/00 PS C01 (SSI paid and title II offset applied)
5/00 – 6/00 PS N01 (due to payment of title II benefits)