MEMORANDUM

2012 Memorandums

IM-#100      12/07/12

DEPARTMENT OF SOCIAL SERVICES

FAMILY SUPPORT DIVISION

P.O. BOX 2320

JEFFERSON CITY, MISSOURI

TO:
ALL COUNTY OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
JANUARY 2013 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME
MANUAL REVISION #49
0410.010.15
0805.015.10.05
0825.000.00
0855.005.40.01
0865.010.10.20
0905.012.80
0920.010.35.20
0925.010.25.20 and
APPENDIX E

DISCUSSION:

In January 2013, recipients of Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) income will receive a 1.7% cost of living adjustment (COLA). A mass adjustment of FAMIS Child Care (CC), Food Stamps(FS), Temporary Assistance (TA) and MO HealthNet (MHN) eligibility units (EUs) with SSA, SSI, VA, and/or RR income increases will occur the weekend of December 8, 2012.

This memorandum discusses the following:

NEW AMOUNT OF SSI AND SMI

Effective 2013, SSI benefit amounts are as follows:

 

NEW AMOUNT

INCREASE/DECREASE

SSI Individual maximum (in own household)

$ 710.00

$ 12.00

SSI Couple maximum (in own household)

$ 1066.00

$ 18.00

SSI Individual in household of another

$ 473.34

$ 8.00

SSI Couple in household of another

$ 710.67

$ 12.00

SSI Essential person/own home

$ 356.00

$ 6.00

The minimum Supplemental Medical Insurance (SMI) Premium is $104.90 for 2013.

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Maximum Allotment to Community Spouse

$2898.00

Maximum Allotment to Child

$623.00

Minimum Maintenance Standard for Allotments

$1892.00

Minimum Spousal Share

$23,184.00

Maximum Spousal Share

$115,920.00

Maximum Home Equity

$536,000.00

HCB Maximum

$1241.00

SAB Standard

$767.00

ADJUSTING THE ELIGIBILITY UNITS BY PROGRAM

Food Stamps

FS cases are adjusted for all eligibility units with SSA, SSI, VA, RR income update, or SMI change.

Temporary Assistance

TA cases are adjusted for all eligibility units with SSA, SSI, VA, or RR income update.

Changes in TA grants resulting from the mass adjustment will be included in the CC and FS adjustments. If the TA case is closed, the grant will be removed from the CC and FS budgets.

Child Care

CC cases are adjusted for all eligibility units with SSA, VA, and RR income. SSI continues to be excluded when determining eligibility for CC.

MO HealthNet

Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for MHN programs with income eligibility based on Federal Poverty Level (FPL) until the FPL adjustment in April. All SSA, SSI, VA, and RR income sources are being updated with the new income amount. FAMIS will populate the verification code to "CO" for COLA adjustment.

For the following MHN programs, FAMIS will disregard the new SSA and SSI amounts and use the prior SSA and SSI amounts until the FPL adjustment. FAMIS will adjust the VA and RR income and use the adjusted VA and RR amounts effective January 1, 2013.

For the following MHN programs, FAMIS will adjust the SSA, SSI, VA and RR income and use the new adjusted SSA, SSI, VA and RR amounts:

SMI PREMIUM ADJUSTMENT

SMI premiums that were $99.90 prior to COLA are updated to $104.90.

EUs with an SMI premium verified by the BENDEX file will be adjusted according to the information transmitted from the file to FAMIS. The SMI expense type SM on the Medical Expense (MEDEXP or FMXA) screen in FAMIS will be end dated as of December 31, 2012. The comment, "SMI Expense ended because of new Amount on Bendex file," will be added to the Expense Comment (FMF7) screen. FAMIS will add a new expense type SM of $104.90 to the Medical Expense (MEDEXP or FMXA) screen with a start date of January 2013. The comment, "SMI Expense created for new Amount from Bendex file," will be added to the Expense Comment (FMF7) screen.

If the Benefit Claim Number on the Income (FMX0) screen in FAMIS is blank or incorrect, FAMIS will complete the adjustment to end date the SMI premium on the Medical Expense (MEDEXP or FMXA) screen. The comment, "SMI Expense ended because of New SMI Max – system update," will be added to the Expense Comment (FMF7) screen. FAMIS will also complete the adjustment to add a new expense type SM of $104.90 to the Medical Expense (MEDEXP or FMXA) screen. The comment, "SMI Expense created because of new SMI MAX – system update," will be added to the Expense Comment (FMF7) screen.

