|
|
SSI Administration Handbook Release 11-01 February 16, 2011 |
|
|
SSI Administration Handbook Release 11-01 February 16, 2011 |
3.1.1 Personal and Financial Eligibility
3.1.3 State-Only SSI Payment Levels
3.1.5 Relationship Between State-Only SSI and Medicaid
3.1.6 Termination From State-Only SSI Due to Unearned Income
3.1.7 Termination of State SSI Cash Benefits and Medicaid Due to Earned Income
3.1.8 1619(b) Medicaid Work Incentive Program for State-Only SSI Recipients
3.1.9 Additional Reasons for Termination From State-Only SSI
3.1.11 Termination From Grandfathered State-Only Status
3.1.12 Eligibility and Termination of SSI-E
3.1.14 Monthly Review of Unearned Income
3.1.15 Annual Eligibility Review for State-Only SSI Benefits
3.1.16 Appeals and Due Process
3.1.17 State-Only SSI Payment Continuation While Appeal is Pending
3.1.21 Advocacy Resources During an Appeal
3.1.22 Establishing a Representative Payee for State-Only Benefits
To be eligible for state SSI Supplement as a state-only cash and/or Medicaid recipient, a person must meet all of the following criteria:
"Grandfathered" as a state-only SSI recipient in December 1995.
Maintain resources that are not more than $2,000 for an individual or $3,000 for a couple (cash on hand or in savings or checking accounts). The following resources are to be excluded such as:
Own home if the state-only recipient 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 with a face value of not more than $1,500.
Household goods and personal belongings.
Burial plot and a burial fund of not more than $1,500.
Maintain residence in the state of Wisconsin.
Meet program income and disability eligibility criteria.
Reside in an allowable living arrangement for recipients of SSI.
State-only SSI recipients, by definition, are individuals who, because of either earned or unearned income, have income that is higher than the federal SSI payment level, but lower than the combined federal and state SSI payment level (taking into account any income disregards).
A state-only SSI recipient may either be receiving a state-only regular SSI payment or receiving this payment in conjunction with the Exceptional Expense Supplement (E-Supplement) or Caretaker Supplement (CTS), or both.
However, effective January 1, 1996, no new certifications for the Exceptional Expense Supplement may occur in the case of individuals who were not state-only recipients as of that date or are not federal and state SSI recipients at the time of certification.
For married individuals applying for or receiving state-only SSI, the spouse's income is not counted. However, the total assets of the couple are counted.
The effective date for eligibility for all state-only SSI recipients was December 1995.
However, individuals who were participating in Social Security Administration's (SSA) work incentive programs or a Plan for Achieving Self-Support (P.A.S.S.) in December 1995 may, on a case-by-case basis, be considered for state-only SSI recipient status.
In these situations, an individual’s income must be less than the combined maximum federal and state payment level, minus disregards, that was in effect in December 1995.
SSI payment levels effective January 1, 2011, by living arrangement, are in 4.1 SSI Payment Levels. A monthly state-only SSI payment may include as many as three components: State SSI payment, Exceptional Expense Supplement and Caretaker Supplement (CTS)
Recipients may receive state-only SSI payments 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 only a state SSI payment who opt for EFT must provide their bank account number and bank routing number to Member Services at 1-800-362-3002 for payment to occur.
Any Wisconsin resident who is eligible for federal or state SSI is also eligible for Wisconsin Medicaid, also referred to as 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 an identification card (Forward Card) that must be presented when covered services are provided.
Note: Some grandfathered state-only SSI recipients receive Medicaid benefits, but no cash benefits. These recipients are referred to as state-only 1619(b) recipients. Eligibility reviews may determine that a state-only 1619(b) recipient has a change in employment earnings that once again make them eligible for cash benefits. Assuming these recipients still meet all other SSI requirements, the State SSI cash benefit would be restored in future benefit months.
