Social Supports and Long-term Recovery for Individuals with Disabilities
Long Term Care for SSI Individuals
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Transcript of Long Term Care for SSI Individuals
![Page 1: Long Term Care for SSI Individuals](https://reader035.fdocuments.in/reader035/viewer/2022072013/56812ae0550346895d8eca07/html5/thumbnails/1.jpg)
Long Term Care for SSI Individuals
Authorizing Vendor Payments for SSI
Recipients
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Eligibility for SSI Individuals
SSI Recipients already meet all technical, resource, and income eligibility requirements for LTC.
Since SSI Recipients already receive a Medicaid Card, the only additional LTC benefit is the vendor payment.
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Confirmation Notices
For SSI Individuals you will receive either: Automated certification – LTC, HCBS MAP-374 – Hospice MAP-24 – SCL MAP-24B – ABI
SSI Individuals will also be on the RDS report titled “PRO Certifications Not Matched to KAMES”
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Categories for SSI Individuals
Aged - category A Blind - category B Disabled - category D
All LTC cases for SSI individuals are now entered on the KAMES system.
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SSI Individuals in LTC
Upon receipt of “confirmation” for an SSI recipient receiving LTC or Waiver Services:– Immediately authorize a vendor payment
on the KAMES system– Set up a case file using A, B or D category– Enter all information on the KAMES
system and work as normal– Send a PAFS-5.1 to notify SSA of
institutionalization
The next few slides have more details...
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“SSI Only” or “SSI Alert”?
SSA determines ongoing SSI amount using a $30 standard, and $20 of any other income is excluded. So, if the individual has other income, and it is: $50 or more - case is “SSI Alert”
• SSI will be discontinued, if individual is institutionalized.
Less than $50 - case is “SSI Only”• SSI Payment will equal $50, less other
income amount, if institutionalized.
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Income Consideration
If no income besides SSI, count $30 SSI.If there is “other” income, besides the SSI: – Count the entire amount of the “other” income.– Determine the amount of SSI to consider, by using
the following formula$50 – “other” income = SSI ongoing amountIf this is a negative number, the SSI will be discontinued.
Always enter a spot-check for 3 months to check on the new SSI amount.
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For “SSI Alert” Cases
Send PAFS-5.1 to SSA to “alert” them if the individual is in an LTC facility
Spot check the case for 3 months, to see if SSI has been discontinued
Once SSI stops, it will discontinue the A,B or D Case and issue Exparte eligibility for 2 months
Individual will be advised to come into the DCBS office to re-apply for AMA in the J, K or M category
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“SSI Only” Cases
If no income received other than SSI:– Count $30 continuing SSI– Patient Liability is zero
If other income is less than $50:– Adjust SSI amount to $50 minus the
amount of other income sources– Patient liability is zero
In both of these situations, we would send PAFS-5.1 to SSA
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Wrap Up
SSI Individuals who meet Patient Status and Level of Care are eligible for LTC.
Upon receipt of a Confirmation Notice, immediately authorize payments on KAMES system.
Send form PAFS-5.1 to SSA to notify them of the individual’s LTC admission.