NOTE:  If the SMI premium expense has not been entered in FAMIS or has the incorrect source code (such as MS or HI), FAMIS will not make an adjustment on the Medical Expense (FMXA) screen.

Adding SMI Premium

EUs with an SMI premium verified by the BENDEX file as 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 on the Medical Expense (MEDEXP or FMXA) screen in FAMIS, the medical expense SM and amount verified by the BENDEX file will be added for the month of January 2013 during the mass adjustment. The comment, "SMI Expense created for new Amount from BENDEX file," will be added to the Expense Comment (FMF7) screen. If the Benefit Claim Number on the Income (FMX0) screen in FAMIS is blank or incorrect, 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 on the Medical Expense (MEDEXP or FMXA) screen 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 paid by the State of Missouri, the medical expense will be end dated on the Medical Expense (MEDEXP or FMXA) screen in FAMIS as of December 31, 2012. The comment, "SMI Expense ended due to state paying premium – BENDEX file," will be added to the Expense Comment (FMF7) screen. FAMIS will remove the expense effective the month of January 2013, and complete an eligibility determination.

MASS ADJUSTMENT PROCESS

The mass adjustment will begin in FAMIS on December 8, 2012. FAMIS will be unavailable until the adjustments are completed. If the adjustments are not completed by the morning of Monday, December 10, 2012, staff will be notified.

Most EUs with SSA/SSI/VA/RR income that are active by the end of the day on December 7, 2012, with a certification ending January 2013 or later will be adjusted to show the increased benefit amounts. FAMIS will identify any EU that has been adjusted by the eligibility specialist if there is a January 2013 budget with an increased SSA/SSI/VA/RR income and will not adjust the case.

Social Security Adjustments

FAMIS receives the BENDEX file from Social Security Administration. The BENDEX file contains SSA income information. Information from the file is transmitted to FAMIS during the adjustment. All cases with SSA income that have a matching Benefit Claim Number entered on the Income (FMX0) screen will have the income increased to the amount shown on the file. Cases adjusted with income from the BENDEX file will include the comment, "SSA Income Adjusted by the - BENDEX File."

Cases that do not contain the Benefit Claim Number and cases that the Benefit Claim Number does not match the BENDEX file will be increased by 1.7% of the income currently entered in FAMIS. The comment, "SSA, VA, RR Adjusted by the system – increased by the COLA Percentage," will be added to the Monthly Income Comment (FMF7) screen.

Supplemental Security Income (SSI) Adjustments

FAMIS receives the SDX file from Social Security Administration. The SDX file contains SSI income information. Information from the file is transmitted to FAMIS during the adjustment, increasing SSI income on all cases with that have a matching social security number (SSN). Cases adjusted with income from the SDX file will include the comment, "SSI Income adjusted by the system - SDX File," on the Monthly Income Comment (FMF7) screen.

When the SDX file shows SSI income has started or stopped, FAMIS will add or end date SSI income based on information transmitted in the file. When FAMIS adds a SSI income source, the comment, "New SSI Income Source Created by the system - SDX File," will be added to the Monthly Income Comment (FMF7) screen. When FAMIS end dates an SSI income based on information from the SDX file, the comment, "SSI Income End Dated by the system - system calculation," will be added to the Monthly Income Comment (FMF7) screen.

Cases that do not contain the SSN or the SSN does not match the SDX file will be increased by 1.7% of the income currently entered FAMIS. A comment will be added to the Monthly Income Comment (FMF7) screen, "SSI Income Adjusted by the system – system calculation."

VA and RR Adjustments

VA and RR income will be increased by the COLA of 1.7%. The comment, "SSA, VA, RR Adjusted by the system – increased by the COLA Percentage," will be added to the Monthly Income Comment (FMF7) screen.

Cases in the Controlled Flow

FAMIS will not complete the ELIGIBILITY DETERMINATION for applications in the controlled flow. For pending CC or FS recertifications, if the CC certification period or last month of FS certification is January 2013 or February 2013, 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.

SMI Adjustments

FAMIS will adjust, end, or add the medical expense type SM-SMI PREMIUM as described in the SMI Premium section of this memorandum.

Other Medical Expenses on Food Stamp Cases

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 the medical expenses other than mileage or transportation costs verified by client statement (CS). Medical expenses should be reviewed and discussed with the EU at the next contact to attempt to verify expenses.

Reviewing Actions from EU Action Log

If an active FAMIS EU is adjusted or closed, the EU Action Log (EULOG/FM40) screen displays the action taken by the system and the benefit amount for the benefit month 012013. 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 (FM33) screen. The income types, sources, and gross amounts are displayed for budget month 012013. Press F21=Return to return to the Budget Summary screen, and press F15=EXPSUM to view the Expense Summary (FM34) screen. The expense classes, types, and amounts are displayed for budget month 012013.

