MEMORANDUM

2016 Memorandums

IM-#95; 12/28/16

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
PO BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL FAMILY SUPPORT DIVISION OFFICES
FROM:
PATRICK LUEBBERING, ACTING DIRECTOR
SUBJECT:
JANUARY 2017 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME
MANUAL REVISION #58
0410.010.15  
APPENDIX E

DISCUSSION:

In January 2017, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive a 0.3% 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 10, 2016.

This memorandum discusses the following:

NEW AMOUNT OF SSI

Effective 2017, SSI benefit amounts are as follows:

 

NEW AMOUNT

INCREASE/DECREASE

SSI Individual maximum (in own household)

$ 735.00

$ 2.00

SSI Couple maximum (in own household)

$ 1103.00

$ 3.00

SSI Individual in household of another

$ 490.00

1.33

SSI Couple in household of another

$735.00

$2.00

SSI Essential person/own home

$ 368.00

$ 1.00

The minimum SMI Premium is $104.90 for 2017.

NEW MO HEALTHNET FOR AGED, BLIND, AND DISABLED STANDARDS

Maximum Allotment to Community Spouse

$3023.00

Maximum Allotment to Child

$368.00

Minimum Maintenance Standard for Allotments

$2003.00

Minimum Spousal Share

$24,180.00

Maximum Spousal Share

$120,900.00

Maximum Home Equity

$560,000.00

HCB Maximum

$1285.00

SAB Standard

$794.00

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, 2017.

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:

SMI PREMIUM ADJUSTMENT

SMI premiums will increase for most individuals in 2017.  The SMI premium for those who begin receiving Medicare in 2017 will be $134.  Premiums for those who were receiving Medicare prior to 2017 will be adjusted, but will not increase more than the amount of the increase in benefit the individual received. 

EXAMPLE:  Ms. Brown receives Social Security of $1000 and pays $104.90 SMI in 2016.  Effective January 1, her Social Security will increase to $1003.  Her SMI will increase, but by no more than the amount of her benefit increase, $3 in this example.  It may be necessary to request verification from the participant of their SMI premium.

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 2017 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, 2016.  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 2017, 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. 

If the participant reports their SMI increased, but no adjustment was completed during the COLA adjustment, check IIVE.  If the amount shown on IIVE is not the same as reported by the participant, request verification of the new amount from the participant.  The Social Security Administration will send notices with the new benefit amount and SMI premium to each individual.

NOTE: If IIVE and the Social Security Administration letter differ in benefit amount or SMI premium, use the amounts listed on the letter.

MASS ADJUSTMENT PROCESS

The mass adjustment will begin in FAMIS on December 10, 2016.  FAMIS will be unavailable until the adjustments are completed.  If the adjustments are not completed by the morning of Monday, December 12, 2016, staff will be notified. 

Most EUs with SSA/SSI/VA/RR income that are active by the end of the day on December 9, 2016, with a certification ending January 2017 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 2017 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 0.3%.  The comment, "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 0.3%.  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 0.3%.  The comment, "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 2017 or February 2017, 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 012017.  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 012017.  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 012017. 

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.

REPORTS WITH ACTIONS NEEDED

The following reports with action needed will be distributed to the Food Stamp, Temporary Assistance/Child Care, and MO HealthNet Program Administrators for assignment.   Following are instructions on how to process each type of report.

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:

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:

Each eligibility specialist must access the report assigned to him/her by the Program Administrator. 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.

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 0.3% 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 9, 2016.

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 2016 or January 2017 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:

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-510or 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 2017 and later months when completing the application/controlled flow.

NOTE:  For 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 an eligibility specialist, FAMIS will send an FA-510 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 and search the virtual file room (VFR). 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.

NOTICES

Two types of notices are generated as a result of the mass adjustment. The Adverse Action Notices will be dated December 12, 2016. The Action Notice generated by the mass adjustment will be dated December 27, 2016, to allow adequate mail time due to the large volume of cases affected. Notices will not be 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-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.

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.  

REQUEST FOR HEARING/CONTINUED BENEFITS

If the EU requests a fair hearing, see APPLICATION FOR STATE HEARING (IM-87) FOR ALL INCOME MAINTENANCE PROGRAMS AND THE FOOD STAMP PROGRAM  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:

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 and FA-420 Adverse Action Notice is dated December 12, 2016. Any EU receiving an FA-510or 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 and FA-460 Action Notice generated by the mass adjustment is dated December 28, 2016. Mass adjustment actions REDU (reduction), and CLOS (closing) receive the FA-150 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 28, 2016.

NECESSARY ACTION:

PL/ha/vb

2016 Memorandums