IM-176 12/06/00 JAN 2001 COLA ADJUSTMENT; INCOME MAINT PROGRAMS
| SUBJECT: |
| JANUARY 2001 COST OF LIVING ADJUSTMENT (COLA); INCOME MAINTENANCE PROGRAMS |
| DISCUSSION: |
| Effective January 1, 2001, Social
Security (OASDI) benefits increase in the annual Cost of Living Adjustment
(COLA). The new amounts are as follows:
Percentage increase in benefits 3.5%
The Cost Of Living Adjustments will be made on the weekend of December 9, 2000. When entering IMU5 transactions prior to the mass adjustment, use the current amount of OASDI being received. After the mass adjustment, enter the new amount of OASDI benefits. For applications approved after the mass adjustment, verify the new OASDI amount through the local Social Security Office. If the new amount is unavailable and the old amount of Social Security benefits has been verified, multiply the old amount by 103.5% to arrive at the approximate new amount of benefits. A BENDEX printout will be sent to verify the new amount of benefits as soon as BENDEX data exchange is established on the individual. State Office will compute the new OASDI amount and SSI amount and the resulting grant or surplus amounts. State Office will do the complete adjustment:
Which Cases Are Mass-Adjusted
The computer program identifies claimants that receive OASDI, either from BENDEX or from the IM database. It then updates the OASDI amount field with the new figure (actual from BENDEX or calculated from IM). The COLA increase is added to the gross and net income figures (fields 34 and 41), and a new deficit or surplus amount is calculated for field 35. If the increase causes ineligibility based on a surplus of income, the case is closed and an adverse action notice is sent to the claimant. If no OASDI amount appears in field 13J, but there is OASDI income included in the gross income in field 41, the total new amount of OASDI will be added to the income in fields 41 and 34, because the system cannot tell that the figure in field 41 includes OASDI. For these cases, the worker must make the correct adjustment by entering the new amount of OASDI in fields 13J, 34, and 41. The worker must also send the IM-80 to reduce the grant. Vendor cases are adjusted by changing the
surplus amount the claimant must pay the nursing home. The system
generates a notice of adjustment to the nursing home in addition to the
claimant notice.
No turnaround IM-5's are produced for this adjustment. These cases will appear on a listing titled "Cases Adjusted" sent to each county office for control purposes. In some instances, case information is incomplete or incorrect, or otherwise cannot be mass adjusted or updated. Counties must review these cases manually, using the lists provided by State Office. Each case listed includes a caption to identify why the case could not be adjusted. Review these listed cases and manually adjust if necessary. For example, if the expense figure for a Temporary Assistance case is not the maximum grant amount for household size, the computer program cannot make the correct computations from an incorrect expense figure and the case cannot be adjusted. For all types of assistance, cases that will not be adjusted include:
There are three lists of cases not adjusted:
This list shows information for all types of assistance For the case: name, number, increase, expense, income, surplus or deficit, restitution amount, old grant, new grant, amount of change, type of change, old SMI, new SMI, old SSI and new SSI. For the individual: name, DCN, level of care, old SSA amount, new SSA amount and claim number, if applicable. Review all listed cases for manual adjustment. Captions and possible actions BENDEX < IM--BENDEX shows less than IM (13J), which indicates probable error in 13J. BENDEX > IM--The IM database has an amount in Field 13J (OASDI Amt) for a payee or an individual that is less than that which appears in BENDEX, or is zero. Occurs in NC cash cases when there is SSI in Field 20 and no OASDI in 13J. Also occurs when an inactive payee is the only BENDEX match and there is no income reported. Review appropriate fields for consistency. Review appropriate fields for consistency. Incor Exp--The expense figure is incorrect for the type of assistance or the number of household members. Review Field 33 for appropriate figures. Incor/1619--For MA cases, the expense figure is either incorrect for the type of assistance or the number of household members, or this is a 1619 case. Review Field 33 for correct SSI or HCB expense. IM No BENDEX--The IM database contains an amount in Field 13J (OASDI Amt) for the payee or individual, and NO amount appears in the BENDEX master file for the same payee or individual. Verify OASDI as needed and adjust case if OASDI continues. Review 13X--Field 13X (Main. Std) contains an "H" (the allotment is set by a hearing decision) or an "L" (the institutionalized spouse chooses to make an allotment less than the maximum allowable). No case at this time has been approved for an "H". Consider changing 13X. OASDI > CS Inc--The OASDI amount in Field 13J (OASDI Amt) is greater than the amount in Field 13V (Income of community spouse). Review 13V and 13J. 13V must include the amount in 13J. Max Allot > Exp--The current maximum allotment for the case is greater than the amount entered in Field 33 (EXP/EIL). Review 33, 13V, and 13Y for consistency. OASDI > Dep Inc--The OASDI amount in Field 13J (OASDI Amt) is greater than the amount shown for the dependent in Field 13V (Income of Dependent). Review 13V and 13J. 13V must include the amount in 13J. Review 13V and 13J. 13V must include the amount in 13J OASDI > STD--The new OASDI amount is greater than the new SAB standard of $554.00. Investigate possible closing. SSI CHG--On "F" type of assistance, an amount appears in Field 20 (SSI Amt) indicating that this case contains SSI. SSI amounts are