Outstanding Eligibility Determinations

Eligibility determinations which have not been completed prior to the mass adjustment will be completed during the mass adjustment. This may result in the creation of RTA (ready to authorize) status. An alert "OUTSTANDING ELIGIBILITY DETERMINATION" will be generated and must be resolved.

NOTE: 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. Do not disregard the mass adjustment action.

CONFLICT OF ACTIONS

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 eligibility specialist receives the alert "ADVERSE ACTION NEEDS RESOLVING." The conflict must be resolved by the eligibility specialist.

To resolve the conflict:

NOTICES

Two types of notices are generated as a result of the mass adjustment. The Adverse Action Notice (FA510, FA410, or FA 420) is dated December 10, 2012. The Action Notice (FA150, FA450, FA460) generated by the mass adjustment is dated December 27, 2012, to allow adequate mail time due to the large volume of cases affected. There will not be any notices generated for no change (NOCH) actions in FAMIS.

Food Stamps

An FA-510 Adverse Action Notice is generated for any FS simplified reporting EU whose benefits is reducing due to the mass adjustment and previously disregarded changes. An FA-150 Action Notice is generated for mass adjustment actions REDU (reduction), and CLOS (closing) notifying the EU the action has been taken.

Child Care

The FA-510 Adverse Action Notice is generated for any CC EU whose benefits are reducing. The FA-150 Action Notice will be generated after the FA-510 Adverse Action Notice expires, if the EU has not requested a hearing.

Temporary Assistance

Only the FA-150 Action Notice is generated for a TA 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 Actions section in this memorandum to resolve.

MO HealthNet

An FA-410 Adverse Action Notice is generated for any MHF, MHK, or UWHS participant whose benefits are reducing or closing due to the mass adjustment. An FA-450 Action Notice is generated for mass adjustment actions after the FA-410 expires, if the EU has not requested a hearing.

An FA-420 Adverse Action Notice is generated for any Adult MHN participant whose benefits are reducing or closing due to the mass adjustment. An FA-460 Action Notice is generated for mass adjustment actions after the FA-420 expires, if the EU has not requested a hearing.

REQUST FOR HEARING/CONTINUED BENEFITS

The Adverse Action Notice (FA-510, FA-410, and FA-420) is dated December 10, 2012. Any EU receiving an FA-510, FA-410, or FA-420 Adverse Action Notice may request a hearing on the mass adjustment action within 90 days from the date of the notice. The Hearing Request (FA560) form will not be mailed with the notices for the COLA mass adjustment. Language has been added to the Action notices that the participant may request a hearing by mail, telephone, or in person contact with the FSD office. If contacted by a participant requesting a hearing, complete the IM-87 Hearing Request form and forward to the appropriate hearings unit.

The Action Notice (FA-150, FA-450, and FA-460) generated by the mass adjustment is dated December 27, 2012. Mass adjustment actions REDU (reduction), and CLOS (closing) receive the FA-150, FA-450, and FA-460 Action Notice notifying the EU the action has been taken.

Any EU receiving an Action Notice may request a hearing on the mass adjustment action within 90 days from December 27, 2012.

Food Stamps

The FS 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.

FS EUs receiving the FA-150 Action Notice of a reduction (REDU) 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.

FS 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 FS adjustment by December 20, 2012, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. 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 FS 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 (ACTRES/FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

Temporary Assistance

If the EU requests a hearing on a TA adjustment by December 20, 2012, the EU may request TA benefits continue at the level before the mass adjustment until the hearing decision is made. 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 TA benefits at the higher amount pending the hearing decision, complete a WIBCA budget to issue supplemental benefits. Set a reminder for January 2, 2013, and February 1, 2013. 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 20, 2012, 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 CC adjustment by December 20, 2012, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. 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 CC 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 (ACTRES/FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

If the EU requests a hearing after December 20, 2012, 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.

MO HealthNet

If the EU receiving an FA-410 or FA-420 Adverse Action Notice requests a hearing on the MHN adjustment by December 20, 2012, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. 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 MHN benefits for EUs who received an FA-410 or FA-420 pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (ACTRES/FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

If the EU requests a hearing after December 20, 2012, 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. 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:

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.

NOTE:  If eligibility specialists discover an adjustment that did not have the expected result or did not adjust correctly based on policy, immediately report the discrepancy to Income Maintenance Program and Policy thru normal supervisory channels.

