| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | FAMIS SSI/SSA/VA/RR COST OF LIVING ADJUSTMENT |
DISCUSSION:
In January, 2007, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 3.3% 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 10, 2006. 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 eligibility for Child Care assistance. 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.
Please review the following topics carefully as some procedures are changed from previous years.
New Amount of SSI
SMI Premium
Mass Adjustment Process
Food Stamp Simplified Reporting EUs
Conflict of Actions
Notices
Request for Hearing/Continued Benefits
Managed Reporting/EUs Needing Review
Reasons for Review
Manual Adjustments by County Staff
Increases in SSI benefit amounts are as follows:
|
NEW AMOUNT |
INCREASE |
Individual in own household |
$ 623.00 |
$ 23.00 |
Couple in own household |
$ 934.00 |
$ 30.00 |
Individual in household of another |
$ 415.34 |
$ 13.34 |
Couple in household of another |
$ 623.34 |
$ 20.00 |
Essential person/own home |
$ 312.00 |
$ 10.00 |
Adjusting $88.50 to $93.50
The SMI premium increases from $88.50 to $93.50 per month effective January 2007. Medical expense with type SM-SMI PREMIUM in FAMIS of $88.50 or less will be adjusted to $93.50. SMI premiums which are coded incorrectly in FAMIS will not be adjusted by the system and must be reviewed and updated as soon as possible. For example, an $88.50 SMI premium incorrectly coded as HI–HEALTH INSURANCE, or MS-MEDICARE SUPPLEMENT in FAMIS will not be adjusted.
Adding SMI Premium
EUs with an SMI premium verified by the BENDEX file as being paid by the individual are eligible for the medical expense for food stamp benefits and Child Care assistance. If the individual pays the SMI amount and there is no medical expense type SM in FAMIS, the medical expense type SM and amount verified by the BENDEX file will be added for the month of January, 2007 during the mass adjustment. If the Social Security claim ID is blank or incorrect in FAMIS, the system will be unable to complete the adjustment to add the SMI premium as a medical expense.
NOTE: If the SMI premium expense has been entered in FAMIS with the incorrect source code (such as MS or HI), the additional expense type code of SM will be added, allowing the expense twice.
End-Dating SMI Premium
EUs with medical expense type SM in FAMIS who are no longer paying the premium are not eligible for this medical expense. If there is a medical expense type SM in FAMIS and the BENDEX file verifies the SMI premium is being paid by the State of Missouri, the medical expense will be end dated in FAMIS as of December 31, 2006. FAMIS will remove the expense effective the month of January 2007, and complete an eligibility determination. The EU will receive an FA-150 Action Notice of any change in benefits due to the increase in income and removal of the medical expense. An FA-510 Adverse Action Notice, will not be sent to the food stamp EUs since this is being done as part of a mass adjustment.
The mass adjustment will begin in FAMIS on December 9, 2006. The system will be unavailable until the adjustments are completed. If the adjustments are not completed by the morning of December 11, 2006, staff will be notified.
Most EUs with SSA/SSI/VA/RR income that are active by the end of the day on December 8, 2006, with a certification ending January 2007 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 2007 budget with an increased SSA/SSI/VA/RR income and will not adjust the case.
FAMIS will not complete the eligibility determination for applications in the controlled flow. For pending Child Care or food stamp recertifications, if the child care certification period or last food stamp month of certification is January 2007 or February 2007, the SSA/SSI/VA/RR amount is adjusted by the system. Review the SSA/SSI/VA/RR amount prior to completing the application. If the SSA/SSI/VA/RR amount is not correct, follow instructions in the Manual Adjustments by County Staff section of this memorandum.
The eligibility specialist must compute the net adjusted income using the new SSA/SSI/VA/RR amounts for new Child Care, food stamp, and Temporary Assistance application processed after December 9, 2006.
For couple cases, if the couple receives total maximum SSA and SSI, the SSA amount is adjusted by the amount on the BENDEX file or 3.3%. Then, the SSI amount is adjusted by the difference between the SSA increased benefit and the new SSI maximum plus $20. Due to rounding, this calculation may end up $1 different than the actual amount of SSA/SSI/VA/RR income.
FAMIS will mass adjust, end, or add the medical expense type SM-SMI PREMIUM as described in the SMI Premium section of this memorandum. On the food stamp budget, if there is a medical expense entered which does not have an allowable verification code, the FA-150 Action Notice 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.
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 012007. 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 012007. 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 012007.
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.
NOTE: It is important to review income from SSA/SSI/VA/RR, and SMI Premium at the next contact to verify the correct amounts.
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. Do not disregard the mass adjustment action. This includes a previously disregarded Adverse Action to Remove a Person (AARP).
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 eligibility specialist.
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 11, 2006. The FA-150 Action Notice generated by the mass adjustment is dated December 2006, 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 Action Notice is generated for all other EUs adjusted in the mass adjustment, including no change actions.
- 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 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 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 Conflict of Action section in this memorandum to resolve.
Request for Hearing/Continued Benefits
The FA-510 Adverse Action Notice is dated December 11, 2006. 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 Action Notice generated by the mass adjustment is dated December 2006. Mass adjustment actions REDU (reduction), NOCH (no change), and CLOS (closing) receive the FA-150 Action Notice notifying the EU the action has been taken. Any EU receiving an FA-150 Action Notice may request a hearing on the mass adjustment action within 90 days from December 31, 2006.
- 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 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 Living 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 21, 2006, 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.
- Cost of Living adjustment is the only change
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 21, 2006, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing.