not increased by Data Processing in the mass adjustment. Adjust SSI manually and adjust SAB grant. REST > GRNT--For cases with restitution, the restitution amount is greater than the new grant amount. GRNT < $10--A Temporary Assistance case with restitution becomes a $10 minimum pay case due to the COLA increase. The system cannot adjust because there is no longer a grant from which to deduct restitution. Manual adjustment is required. SURP DECR--The new surplus amount is less than the current surplus amount for a non-allotment case. Review 13J, 33, and 34 for consistency. SSI DECR--On NC cash cases with SSI, the OASDI increase caused an SSI decrease or closing. This may indicate an OASDI increase for a reason other than the COLA. MA/GR--MA/GR case that matched to BENDEX. Review for manual adjustment. Temporary Assistance Cash Ineligibility-Review for MC+/Medicaid This listing indicates Temporary Assistance cash payments ended in the mass adjustment because ineligible on the 185% test or because Field 35 was zero or a surplus. The MAF eligibility was allowed to continue as all the children and many of the parents should remain eligible for healthcare. Review for possible eligibility changes. Individuals with SSI in MC+ for Children Cases This listing contains individuals appearing in MC+ for Children and Custodial Parents cases who receive SSI benefits. Individuals with "Q", "Z", "1", "2", "3", or "R" level of care are listed. Use this listing to assure adjustments due to the increase in SSI are made. MC+/MAF Cases Needing Review The listing will be produced in cases where the mass adjustment would cause a Level of Care change or a MC+ or MAF case to be closed. Field staff must review these cases and take appropriate action. Cases Adjusted--Review for Further Action Also included on the listing of cases adjusted are the following types of Temporary Assistance situations, which require worker review to determine if further adjustment is needed. Individuals appearing on this listing with "Not Included" captions must be reviewed for necessary action. a. Temporary Assistance Case Adjusted--Individual with a "C" level of care not adjusted An individual with a "C" level of care was "Not Included" in the adjustment if we could not tell from information in the system whether the individual's income should be included in the budget. Review to see if individual should be included in adjustment and adjust if needed. b. Temporary Assistance Case Adjusted--Individual with a "T" level of care not adjusted Cash Temporary Assistance cases which contain an individual with a "T" or "Q" level of care are mass-adjusted if all "A" level of care individuals match to BENDEX. The "T" or "Q" level of care individual appears as "Not Included" in the adjustment. The caseworker must review these cases to determine if the "T" or "Q" individual is still eligible for Title XIX. Hearings on Computer Adjusted Cases The adverse action notices generated by the mass adjustment will be dated December 11, 2000. The claimant has until December 21, 2000, to request a hearing and have benefits restored to pre-adjustment levels. If the claimant requests a hearing on or before December 21, 2000, complete an IM-5/IMU5 transaction to cancel the computer adjustment (i.e., cancel-close a closed case, restore a grant, etc.) and follow usual hearing procedures. Immediately request a copy of the computer generated IM-80 from Program & Policy by calling (573) 751-2549. If the claimant does not request a hearing on or before December 21, 2000, no further case action is necessary. Listings of Cases Adjusted Cases that are mass-adjusted are included on one of several listings sent to each county. "Not Included" on the "Cases Adjusted" list requires action. All others are for information. Note that any caption flagged with an asterisk means that the case was adjusted according to a percentage calculation and may not exactly match SSA information. All lists include a footnote on each page as a reminder. 1. Cases Adjusted This list is sorted by county, load, and program. The claimants are listed alphabetically within program. The date of any IM-80 generated by the system for this adjustment appears in the upper right corner of the listing. NOTE: All cases appearing with a caption of "Not Included" for any individual MUST be reviewed for necessary action by the county. Captions Not Included--This caption indicates that the individual is not included in the case budget, and therefore has no affect on the adjustment computations. However, these individuals must be reviewed by the county for necessary action. Identifying information also appears on the listing for these individuals. CLOSE--The case was closed in the mass adjustment. NO CHG--The mass adjustment resulted in no change to the case. DECR--The grant was decreased in the mass adjustment. Surp Inc--The surplus was increased in the mass adjustment. Surp Inc/Allot--The surplus was increased for an allotment case in the mass adjustment. Surp Dec/Allot--The surplus was decreased for an allotment case in the mass adjustment. 2. Surplus Changes as a Result of OASDI Increases Each vendor nursing home or institution
receives a list of its residents with OASDI. This list shows the
case number, case name, old surplus amount and
Use the IM-62 to notify the vendor of any correction in the January surplus amount or to supply the January 2001 surplus amount for any claimant with OASDI who is not on the vendor's listing. Use normal procedures for changing surplus amounts when an error is discovered: for increases the effective date is the month following the expiration of the IM-80 or the signing of the IM-80A for decreases, the effective date is the month following the month of the report or discovery. See Chapter VI, pages 49-50. Do not
make the changes retroactive to January 1, 2001.
