IM-156 12/03/03 JANUARY
2004 COST OF LIVING ADJUSTMENT (COLA);
INCOME MAINTENANCE PROGRAMS
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JANUARY 2004 COST OF LIVING ADJUSTMENT (COLA); INCOME MAINTENANCE PROGRAMS | ||||||||||||||
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Effective January 1, 2004, Social Security
(OASDI) benefits increase in the annual Cost of Living Adjustment (COLA).
The new amounts are as follows:
NOTE: The SSI amounts are for information only. Use 90% of the FPL for Medicaid eligibility determinations. The Cost of Living Adjustments will be made on the weekend of December 6, 2003. 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 102.17 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 appears to cause ineligibility based on a surplus of income, some cases are closed with an adverse action notice sent to the claimant and other cases are listed for review by the caseworker. 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. MA spenddown cases are adjusted by changing surplus amount in Field 36. The increased spenddown amount will be for February 2004 as January invoices have been sent. 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. If a case does not appear on BENDEX but shows OASDI on the IM database, the case may be adjusted. Cases will be adjusted by applying the 2.1% increase to the OASDI amount shown in 13J. For these cases, if the amount in 13J is wrong, the adjustment will be wrong. The worker is responsible for correcting 13J and any other affected figures. Because SMI premium information will not be available from BENDEX on percentage-adjusted cases, the program will attempt to identify premium payers and will assume the premium was $58.70 as of December 2003. Because not every premium is $58.70, a small portion of percentage-adjusted cases may be wrong due to this assumption. Therefore, each percentage-adjusted case is marked on the listing with an asterisk (*) to help caseworkers identify them in case of incorrect adjustments. 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 two 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.Review all listed cases for manual adjustment. Captions and possible actions
This listing contains individuals appearing in MC+ for Children cases that receive SSI benefits. Individuals with "Q", "Z", "1", "2", or "3" 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 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.
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.
An individual losing Level of Care "A" eligibility was adjusted and changed to a "T" level of care. Review to see if individual is eligible for another type of assistance and take necessary action.
An individual losing cash eligibility was adjusted and changed to a "T" level of care. Review to see if individual is eligible for another type of assistance and take necessary action.Hearings on Computer Adjusted Cases The adverse action notices generated by the mass adjustment will be dated December 8, 2003. The claimant has until December 17, 2003, to request a hearing and have benefits restored to pre-adjustment levels. If the claimant requests a hearing on or before December 17, 2003, complete an 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) 751-3507. If the claimant does not request a hearing on or before December 17, 2003, no further case action is necessary. Listing 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.
Captions
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 new surplus amount. The list includes a letter to the administrator of the nursing home.
Use normal procedures for changing surplus
amounts when an error is discovered:
See Chapter VI, pages 49-50. Do not make the changes retroactive to January 1, 2004.Cases Bypassed The county is not required to act on bypassed cases. They will not be adjusted or listed.
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 LetterFood Stamps Instructions for handling Food Stamp cases are covered in a separate memorandum. |
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NECESSARY ACTION: | ||||||||||||||
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IM-155 |
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