MEMORANDUM

DISCUSSION:

Effective January 1, 2009, Social Security (OASDI) benefits increase in the annual Cost of Living Adjustment (COLA). The new amounts are as follows:

Percentage increase in benefits	5.8%
SSI Maximum, single person	$674.00
SSI Maximum, two persons	$1011.00
SMI (Medicare Part B) premium	$96.40
Maximum Allotment to Community Spouse	$2739.00
HCB Maximum	$1,178.00
SAB Standard	$728.00

NOTE: The SSI amounts are for information only. Use 85% of the Federal Poverty Level (FPL) for MO HealthNet for the Aged, Blind, and Disabled (MHABD) eligibility determinations.

Senate Bill 577 (2007) specified that programs in which income eligibility is determined by Federal Poverty Level (FPL) will not be adjusted for changes in OASDI or SSI benefits until the next FPL adjustment. Cases not being adjusted for OASDI/SSI income due to the SB 577 (2007) include the Family Healthcare Programs, MO HealthNet for the Aged, Blind, and Disabled (MHABD) spenddown and non spenddown, and the Ticket to Work Health Assurance (TWHA) Program.

The Cost of Living Adjustments will be made on the weekend of December 6, 2008. 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. If the new amount is unavailable and the old amount of Social Security benefits has been verified, multiply the old amount by 1.058 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 and 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 BEING MASS-ADJUSTED

During the weekend of December 6, 2008, State Office will complete adjustments for the following types of assistance and send adverse action or adjustment notices to participants:

• Supplemental Aid to the Blind (SAB) cash cases.
• Vendor Cases including those with allotments.
• Missouri Children with Developmental Disabilities (MOCDD) cases.
• Home and Community Based (HCB) Waiver Services cases.
• Supplemental Nursing Care (SNC) cash cases , type of assistance "N" with payee level of care "W”, “X”, “P”, “V”, “Y”, or “B”. If ineligible for the cash grant, the cash grant will be closed but the level of care will be changed to a “T”.

HOW CASES ARE MASS ADJUSTED

The Legacy computer program identifies participants that receive OASDI, either from BENDEX or from the IM database. The system then updates the OASDI amount in field 14M with the new figure (calculated from BENDEX or calculated from the IM database). 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 participant and other cases are listed for review by the Eligibility Specialist.

Vendor cases are adjusted by changing the surplus amount the participant must pay the nursing home. The system generates a notice of adjustment to the nursing home in addition to the participant notice.

If a case does not appear on BENDEX but shows OASDI in field 14M, the case may be adjusted. Cases will be adjusted by applying the 5.8% increase to the OASDI amount shown in field 14M. For these cases, if the amount in 14M is wrong, the adjustment will be wrong. The Eligibility Specialist is responsible for correcting field 14M and any other affected figures. Because SMI premium information will not be available from BENDEX on percentage adjusted cases, the system will attempt to identify premium payers and will assume the premium is $96.40 as of December 2008. Because not every SMI premium is $96.40, a small portion of percentage adjusted cases may be wrong due to this assumption. Therefore, each percentage adjusted case is marked with an asterisk (*) to help staff indentify them in case of incorrect adjustments.

No IM-5 turnarounds will be produced for this adjustment. These cases will appear on a reported 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. Counties must review these cases using the MOBIUS lists. Each case listed includes a caption to identify why the case could not be adjusted. Review the listed cases and manually adjust if necessary. For example, if the expenses figures for a Supplemental Aid to the Blind case is not the maximum grant amount for the 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 OASDI amount in the IM database which is greater than the amount shown on the 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 14M.

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

There is one list of cases not adjusted:

• Cases Needing Review for Adjustment

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 (14M), which indicates probable error in 14M.
• BENDEX > IM - The IM database has an amount in Field 14M (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 14L and no OASDI in 14M. 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 MHABD 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 14M (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 14M (OASDI Amt) is greater than the amount in Field 13O (Income of community spouse). Review 13O and 14M. 13O must include the amount in 14M.
• 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 14M (OASDI Amt) is greater than the amount shown for the dependent in Field 13O (Income of Dependent). Review 13O and 14M. 13O must include the amount in 14M.
• OASDI > STD - The new OASDI amount is greater than the new SAB standard of $728.00; 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 14M, 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.

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 8, 2008. The participant will have until December 18, 2008, to request a hearing and have benefits restored to pre-adjustment levels.

If the participant requests a hearing on or before December 18, 2008, 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 participant does not respond by December 18, 2008, 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 participants 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.

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.

   NOTE: All cases appearing with a caption of “Not Included” for any individual MUST be reviewed for necessary action by the county.

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 2009 surplus amount for any participant 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);
• Presumptive Eligibility for Children;
• Darling cases- These are “M” type of assistance cases identified by an “M" indicator in field 27 of IMU5;
• QMB-only cases (“Q” type of assistance);
• SLMB-only cases (“L” type of assistance);
• Blind Pension cases;
• Conversion cases (SSI only, SSI-SP, and SP only); and
• BCCT cases.

Notices to Participants

Adverse action notices and notices of adjustment will be generated by the system and mailed to participants. The following are samples of the notices being sent to participants. 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, D, or K Level of Care) No L Level of Care Individuals
• Increase in Surplus Amount (Cases with N, D, or K Level of Care) With L Level of Care Individuals
• No change or a Decrease in Surplus but an Increase in Participant's or L Level Individuals OASDI
• SNC and SAB with levels of Care V, W, X, Y, B, or P ( May include decreases and closings)

NECESSARY ACTION:

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

SS