Budgeting-Medical Benefits 2015 Social Security Cost of Living Adjustments

Illinois Department of Human Services
Illinois Department of Healthcare and Family Services

06/08/15

Action Memo

Summary:

  • Provides information about the central budgeting of the January 2015 Social Security (SSA) cost of living adjustment (COLA) for persons residing in nursing homes (NH) or supportive living facilities (SLF);
  • Due to federal law, provides that the 2015 SSA COLA is not to be used for the months of January, February, and March 2015 when determining medical eligibility for a person who resides in the community under category 91, 92, 93, 94, or 96 or when determining QMB, SLIB, or QI-1 eligibility.

Starting with SSA checks received in January 2015, a person receiving SSA benefits got a COLA increase. Effective January 2015, we centrally budgeted this adjustment for a person who receives regular medical benefits under categories 91, 92, or 93 and who resides in an SLF or NH. This action included central budgeting of the SSA COLA for cases with income other than SSA benefits. The central action did not affect QMB, SLIB, or QI-1 eligibility.

The Family Community Resource Center (FCRC) is responsible for budgeting the SSA COLA for an SLF or NH resident enrolled in spenddown.  These individuals SSA COLA was not Centrally budgeted.

Central budgeting of SSA benefits is an effort to process the January SSA COLA. This central action applied only to changes in SSA benefits for NH or SLF residents.

The January 2015 central action did not include persons who reside in the community and receive regular medical benefits under categories 91, 92, 93, 94, or 96. We centrally budgeted the SSA COLA for these persons effective April 2015.

Exceptions to Central Budgeting

Certain NH and SLF case situations prohibit central budgeting of the SSA COLA. These cases are reported to FCRCs on a list titled "Exceptions to Central Budgeting of SSA COLA Adjustments." The exception list was mailed to FCRCs and placed in Mobius (Report #2736Y101) on or about 12/15/14. FCRC staff must budget the SSA COLA for NH or SLF cases that appear on this exception list by updating IPACS with the new SSA benefit information. Updates to IPACS, with the new SSA information, later than March 2015 may cause Medicaid Quality Control errors. The January 2015 SSA benefit change amount should be processed in the LTC Subsystem.

Information on the exception list includes one of the following exception reason codes. Refer to the following exception reasons when reviewing cases identified on the exception list.

NOTE: Although the January 2015 central process affects only those persons who reside in an SLF or NH, the exception list contains all of the exception codes.

Exception Codes and Code Descriptions

Exception Code Code Description
1 Person receives medical benefits under category 90, 98, QMB Only, or SLIB Only.
2 NH or SLF case with a credit segment opened in MMIS for 01/15.
3 NH or SLF case in which the central budgeting of the COLA adjustment results in a credit amount equal to or greater than the HFS rate (zero balance bill).
4 Form 552 shows case receives SSA, but BENDEX is not reporting it for December.
5 NH or SLF case with the most recent credit information closed in MMIS.
6 NH or SLF case with income diverted as the FMNA (code 671 in Item 90 of Form 552).
7 Community case with code 158 CI in Item 80 and the COLA adjustment may result in a spenddown based on the number of persons in the Income Standard.
8 NH or SLF spenddown case (code 391 SPDGC in Item 80).
9 Community spenddown case (code 390 SPD in Item 80).
10 Community case with no code 158 CI entered in Item 80 of Form 552.
11 NH or SLF case with no SUP. BY indicator 3 or 4 entered with code 395 GCARE in Item 80.
12 NH or SLF case with an opened credit amount in MMIS and no credit information entered in CIS (no Item 80 code 395 GCARE).
13 NH or SLF case with code 395 GCARE in Item 80 and no opened credit amount in MMIS.
14 Community case in which Item 11 has a code 1, 2, 3, 4, 7, or 9 in the S or O columns.
15 Case with a code A, F, H, N, P, or R in Item 78, or All Kids/FamilyCare Share, All Kids/FamilyCare Premium, or All Kids/FamilyCare Rebate case.
16 Reserved.
17 Person resides in Sheltered Care facility (code 13 in Item 20).
18 NH or SLF case in which:
  • the SSA benefit amount (as entered in BENDEX) for 01/15 is less than the benefit amount for 12/14; and
  • income is diverted to a community spouse and/or a dependent child(ren) under age 21 who does not reside with a community spouse (SUP. BY indicator number 4 in code 395 GCare and code 670 and/or code 672 in Item 90).
19 Client database shows SMIB Buy-In, but BENDEX records do not yet indicate SMIB Buy-In.
20 Community case with code 20 in Item 20 in which income is diverted as the CSMNA or the FMNA (SUP. BY indicator 4 in code 158 CI of Item 80 and code 670 and/or code 671 in Item 90).
21 Community case with code 20 in Item 20 in which a SUP. BY indicator 3 or 4 is not entered with code 158 CI in Item 80.
22 Case receives SSA as entered on Form 552, but BENDEX did not report during the COLA process.
23 Case is eligible for a medical extension or Family Assist (code X or F in Item 25).