Termination of state-only SSI cash payment and Medicaid will result if the recipient’s monthly unearned income, minus a $20 disregard, exceeds the combined amount for the following:
The federal SSI benefit amount
The state SSI benefit amount
See 4.1 SSI Payment Levels for the current amounts.
Terminations based on excess unearned income will occur monthly.
Many SSI recipients earn wages from work.
Termination of SSI cash benefits will occur when a recipient who is otherwise eligible, based on unearned income and assets, has countable earned income that increases the countable total income to an amount higher than the current combined monthly amount of SSI cash benefits.
Countable earned income is defined as all income from wages, minus the following:
The first $65 of earned income.
Half of the remaining earned income.
Blind work expenses.
Impairment related work expenses.
Terminations from state-only SSI cash benefits, Medicaid and grandfathered status due to earned income will occur annually.
A state-only SSI recipient who, because of earnings from employment, no longer meets the financial eligibility requirement for state SSI cash benefits may be placed in state 1619(b) Medicaid status.
The federal and state 1619(b) Medicaid programs allow certain former recipients of cash payments from federal or state SSI to maintain Medicaid coverage. To obtain Medicaid eligibility under Section 1619(b) of the Social Security Act, the recipient must meet the following requirements:
Continue to have a disabling condition.
Need Medicaid in order to work.
Be unable to afford equivalent medical coverage and publicly funded personal and attendant care which would be lost without assistance.
Meet all nondisability requirements for SSI other than earnings.
Have been eligible to receive SSI cash payment in a previous month with the current period of eligibility.
Have combined maximum gross earnings less than the "charted threshold" established by SSA or an individualized threshold determined by the state SSI Program. In 2011, the charted threshold is $32,284.
During an eligibility review, if there has been a change in the earnings from employment in which the recipient would again meet the financial eligibility requirement, and still meet all other SSI requirements, the state SSI cash benefit could be restored for future benefit months.
The person dies, or
The person fails to complete and return the state SSI Annual Eligibility Review, or
Note: Persons placed in state-only 1619(b) Medicaid status must also complete an annual eligibility review, or
The Disability Determination Bureau (DDB) has determined, during continuing disability or medical review for Medicaid, SSI or Title II (SSDI or Social Security), that a finding of disability or blindness no longer exists.
If a state-only SSI recipient moves out of state, the recipient must report such movement to Member Services at 1-800-362-3002. DHS will then note the recipient’s out of state address change.
Unless otherwise notified, DHS will assume the change is correct and immediately place the recipient in a nonpayment status. If the recipient remains in a nonpayment status for more than 12 months, the recipient will lose his or her grandfathered status.
If the recipient returns to Wisconsin within 12 months, he or she will be paid the next month following the month of his or her return to Wisconsin.
Loss of grandfathered state-only status will result if any of the following occurs:
The recipient dies, or
The recipient remains in nonpayment status for state SSI for more than 12 consecutive months, or
The recipient has been placed in state-only 1619(b) Medicaid status.
All state-only SSI-E recipients must meet all eligibility criteria for state SSI before they may 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 effect SSI-E certification. If a person in a nonpayment or SSI suspense status goes back into current SSI pay status and is SSI-E certified, he or she will be paid on the SSI-E living arrangement payment standard.
Only a county agency-initiated termination or decertification action will change an SSI-E recipient's eligibility status to decertified or terminated.
A recipient will receive one additional monthly state-only SSI payment after any month in which he or she is found ineligible for state-only SSI. Exceptions are as follows:
Terminations due to excess unearned income will be effective on the first of the month following the month in which the income is reported to the SSI Program.
Terminations based on information gathered in the state SSI Annual Eligibility Survey will be effective January 1 of the following year.
Termination will be immediate when the SSI Program learns that a recipient has died, been incarcerated, or placed in a nursing home.
On a monthly basis, the state SSI Program will review the unearned income received by each state-only SSI recipient. Terminations based on excess unearned income will occur monthly.
