MEMORANDUM

DISCUSSION:

In January 2014, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 1.5% cost of living adjustment (COLA). A mass adjustment of FAMIS Child Care, Food Stamps, Temporary Assistance and MO HealthNet eligibility units (EUs) with SSA, SSI, VA, and/or RR income increases will occur the weekend of December 7, 2013.

This memorandum discusses the following:

• NEW AMOUNT OF SSI
• NEW MO HEALTHNET FOR AGED, BLIND AND DISABLED STANDARDS
• ADJUSTING THE ELIGIBILITY UNITS BY PROGRAM
• SMI PREMIUM ADJUSTMENT
• MASS ADJUSTMENT PROCESS
• CONFLICT OF ACTIONS
• NOTICES
• REQUEST FOR HEARING/CONTINUED BENEFITS
• MANAGED REPORTING/EUS NEEDING REVIEW
• MANUAL ADJUSTMENTS BY COUNTY STAFF
• INTERIM CHANGES AFTER MASS ADJUSTMENT

NEW AMOUNT OF SSI

Effective 2014, SSI benefit amounts are as follows:

	NEW AMOUNT	INCREASE/DECREASE
SSI Individual maximum (in own household)	$ 721.00	$ 11.00
SSI Couple maximum (in own household)	$ 1082.00	$ 16.00
SSI Individual in household of another	$ 480.67	$7.33
SSI Couple in household of another	$721.00	$10.33
SSI Essential person/own home	$ 361.00	$ 5.00

The minimum SMI Premium is $104.90 for 2014.

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Maximum Allotment to Community Spouse	$2931.00
Maximum Allotment to Child	$361.00
Minimum Maintenance Standard for Allotments	$1939.00
Minimum Spousal Share	$23,448.00
Maximum Spousal Share	$117,240.00
Maximum Home Equity	$543,000.00
HCB Maximum	$1260.00
SAB Standard	$779.00

ADJUSTING THE ELIGIBILITY UNITS BY PROGRAM

Food Stamps

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

Temporary Assistance

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

Child Care

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

MO HealthNet

Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for MO HealthNet programs with income eligibility based on federal poverty level until the next 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 MO HealthNet programs, FAMIS will disregard the new SSA and SSI amounts and use the prior SSA and SSI amounts until FPL adjustments. FAMIS will adjust the VA and RR income and use the new adjusted VA and RR amounts effective January 1, 2014.

• MO HealthNet for Families and Kids (MHK)
• MO HealthNet for Pregnant Women (MPW)
• Newborn (NBN)
• Transitional MO HealthNet (TMH)
• Refugee (REF)
• Extended Women's Health Services (EWHS)
• Uninsured Women's Health Services (UWHS)
• MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down (MHSD) and Non Spend Down (MHNS)
• Qualified Medicare Beneficiary (QMB)
• Specified Low Income Beneficiary (SLMB)
• Blind Pension (BP)
• Program for All-Inclusive Care for Elderly (PACE)
• Ticket to Work Health Assurance (TWHA) and
• Gateway to Better Health (GTBH)

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

• Supplemental Aid to the Blind (SAB)
• Supplemental Nursing Care (SNC)
• Vendor
• Home and Community Based (HCB)
• Missouri Children with Developmental Disabilities (MOCDD)

SMI PREMIUM ADJUSTMENT

SMI premiums remain at $104.90 for 2014.

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 2014 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, 2013. 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 2014, and complete an eligibility determination. The EU will receive an 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.

MASS ADJUSTMENT PROCESS

The mass adjustment will begin in FAMIS on December 7, 2013. FAMIS will be unavailable until the adjustments are completed. If the adjustments are not completed by the morning of Monday, December 9, 2013, staff will be notified.

Most EUs with SSA/SSI/VA/RR income that are active by the end of the day on December 6, 2013, with a certification ending January 2014 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 2014 budget with an increased SSA/SSI/VA/RR income and will not adjust the case.

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, increasing all cases with SSA income that have a matching Benefit Claim Number entered on the Income (FMX0) screen 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 1.5%. The comment, "SSA, VA, RR Adjusted by the system – increased by the COLA Percentage," will be added to the Monthly Income Comment (FMF7) screen.

