FROM: KIM EVANS, DIRECTOR
SUBJECT: JANUARY 2022 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI
MANUAL REVISION #
0410.010.15
0805.020.15
1030.010.05
MHABD APPENDIX E
MHABD APPENDIX J
MHABD APPENDIX K
DISCUSSION:
In January 2022, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 5.9% Cost of Living Adjustment (COLA). A mass adjustment of Child Care (CC), Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance (TA), and MO HealthNet for the Aged, Blind, and Disabled (MHABD) eligibility units (EUs) with SSA, SSI, VA, and/or RR income increases will be completed the weekend of December 11, 2021.
This memorandum discusses the following:
NEW AMOUNT OF SSI
Effective 2022, SSI benefit amounts are as follows:
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NEW AMOUNT
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INCREASE
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SSI Individual maximum (in own household)
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$ 841.00
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$ 47.00
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SSI Couple maximum (in own household)
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$ 1261.00
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$ 70.00
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SSI Individual in household of another
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$ 561.00
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$32.00
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SSI Couple in household of another
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$841.00
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$47.00
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SSI Essential person/own home
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$ 421.00
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$ 24.00
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The standard SMI Premium is $170.10 for 2022.
NEW MHABD STANDARDS
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Maximum Allotment to Community Spouse
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$3435.00
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Minimum Maintenance Standard for Allotments
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$2178.00
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Maximum Allocation to a child
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$420.00
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Maximum Allotment to a child
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$726.00
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Minimum Spousal Share
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$27,480.00
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Maximum Spousal Share
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$137,400.00
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Maximum Home Equity
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$636,000.00
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HCB Maximum
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$1470.00
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SAB Standard
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$908.00
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ADJUSTMENTS BY PROGRAM
SNAP
SNAP cases will be adjusted for all eligibility units with SSA, SSI, VA, RR income update, or SMI change.
TA
TA cases will be adjusted for all eligibility units with SSA, SSI, VA, or RR income update.
Changes in TA grants resulting from the mass adjustment are included in the CC and SNAP adjustments. If the TA case is closed, the grant is removed from CC and SNAP budgets.
CC
CC cases will be adjusted for all eligibility units with SSA, VA, and RR income. SSI continues to be excluded when determining eligibility for Child Care.
MHABD
The Families First Coronavirus Response Action of 2020 (FFCRA) requires that MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse actions to reduce or end MHN coverage due to the COLA changes until the PHE ends.
Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for MHN programs with income eligibility based on federal poverty level (FPL) until the next FPL adjustment in April. All SSA, SSI, VA, and RR income sources will be updated with the new income amount and verification code “CO” for COLA adjustment.
For the following MHN programs, FAMIS will disregard the new SSA and SSI amounts and use the prior SSA and SSI amounts until FPL adjustments. FAMIS will adjust the VA and RR income and use the new amounts on the January 2022 budgets:
- MHABD Spend Down (MHSD) and Non Spend Down (MHNS)
- Qualified Medicare Beneficiary (QMB)
- Specified Low Income Beneficiary (SLMB)
- Blind Pension (BP)
- Program for All-Inclusive Care for Elderly (PACE)
- Ticket to Work Health Assurance (TWHA)
- Gateway to Better Health (GTBH)
For the following MHN programs, FAMIS will adjust the SSA, SSI, VA, and RR income and use the new adjusted SSA, SSI, VA, and RR amounts:
- Supplemental Aid to the Blind (SAB)
- Supplemental Nursing Care (SNC)
- Vendor
- Home and Community Based (HCB)
- Missouri Children with Developmental Disabilities (MOCDD)
NOTE: Actions to reduce benefits will not be taken until the COVID-19 PHE has ended. Actions to increase benefits will be taken.
SMI PREMIUM ADJUSTMENT
The standard SMI will increase for 2022 to $170.10. The SMI premium for those who begin receiving Medicare in 2022 will be $170.10. Premiums for those who were receiving Medicare prior to 2022 may be adjusted, if it was less than $148.50 for 2021, but will not increase more than the amount of the increase in Social Security benefit the individual received.
EXAMPLE: Ms. Brown receives Social Security of $1000 and pays $105 SMI in 2021. Effective January 1, her Social Security will increase to $1013. Her SMI will increase, but by no more than the amount of her benefit increase, $13 in this example. It may be necessary to request verification from the participant of their SMI premium.
