P Redetermining Eligibility when SSI Cash Ends

Program	Manual Section
ALTCS	MA1502AA

Procedures

When SSI-Cash ends, the customer’s eligibility must be redetermined. The process used depends on whether the customer was:

Eligible for MA automatically based on SSI-Cash eligibility, or
Is also receiving ALTCS when the SSI-Cash ended.

1) Automatic MA is ending due to loss of SSI-Cash

Take the following steps when a customer a customer’s SSI Cash stops and the Exparte case shows on your worker task list.

Step	Action
1	Review the SOLQI to determine why the customer’s SSI Cash has stopped. NOTE If the customer lost their SSI Cash due to loss of contact, have the customer contact SSA to update their address, at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 7 am to 7 pm or online at ssa.gov.
2	Check PMMIS or WAVES regularly to determine if the customer’s SSI Cash has been restarted. NOTE HEAplus will automatically send an automated renewal at the beginning of the month following the month the SSI Cash stopped.
3	Did the SSI Cash start again? If YES, continue to step 4. If NO, skip to step 5.
4	Is the customer paying a premium for Medicare part A? If YES, STOP. Approve QMB and process the denial for medical assistance using the reason “Other AHCCCS eligibility”. If NO, STOP. Deny the exparte application for “Other AHCCCS eligibility”.
5	Check the HUBS at least twice monthly to determine if the renewal can be processed with the proof provided by the HUBS.
6	Do you have all the proof needed to complete the renewal for the customer? See MAP1401 A for instructions. If YES, continue to step 7 If NO, continue to step 8
7	Is the customer eligible for another Medical assistance program? If YES, STOP. Process the application. IF NO, continue to step 8.
8	If the customer is not eligible or did not provide proof for Medical Assistance process the application allowing for adverse action and 60 days of exparte eligibility.

2) Reviewing ALTCS eligibility when SSI-Cash ends

Take the following action when you receive a Report a Change in your task list that SSI Cash eligibility ended:

Step	Action
1	When there is no SOLQI from the last 30 days, request a new SOLQI.
2	Review the SOLQI to determine why the customer’s SSI Cash has stopped. NOTE If the customer lost their SSI Cash due to loss of contact, have the customer contact SSA to update their address, at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 7 am to 7 pm or online at ssa.gov.
3	Call the customer or representative and review each battery in HEAplus to either confirm the information entered or make any updates needed. When the customer cannot be reached by phone, continue to step 4 to send an RFI to the customer.
4	Verify as much information as you can using electronic sources, prior applications, and the customer’s case file. Is there a pending verification factor for a financial account or questionable information about financial accounts? If YES, manually submit the case to the Asset Verification System. Continue to step 5. If NO, do not create an Ad-hoc request in AVS. Continue to step 5.
5	Do any of the eligibility factors require proof from the customer? If YES, send an RFI. When the information is received, continue to step 6. If NO, continue to step 6. NOTE If the customer’s SSI Cash is reinstated before the RFI due date and there are no trust or transfer verifications pending, process the change. Proof is not needed.
6	Is this change within 60 days of the renewal date? If YES, disposition the RAC. Then create and process a renewal. If NO, do not create a renewal. It will be completed at the regular scheduled time.
7	Process the case and enter case notes.