SUBJECT:
FAMIS SSI/SSA/VA/RR COST OF LIVING ADJUSTMENT
DISCUSSION:
In January 2006, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 4.1% cost of living adjustment (COLA). A mass adjustment of FAMIS Child Care, food stamp, and Temporary Assistance EUs with SSA, SSI, VA, and/or RR income increases will occur the weekend of December 3, 2005. Child Care EU's with an active food stamp EU will have an increase to their SSI income. This income source continues to be excluded when determining the family's Child Care eligibility.
Please review the following topics carefully as some procedures are changed from previous years.
New Amount of SSI
SMI Premium
Adjusting SSA, SSI, and VA Benefits
Mass Adjustment Process
Simplified Reporting EUs
Conflict of Actions
Notices
Request for Hearing/Continued Benefits
Managed Reporting/EUs Needing Review
Manual Adjustments by County Staff
NEW AMOUNT |
INCREASE |
|
|---|---|---|
| Individual in own household | 603 |
24 |
| Couple in own household | 904 |
35 |
| Individual in household of another | 402 |
16 |
| Couple in household of another | 603.34 |
24 |
| Essential person/own home | 302 |
12 |
The SMI premium increased from $78.20 to $88.50 per month for January 2006. Medical expense with type SM in FAMIS of $78.20 or less will be adjusted to $88.50, unless the premium could not be matched to the BENDEX file. SMI premiums which are coded incorrectly in FAMIS, or could not be matched to the BENDEX file will not be adjusted by the system and must be reviewed and updated as soon as possible.
EUs with medical expense type SM in FAMIS who are no longer paying the premium are not eligible for this medical expense. A report will be generated to the counties following the mass adjustment of cases that require update.
Adjusting SSA, SSI, VA, and RR Benefits
FAMIS EUs containing individuals with SSA, SSI, VA, and/or RR income will be included in the mass adjustment. Changes in Temporary Assistance grants resulting from the mass adjustment will be included in the Child Care and food stamp adjustments. If the Temporary Assistance case is closed, the grant will be removed from the Child Care and food stamp budgets.
Most EUs with SSA, SSI, VA, or RR income that are active by the end of the day on December 2, 2005, with a certification ending January 2006 or later will be adjusted to show the increased benefit amounts. FAMIS will identify any EU that has been adjusted by the worker if there is a January 2006 budget with an increased SSA, SSI, VA, or RR income and will not adjust the case.
FAMIS will be unavailable during the mass adjustment. If the adjustments are not completed by the morning of December 5, 2005, FAMIS will be unavailable until the adjustments are completed. Staff will be notified if the system is not available Monday morning.
For any new Child Care, food stamp, and Temporary Assistance application processed after December 3, 2005, the worker must compute the net adjusted income using the new SSA, SSI, VA, and/or RR amounts. For pending Child Care or food stamp recertifications, if the child care certification period or last food stamp month of certification is January 2006 or February 2006, the SSA/SSI amount is adjusted by the system. For all cases in the controlled flow, review each SSA, SSI, VA, and RR amount prior to completing the application. If the SSA, SSI, VA, and RR amount is not correct, follow instructions in the Manual Adjustments by Staff section of this memorandum. If any application remains in the controlled flow, all FAMIS programs for that EU are not adjusted. The adjustment will be made for all programs when the controlled flow is complete.
Due to rounding, this calculation may end up $1 different than the actual amount of SSA, SSI, VA, or RR. Review all income at recertification or interim change and adjust if necessary.
If the EU receives total maximum SSA and SSI, the SSA amount is adjusted by the amount on the BENDEX file or 4.1%. Then, the SSI amount is adjusted by the difference between the SSA increased benefit and the new SSI maximum plus $20.
