Section 1634. [42 U.S.C. 1383c (a) of the Social Security Act (the act) provides that the Commissioner may enter into an agreement with any State which wishes to do so under which the Commissioner will determine eligibility for medical assistance in the case of aged, blind, or disabled individuals under such State’s plan approved under Title XIX. Any such agreement shall provide for payments by the State, for use by the Commissioner of Social Security in carrying out the agreement, of an amount equal to one-half of the cost of carrying out the agreement, but in computing such cost with respect to individuals eligible for benefits under this title, the Commissioner of Social Security shall include only those costs which are additional to the costs incurred in carrying out this title.

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The role of SSA in making determinations of Medicaid eligibility or giving information to States is determined by agreement. The State remains responsible under Title XIX. In general, SSA's role includes the following areas:

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  Determining and redetermining Medicaid eligibility for SSI recipients;

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  Providing SSI applicant information a State requires for administering its Medicaid program. This includes assignment of rights and third party liability information; and

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  Referring applicants/recipients to local Medicaid agencies, when specified in the agreement.

One-half of the incremental administrative cost is charged for federally administered Medicaid determinations as required under Title XVI . Other information is generally provided on a full reimbursement basis.

1. a. 

   The costs of Federal Medicaid eligibility determinations are derived primarily from data in the Cost Analysis System, a subsystem of the General Accounting Office approved overall SSA administrative accounting system. They include:

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     Direct time- the salary needed to perform the workload;

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     Indirect time- training, supervision, travel, staff work, and leave time; and

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     SSA field overhead rate- the cost of services provided to the field by central office components and a portion of the centralized common expenses account.

2. b. 

   The agreement may specify the reimbursement rate. SSA bills no less frequently than annually, not more frequently than quarterly on a fee schedule basis. Charges to the State in a fiscal year are computed by multiplying the unit cost reflected in the schedule by the number of items delivered.

Each billing period, SSA sends the State an original and two copies of form SSA-1036 (see AMWA 4-50-01 Reimbursable Accounting). The form includes:

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  Description of the services performed;

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  Number of work units;

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  Unit cost for which the State is being billed; and

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  Address for sending payment.

The State is billed during the first month after the end of each billing period, and should remit the amount due within 30 days of receipt of the bill, with a copy of the billing form to identify the payment. Questions on billing problems, including disagreement with the amounts involved and how the amounts were computed should be directed to the Assistant Regional Commissioner and Operations Support (ARC MOS). Also, the ARC MOS, is to be informed of the name, title, address, and telephone number of the State official to whom billing problems are directed.

The State should supply SSA with the title of the State official and address for sending billing forms. Forward this information to the address shown in SI 02901.520 B.2.

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  Social Security Administration

  Office of Income Security Programs

  Attn: Office of SSI and Program Integrity Policy

  2513B Robert M. Ball Building

  6401 Security Boulevard

  Baltimore, Maryland 21235-6401