Budgeting-Medical Benefits 2017 Social Security Cost of Living Adjustments

Illinois Department of Healthcare and Family ServicesIllinois Department of Human Services

03/17/17

Action Memo

Summary:

  • Provides information about the central budgeting of the 2017 Social Security (SSA) cost of living adjustment (COLA) effective January 2017 for persons residing in nursing homes (NH) or supportive living program (SLP) facilities;
  • Federal law provides that the 2017 SSA COLA increases are not to be used for the months of January, February, and March 2017 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.
  1. Exceptions to Central Budgeting
  2. Exception Codes and Code Descriptions
  3. Central Budgeting
    1. SLP Cases with SNAP
  4. Central Budgeting Process
  5. Central Notices
    1. Client Notice 16.17
    2. Client Notice 16.16
  6. Provider Report
  7. LTC Hub Report
  8. Budgeting the 2017 SSA COLA For Persons Who Reside In the Community and For Persons Who Receive QMB, SLIB, OR QI-1 Benefits
    1. Applications Processed Through IPACS
    2. Active Cases
  9. Forms referenced

Effective January, 2017 SSA COLA adjustments were centrally budgeted for persons who receive regular medical benefits under categories 91, 92, or 93 and who reside in an NH or SLP. This action included central budgeting of the SSA COLA for cases with income other than SSA benefits. The Long Term Care (LTC) Hub and the Family Community Resource Center (FCRC) are responsible for budgeting the SSA COLA for an NH or SLP resident enrolled in spenddown. SSA COLA adjustments are not centrally budgeted for an NH or SLP resident enrolled in spenddown.

The January central budgeting of 2017 SSA COLA adjustments does not include persons who reside in the community and receive medical benefits under categories 91, 92, 93, 94, or 96.  The 2017 SSA central budgeting for persons who reside in the community and receive regular medical benefits is effective in April 2017.

The January central budgeting of 2017 SSA COLA adjustment does not affect QMB, SLIB, or QI-1 eligibility.  2017 SSA COLA adjustments for QMB, SLIB and QI-1 are effective in April 2017.

Exceptions to Central Budgeting

Certain NH and SLP case situations prohibit central budgeting of the SSA COLA. These cases are found in report titled "Exceptions to Central Budgeting of SSA COLA Adjustments". The exception report was mailed to FCRCs and placed in Mobius (Report #2736Y101) on or about 12/21/16. Manually budget the 2017 SSA COLA adjustment for NH or SLP cases that appear on the exception report by updating IPACS with the new SSA benefit information. Updates to IPACS, with the new SSA information, later than March 2017 may cause Medicaid Quality Control errors. The January 2017 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: The exception list includes all of the exception codes and is not specific to persons who reside in an NH or SLP.

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 SLP case with a credit segment opened in MMIS for 01/17.
3 NH or SLP 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 SLP case with the most recent credit information closed in MMIS.
6 NH or SLP 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 SLP 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 SLP case with no SUP. BY indicator 3 or 4 entered with code 395 GCARE in Item 80.
12 NH or SLP case with an opened credit amount in MMIS and no credit information entered in CIS (no Item 80 code 395 GCARE).
13 NH or SLP 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 SLP case in which:
  • the SSA benefit amount (as entered in BENDEX) for 01/17 is less than the benefit amount for 12/16; 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

SLP Cases with SNAP

SLP cases with SNAP require special procedures to prevent the central budgeting action from affecting the 01/17 SNAP benefits. Source code "9" is centrally entered with the 2016 SSA income amount in Item 90 and applies only to the SNAP benefits. The second SSA income amount in Item 90, with no source code, applies only to the medical benefits. Central budgeting of the 2017 SSA COLA adjustment occurs only for SSA Item 90 income entries without a source code "9".

Central Budgeting Process

View the updated case information in Mobius (Report #27364051) for each NH and SLP case centrally budgeted. The updated case information includes:

  • the 2017 gross SSA benefit amount for medical in Item 90 ;
  • the revised NH or SLP credit amount in Item 80 code 395 GCARE; and
  • the message "SSA COLA Centrally Budgeted" in Item 93.

Central Notices

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

Client Notice 16.17

CN 16.17/CN 16.17S, Giving Income to Community Spouses or Dependent Family Members (pdf) was mailed the last week of December 2016, to certain NH and SLP customers receiving benefits (regular or spenddown) under Category 91, 92, or 93. This notice was centrally mailed to customers who divert income to a community spouse or a dependent family member. CN 16.17 informs the customer that proof of all family members monthly income is required and must be provided to the Long Term Care (LTC) hub (Macon County LTC or Medical Field Operations) to determine if the increased SSA benefits may be diverted.

Allow the increased deduction for the effective month of the reported change when verification is received.

Client Notice 16.16

CN 16.16/CN 16.16S, Notice of Change in the Amount Owed for Long Term Care (pdf) was centrally mailed the last week of December 2016 to NH and SLP customers without a community spouse or dependent family member and for whom the 2017 SSA COLA adjustment was centrally budgeted.

CN 16.16 contains case-specific information regarding the NH and SLP customers gross 2017 SSA benefit including the amount for January 2017 that was determined as available to apply toward the cost of care.

This notice eliminates the need to complete HFS 2500 Nursing Home/Supportive Living Facility Resource Calculation  for each NH and SLP customer whose 2017 SSA COLA adjustment was centrally budgeted. If the customer has an approved representative, complete and send HFS 2500 to the approved representative.

Provider Report

A provider-specific report titled "LTC Central Budgeting of SSA COLA Adjustment" is sent to each NH and SLP.  The report identifies each customer whose 2017 SSA COLA adjustment was centrally budgeted.

A copy of the provider-specific report is sent to the LTC hub and can be viewed in Mobius (report #2736Y151).

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

LTC Hub Report

Report titled, "Long Term Care Residents - Diversion of Income"  is sent to the hub and can be viewed in Mobius (report #2736M101). The report identifies each customer who received CN 16.17

Contact Programs Control at (217) 785-7716 with questions regarding any COLA report.

Budgeting the 2017 SSA COLA For Persons Who Reside In the Community and For Persons Who Receive QMB, SLIB, OR QI-1 Benefits

The 2017 SSA COLA adjustment is not to be used for the months of January, February, and March 2017 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 2017 using the December 2016 SSA benefit amount for community cases. Set a control to recalculate the person's medical eligibility for April 2017 using the adjusted 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 2017, 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 2017

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 2017 using the increased SSA benefit amount.

We plan to centrally budget the SSA COLA effective April 2017 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 2017. Refer to the Action Memorandum titled "2017 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.

[signed copy on file]

James T. Dimas
Secretary, Illinois Department of Human Services

Felicia F. Norwood
Director, Healthcare and Family Services

Forms referenced

CN 16.16, CN 16.16S

CN 16.17, CN 16.17S

Form 2500