FAMIS will match the SMI premium to the BENDEX file. A medical expense type SM for $78.20 or less, FAMIS will update the SMI premium to $88.50, unless it could not be matched to the BENDEX file. Medical expense other than SM will NOT be updated in FAMIS. Staff must ensure that the medical insurance premium costs are manually adjusted when the family's Medicare premium is coded with an expense type other than SM in FAMIS, or the premium could not be matched to the BENDEX file. These will appear in managed reporting.
On the food stamp budget, if there is a medical expense entered which does not have an allowable verification code, the FA-150 notifies the EU the expense is not being considered in the budget. This includes medical expenses other than mileage or transportation costs verified by client's statement (CS). Medical expenses should be reviewed and discussed with the EU at the next contact to attempt to verify expenses.
It is important to review IIVE interface or BENDEX at the next contact to verify the correct amounts.
If an active FAMIS EU is adjusted or closed, the EU Action Log (FM40) displays the action taken by the system and the benefit amount for benefit month 012006. To view information that resulted in 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 screen (FM33). The income types, sources, and gross amounts are displayed for budget month 012006. Press F21=RETURN to return to the Budget Summary screen, and press F15=EXPSUM to view the Expense Summary screen (FM34). The expense classes, types, and amounts are displayed for budget month 012006.
Eligibility determinations which have not been run prior to the mass adjustment will be completed during the mass adjustment. This may result in creation of an RTA (ready to authorize) status. An alert “OUTSTANDING ELIGIBILITY DETERMINATION” will be generated and must be resolved.
Food Stamp Simplified Reporting EUs
The SSA/SSI/VA/RR COLA is considered a change that must be acted on and all cases are required to be adjusted to accurately reflect all information known at the time of the adjustment. Therefore, simplified reporting EUs with previously disregarded actions (action status DIS) are adjusted using ALL information in the system. If the food stamp benefits for a simplified reporting EU decrease as a result of the cumulative changes, an FA-510 ADVERSE ACTION NOTICE will be generated and the adjustment will be made to decrease the benefits or close the case. If there was a previously disregarded Adverse Action to Remove a Person (AARP), the adverse action will be re-generated as a result of the mass adjustment. Do not disregard the mass adjustment action.
FAMIS adjusts the income and expenses on EUs 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 worker receives the alert “OUTSTANDING ELIGIBILITY DETERMINATION”. The conflict must be resolved by the worker.
To resolve the conflict:
- access the Action Resolution screen (FM50 or ACTRES) and void the pending adverse action. Refer to the user guide “Changing an Adverse Action Status” for instructions.
- After voiding the adverse action, access the Eligibility Determination Resolution screen (FM3Y or EDRES) and run a new eligibility determination.
- Authorize the new adverse action.
Two types of notices are generated as a result of the mass adjustment. The FA-510 ADVERSE ACTION NOTICE is dated December 5, 2005. The FA-150 CLAIMANT ACTION NOTICE generated by the mass adjustment is dated December 2005, to allow adequate mail time due to the large volume of cases affected.
- Food Stamps
An FA-510 ADVERSE ACTION NOTICE is generated for any food stamp simplified reporting EU whose benefits are reducing due to the mass adjustment and previously disregarded changes. An FA-150 CLAIMANT ACTION NOTICE is generated for all other EUs adjusted in the mass adjustment. EUs whose SSA, SSI, VA, or RR benefits are adjusted, but the food stamp benefits do not change receive a notice of no change in food stamp benefits.
- Child Care
Two types of notices are generated as a result of the mass adjustment for Child Care. An FA-510 ADVERSE ACTION NOTICE is generated for any Child Care EU whose benefits are reducing. An FA-150 CLAIMANT ACTION NOTICE is generated for all EUs whose case was adjusted but the Child Care benefits do not change.
- Temporary Assistance
Only the FA-150 CLAIMANT 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.
Request for Hearing/Continued Benefits
The FA-510 ADVERSE ACTION NOTICE is dated December 5, 2005. Any EU receiving an FA-510 ADVERSE ACTION NOTICE may request a hearing on the mass adjustment action within 90 days from the date of the notice.