The state SSI Program will use data from the SSA, state Data Exchange (SDX and BENDEX) to determine the amount of each recipient’s unearned income.
Once a year, the state SSI Program will conduct an eligibility review in the form of a written survey mailed to recipients.
The annual review will also verify state-only recipient living arrangement, income, resources, marital status, address change, and any other factors that may affect continued eligibility and payment level.
DHS will verify reports of income using information provided by the state Wage and Income Compensation Agency (SWICA) report.
Based on this review, the state SSI Program will adjust state SSI payment amounts and recipients may also be placed in state SSI work incentive programs such as 1619(b) Medicaid.
State-Only SSI recipients who lose eligibility for state-only SSI payment because of information gathered in the annual survey or failure to complete and return the survey will be informed in writing regarding loss of state SSI benefits and right to a hearing.
4.2 Forms and Pubs contains a sample Annual Eligibility Review Form.
State-only SSI recipients have a right to appeal any administrative action and decision that adversely affects their state SSI benefits. This right to a fair hearing includes the following:
State-only cash or 1619(b) Medicaid benefits are denied.
State-only SSI cash or 1619(b) benefits are suspended.
State-only SSI cash benefits are reduced.
State-only SSI benefits are incorrectly determined.
Note: State-only SSI recipients must appeal any adverse action the DHS takes regarding their state-only SSI benefits to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707-7875.
All appeals must be in writing and should include the person’s Social Security Number and the reason(s) for the appeal for hearing on the adverse action.
If a state-only SSI recipient asks for and is granted state SSI payment continuation by the Division of Hearings and Appeals, the state SSI Program will continue making a state SSI payment while the person’s appeal is pending.
A state-only SSI recipient whose appeal is settled in favor of the DHS must refund the state SSI Program all state SSI payments he or she received while the appeal was pending.
The Division of Hearings and Appeals may dismiss a request for a hearing where:
The action contested is a result of a change in federal or state law or policy affecting a significant number of recipients (a "mass change") unless the contested issue for requesting a hearing is that the new law or policy has been incorrectly applied in this case.
A request for a hearing was made past 45 days from the date indicated on the notice sent to the recipient.
The petitioner or his or her representative do not appear at the scheduled hearing without good cause being shown.
All requests for a hearing on an adverse action by the DHS must be sent to the Division of Hearings and Appeals within 45 days from the date shown on the notice sent to the recipient.
Exceptions:
All requests for state-only SSI payment continuation while an appeal is pending must be received by the Division of Hearings and Appeals within 10 days from the date shown on the notice sent to the recipient.
The state-only SSI recipient is incarcerated.
There is evidence of fraud.
The notice of benefit termination sent to any state-only recipient or his/her representative payee will include the following:
A statement describing the intended action.
The basis for the intended action.
The recipient’s rights and responsibilities in the hearing process.
Information about the possible availability of free legal representation.
A statement that informs the recipient that if he or she requests a hearing before the effective date of the action state-only SSI benefits may continue until the hearing decision is made.
A statement that informs the recipient that if he or she requests a hearing before the effective date of the action state-only SSI benefits may continue until the hearing decision is made.
A statement that the recipient may be required to repay state-only SSI payments that are ordered to be continued during the appeal if the recipient does not prevail or abandons or withdraws from the hearing.
A toll free number to call to receive more information.
Any SSI recipient who receives notice of an action by the DHS that adversely affects his or her 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.
Representative payees for SSI recipients are established at the request of a recipient or when a recipient cannot manage his or her own SSI payment benefits. Representative payees may be either individuals, county agencies, or nonprofit agencies.
State-only SSI recipients who receive SSDI or Social Security payments must refer all inquiries for establishing a representative payee to SSA.
State-only SSI recipients who do not receive SSDI or Social Security payments should contact the human or social services department in their county of residence to inquire about obtaining the services of a representative payee.
This page last updated in Release Number: 11-01
Release Date: 02-16-11
Effective Date: 02-16-11