To adjust the SMI amount, FAMIS compares the new SMI amount ($170.10) with the amount listed on the Medical Expense (MEDEXP/FMXA) screen.
If the new expense is:
- less than current expense – case will be added to an error report and MEDEXP will not be updated
- equal to current expense – no update will be made to MEDEXP
- greater than current expense – MEDEXP will be updated with the new SMI amount and FAMIS will check for active QMB, SLMB1, or SLMB2.
- If active QMB, SLMB1, or SLMB2 case will be added to an error report
- If the current expense is not equal to the old SMI standard expense ($148.50) the case will also be added to the error report
FAMIS will NOT add or end the SMI expense when BENDEX disagrees with what is currently listed on MEDEXP. These cases will be added to an error report for staff to review.
MASS ADJUSTMENT PROCESS
The mass adjustment begins in FAMIS on December 11, 2021.
Most cases with SSA/SSI/VA/RR income that were active by the end of the day on December 10, 2021, with a certification ending January 2022 or later will be adjusted to show the increased benefit amounts. FAMIS identifies any EU that has been previously adjusted by staff, if there is a January 2022 budget with an increased SSA/SSI/VA/RR income, FAMIS will not adjust the case.
BENDEX:
FAMIS receives a BENDEX file from the Social Security Administration (SSA) containing SSA income information. Information from the file is transmitted to FAMIS during the mass adjustment, updating all cases with SSA income that have a matching Benefit Claim Number entered on the Income (FMX0) screen to the amount shown on the BENDEX file. Cases adjusted with income from the BENDEX file include the comment, “SSA Income Adjusted by the – BENDEX File” on the Monthly Income Comment (FMF7) screen.
Cases that do not contain the Benefit Claim Number and cases that the Benefit Claim Number does not match the BENDEX file will be increased 5.9%. The comment, “Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.
SDX:
FAMIS receives an SDX file from SSA, containing SSI income information. Information from the file is transmitted to FAMIS during the mass adjustment, updating all cases with SSI income that have a matching social security number (SSN). Cases adjusted with income from the SDX file include the comment, “SSI Income adjusted by the system – SDX File,” on the Monthly Income Comment (FMF7) screen.
When the SDX file shows SSI income has started or stopped, FAMIS adds or ends SSI income based on information transmitted in the file. When FAMIS adds an SSI income source, the comment, “New SSI Income Source Created by the system – SDX File,” is added to the Monthly Income Comment (FMF7) screen. When FAMIS end dates SSI income based on information from the SDX file, the comment, “SSI Income End Dated by the system – system calculation,” is added to the Monthly Income Comment (FMF7) screen.
Cases that do not contain the SSN or the SSN does not match the SDX file will be increased by 5.9%. A comment will be added to the Monthly Income Comment (FMF7) screen, “SSI Income Adjusted by the system – system calculation.”
VA and RR Income:
VA and RR income will be increased by the 5.9% COLA. The comment, “Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.
Pending Applications:
FAMIS will not complete the eligibility determination for applications in the controlled flow. For pending CC or SNAP recertification’s, if the last month of certification is January 2022 or February 2022, the SSA/SSI/VA/RR amount is adjusted by the system. Review the SSA/SSI/VA/RR amount prior to authorizing benefits. If the SSA/SSI/VA/RR amount is not correct, follow instructions in the Manual Adjustments by Field Staff section of the memorandum.
SMI Premiums:
FAMIS will adjust the medical expense type SM-SMI PREMIUM as described in the SMI Premium section of this memorandum. On the SNAP budget, if there was a medical expense entered which did not have an allowable verification code, the FA-150 Action Notice notifies the EU that the expense will not be considered in the budget. This includes medical expenses other than mileage or transportation costs verified by client statement (CS). Medical expenses should be reviewed and discussed with the EU at the next contact.
