DLTC INFO MEMO 2009-03

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

To: Listserv

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
ADRCs
MCOs
Area Administrators/Human Services Area Coordinators

From: Fredi-Ellen Bove
Interim Administrator

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.

Background
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 populations.

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.

Monitoring
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 or http://www.dhs.wisconsin.gov/forms1/f2/f20818.doc 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 at 608-267-9313.

MEMO WEBSITE:
http://www.dhs.wisconsin.gov/dsl_info/InfoMemos/DLTC/CY2009/index.htm

cc: Beth Wroblewski
Irene Anderson
Rita Cairns
Vicki Jessup
Morgan Groves
Betty Blessinger
Kathleen Luedtke
Gail Propsom
Sean Gartley
Janice Smith

Last Revised: September 13, 2010