Central Budgeting

SLF Cases SNAP

SLF/SNAP cases require special procedures to prevent this central budgeting action from affecting the 01/15 SNAP benefits. In order to budget the SSA COLA adjustment for only the medical benefits portion of the case, a source code 9 is centrally entered with the current SSA Item 90 income code. This entry, with the source code 9, applies only to the SNAP portion of the case. A second SSA Item 90 income code is centrally entered with the new January 2015 gross SSA benefit amount. A source code 9 is not entered with the second Item 90 income code. The second entry, with no source code 9, applies only to the medical benefits portion of the case. Central budgeting of the SSA COLA adjustment occurs only for SSA Item 90 income entries without a source code 9.

Central Budgeting Process

FCRCs may view the updated case information in Mobius (Report #27364051) for each NH and SLF case centrally budgeted. The updated case information includes:

  • the new gross SSA benefit amount in Item 90;
  • the revised NH or SLF credit amount in Item 80 code 395 GCARE; and
  • the message "SSA COLA Centrally Budgeted" in Item 93.

The updated Form 2449 contains the revised NH or SLF credit amount for January 2015 in Item C and the message "SSA Cost of Living Adjustment Centrally Budgeted" in the lower right-hand corner of the form.

Central Budgeting Process - Information Does Not Match

Central budgeting of the SSA COLA includes the following specific central actions when the BENDEX type of SSA benefit information does not match the SSA type of benefit information shown in ACM.

For all NH cases, and for SLF cases which do not receive SNAP:

  • the inappropriate SSA Item 90 code(s) is deleted; and
  • the new gross SSA benefit amount for January 2015 is entered with the appropriate SSA Item 90 income code(s).

For SLF cases that receive SNAP, the following actions prevent the central budgeting of the COLA adjustment from affecting the 01/15 SNAP benefits:

  • source code 9 is centrally entered in the current SSA Item 90 income code which does not include the COLA adjustment; and
  • the gross SSA benefit amount for January 2015 is centrally entered with the appropriate SSA Item 90 income code and without a source code; and
  • the appropriate SSA Item 90 income code is centrally entered with $0.00 for the amount and with source code 9.

FCRCs may delete the Item 90 code which does not include the COLA adjustment, and the Item 90 code with source code 9, when the amount to be budgeted for medical benefits and SNAP is equal.

Central Notices

The following notices are issued as part of the central budgeting process.

Client Notice 15.04 (CN 15.04)

CN 15.04/CN 15.04S, Giving Income to Community Spouses or Dependent Family Members (pdf) was mailed the last week of December 2014, to certain NH and SLF customers receiving benefits (regular or spenddown) under Category 91, 92, or 93. This notice was centrally mailed to each customer who is diverting income to a community spouse or a dependent family member. CN 13.36 informs the customer that proof of all income their family members receive monthly must be provided to their local FCRC (in Chicago, Medical Field Operations) if they want DHS to determine if the increased SSA benefits may be diverted.

If the person submits the documentation to the FCRC, and the increased SSA benefits may be diverted, allow the increased deduction effective with the month of the reported change.

It is important to note that central budgeting of the SSA COLA occurred for these cases, unless an exception code prohibited the central action.

Client Notice 15.03 (CN 15.03)

CN 15.03/CN 15.03S, Notice of Change in the Amount Owed for Long Term Care (pdf), was centrally mailed the last week of December 2014, to resident's without a community spouse or dependent family member and for whom the SSA COLA was centrally budgeted. A copy was not sent to FCRCs.