Cases Bypassed The county is not required to act on bypassed cases. They will not be adjusted or listed. Refugee cases (because none currently receive OASDI) Transitional Medical Assistance or Child Support Related closing cases ETMA-Extended Transitional Medical Assistance MC+ for Pregnant Women cases EWHS-Extended Womens Health Services Darling cases--These are MA cases identified by an "M" indicator in Field 27 of IMU5 Non-spenddown cases with SSI QMB-only cases ("Q" type of assistance) SLMB-only cases ("L" type of assistance).
Notices to Claimants Adverse action notices and notices of adjustment
will be computer generated. The following are samples of the notices
being sent to claimants.
Temporary Assistance Ineligibility Letter Dear: (Case Name) (Case ID) (Date) According to the information available to the Division of Family Services, your Social Security benefits will increase by $XXX.XX in January, 2001. Because of this increase, your household's income now exceeds the allowable limits to qualify for Temporary Assistance. Effective January, 2001 your cash payments will be discontinued. Healthcare coverage for your family will continue until further notice. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing within 10 days of the above date and request that benefits not be continued, your benefits will continue until a hearing decision. If you do not request a hearing after the above action, you have 90-days from January 1, 2001 to make the request. At the hearing, you may present the case
or by represented by someone else, including an attorney. You may
bring or question witnesses.
Temporary Assistance Cash Reductions Dear: (Case Name) (Case ID) (Date) According to the information available to the Division of Family Services, your Social Security benefits will increase by $XXX.XX in January 2001. Since all available income must be considered in determining need for Temporary Assistance (13 CSR 40-2.310) your Temporary Assistance grant will be reduced to $XXX.XX in January 2001 because of the above change. If you believe this decision is not correct,
you have the right to request a hearing by phone, in person, or in writing.
Should you request a hearing within 10 days of the above date, unless you
request that benefits not be continued, your benefits will continue until
a hearing decision. If you do not request a hearing, your grant will
be reduced. If you wish to request a hearing after the above action,
you have 90 days from January 1, 2001, to make the request.
Increase in Surplus Amount (Cases with N, I, D, or K Level of Care) No L Level of Care Individuals Dear: (case name) (case ID) (date) According to the information available to the Division of Family Services, your Social Security Benefit will be increased by $XXX.XX in January 2001. Since this income must be considered in deter-mining your benefits (13 CSR 40-2.200), the amount you must pay to the nursing home or institution will be increased to $XXX.XX effective January 1, 2001. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing within 10 days of the above date, your benefits will continue until a hearing decision. If you do not request a hearing, your surplus will be increased effective January 1, 2001. If you wish to request a hearing after the above action, you have 90 days from January 1, 2001, to make the request. At the hearing, you may present your case or be represented by someone else including an attorney. You may bring or question witnesses. Increase in Surplus Amount (Cases with D, I, K, or N Level of Care) With L Level of Care Individuals Dear: (case name) (case ID) (date) According to information available to the Division of Family Services, your Social Security Benefit will be increased by $XXX.XX in January 2001. In addition, your spouse's and dependent(s) Social Security Benefit(s) will be increased by $XXX.XX in January 2001. Due to these changes, the allotment you are making to your spouse and dependents will change to $XXX.XX beginning January 1, 2001. Since all available income must be considered in determining your benefits (13 CSR 40-2.200), the amount you must pay the nursing home or institution will be $XXX.XX effective January 1, 2001. If your income increases, you may give your spouse or eligible dependents up to $XXX.XX monthly. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing within 10 days of the above date, your benefits will continue until a hearing decision. If you do not request a hearing, your surplus will be increased effective January 1, 2001. If you wish to request a hearing after the above action, you have 90 days from January 1, 2001, to make the request. At the hearing, you may present your case
or be represented by someone else including an attorney. You may
bring or question witnesses.