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 all cases with SSI income 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 also be adding or end dating SSI income based on information transmitted in the file. When FAMIS adds an 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 1.5%. A comment will be added to the Monthly Income Comment (FMF7) screen, "SSI Income Adjusted by the system – system calculation."

VA and RR income will be increased by the COLA of 1.5%. The comment, "SSA, VA, RR Adjusted by the system – increased by the COLA Percentage," will be added to the Monthly Income Comment (FMF7) screen.

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 2014 or February 2014, 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 the memorandum.

FAMIS will 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 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.

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 the benefit month 012014. 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 012014. 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 012014.

Eligibility determinations which have not been run 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: It is important to review income from SSA/SSI/VA/RR, and SMI Premium at the next contact to verify the correct amounts.

CONFLICT OF ACTIONS

FAMIS adjusted 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:

• Access the Action Resolution (ACTRES or FM50) screen 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 (EDRES or FM3Y) screen and run a new eligibility determination.
• Authorize the new adverse action.

NOTICES

Two types of notices are generated as a result of the mass adjustment. The Adverse Action Notice (FA510) is dated December 9, 2013. The Action Notice (FA150) generated by the mass adjustment is dated December 27, 2013, 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-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 Child Care 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 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 Actions section in this memorandum to resolve.

MO HealthNet

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

An FA-420 Adverse Action Notice is generated for any MO HealthNet for the Aged, Blind or Disabled programs whose benefits are reducing or closing due to the mass adjustment. An FA-460 Action Notice is generated for mass adjustment actions after the Adverse Action Notice expires, if the EU has not requested a hearing.

REQUST FOR HEARING/CONTINUED BENEFITS

If the EU requests a fair hearing, see Income Maintenance Memorandum IM-#65 dated October 26, 2011 for procedures for processing the hearing request. It is important to send all Agency evidence to the Hearings Unit as soon as possible. Do not wait until a few days before the hearing to send the evidence.

For a request for fair hearing due to the mass adjustment, evidence may include, but is not limited to:

• The FA 510, FA-410, or FA-420 Adverse Action Notice
• FA-150, FA-450, or FA-460 Action Notice
• Manual Section/legal references
• Budget Summary (FM4A, FM4D, FM4H, FM4K) for applicable months
• Adult MO HealthNet AG Budget Summary (FMD8) screen (Adult MO HealthNet only)
• Detail screens of budget entries, as applicable:
  • Income Summary Detail (FM33)
  • Assistance Group Details (FM4E) (Family Healthcare only)
  • ADM AG Income Summary Detail (FMDE) screen (Adult MO HealthNet only)

  • Expense Summary (FM34)
  • Income (FMX0) screen
  • Income Amount (FMX3) screen
  • ADM AG Income Summary Detail (FMDE) screen (Adult MO HealthNet only)
  • Shelter Expense (FMX3) screen
  • Utility Expense Standard (FMXK) screen
  • Court Ordered Expense (FMXL) screen
  • Medical Expense (FMXA) screen

Provide a copy of the evidence to the EU asking for the hearing, and their legal representative, and schedule a pre-hearing conference. If the EU designates an attorney or authorized representative for the hearing, send a copy of all notices and evidence for the hearing to the EU and the designated individual.

The FA-510, FA-410, and FA-420 Adverse Action Notice is dated December 9, 2013. 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 FA-150, FA-450, and FA-460 Action Notice generated by the mass adjustment is dated December 27, 2013. 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 FA-150 Action Notice may request a hearing on the mass adjustment action within 90 days from December 27, 2013.

• Food Stamp

  Food stamp 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.

• Temporary Assistance

  If the EU requests a hearing on a Temporary Assistance adjustment by December 19, 201,  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 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 19, 201, 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 19, 201, 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 19, 201, 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 MO HealthNet adjustment by December 19, 201, 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 MO HealthNet benefits at a higher amount for EUs who received an FA-410 or FA-420 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 18. 2013, 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 the 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)

NOTE: The report is also located in FAMIS Eligibility Specialist Reports, FAMIS Manager Level 2 Reports and FAMIS County Office 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.

