2635 Persons with Drug Addiction or Alcoholism - Based on the drug addiction and alcoholism provisions of the SSI program, SSI benefits are not available to individuals whose drug addiction or alcoholism is a contributing factor to the determination of disability (i.e., would not be found disabled if the drug abuse and/or alcohol abuse were to stop). These provisions became effective as of March 29, 1996. Medical eligibility under the SI or MS program shall not be provided in such instances. However, SSI beneficiaries whose benefits are terminated due to these provisions and who are medical recipients shall continue to be eligible for Medicaid if they timely appeal the SSI decision and are otherwise eligible except for the disability determination. Such eligibility continues throughout the appeal process. Verification from SSA that the appeal was filed timely is required.

2636 Loss of Recipient Status - "See Policy Memo #99-10-10 re: "Medical Redetermination Following Cash Closure".

Upon the loss of SSI recipient status (other than that noted in 2634 and 2635), case action must be effective no later than the end of the month following the month of such loss allowing for timely and adequate notice. However, persons whose benefits are terminated due to loss of disability status and who timely appeal the SSI decision (defined as within 90 days of notification of termination) shall continue to be eligible for medical assistance if they are otherwise eligible except for the disability decision. Such eligibility continues throughout the appeal process. Verification from SSA that the appeal was filed timely is required. Those who appeal within 10 days of notification can choose to continue SSI benefits during the appeal process and would still be considered SSI recipients.

For persons whose SSI benefits are suspended for a month due to excess income, medical assistance shall continue provided there is SSI eligibility in the following month and all other eligibility factors are met. If it is documented that the SSI case is suspended because the Social Security Administration is unable to determine current eligibility for SSI, the case should no longer be considered eligible under this section. Continued eligibility may be determined for MS or other programs including Working Healthy if the person is employed.

If the local office has information that the SSI recipient has resources, including income, which the SSA verifies will make the individual ineligible for SSI, EATSS information will be disregarded, and the case would no longer be considered eligible under this section. Continued eligibility may be determined for MS or other programs.

2637 Effect of Institutionalization - Persons who enter a medical institution and for whom Medicaid will pay for a portion of their care will be limited to a maximum $30 SSI payment level for each full month they stay in the institution except as noted below for 1619 eligibles and persons approved under SSI's temporary stay policy. As a result, some individuals may lose their SSI payment status while institutionalized if their countable income exceeds this level and continuing eligibility under another program such as MS may need to be determined.

There is no SSI eligibility for persons who reside in most public institutions such as prisons or other correctional facilities unless it is a medical facility for which Medicaid payment can be provided. This would include the state psychiatric and mental retardation hospitals. However, individuals between the ages of 21 and 65 in a state psychiatric hospital are not eligible for Medicaid payments and thus would lose SSI eligibility. See also 8112.4. Upon return to the community, such payments would be approved again. This provision would not apply to persons in the institution less than a full calendar month or as noted below for 1619 eligibles.

SSI recipients in long term care in a Medicaid approved institution may be obligated for a share of their cost of care if income is in excess of the $62 PIL (other than the 1619 payment referred to below) beginning with the month following the month of entrance. (See 8172.) In such instances, a separate medical budget must be done off the system to compute the amount of obligation.

NOTE: SSI recipients (including those in 1619b status) in the HCBS program will not have a client obligation. See 8271.

SSI recipients who qualified for 1619 (a) or 1619 (b) status in the month prior to entering a Medicaid-approved institutional living arrangement may be eligible to have up to 2 months of SSI payments determined at the regular benefit level and such payments shall be totally disregarded in determining the client obligation. In addition, SSI recipients who enter a Medicaid approved institution for a temporary stay may be eligible to receive continued full SSI benefits for a period not to exceed 3 months following the month of entrance. Such benefits shall not be considered in determining the client obligation but any other income would be counted if LTC procedures are being used.

NOTE: Persons who retain SSI recipient status while institutionalized may be subject to transfer of property penalties. See 8170.

2638 Protected Filing Date - If an individual makes application for medical and has been or is later denied disability status under the SSI program, there is no eligibility for automatic status and, unless the individual otherwise qualifies for another FFP medical program, the application shall be denied. However, if the individual requests reconsideration of the disability decision or formally appeals the SSI decision within the allowable SSA reconsideration/appeal period, the medical application date shall be protected for purposes of eligibility (including prior eligibility). Verification of the timely request or appeal must be documented. If the client obtains disability status upon reconsideration or wins the SSI appeal and reapplies for medical, automatic eligibility shall be provided back to the protected medical application date, including the 3 prior months, provided that the individual is determined eligible for SSI for this entire time period.

2639 Special Provisions for Children Terminated from SSI Due to Changes in Disability Criteria - Based on the provisions of the Budget Reconciliation Act of 1997, children who lose eligibility for SSI benefits due to changes in the SSI childhood disability criteria resulting from the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) shall continue to be eligible for medical assistance as long as they would be otherwise eligible for SSI except for the loss of disability status. See also 2636 regarding children whose termination of benefits is timely appealed. This group of children is limited to those receiving SSI benefits as of August 22, 1996, including those who have been receiving SSI in another state and subsequently move to Kansas. Documentation of SSI termination due to the new disability criteria is required as well as verification that the individual was receiving SSI on August 22, 1996. The Social Security Administration provides periodic lists of individuals who no longer meet disability criteria under these provisions.

In order to continue medical coverage under this provision, the general eligibility requirements of cooperation and residency contained in 2100 must be met. In addition, financial eligibility must be redetermined on a yearly basis. This can be accomplished in one of two ways. First, a Medicaid poverty level determination in accordance with the Kansas Family Medical Assistance Manual is to be done and children meeting this criteria set up under the MP program. If the child does not meet the financial criteria for MP Medicaid, falls into Title 21 or loses poverty level coverage, an SSI financial determination is to be done. Countable resources of the custodial parent(s) and the child must be below the appropriate resource standard per 5130. Countable income shall be determined through use of the electronic SSI eligibility worksheet. The income of the custodial parents (including any stepparents) and the child, and any of the child's natural or adoptive siblings is to be considered on this worksheet. If the countable income obtained is less than current one-person SSI beneficiary level, the child remains eligible. Procedures set forth in Policy Memo 99-10-10 regarding ex parte redeterminations shall be utilized to the extent possible when completing the financial determination.

NOTE: Children identified to be protected under this class shall be identified with a person alert of "SI" on the KAECSES PRAP screen.

Coverage under this provision is available through the month the child turns age 18. Continued medical eligibility after this time would then have to be determined under other existing categories (e.g., MS if person meets adult disability criteria).