The FA-150 CLAIMANT ACTION NOTICE generated by the mass adjustment is dated December 2005. Mass adjustment actions REDU (reduction), NOCH (no change), and CLOS (closing) receive the FA-150 notifying the EU the action has been taken. Any EU receiving an FA-150 CLAIMANT ACTION NOTICE may request a hearing on the mass adjustment action within 90 days from December 31, 2005.
- Food Stamp Continued Benefits
The food stamp EU may have benefits continued at the level before the mass adjustment depending on the circumstances. The decision of whether or not to continue benefits at the level before the mass adjustment is determined by the changes acted upon during the mass adjustment.
- Cost of Living adjustment is the only change
Food stamp EUs receiving the FA-150 CLAIMANT ACTION NOTICE of a reduction (REDU), no change (NOCH), 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.
- Changes acted upon in addition to the Cost of Listing increase
Food stamp EUs receiving the FA-510 ADVERSE ACTION NOTICE have other changes being acted upon in addition to the cost of living increase. If the EU receiving an FA-510 requests a hearing on the food stamp adjustment by December 15, 2005, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. County 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 food stamp 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 December 15, 2005, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing.
- Cost of Living adjustment is the only change
- Temporary Assistance
If the EU requests a hearing on a Temporary Assistance adjustment by December 30, 2005, the EU may request Temporary Assistance benefits continue at the level before the mass adjustment until the hearing decision is made. County 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 Temporary Assistance benefits at the higher amount pending the hearing decision, complete a WIBCA budget to issue supplemental benefits. Set a reminder for January 3, 2006, and February 1, 2006. To complete a WIBCA budget for January, use the budget information before the mass adjustment and issue supplemental benefits. If the hearing decision is not received before the February benefit is available, complete a WIBCA for February using the same budget information and issue supplemental benefits.
If the EU requests a hearing after December 30, 2005, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing.
- Child Care
If the EU receiving an FA-510 requests a hearing on the Child Care adjustment by December 15, 2005, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. County 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 December 15, 2005, 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.
Managed Reporting/EUs Needing Review
FAMIS will generate reports in the Managed Reporting system of active EUs that need review. To review the reports:
- From the FSD Employee Intranet, under Tools in the right hand lower section of the page click on Managed Reporting.
- Click on “OK” when the notice appears and log into the managed reporting area.
- Click on the appropriate domain. For example, a caseworker would click on Caseworker Reports and an IM Supervisor I would click on Caseworker/Supervisor Reports.
- Click on CC, FS & TA Cost of Living Adjustments Needing Review. Click on the View box next to Cost of Living Adjustments Needing Review.
- Select SSA/SSI/VA Unable to Adjust to request the on-line report for SSA/SSI cases.
Each worker must access the report for his/her primary caseload. An error reason 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 entered.
Manual Adjustments by County Staff
If a child care, food stamp, or Temporary Assistance application is in the controlled flow, review the SSA, SSI, VA, or RR benefit. Determine the correct SSA, SSI, VA, or RR benefit amount and manually adjust the benefit amount for January 2006 and later months when completing the application/controlled flow.
To manually adjust the SSA amount in the Child Care, food stamp, or Temporary Assistance EU, obtain the new SSA amount from the BENDEX printout or the IIVE interface. The new SSA amount can also be computed by multiplying the original SSA amount by 104.1% and rounding down to the nearest dollar.
To manually adjust the SSI amount, the worker adds the amount of increase from the chart near the beginning of this memorandum to the verified SSI amount, or multiplies the original SSI amount by 104.1% and rounds down to the nearest dollar.
To manually adjust the VA or RR amount, the worker multiplies the original VA or RR amount by 104.1% and rounds down to the nearest dollar.
Manual adjustments of the SSA, SSI, VA, or RR as a result of the COLA are considered a change that must be acted upon. If the child care, food stamp, or Temporary Assistance benefits decrease, or the EU closes, authorize the actions to generate an FA-510 ADVERSE ACTION NOTICE.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.