• Must comply with an appropriate treatment program or face suspension or termination of benefits;

• May receive OASDI and/or SSI benefits up to a maximum of 36 months;

• Must have benefits paid to a representative payee; and 

• Must have any past due benefits paid in installments instead of a lump sum payment.

This memorandum explains each of SSA's provisions and their impact on IM programs

A.     SUSPENSION FOR NON-COMPLIANCE

When an individual is determined, by the SSA, not to be in compliance with the individual's treatment requirements, payments will be suspended:

• 2 consecutive months for the first determination of non-compliance;

• 3 consecutive months for the second determination of non-compliance;

• 6 consecutive months for the third and all subsequent determinations of non-compliance

The SDX or TPQY printout will show one of the following codes when an individual's SSI payments have been suspended:

• N10 Non-compliance with a drug treatment program.

• N11 Non-compliance with an alcohol treatment program.

• S08 no representative payee assigned

• S09 Non-compliance with treatment requirements.

2)     Food Stamp Categorically Eligible

A household in which a member is suspended from SSI for non-compliance with DA&A treatment requirements is not categorically eligible to participate in the Food Stamp Program.  The household cannot be considered categorically eligible as SSI recipients again until that individual's suspension ends and s/he starts receiving SSI benefits.

Because these individuals will not receive any retroactive SSI benefits for the period of suspension, they would not be "authorized to receive" SSI benefits as required for categorical eligibility.  In order to regain food stamp certification, the household would have to be determined eligible under normal requirements.  Their food stamp eligibility determination would be calculated without including an SSI benefit as income for the suspended individual until the suspension period ended and benefits are resumed.

3)     Title XIX (Medicaid) Benefits

An individual placed in suspended status, for non-compliance, by the SSA, is still considered an SSI recipient for purposes of disability.  No MRT decision is required in determining MA eligibility for these individuals.

4)     General Relief

An individual placed in suspended status for non-compliance by SSA is NOT eligible for General Relief benefits.

For GR rejection notices, cite Section 208.015 RSMo, which provides that an individual approved for SSI is not eligible for General Relief.

B.     TERMINATION FOR NON-COMPLIANCE

A suspension of benefit payment, by the SSA, due to non-compliance with the treatment requirements for 12 consecutive months will result in termination of all OASDI and SSI benefits.

The SDX or TPQY printout will show code T031 for individuals when benefits have been terminated for non-compliance.

The SSA has not implemented a code for the Bendex System.  This information will be forwarded when a code is assigned.

1)     Title XIX (Medicaid) Benefits

An independent disability determination must be completed for any individual when OASDI and SSI benefits have been terminated, by the SSA, due to non-compliance with the individual's treatment requirements.

2)     Reinstatement of OASDI and SSI benefits

Any individual whose OASDI and/or SSI benefits have been terminated, by the SSA, for non-compliance with treatment requirements may reapply and receive OASDI and/or SSI payments based on DA&A following a period of compliance with an appropriate treatment program.

3)     General Relief

Any individual whose benefits have been terminated for non-compliance, by the SSA, is NOT eligible for General Relief benefits.

For GR rejection notices, cite Section 208.015 RSMo, which provides that an individual approved for SSI is not eligible for General Relief.

C.     TERMINATION AFTER 36 MONTH PAYMENTS

OASDI and/or SSI payments will terminate following receipt of a maximum of 36 months of benefit payments when disability is based on DA&A.  Individuals may not be entitled to any subsequent OASDI and/or SSI payments when DA&A is the determining factor for disability following receipt of 36 months payments.

1)     For OASDI a month is counted toward the 36 months only when 
         treatment is available.

2)     For SSI all months of SSI receipt count towards the 36 months.

Any individual whose OASDI and/or SSI payments have been terminated, by the SSA, following receipt of 36 months payments based on DA&A is still considered an OASDI or SSI recipient for purposes of disability.  NO MRT decision is required in determining MA eligibility for these individuals.

Such terminations can not occur prior to March 1, 1998; additional information will be provided prior to that time.

D.     REPRESENTATIVE PAYEE

Any individual entitled to OASDI and/or SSI payments, when DA&A is a contributing factor for disability, must have payments made payable through a representative payee.

The representative payee will be allowed to charge the individual a service fee, as established by the SSA, not to exceed $50.00 per month, in any case in which the individual is entitled to benefits where disability is based on DA&A.

1. Medical Assistance, SAB and SNC Programs

The amount of the service fee which the representative payee withholds is not an allowable expense for medical assistance programs.  The gross income will be used for eligibility determinations.

2. Food Stamps

The amount of the fee, which the representative payee withholds from the funds it receives on behalf of the SSI or OASDI recipient, is not counted as income to the household for food stamp purposes.
 
3. AFDC and AFDC Related Medicaid Programs

The amount of the fee, which the representative payee withholds from the funds it receives on behalf of the SSI or OASDI recipient, is not counted as income to the household for AFDC and AFDC related Medicaid programs.

Individuals approved for retroactive OASDI and/or SSI benefits, where disability is based on DA&A, will have past due benefits paid by installments through a representative payee.

How to Count OASDI and SSI Retroactive Payments
 

1. Medical Assistance, SAB and SNC Programs

When an individual is approved for retroactive benefits that will be paid by installment count the total past due benefits as income during the first month the individual (through a representative payee) receives a check for past due benefits, even though the individual (through a representative payee) will not receive the total amount for which he/she has been approved in that month.

Do not count past due benefits, paid to the individual (through a representative payee) by installment payments, in any subsequent months as income for eligibility determinations.

2. Food Stamp Program

When a household receives installment payments for two or more months, they will be considered recurring payments and the total amount actually received will be counted as income in the month the payment is received.

3. AFDC

Installment OASDI payments to AFDC recipients will be budgeted as income in the month received.  Any portion of the payment retained beyond the month of receipt will be considered an available resource.

Installment SSI payments to AFDC recipients will be excluded from consideration as income.  If the individual continues to be SSI eligible, any portion of the SSI payment retained beyond the month of receipt will be excluded from consideration as an available resource for the remaining members of the assistance group.  If the SSI payment is retroactive only and the individual does not continue to be SSI eligible, the SSI payment is excluded form income and is excluded from consideration as an available resource in the month of receipt and the following month.  Any portion retained beyond that time is counted as an available resource.

Installment OASDI payments to AFDC recipients who also receive an SSI payment will be excluded from income.  The resource determination also excludes SSI recipients from consideration in the AFDC eligibility determination.

4. AFDC Related Medicaid Programs

For AFDC related Medicaid cases both OASDI and SSI installment payment will be counted as income in the month they are actually received.

• Review this memorandum with all appropriate staff.