DLTC INFO MEMO 2009-03
STATE OF WISCONSIN
Department of Health Services
Division of Long Term Care
DLTC Information Memo Series 2009-03
Date: July 1, 2009
Index Title: SSI-E Certification
Replaces/updates Info Memo 2008-11
For: County Departments of Human Services Directors
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: Fredi-Ellen Bove
Subject: Supplemental Security Income (SSI-E) Certification
The purpose of this memo is to clarify responsible agencies for
certification and monitoring of 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: Departments of Social
Services, Departments of Human Services, Departments of Community
Programs, County Aging Units, and Developmental Disability Services
agencies. In addition, these county agencies are permitted to have the SSI-E
assessment and certification forms prepared by a contracted agency.
At present, all SSI-E application forms (F-20818,
Application for SSI-E Certification form), must be signed by the county
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 for 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 a decertification of SSI-E eligibility may include:
loss of federal SSI eligibility or a move to another state. Because
federal SSI recipients' data interfaces with the state's system, whenever
individuals lose eligibility for federal SSI they also automatically lose
eligibility for 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
remaining, and DHS expects this number to phase-down to zero within a few
years. "Grandfathered" individuals' information is monitored on
a yearly basis through a state survey process administered by EDS. EDS
ends eligibility for individuals who no longer meet financial eligibility
criteria as a result of this process.
Family Care Expansion
For Family Care populations in Family Care counties, at the county's
option, the county or the Aging and Disability Resource Center (ADRC) may
determine SSI-E eligibility.
For non-Family Care populations, i.e., people with mental illness and
children, the county can complete the SSI-E determination or contract with
a private contract agency or 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 situations, the MCO will
complete the initial SSI-E determination and certification, since the MCO
is familiar with these individuals and their functional condition.
Whichever entity the county designated responsible for the initial SSI-E
determination (a county agency or ADRC) that same entity would be
responsible for the certification of individuals who become eligible for
SSI-E after enrollment in IRIS.
For Family Care populations, the MCO is responsible for the annual Family
Care eligibility recertification of its members. The ADRC is responsible
for the annual eligibility recertification of clients in the IRIS
self-directed supports waiver.
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 their
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
for Word version). This form is used to either certify or decertify
individuals (see item # 12 to give reason for decertification). No
additional action or paperwork is needed in cases where the client
continues to meet where the client continues to meet eligibility criteria
for SSI-E, which will be the majority of cases.
CENTRAL OFFICE CONTACT:
Sean Gartley, Sean.Gartley@dhs.wisconsin.gov
cc: Beth Wroblewski
Last Revised: September 13, 2010