DLTC INFO MEMO 2008-11
STATE OF WISCONSIN
DLTC Info Memo Series 2008-11
Department of Health Services Date: September 24, 2008
Division of Long Term Care Index Title: SSI-E Certification
For: County Departments of Human Services Departments
County Departments of Social Services Directors
County COP and Waiver Coordinators
Children's Services Specialists
Community Support Programs
Children's Services Specialists
Board on Aging and Long Term Care
Disability Rights of Wisconsin
Area Administrators/Human Services Area Coordinators
From: Sinikka Santala
Subject: SSI-E Certification
The purpose of this memo is to clarify who certifies and monitors for
SSI-E eligibility in counties under the Family Care expansion.
The SSI-E supplement is a state program which provides extra monthly
income to qualifying individuals who already receive state federal SSI
(see policy manual at: http://www.emhandbooks.wi.gov/ssi-e/).
Under current policy, the following county agencies are authorized to
carry out SSI-E certification and monitoring: Department of Social
Services, Department of Human Services, Department of Community Programs,
County Aging Units, and Developmentally Disabled Services. In addition,
these county agencies are permitted to have the SSI-E assessment and
certification forms prepared by a private contract agency.
At present, all SSI-E application forms F-20818 (Application
for SSI-E Certification form) must be signed by the agency director or
by his/her authorized representative.
For non-Family Care counties and populations, county agencies are also
responsible for monitoring that SSI-E recipients continue to reside in a
qualified substitute care setting with costs to the person at least equal
to the SSI-E payment level. If the person no longer resides in such a
setting, the agency will decertify the person and will notify EDS, who
will stop payment. Similarly, if the authorizing agency becomes aware that
the person no longer needs at least 40 hours per month of qualifying
services, the agency will decertify the person and will notify EDS.
Other reasons for termination may include: loss of federal SSI
eligibility or moving to another state. Because federal SSI recipients'
data interfaces with the state's system, whenever individuals are
terminated from federal SSI they are also automatically terminated from
state SSI and SSI-E. Occasionally someone who moves out of State is not
properly identified in the federal exchange data. When counties become
aware that an SSI-E recipient has moved out of state, the county should
decertify the individual.
Moreover, information about a small group of State SSI
"grandfathered" individuals does not interface with federal
exchange data. There are approximately 4,500 of these individuals left
across the state, and we expect their numbers to dwindle to zero within a
few years. "Grandfathered" individuals' information is monitored
on a yearly basis through a state survey process administered by EDS.
Individuals who no longer meet financial eligibility criteria are
terminated by EDS.
Family Care Expansion
For Family Care populations in Family Care counties, the Aging and
Disability Resource Center (ADRC) determines SSI-E eligibility as part of
the initial functional screen process. State statutes [s.46.283(3)(k)]
include SSI-E determination as one of the required ADRC responsibilities.
For non-Family Care populations, i.e., people with mental illness and
children, the county could contract with a private contract agency as they
currently do, or the county could contract with the ADRC.
For SSI-E determinations performed by ADRCs, the requirement that
the county agency director review and approve the SSI-E certification is
being replaced by the requirement that the ADRC director or designee
review and approve the SSI-E certification. This will simplify and
eliminate the county workload related to review of SSI-E determinations
for Family Care populations, as well as non-Family Care populations when
counties contract with ADRCs to perform SSI-E certification for these
It is possible that an individual would become eligible for SSI-E after
initial enrollment in Family Care due to change(s) in the individual's
condition and/or circumstances. For these cases, the MCO will complete the
initial SSI-E determination and certification, since the MCO is familiar
with these individuals and their functional condition. The ADRC would be
responsible for the initial SSI-E determination and certification of
individuals who become eligible for SSI-E after enrollment in IRIS.
For Family Care populations, the MCO is responsible for the annual
recertification of its members. The ADRC will be responsible for the
annual recertification of clients in the new self-directed supports
waiver, called IRIS.
It is most efficient for the monitoring of SSI-E eligibility to be
coupled with the annual Family Care/IRIS recertification, because the
recertification process involves a comprehensive review of a client's
needs and living situation. For this reason, for Family Care populations,
MCOs will be responsible for monitoring SSI-E eligibility for its members
and ADRCs will be responsible for monitoring SSI-E eligibility for IRIS
members, as part of the annual recertification of each group. To fulfill
the monitoring requirement, the MCO or ADRC would only need to provide
notification to EDS if a client no longer met SSI-E eligibility by
completing Form F-20818 (available at http://www.dhs.wisconsin.gov/forms1/f2/f20818.pdf
). This form is used to both certify or decertify individuals (see item #
12 to give reason for decertification).
No additional action or paperwork would be needed in cases where the
client continues to meet eligibility criteria for SSI-E, which will be the
majority of cases.
CENTRAL OFFICE CONTACT: Mary Moyer, Mary.Moyer@dhs.wisconsin.gov,
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
cc: Fredi Bove
Last Revised: September 13, 2010