Review of Actions Taken During Mass Adjustment:
If an active FAMIS case is adjusted or closed, the EU Action Log (FM40) screen displays the action taken by the system and the benefit amount for the benefit month 012022. To review the action, select the action and press F17=INQAUTH. The Action Authorization (FM3H) screen is displayed. Press F16=BUDSUM to access the Budget Summary screen for each program type. From the Budget Summary screen, press F14=INCSUMM to access the Income Summary Detail (FM33) screen. The income types, sources, and gross amounts are displayed for budget month 012022. Press F21=Return to return to the Budget Summary screen, and press F15=EXPSUM to view the Expense Summary (FM34) screen. The expense classes, types, and amounts are displayed for budget month 012022.
Eligibility determinations which were incomplete prior to the mass adjustment will be completed during the mass adjustment. This may result in the creation of RTA (ready to authorize) status. An alert “OUTSTANDING ELIGIBILITY DETERMINATION” is generated and must be resolved.
NOTE: Review income from SSA/SSI/VA/RR, and SMI Premiums at next contact to confirm the correct amounts.
REPORTS WITH ACTIONS NEEDED
The following reports with action needed will be distributed to the SNAP, TA/CC, and MHN Program Managers for assignment. Following are instructions on how to process each type of report.
CONFLICT OF ACTIONS
FAMIS will complete the COLA adjustments for cases with a pending adverse action at the time of the mass adjustment. This results in a conflict of actions because one adverse action must be completed or voided before the other can be taken. The alert “ADVERSE ACTION NEEDS RESOLVING” is generated and must be resolved.
To resolve the conflict:
- Access the Action Resolution (ACTRES or FM50) screen and void the pending adverse action. Refer to user guide Changing an Adverse Action Status for instructions.
- Void the adverse action, access the Eligibility Determination Resolution (EDRES or FM3Y) screen, and run a new eligibility determination.
- Authorize the new adverse action.
MANAGED REPORTING/COST OF LIVING ADJUSTMENTS NEEDING REVIEW
There is no longer an “error” report for the COLA adjustment in the Managed Reporting system. Some cases being adjusted require review to ensure accurate eligibility determinations were made. FAMIS will generate reports in the Managed Reporting system of active EUs that need review. It is important to review and take the necessary actions for each case on the report to ensure accurate eligibility determinations.
To review the reports:
- From the FSD Intranet page, click on the Administration & Systems header, and click on Managed Reporting.
- Log into the Managed Reporting area.
- Click on the appropriate domain (FAMIS Caseworker Supervisor Reports)
NOTE: The report is also located in FAMIS Eligibility Specialist Reports, FAMIS Manager Level 2 Reports, and FAMIS County Office Reports.
- Click on Cost of Living Adjustments Needing Review.
- Select SSA/SSI/VA/RR Needing Review to request the online reports.
Staff must access the report assigned to him/her by the Program Manager. A reason for review is included for each EU member on the report. More than one reason may appear for each EU on the report. Review all EU information to ensure correct data is in the eligibility system.
NOTE: If staff discover that the case did not adjust as expected or did not adjust correctly, immediately report the case information to FSD Program and Policy through normal supervisory channels.
REASONS FOR REVIEW
The following reasons for review will be displayed in the SSA/SSI/VA/RR Needing Review online report in Managed Reporting. It is important to review every eligibility unit displayed and take the following actions to ensure accuracy of the FAMIS record and correct eligibility determinations for these individuals.
- CHECK JANUARY INCOME – The mass adjustment was unable to update the income for January, or the SSA/SSI/RR/VA income was entered for January 2022, and used in an eligibility determination prior to the COLA mass adjustment.
NOTE: Cases with this reason type require immediate review as these cases did not adjust during the COLA mass adjustment. Verify the 2022 SSA/SSI/VA/RR income amount, update if necessary using “CO” verification code, and complete an eligibility determination.
- VENDOR LEVEL OF CARE EU MEMBERS – There is an active Nursing Home Level of Care for an individual receiving SNAP benefits.
Review the living arrangement of the individual. If the individual is not in an allowable living arrangement, update the living arrangement on the Address Screen (FM0A), and complete an eligibility determination.
If the individual is in an allowable living arrangement, review the Income (FMX0) screen to ensure the Supplemental Nursing Care (N1) grant is budgeted for SNAP benefits. If the Supplement Nursing Care grant is not budgeted, add the grant to the Income (FMX0) screen and complete an eligibility determination.
- Last Year SMI>Last Year Max – The amount of the medical expense type SM–SMI PREMIUM in FAMIS is larger than $170.10.