This notice contains case-specific information regarding the resident's January 2015 SSA benefits and provides the amount for January 2015 that was determined as available to apply toward the cost of care.

This notice eliminates the need to complete Nursing Home/Supportive Living Facility Resource Calculation (Form 2500) for each resident whose SSA COLA was centrally budgeted. If the person has a representative, the FCRC must complete and send Form 2500 to the representative.

Provider Report

Each SLF and NH will receive a provider-specific report titled "LTC Central Budgeting of SSA COLA Adjustment." The report identifies each customer whose SSA COLA was centrally budgeted. The FCRC will also receive a copy of the provider-specific report and the report will be in Mobius (#2736Y201). The report includes the following information:

customer's name;

RIN;

case number;

January 2014 NH or SLF credit amount; and

January 2014 SSA check amount.

Refer provider questions regarding this report to SSA Programs Control at (217) 785-7716.

FCRC Report

Each FCRC received an FCRC-specific report titled, "Long Term Care Residents - Diversion of Income" also found in Mobius (#2736M101), that lists each customer who received CN 15.04. The report includes the following information:

  • customer's name;
  • RIN;
  • case number;
  • facility name;
  • facility number;
  • county; and
  • caseload.

Each FCRC received a FCRC-specific report titled "COLA Updated Cases with More Than One Source of Income" also found in Mobius (#50489761). This report identifies each customer whose SSA COLA increase was centrally budgeted and who has one or more other sources of income. The report includes the following information:

  • customer's name;
  • case number;
  • caseload;
  • TPL code (if any); and
  • other income code(s).

FCRCs may contact SSA Programs Control at (217) 785-7716 with questions regarding any COLA report.

Budgeting the SSA COLA For Persons Who Reside In the Community and For Persons Who Receive QMB, SLIB, OR QI-1 Benefits

The 2015 SSA COLA is not to be used for the months of January, February, and March 2014 when:

  • determining medical eligibility for a person who resides in the community under a category 91, 92, 93, 94, or 96 (including a person who resides in a sheltered care facility); or
  • determining QMB, SLIB, or QI-1 eligibility.

Applications Processed Through IPACS

Determine medical eligibility for January, February, and March 2015 using the December 2014 SSA benefit amount for community cases. Control to recalculate the person's medical eligibility for April 2015 using the increased SSA benefit amount.

If the case has SNAP benefits, use the correct SSA amount for the proper month. If the first regular roll month is prior to April 2015 and the amount of SSA to budget differs for medical and SNAP benefits, enter a source code 9 with the Item 90 SSA income code for the amount to budget for SNAP benefits and no source code 9 with the Item 90 SSA income code for the amount to budget for medical.

Active Cases

For medical eligibility, do not consider the increase until April 2015.

Enter the correct SSA benefit amount the person is expected to receive for the budgeting month in ACM. ACM will calculate medical eligibility for the effective month of January, February, and March by subtracting the SSA COLA increase from the SSA benefit amount for community cases. ACM does not subtract the SSA COLA increase from the amount budgeted for SNAP benefits. To budget a different SSA amount for SNAP benefits, ACM allows for the optional entry of SSA income to be budgeted for SNAP benefits only. Establish a control to recalculate the person's medical eligibility for April 2015 using the increased SSA benefit amount.

We plan to centrally budget the SSA COLA effective April 2015 for persons who receive regular medical assistance under categories 91, 92, 93, 94, or 96 and who reside in the community.

For the SNAP benefit portion of a medical assistance case, the SNAP benefit central budgeting process will budget the SSA COLA for March 2015. Refer to the Action Memorandum titled "2015 SSA and SSI Benefit Increase - Cash and SNAP Cases." A second Item 90 SSA income code with a source code 9 will be entered so the increase will only budget for SNAP benefits.

[signed copy on file]

James Dimas

Secretary designate, Illinois Department of Human Services

Felicia F. Norwood

Director, Illinois Department of Healthcare and Family Services

Forms referenced:

CN 15.03, CN 15.03S

CN 15.04, CN 15.04S

Form 2500