No Change or a Decrease in Surplus But An Increase In Claimant's or L Level Individuals OASDI Dear (case name) (case ID) (date) According to the information available
to the Division of Family Services, your Social Security benefits will
increase by $XXX.XX in January 2001. Because you are making all or
part of your income available to your spouse and dependents who live at
home, the amount you
Our records indicate that you may make the entire Social Security increase available to your spouse and dependents who live at home and not have to pay any additional amount to the nursing home. If you do not wish to give the full amount of the Social Security increase to your spouse, contact your caseworker and an adjustment will be made. If your income increases, you may give
your spouse or eligible dependents up to $XXX.XX monthly.
MA Non-Spenddown Closing Dear (case name) (case ID) (date) According to the information available to the Division of Family Services, your Social Security benefits will be increased by $XXX.XX in January 2001. Since this income must be considered in determining eligibility for benefits (13 CSR 40-2.200), you are no longer eligible for Medicaid on a non-spenddown basis. Your Medical Assistance case will be closed effective December 31, 2000. You may be eligible for Medicaid on a spenddown basis. If you want your eligibility determined on this basis, you must apply at your county Division of Family Services office on or after January 2, 2001. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing within 10 days from the above date, your benefits will continue until the hearing decision. If you do not request a hearing, your case will be closed. If you wish to request a hearing after the above action, you have 90 days from January 1, 2001, to make the request. At the hearing, you may present your case
or be represented by someone else including an attorney. You may
bring or question witnesses.
SNC, GR, and SAB With Levels of Care V, W, X, Y, B, or P (May Include Decreases and Closings) Dear (Case name) (Case ID) (Date) According to the information available to the Division of Family Services, your Social Security or Supplemental Security Income benefits will increase by $XXX.XX in January 2001. As a result of these changes and in accordance with 13 CSR 40-2.120, your grant will be $XXX beginning in January 2001. If the amount shown is zero, you are no longer eligible for a cash grant or Medi-caid benefits. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing with 10 days of the above date, your benefits will continue until a hearing decision. If you do not request a hearing, your case will be closed or benefits reduced. If you wish to request a hearing after the above action, you have 90 days from January 1, 2001, to make the request. At the hearing, you may present your case or be represented by someone else including an attorney. You may bring or question witnesses. General Relief Cash (Reduction or Closing) Dear: (Case name) (Case ID) (Date) According to the information available to the Division of Family Services, your Social Security benefits will be increased by $XXX.XX in January 2001. Since all available income must be considered in determining need (13 CSR 40-2.120), your grant will be reduced to $XXX.XX effective January 2001. If the reduction is more than you are currently receiving, you are no longer eligible for a cash grant or Medicaid benefits. If you believe this decision is not correct, you have the right to request a hearing by phone, in person, or in writing. Should you request a hearing within 10 days of the above date, your benefits will continue until a hearing decision. If you do not request a hearing, the above action will be taken. If you wish to request a hearing after the above action, you have 90 days from January 1, 2001, to make the request. At the hearing, you may present your case or be represented by someone else, including an attorney. You may bring or question witnesses. Notice to NF, IMR, or MHC Administrator of Change in Surplus To the Administrator: Enclosed is a list of patients for whom you receive nursing facility (NF), mentally retarded (IMR), or mental hospital (MHC) payments from the Division of Family Services. According to our records, these patients currently receive Social Security benefits (OASDI) and will receive an increase in January 2001. This increase will also cause a change in the amount they must pay to your institution for their care. The attached listing shows the name and number of each patient and the old and new surplus amount. The surplus amount shown will be effective January 1, 2001, unless you receive a notice (IM-62) mailed from the county office after December 11, 2000, which indicates a different amount. If you have an NF, IMR, or MHC patient in your institution who was approved for vendor care before December 13, 1999, and is not on this listing, please contact his or her caseworker to get the January 2001 surplus amount. Food Stamps Instructions for handling Food Stamp cases are covered in a separate memorandum. |
| NECESSARY ACTION: |
Distribution #6 |