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SSI Administration Handbook Release 11-01 February 16, 2011 |
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SSI Administration Handbook Release 11-01 February 16, 2011 |
2.1.2 Non-Financial Eligibility
2.1.5 State SSI Payment Levels
2.1.7 Relationship Between State SSI and Medicaid
2.1.8 Termination of State SSI
2.1.9 Movement of State SSI Recipients Out of State
2.1.10 Losing State SSI Eligibility Due to SSA COLA Increases
2.1.12 Termination of State SSI-E Payments
2.1.15 Appeals and Due Process
2.1.16 20 Day Notice Requirement
2.1.17 Information Included in Notice of Adverse Action
2.1.18 Advocacy Resources During an Appeal
2.1.19 State SSI Payment While an Appeal is Pending
2.1.20 Continuation of Medicaid Eligibility While a Disability-Related Appeal is Pending
2.1.22 Non-Receipt of State SSI Checks
2.1.23 Lost or Stolen State SSI Checks
2.1.24 Request for Written Verification of State SSI Monthly Payment Amount
To become eligible for state Supplemental Security Income (SSI) Supplement, a person must first apply for and be found eligible to receive federal SSI.
Only those individuals who were receiving only a state SSI Supplement, and not a federal SSI payment, as of December 1995 and who continue to maintain their "grandfathered state-only SSI status" are excluded from this requirement.
To qualify for federal SSI and thereby automatically become eligible for the state SSI Supplement, an applicant must meet federal SSI financial and non-financial eligibility requirements.
The requirements for SSI non-financial eligibility are that a person must be 65 years of age or older or blind or disabled.
He or she must meet the SSA’s test for U.S. citizenship or meet immigrant status requirements and be a resident of the U.S. In order to receive the state SSI Supplement, a person must reside in Wisconsin.
To meet the financial qualifications for SSI a person must achieve and maintain the following financial criteria:
Have assets that are not more than $2,000 for an individual or $3,000 for a couple. The following assets/properties are to be excluded such as:
Own home if the person resides there.
One vehicle, regardless of value, if it is used for transportation for the recipient or a member of the recipient’s household.
Life insurance policies of no more than $1,500.
Household goods and personal belongings.
Burial plot and a burial fund of not more than $1,500 per person.
The recipient must have a monthly income that is not more than the applicable Federal maximum SSI payment level, plus $20. (In 2011, maximum federal SSI payment levels, plus disregards, were $674 for an individual and $1,011 for a couple.)
The effective date for receiving state SSI is the date an applicant becomes eligible for federal SSI. In some instances, several months may pass before the SSA completes an individual’s eligibility review and determination.
However, once the SSA finds a person eligible for federal SSI, the SSA will make retroactive SSI payments to the person for all the months in which they were eligible to receive federal SSI.
The state SSI Program will also pay retroactive state SSI payments beginning the month when an individual became eligible for federal SSI payments.
SSI payment levels effective January 1, 2011, by living arrangement, are in 4.1 SSI Payment Levels. A monthly state SSI payment may include as many as three components: state SSI payment, Exceptional Expense Supplement , and Caretaker Supplement .
Recipients may receive state SSI payment in the form of a paper check mailed to their address or that of their representative payee or they may opt for electronic funds transfer (EFT) of their payment to a personal savings or checking account at a financial institution.
Recipients who receive both a federal SSI payment and a state SSI payment who opt for EFT must provide their bank account number and bank routing number for SSI payment to occur.
Note: When a recipient opts for EFT of federal SSI benefits, his or her state SSI payment must also be made electronically.
Any Wisconsin resident who is eligible for federal or state SSI is also eligible for Wisconsin Medicaid, also referred to as Forward Health (formerly Medical Assistance (MA) or Title XIX .)
Medicaid is a health care benefit that covers a wide range of medical, therapeutic, and supportive care. Recipients receive a monthly identification card that must be presented when covered services are provided.
Because eligibility for state SSI is based on eligibility for federal SSI, a person who loses his or her federal SSI eligibility will also be terminated from the state SSI Supplement. See 3.1 state-Only SSI Recipients.
Other factors that may result in the loss of state SSI Supplement:
Admission to a nursing home longer than 90 days, effective the first of the month following the 90th day after admission.
Incarceration.
Move out of state.
Voluntary withdrawal from the SSI Program by a recipient.
Placed in a nonpayment status for 12 months or longer.
Increase in unearned income due to a federal cost of living adjustment (COLA) for a recipient of Social Security or Social Security Disability Insurance (SSDI) benefits.
If a federal and state SSI recipient moves out-of-state, the recipient must report such movement to Federal SSA and to DHS' Member Services at 1-800-362-3002.
Annually the federal government applies a COLA to Social Security and SSDI benefits. These COLA increases may cause ineligibility for state SSI benefits.
Under the state SSI 503 status provisions, persons who lose their state SSI eligibility due to the federal government’s COLA will maintain their Medicaid coverage for three months.
Before the end of three months the individual must contact his or her county human or tribal social services department to apply for ongoing Medicaid eligibility.
State SSI-E recipients will be terminated from the SSI-E Supplement when DHS receives a SSI-E decertification action from a county agency.
