MEMORANDUM

2014 Memorandums

IM-#76     12/23/14

DEPARTMENT OF SOCIAL SERVICES

FAMILY SUPPORT DIVISION

P.O. BOX 2320

JEFFERSON CITY, MISSOURI

TO:
ALL FIELD OFFICES
FROM:
ALYSON CAMPBELL, DIRECTOR
SUBJECT:
JANUARY 2015 FAMIS COST OF LIVING ADJUSTMENT OF SOCIAL SECURITY, SUPPLEMENTAL SECURITY, VETERANS ADMINISTRATION AND RAILROAD RETIREMENT INCOME
MANUAL REVISION #45
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 2015, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 1.7% 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 13, 2014

This memorandum discusses the following:

NOTE: This memo addresses FAMIS changes only. A separate memo will be issued regarding COLA in MEDES.

NEW AMOUNT OF SSI

Effective 2015, SSI benefit amounts are as follows:

  NEW AMOUNT INCREASE/DECREASE
SSI Individual maximum (in own household) $ 733.00 $ 12.00
SSI Couple maximum (in own household) $ 1100.00 $ 18.00
SSI Individual in household of another $ 488.67 $8.00
SSI Couple in household of another $733.00 $12.00
SSI Essential person/own home $ 367.00 $6.00

The minimum SMI Premium remains unchanged for 2015 at $104.90.

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Maximum Allotment to Community Spouse $2981
Maximum Allotment to Child $367
Minimum Maintenance Standard for Allotments $1967
Minimum Spousal Share $23,844.00
Maximum Spousal Share $119,220.00
Maximum Home Equity $552,000.00
HCB Maximum $1281.00
SAB Standard $792.00

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.

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.

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.

MO HealthNet

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.

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. For the following MO HealthNet programs, FAMIS will:

For the following MO HealthNet programs, FAMIS will

SMI PREMIUM ADJUSTMENT

SMI premiums remain at $104.90 for 2015.

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 2015 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, 2014. 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 2015, 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 was completed in FAMIS on the weekend of December 13, 2014.

Most EUs with SSA/SSI/VA/RR income that are active by the end of the day on December 12, 2014, with a certification ending January 2015 or later were 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 2015 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 1.7%. The comment, “SSA, VA, RR Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.

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

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 2015 or February 2015, 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 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 012015. 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 012015. 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 012015.

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. FAMIS generates the alert “ADVERSE ACTION NEEDS RESOLVING.”

To resolve the conflict:

NOTICES

Two types of notices are generated as a result of the mass adjustment. The Adverse Action Notice (FA510) is dated December 15, 2014. The Action Notice (FA150) generated by the mass adjustment is dated December 29, 2014. Notices of no change (NOCH) actions are not generated.

Food Stamps

 An Action Notice (FA-150) is generated for mass adjustment actions REDU (reduction), and CLOS (closing) notifying the EU the action has been taken.

Child Care

The FA-510 is generated for any Child Care EU whose benefits are reducing. The FA-150 will be generated after the FA-510 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 Adverse Action Notice (FA-410) is generated for any MO HealthNet for Families, MO HealthNet for Kids, or UWHS whose benefits are reducing or closing due to the mass adjustment. An Action Notice (FA-450) is generated for mass adjustment actions after the FA-410 expires, if the EU has not requested a hearing.

An Adverse Action Notice (FA-420) 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 Action Notice (FA-460) is generated for mass adjustment actions after the FA-420 expires, if the EU has not requested a hearing.

REQUEST FOR HEARING/CONTINUED BENEFITS

If the EU requests a fair hearing, refer to APPLICATION FOR STATE HEARING for procedures for processing the hearing request (IM-87). Send all Agency evidence to the Hearings Unit as soon as possible.

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

Conduct a pre-hearing conference. Provide a copy of the evidence to the EU asking for the hearing, and their legal representative. 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.

MANAGED REPORTING/EUs NEEDING REVIEW

To review the reports:

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 income or expenses did not adjust or adjusted incorrectly, immediately report to FSD Program and Policy through 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. Review every EU displayed and take the following actions to ensure accuracy of the FAMIS record and correct eligibility determinations for these individuals.

NOTE: Act on information learned as a result of a mass adjustment. Do not disregard the adverse action for Food Stamp benefits.

MANUAL ADJUSTMENTS

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. If not available, compute the new SSA/SSI/VA/RR amount by multiplying the original amount by 1.7% and rounding down to the nearest dollar.

The eligibility specialist must enter the adjusted income using the new SSA/SSI/VA/RR amounts for new applications processed after December 12, 2014. 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 but was not adjusted during the mass adjustment.

FAMIS will use the CO verification code to determine when to use the December 2014 or January 2015 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:

NOTE: For prior quarter months, enter the prior SSA/SSI income amount with the appropriate verification code (HC, TC) for months prior to January 2015.

Manual adjustments for COLA of:

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 2015 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. FAMIS generates the alert –“Action Not Authorized". If no action is taken, 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 eligibility determination, and authorize the action. If the verification was not provided or requested, request the verification on the Request for Information (FA-325) 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 amounts change that are not related to a COLA.  When the income has changed and is not the result of the COLA, enter the verification code (HC or TC) as appropriate. FAMIS will then adjust the SSA and SSI income prior to the April FPL 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 FPL adjustment in April.

NECESSARY ACTIONS:

AC/HA/MAH

2014 Memorandums