Reasons for Review

The following reasons for review will be displayed in the SSA/SSI/VA/RR Needing Review online report in Managed Reporting:

Verify SSA/SSI/VA/RR income amount, update if necessary using "CO" verification code, and complete an EDRES.

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 EDRES.

If the individual is in an allowable living arrangement, review the Income (FMX0) screen to ensure the SNC (N1) grant is budgeted for FS benefits. If the SNC grant is not budgeted, add the grant to the Income (FMX0) screen and act upon the action.

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 EDRES.

If the SMI premium has recently been approved for state payment, (i.e.: 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 EDRES.

Request an IIVE interface to verify the change in the SMI payer. If it is verified the individual is now paying the SMI premium, add the medical expense type SM-SMI PREMIUM and complete an EDRES.

Request an IIVE interface to verify the SMI premium and adjust, if necessary. Complete an EDRES.

Request an IIVE interface to verify whether or not there is a SMI premium. Remove the SMI expense and complete an EDRES.

Request an IIVE interface to verify the claim ID and add to FAMIS. It is important for the accuracy of the FAMIS record to enter the correct claim number on the Income (FMX0) screen.

Request an IIVE interface to verify the income from Social Security and add to FAMIS. Complete an EDRES.

Request an IIVE interface to verify the income sources. Update FAMIS to show the correct income source. Be sure to enter the SSA claim number for future adjustments. Complete an EDRES.

Verify the 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 EDRES.

There are some reasons the SSA/SSI/VA/RR income could not be adjusted. Verify the correct amount of income and review the eligibility unit to determine if action is needed. Complete an EDRES.

NOTE:  It is important to review every eligibility unit displayed and take actions to ensure accuracy of the FAMIS record and correct eligibility determinations for these individuals. 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 income in FAMIS, 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 income amount by 1.7% and rounding down to the nearest dollar.

The eligibility specialist must enter the updated SSA/SSI/RR/VA income in FAMIS for all programs using the verification code "CO"- COLA if the income increased due to the COLA increase but was not adjusted during the mass adjustment.

FAMIS uses the CO verification code to determine when to use the December 2012 or January 2013 SSI/SSA/VA/RR. FAMIS is programmed to disregard the SSA/SSI income increase until the FPL adjustment in April if the verification code is "CO" for MHN programs with income eligibility based on FPL.

NOTE: For prior quarter months, enter the prior SSA/SSI income amount with the appropriate verification code (HC, TC) for months prior to January 2013.

Manual adjustments of the:

If the CC, FS, TA, or MHN benefits decrease or the EU closes, authorize the actions to generate an FA-510, FA-410, or FA-420 Adverse Action Notice.

CONTROLLED FLOW

If a CC, FS, TA, or MHN 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 using verification code CO effective January 2013 and later months when completing the application/controlled flow.

NOTE:  For MHN programs, with the exception of SAB, SNC, Vendor, HCB and MOCDD, SSA and SSI adjustments are disregarded until FPL adjustments in April.

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, FA-410, or FA-420 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, complete an EDRES, 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 EDRES.

NEW APPLICATIONS AFTER DECEMBER 7, 2012

If the applicant was receiving SSA/SSI benefits in December 2012

For new CC, FS, MHN, and/or TA applications processed after December 7, 2012, staff must enter the pre-cola income for December with the appropriate verification code (HC or TC) and the increased income for January 2013 and later using the SSA/SSI/VA/RR amounts to be received in January and later months with the verification code CO.

If the applicant was not receiving SSA/SSI benefits in December 2012

Staff must enter the income for January 2013 and later using the SSA/SSI/VA/RR amounts to be received in January and later months with the verification code HC or TC.

INTERIM CHANGES AFTER MASS ADJUSTMENT

When completing budget adjustments after mass adjustment, if the verification code is "CO" and there has been no other change to SSA and SSI amounts, leave the verification code "CO" in verification field. Changing the verification code to any other code will incorrectly budget the SSA and SSI COLA amount prior to the FPL adjustment in April for MHN programs with income eligibility based on FPL.

There are times when SSA and/or SSI income changes that are not related to the COLA increase, such as when a spouse dies and the remaining participant has a SSA and/or SSI income adjustment. When there is a non-COLA change and a budget adjustment is necessary, the eligibility specialist must enter the verification code (HC or TC) as appropriate. FAMIS will then adjust the case for the change in SSA and/or SSI income.

NECESSARY ACTION:

HA

2012 Memorandums