IM-109      12/08/06

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI

TO:	ALL COUNTY OFFICES
FROM:	JANEL R. LUCK, DIRECTOR
SUBJECT:	JANUARY 2007 COST OF LIVING ADJUSTMENT (COLA); INCOME MAINTENANCE PROGRAMS MANUAL REVISION #27: SECTIONS 0410.010.15, 0815.000.00, 0820.000.00, & 0825.000.00

DISCUSSION:

Effective January 1, 2007, Social Security (OASDI) benefits increase in the annual Cost of Living Adjustment (COLA).The new amounts are as follows:

Percentage increase in benefits	3.3%
SSI Maximum, single person	$623.00
SSI Maximum, two persons	$934.00
SMI (Medicare Part B) premium	$93.50
Maximum Allotment to Community Spouse	$2541.00
HCB Maximum	$1088.00
SAB Standard	$673.00

NOTE: The SSI amounts are for information only. Use 85% of the Federal Poverty Level (FPL) for Medicaid eligibility determinations.

The Cost of Living Adjustments will be made on the weekend of December 9, 2006. Use the current amount of OASDI when entering IMU5 transactions prior to the mass adjustment. 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 103.3 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 complete the adjustment as follows:

• send the adverse action or adjustment notice;
  
  
• adjust or close the case; and
  
  
• provide a listing of cases for counties.

NOTE: No paper reports or notices will be produced for counties. These documents will be on MOBIUS.

County Staff Must Handle the Case when:

• a hearing is requested within the 10-day adverse action period; and/or
  
  
• the case is listed for review.

Refer to specific instructions later in this memorandum.

Cases Which Are Mass-Adjusted

• Medical Assistance for Families (MAF) cases when the adjustment would not result in a change in eligibility. MAF cases will not be closed as a result of the mass adjustment.
  
  
• MC+ for children cases when the adjustment would not result in a change in level of care. MC+ for Children cases will not be closed as a result of the mass adjustments.
  
  
• “M” type of assistance cases with a “T” level of care.
  
  
• Vendor cases, including those with allotments.
  
  
• Nursing Care cash cases, type of assistance “N”, “R”, and “F” with payee level of care “W”, “X”, “P”, “V”, “Y” or “B”, or any GR (SSI/SP) cases. If ineligible for the cash grant, the cash grant will be closed but the level of care will be changed to a “T”.
  
  
• SAB cash cases and conversion cases using AB criteria.

How 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 Eligibility Specialist.

If no OASDI amount appears in field 14N, 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 Eligibility Specialist must make the correct adjustment by entering the new amount of OASDI in fields 14N, 34, and 41. The Eligibility Specialist must also send the IM-80 to reduce the grant.

NOTE: MA spenddown cases are adjusted by changing the surplus amount in Field 36. The increased spenddown amount will be for February 2007 as January invoices have already 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 in field 14N, the case may be adjusted. Cases will be adjusted by applying the 3.3% increase to the OASDI amount shown in 14N. For these cases, if the amount in 14N is wrong, the adjustment will be wrong. The Eligibility Specialist is responsible for correcting 14N 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 $88.50 as of December 2006. Because not every 2006 premium is $88.50, 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 Eligibility Specialists identify them in case of incorrect adjustments.

No IM-5 turnarounds will be produced for this adjustment. These cases will appear on a report titled “Cases Adjusted.” County offices can access this report on MOBIUS. 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 MOBIUS lists. 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 figures for a Supplemental Aid to the Blind 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:

• Assistance group members having an OASDI amount in the IM database, which is greater than that appearing in BENDEX. (This includes cases in which the inactive payee is the only match to BENDEX, and the income field is zero.)
  
  
• Cases with assistance group members who do not have OASDI listed in field 14N.

Listing of Cases Not Adjusted by State Office which Need Action by County Staff

There are two lists of cases not adjusted:

• Cases Needing Review for Adjustment, and
  
  
• MC+ for Children/MAF (C7) Cases That May Have a Change in Level of Care or Ineligibility.

Cases with BENDEX Discrepancies

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 SSI and new SSI.
  
  
• For the individual: name, DCN, level of care, old SSA amount, new SSA amount and claim number, if applicable.

Captions and possible actions for BENDEX discrepancies:

• BENDEX < IM - BENDEX shows less than IM (14N), which indicates probable error in 14N.
  
  
• BENDEX > IM - The IM database has an amount in Field 14N (OASDI Amt) for a payee or an individual that is less than that which appears in BENDEX, or is zero. Occurs in SNC cash cases when there is SSI in 14M and no OASDI in 14N. Also occurs when an inactive payee is the only BENDEX match and there is no income reported. 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 14N (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 13Q - Field 13Q (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 13Q.
  
  
• OASDI > CS Inc - The OASDI amount in Field 14N (OASDI Amt) is greater than the amount in Field 13O (Income of community spouse). Review 13O and 14N. 13O must include the amount in 14N.
  