- Temporary Assistance
If the EU requests a hearing on a Temporary Assistance adjustment by December 29, 2006, 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 2, 2007, and February 1, 2007. 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 29, 2006, 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 Adverse Action Notice requests a hearing on the Child Care adjustment by December 21, 2006, 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 21, 2006, 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
There is no longer an “error” report for the COLA adjustment. If SSA/SSI/VA/RR benefit did not adjust, there is a reason. Some benefits adjusted require review for accuracy. 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 review message to ensure accuracy of all eligibility determinations for these individuals.
To review the reports:
- From the FSD Employee Intranet, under Quick Links in the right hand lower section of the page click on Managed Reporting.
- Log into the managed reporting area.
- Click on the appropriate domain. (FAMIS Caseworker Supervisor Reports).
- Click on Cost of Living Adjustments Needing Review.
- Select SSA/SSI/VA/RR Needing Review to request the online reports.
Each eligibility specialist must access the report for his/her primary caseload. 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 entered.
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, 2007, and used in an eligibility determination prior to the COLA mass adjustment.
This reason requires immediate review as these cases did not adjust during the COLA mass adjustment! Verify SSA/SSI/VA/RR income amount, update if necessary, and complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits. Complete and verify the January, 2007, income amount in FAMIS is the amount after the COLA adjustment.
- VENDOR LEVEL OF CARE EU MEMBERS – There is an active Nursing Home Level of Care for an individual receiving food stamp 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. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- NEW SMI EXPENSE ADDED – The SMI Premium (SM) expense has been added as a deduction in FAMIS because BENDEX has a self-pay SMI.
Request an IIVE interface to verify the SMI premium. If an incorrect “type” code for the SMI premium is in FAMIS on the Medical Expense (FMXA) screen, the EU will be receiving the deduction twice. Enter an end date for the incorrectly coded expense and complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
If the SMI premium has recently been approved for state payment, (ie: QMB, SLMB), the BENDEX file may not reflect this change. If a medical expense code SM is added during the mass adjustment which is now being paid by the State, end date the premium and complete the eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- SMI EXPENSE HAS BEEN END DATED – The SMI expense has been end dated in FAMIS because it was verified on the BENDEX file that the State of Missouri is paying the SMI premium through BUY-IN, QMB, or SLMB programs.
Request an IIVE interface to verify the change in the person paying the SMI premium. If it is verified the individual is now paying the SMI premium, add the medical expense type SM-SMI PREMIUM and complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- SMI LARGER – The amount of the medical expense type SM–SMI PREMIUM in FAMIS is larger than last year’s maximum of $88.50. Some individuals are required to pay a larger Medicare premium due to late enrollment. The mass adjustment cannot automatically adjust these premiums.
Request an IIVE interface to verify the SMI premium and adjust, if necessary. Complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- CLAIM NUMBER IS BLANK – There is no claim number for the SSA/SSI/VA/RR and the income has been adjusted by percentage. Although this is not a mandatory field at this time, it is very important that the claim number is verified and added for every person receiving SSA/SSI/VA/RR benefits.
Request an IIVE interface to verify the claim ID and add to FAMIS. It is important for the accuracy of the FAMIS record to record the correct claim number on the Select Income (SELINC) screen.
- RECEIVES GENERAL RELIEF - General Relief (GR) income is still being shown in FAMIS on the Income (FMX0) screen and must be end dated.
- 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.
Request an IIVE interface to verify the income from Social Security and add to FAMIS. Complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- 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 income amount. If the EU is no longer receiving this income, end date the income. If the EU is receiving the income, enter the income and complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
- NOT ADJUSTED – There is SSA/SSI/VA/RR income in FAMIS which was not adjusted on an active case.
There are some reasons the SSA/SSI/VA/RR income could not be adjusted. Verify the correct amount of income, review the eligibility unit to determine if action is needed. Complete an eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon. Do not disregard the adverse action for food stamp benefits.
Manual Adjustments by County Staff
To manually adjust the SSA/SSI/VA/RR amount in the Child Care, food stamp, or Temporary Assistance EU, 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 103.3% and rounding 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.
Controlled Flow
If a Child Care, food stamp, or Temporary Assistance application is in the controlled flow, review the SSA/SSI/VA/ RR benefit. Determine the correct SSA/SSI/VA/RR benefit amount and manually adjust the benefit amount effective January 2007 and later months when completing the application/controlled flow.
Blank Verification Code- PEN-Pending
During the mass adjustment, FAMIS sets the status to PEN (Pending) for cases with an unacceptable or blank verification code. The eligibility specialist receives the alert “Action Not Authorized”. If no action is taken by the eligibility specialist, FAMIS will send an FA-510 Adverse Action Notice to reduce or close as appropriate, as the unacceptable or blank verification code has not been resolved.
Review the case file. If the verification is provided, change the verification code, run an eligibility determination and authorize the action. If the verification is not provided or requested, request the verification on the FA-325 Request for Information form. Once verification is received, update FAMIS with the verification and complete an eligibility determination.
ABAWD ISD-Insufficient Data
An ISD (insufficient data) will appear on the Supercase Eligibility Unit Summary (FM30) screen during the mass adjustment on cases that contain an EU member subject to the work requirement when non-work months have not been entered.
FAMIS cannot complete the COLA adjustment on these cases. The alert “OUTSTANDING ELIGIBILITY DETERMINATION” appears on the Alert/Reminder List (FM7M) screen. The eligibility specialist must clear the ISD and manually adjust the SSA/SSI/VA/RR income.
Enter non-work months or change the code on the Employment Assessment (FMMS) and/or Training/Work Requirement (FMMR) screens, as applicable, to clear the ISD.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Each eligibility specialist must access SSA/SSI/VA/RR Needing Review online report in Managed Reporting for their primary caseload.