NOTE: If the eligibility specialist discovers something didn't adjust as expected or didn't adjust correctly, immediately report to FSD 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. 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, 2014, 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 using "CO" verification code, 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, 2014, 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.

  If the individual is in an allowable living arrangement, review the Income (FMX0) screen to ensure the Supplemental Nursing Care (N1) grant is budgeted for Food Stamp benefits. If the Supplement Nursing Care grant is not budgeted, add the grant to the Income (FMX0) screen and act upon the action.

• 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, (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 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.

• Last Year SMI>Last Year Max – The amount of the medical expense type SM–SMI PREMIUM in FAMIS is larger than $104.90. 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.

• Bendex SMI Not Found – There is a SMI premium amount in FAMIS, but the BENDEX file does not show a SMI premium.

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

• 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.

• 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.

• Multiple SSI for Individual – An individual has more than one source of SSI. This usually occurs when an individual has SSI and SSA and the SSA was entered into FAMIS as SSI.

  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 eligibility determination. This information was learned as a result of a mass adjustment and is therefore acted upon.

• 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 and 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 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 amount by 1.5% and rounding down to the nearest dollar.

The eligibility specialist must enter the net adjusted income using the new SSA/SSI/VA/RR amounts for new Child Care, Food Stamp, and Temporary Assistance applications processed after December 6, 2013.
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 will use the CO verification code to determine when to use the December 2013 or January 2014 SSI/SSA/VA/RR. FAMIS is programmed to disregard the SSA/SSI income increase until the federal poverty level (FPL) adjustment in April if the verification code is "CO" for the following MO HealthNet programs:

• MO HealthNet for Families and Kids (MHK),
• MO HealthNet for Pregnant Women (MPW),
• Newborn (NBN),
• Transitional MO HealthNet (TMH),
• Refugee (REF),
• Extended Women's Health Services (EWHS),
• Uninsured Women's Health Services (UWHS),
• MO HealthNet for the Aged, Blind and Disabled (MHABD) spend down (MHSD), and non-spend down (MHNS),
• Qualified Medicare Beneficiary (QMB),
• Specified Low-Income Medicare Beneficiary (SLMB),
• Blind Pension (BP),
• Program for All-Inclusive Care for the Elderly (PACE), and
• Ticket to Work Health Assurance (TWHA).
• Gateway for Better Health (GTBH)

NOTE: For prior quarter months, enter the prior SSA/SSI income amount with the appropriate verification code (HC,TC) for months prior to January 2014.

Manual adjustments of the SSA, SSI, VA, or RR as a result of the COLA are considered a change that must be acted upon for Child Care, Food Stamps and Temporary Assistance. Manual adjustments of VA and RR as a result of the COLA are considered a change that must be acted on for MO HealthNet programs. SSA and SSI adjustments as a result of the COLA are considered a change that must be acted on for SAB, SNC, MOCDD, Vendor and HCB cases. For other MHN programs the SSA and SSI adjustment is disregarded until FPL adjustments in April. If the Child Care, Food Stamp, Temporary Assistance or MO HealthNet 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 Child Care, Food Stamp, Temporary Assistance or MO HealthNet 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 2014 and later months when completing the application/controlled flow.

NOTE: For MO HealthNet for Families, MO HealthNet for Kids, UWHS, and MO HealthNet for the Aged, Blind and Disabled programs, with the exception of SAB, SNC, Vendor, HCB and MOCDD, SSA and SSI adjustments are disregarded until COLA 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, 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.

INTERIM CHANGES AFTER MASS ADJUSTMENT

There are times when SSA and SSI have changes in the amounts that are not related to a COLA adjustment (i.e.: one spouse dies and the other has SSA and/or SSI adjustment). When this happens and a budget adjustment is necessary the eligibility specialist can enter the verification code (HC or TC) as appropriate. FAMIS will then adjust the SSA and SSI income appropriately.

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 FPL adjustment in April. 

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.
• Apply MO HealthNet policy for "CO" income verification to disregard SSA and SSI COLA adjustments until FPL adjustment in April.

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