  
• Max Allot > Exp - The current maximum allotment for the case is greater than the amount entered in Field 33 (EXP/EIL). Review 33, 13O, and 13R for consistency.
  
  
• OASDI > Dep Inc - The OASDI amount in Field 14N (OASDI Amt) is greater than the amount shown for the dependent in Field 13O (Income of Dependent). Review 13O and 14N. 13O must include the amount in 14N.
  
  
• OASDI > STD - The new OASDI amount is greater than the new SAB standard of $673.00; investigate possible closing.
  
  
• SSI CHG - For “F” type of assistance, an amount appears in 14M (SSI Amt) indicating that this case contains SSI. Adjust SSI manually and adjust SAB grant.
  
  
• REST > GRNT - For cases with restitution, the restitution amount is greater than the new grant amount.
  
  
• SURP DECR - The new surplus amount is less than the current surplus amount for a non-allotment case. Review 14N, 33, and 34 for consistency.
  
  
• SSI DECR - On SNC cash cases with SSI, the OASDI increase caused a SSI decrease or closing. This may indicate an OASDI increase for a reason other than the COLA.

Individuals with SSI in MC+ for Children Cases

This listing contains individuals on MC+ for Children cases who receive SSI benefits. Individuals with “Q”, “Z”, “1”, “2”, or “3” level of care are listed. Cases with SSI income will not be manually adjusted by the system. Use this listing to identify cases that require a manual adjustment due to the increase in SSI.

MC+/MAF Cases Needing Review

The listing will be produced for cases where the mass adjustment would cause a Level of Care change or a MC+ or MAF case to be closed. Eligibility Specialists 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 Eligibility Specialist review to determine if further adjustment is needed. Individuals appearing on this listing with “Not Included” captions must be reviewed for necessary action.

• Supplemental Nursing Care Case Adjusted
  
  An individual losing cash eligibility was adjusted and changed to a “T” level of care. Review these cases to see if the individual is eligible for another type of assistance and take necessary action.

NOTE: Review all cases listed in MOBIUS for manual adjustment and make necessary changes.

Hearings on Computer Adjusted Cases

The adverse action notices generated by the mass adjustment will be dated December 11, 2006. The claimant has until December 21, 2006, to request a hearing and have benefits restored to pre-adjustment levels.

If the claimant requests a hearing on or before December 21, 2006, 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 print a copy of the computer generated IM-80, available on MOBIUS.

If the claimant does not request a hearing on or before December 21, 2006, no further case action is necessary.

Listing of Cases Adjusted

Cases that are mass-adjusted are included on one of several listings in MOBIUS.

“Not Included” on the “Cases Adjusted” list requires action. All others are for informational purposes. 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.
   
   
2. 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.
     
     
3. Surplus Changes as a Result of OASDI Increases
   
   Each vendor nursing home or institution receives a listing 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 the IM-62 to notify the vendor of any correction in the January surplus amount or to supply the January 2007 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 and
     
     
   • For decreases, the effective date is the month following the month of the report or discovery.
     
     See the online manual 0815.000.00 for more information.

Cases Bypassed

The county is not required to act on bypassed cases. They will not be adjusted or listed. The following cases will be bypassed during the mass adjustment:

• Refugee cases (because none currently receive OASDI);
  
  
• Transitional Medical Assistance or Child Support Related closing cases;
  
  
• MC+ for Pregnant Women cases;
  
  
• Extended Women's Health Services (EWHS);
  
  
• Presumptive Eligibility for Children;
  
  
• Darling cases-These are “M” type of assistance 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); and
  
  
• BCCT.

Notices to Claimants

Adverse action notices and notices of adjustment will be generated by the system and mailed to recipients. The following are samples of the notices being sent to claimants. These are attached for informational purposes only. For hearing requests, access the copy of the notice sent to the recipient in MOBIUS. To view examples of the notices, click on the appropriate link(s) below:

• Increase in Surplus Amount (Cases with N, I, D, or K Level of Care) No L Level of Care Individuals
  
  
• Increase in Surplus Amount (Cases with D, I, K, or N Level of Care) With L Level of Care Individuals
  
  
• No Change or a Decrease in Surplus but an Increase in Claimant's or L Level Individuals OASDI
  
  
• MA Spenddown Increase
  
  
• MA Non-Spenddown to Spenddown
  
  
• SNC and SAB with Levels of Care V, W, X, Y, B, or P (May Include Decreases and Closings)
  
  
• Notice to NF, IMR, or MHC Administrator of Change in Surplus

Food Stamps and Temporary Assistance Mass Adjustments

Instructions for handling Food Stamp and Temporary Assistance cases are covered in a separate memorandum.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.
  
  
• Review cases and adjust manually as needed.

DS