Some individuals are required to pay a larger Medicare premium due to late enrollment. The mass adjustment cannot automatically adjust these premiums. Review the IIVE interface to verify the SMI premium and adjust, if necessary. Complete an eligibility determination.
- Bendex SMI Not Found – There is an SMI premium amount in FAMIS, but the BENDEX file does not show an SMI premium.
Review the IIVE interface to verify SMI premium information. Remove or update the SMI expense, if needed, and complete an eligibility determination.
- CLAIM NUMBER IS BLANK – There is no claim number for the SSA/SSI/VA/RR and the income has been adjusted by percentage.
Review the IIVE interface to verify the claim number and enter it in the Benefit Claim Number field on the INCOME (FMX0) screen in FAMIS. Although this is not a mandatory field, capturing accurate claim numbers in FAMIS for every person receiving SSA/SSI/VA/RR benefits improves accuracy during mass adjustments, such as COLA.
- BENDEX SSA INCOME NOT FOUND – SSA income is verified on the BENDEX file, however, there is no SS income type in FAMIS. Verify receipt of SSA income and budget in FAMIS as appropriate.
Review the IIVE interface to verify income from Social Security and make the appropriate entries in FAMIS. Complete an eligibility determination.
- Multiple SSI for Individual – An individual has more than one source of SSI. This usually occurs when an individual has SSI and SSA and the SSA was incorrectly entered into FAMIS as SSI.
Review the IIVE interface to verify the income sources and make appropriate entries in FAMIS. Enter the SSA claim number on the Income (FMX0) screen. Complete an eligibility determination.
- CURRENT INCOME AMOUNT IS ZERO – SSI/SSA/RR/VA income code is on the Income (FMX0) screen with zero amounts on the Income Amount (FMX3) screen.
Verify the income amount, using electronic sources if possible. If the participant is no longer receiving this income, make the appropriate entries to end the income source in the eligibility system. If the individual is receiving the income, make the appropriate entries in the eligibility system and complete an eligibility determination.
- NOT ADJUSTED – There is SSA/SSI/VA/RR income in FAMIS which was not adjusted on an active case.
For some cases, the SSA/SSI/VA/RR income could not be adjusted during the mass adjustment. Verify the correct amount of income and review the eligibility unit to determine if action is needed. Make appropriate entries in the eligibility system and complete an eligibility determination.
MANUAL ADJUSTMENTS BY STAFF
To manually adjust the SSA/SSI/VA/RR income in FAMIS, first attempt to verify the new amount from BENDEX/SDX printouts or the IIVE interface. If not available, compute the new SSA/SSI/VA/RR amount by multiplying the original amount by 5.9% (2021 amount x 1.059) and rounding down to the nearest dollar.
Staff must enter the new SSA/SSI/VA/RR amounts for new applications processed after December 10, 2021.
Staff must use the verification code “CO” – COLA when updating SSA/SSI/RR/VA income in FAMIS for all programs if the income increased due to the COLA increase, but was not adjusted during the mass adjustment.
FAMIS will use the CO verification code to determine whether to use the December 2021 or January 2022 SSI/SSA/VA/RR for the period between the COLA adjustment and the FPL adjustment in April. Reference the “Adjustments by Program” section of the memorandum for additional information.
NOTE: For budget months prior to January 2022, do not use the “CO” – COLA verification code.
CONTROLLED FLOW
If a CC, SNAP, TA, or MHABD application is in the controlled flow, review the SSA/SSI/VA/RR benefit prior to authorizing benefits. Determine the correct SSA/SSI/VA/RR benefit amount and manually adjust the benefit amount effective January 2022 and later months when completing the application/controlled flow.
BLANK VERIFICATION CODE – PENDING STATUS
During the mass adjustment, FAMIS will set the status to PEN (Pending) for cases with an unacceptable or blank verification code. The system generates the alert –“Action Not Authorized”. If no action is taken, FAMIS will send an FA-510 or FA-420 Adverse Action Notice to reduce or close as appropriate, as the pending verification has not been resolved.
Review the case to determine if the pending information is in the participant’s file in the ECM or is available from an electronic data source. If verification is available, make the appropriate system entries, including the accurate verification code, and authorize the eligibility determination. If the verification has not been previously requested, request the verification using an FA-325 Request for Information form.