Note: All SSI-E recipients must meet all federal eligibility criteria for SSI before they can be certified for the SSI-E Supplement. In some instances before January 1, 1996, a person who is certified by the county for SSI-E may not receive a regular monthly SSI payment.
This nonreceipt of monthly SSI payments does not affect SSI-E certification. If a person in a nonpayment or SSI suspense status re-enters current SSI pay status and is SSI-E certified, he or she will be paid using the SSI-E living arrangement payment standard.
A recipient will receive one additional monthly state SSI payment after any month in which he or she is found ineligible for state SSI.
The SSA and the DHS-Disability Determination Bureau (DDB) will periodically review SSI cases to determine a person’s continuing eligibility for federal and state SSI. The SSA’s role is to review recipients’ continued financial eligibility.
The frequency and type (in-person or mail) of such reviews is dictated by the SSA. The DDB’s role is to determine whether people who receive Medicaid or federal or state SSI because of disability continue to meet disability standards.
The frequency of the DDB’s review depends upon the likelihood of medical improvement, whether the person seeks work and the DDB’s workload. Such periodic reviews of financial eligibility or continuing disability may result in termination from the SSI Program.
Recipients of the state SSI Supplement have the right to appeal any administrative action that adversely affects their state SSI Supplement. The rights of recipients to appeal includes, but is not limited to, the following:
State SSI benefits are denied.
State SSI benefits are suspended.
State SSI benefits are reduced.
A recipient's eligibility is terminated.
State SSI benefits are incorrectly determined.
A recipient of federal and state SSI should appeal an adverse decision regarding his or her state and federal SSI benefits to the SSA, because the action of the state SSI Program was based on a federal eligibility determination or action.
Notice of actions by the DHS that adversely affect receipt of state SSI benefits must be provided at least 20 days prior to the effective date of the action, with the following exceptions:
There is factual information confirming the recipient has died.
The recipient or payee has communicated in a signed written statement that the benefit is no longer desired, or has communicated this by phone and has not contradicted this communication.
The recipient or payee provides information that requires adverse action and states in writing or communicates verbally that he or she knows adverse action will result.
The recipient has been admitted to a nursing home or other institution and no longer qualifies for the benefit.
The recipient’s whereabouts are unknown and the post office returns mail with no forwarding address.
There is factual information that the recipient has moved out of state.
The action is a denial for initial eligibility for benefits.
There is apparent fraud by the recipient.
The recipient is incarcerated.
Any notice of adverse action sent by the DHS to a state SSI recipient or his or her representative payee must include the following:
A statement describing the intended action.
An explanation of the right to seek a hearing and how to request one.
The recipient’s rights and responsibilities in the hearing process.
Information about the availability of free representation.
A statement that if the hearing is requested within 10 days of the date on the notice of adverse action, benefits may continue until the hearing decision is made.
A statement that the recipient may have to repay benefits continued during the appeal if he or she does not prevail or abandons or withdraws the appeal.
The phone number and address to contact for more information, to request informal resolution, or to obtain information about legal assistance regarding the pending adverse action.
SSI recipients who receive notice of an action by the DHS that adversely affects their receipt of SSI may be eligible for free legal representation during the appeal process. A referral to an agency that provides legal services to low-income residents of Wisconsin may be obtained by calling Member Services at 1-800-362-3002.
If a federal and state SSI recipient asks for and is granted SSI payment continuation by the SSA while an appeal is pending, the state SSI Program will follow suit and continue state SSI payments. State SSI payments will only be continued if SSA grants a continuation of federal SSI payments.
A federal and state SSI recipient who has a payment continuation while appealing to the SSA will, in the event of losing his or her appeal with the SSA, be required to refund to the state SSI Program all state SSI payments paid to them during the time of their appeal.
The Department of Health Services will continue Medicaid eligibility during the period of time an appeal of denial of SSI eligibility due to loss of disability is pending, regardless of whether a recipient has elected to continue cash benefits during an appeal.
Effective July 1, 2006, HFS 2 regulates recovery of overpayments.
If a state SSI recipient has not received his/her monthly state SSI check within three business days after the first of the month, the recipient must call Member Services to report nonreceipt of the check and DHS shall:
Verify that the recipient was eligible for payment that month.
Verify that the recipient’s correct address is on file.
Inform the recipient to call back after three additional business days, to allow for possible mail delays.
Place a stop pay on the original check if the recipient makes a call back. DHS will issue a replacement check to the recipient in the next weekly check cycle.
Based on provisions in s20.912(5), Wis. Stats. (exit DHS), DHS is not liable for cashed checks where a recipient claimed the check was lost, stolen, or not received.
Upon receiving written notification from the recipient that a state SSI check has been stolen and that the recipient has filed a report of the theft with the police, DHS will attempt to stop payment on the original check and may re-issue the payment to the recipient.
Upon request by authorized agencies such as a state SSI recipient’s representative payee, emergency assistance or housing authorities, DHS will provide verification of a state SSI recipient’s monthly state SSI payment amount.
This page last updated in Release Number: 11-01
Release Date: 02-16-11
Effective Date: 02-16-11