NOTICES
- The Adverse Action Notices will be dated December 13, 2021.
- Authorized Representative Cover Letters (AR-100) accompanying the Adverse Action Notices, will be dated December 13, 2021.
- The Action Notice generated by the mass adjustment will be dated December 29, 2021, to allow adequate mail time due to the large volume of cases affected.
- Notices will not be generated for no change (NOCH) actions in FAMIS.
SNAP
An FA-150 Action Notice is generated for mass adjustments that result in a reduction (REDU), or closing (CLOS).
Child Care
An FA-510 Adverse Action Notice is generated for any Child Care EU whose benefits are reducing. The FA-150 Action Notice will be generated after the FA-510 Adverse Action Notice expires, if the EU has not requested a hearing, including a request to continue receiving at the current rate pending the hearing decision.
Temporary Assistance
An FA-150 Action Notice is generated for a Temporary Assistance EU due to the mass adjustment, unless there is a pending adverse action at the time of the mass adjustment. If there is a pending adverse action at the time of the mass adjustment, refer to the Conflict of Actions section in this memorandum to resolve.
MO HealthNet
An FA-420 Adverse Action Notice is generated for any MHABD programs whose benefits are reducing or closing due to the mass adjustment. An FA-460 Action Notice is generated for mass adjustment actions after the Adverse Action Notice expires, if the EU has not requested a hearing, including a request to continue receiving at the current rate pending the hearing decision.
INTERIM CHANGES AFTER MASS ADJUSTMENT
There are times when SSA and SSI have changes in the amounts that are not related to a COLA adjustment (i.e.: one spouse dies and the other has SSA and/or SSI adjustment). When a budget adjustment is necessary, staff can enter the verification code (HC or TC) as appropriate. FAMIS will adjust the budgeted SSA and SSI income appropriately.
When completing budget adjustments after mass adjustment, if the verification code is “CO” and there has been no other change to SSA and SSI amounts, leave the verification code “CO” in verification field. Changing the verification code to any other code will incorrectly budget the SSA and SSI COLA amount prior to FPL adjustment in April.
REQUEST FOR HEARING/CONTINUED BENEFITS
If the EU requests a fair hearing, see Email Memo-22 Income Maintenance Hearing Unit Statewide Rollout of E-Referral Hand Off Button for Hearing Requests, dated April 29, 2021 for procedures for submitting the hearing request.
Any EU receiving an Adverse Action or Action Notice may request a hearing on the mass adjustment action within 90 days from the date of the notice.
SNAP
SNAP EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment.
Temporary Assistance
Temporary Assistance EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment.
If the EU receives an FA-510 Adverse Action Notice based on a previous determination in which a Conflict of Action was resolved due to the COLA mass adjustment and they request the hearing prior to the expiration of that FA-510 Adverse Action Notice, they may continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.
To continue Temporary Assistance benefits at a higher amount for EUs who received an FA-510 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.
If the EU requests a hearing after the FA-510 expires, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.
Child Care
If the EU receiving an FA-510 Adverse Action Notice requests a hearing on the Child Care adjustment prior to the adverse action expiring, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.
To continue the Child Care benefits at a higher amount for EUs who received an FA-510 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.
If the EU requests a hearing after the adverse action has expired, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.
MO HealthNet
The Families First Coronavirus Response Action of 2020 (FFCRA) requires that MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse action to reduce or end MHN coverage due to the COLA changes until the PHE is ended.
When the PHE is ended, actions will be taken to update coverage for individuals whose coverage was maintained due to FFCRA requirements. The following paragraphs may or may not be accurate dependent on when the PHE is officially ended.
If the EU receiving an FA-420 Adverse Action Notice requests a hearing on the MHN adjustment prior to the adverse action expiring, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.
To continue the MHN benefits at a higher amount for EUs who received an FA-420 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.
If the EU requests a hearing after the adverse action has expired, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- State Office will provide the SSA/SSI/VA/RR Needing Review report to be reviewed by designated staff.
- Apply MHN policy for “CO” income verification to disregard SSA and SSI COLA adjustments until FPL adjustment in April.
KE/rnr
