ABD: Special Medical is an article that explains what Special Medical is and its different categories.

There are times when a client may not have been eligible for Special Medical or lose Special Medical status for a variety of reasons.

When Social Security has a COLA (Cost Of Living Adjustment) in January, IMS is programmed to update all cases in December through an Overall. When it appears the updated income makes the client over income, the case is put in Special Medical-“Individual who loses (SSP) eligibility due to reduction in the SSP maximum payment standard”. This is intended to protect the medical and buy-in benefits until a worker can determine if any income needs to be adjusted or for what, if any, benefits the client may still be eligible.

SDX shows SSI closed for N01, income was over the standard. There is earned income in the “Earned Income” block. The block 40 Medicaid Test Indicator shows an “F”, meaning the client is eligible for Special Medical -1619b. Obtain verification of income to determine if the client meets the income standard for either SSP or QMBP. If the client is QMBP eligible, close the Finance section, and code the categorical relationship block. An application is not needed for this action. If a review is due, go ahead and complete the review. Client is eligible for Special Medical – 1619b.

Verification of the client’s earned income is received to determine if the client meets the income standard for either SSP or QMBP. If the client is QMBP eligible, close the Finance section, and code the categorical relationship block. An application is not needed for this action. If a review is due, go ahead and complete it.

If the client is eligible for the SSP, take these steps:

Step 1: On the Household Tab in Interview Notebook: Add individual to Disabled-State Supplement.

Step 2: Make the necessary changes to the income showing on the case.

Gross Earned: $650

Non-TANF Exp: $347 [$282 (countable earned income with cents dropped + 65]

General Income Deduction: $20

Diverted Income: $282 [$750 (current SSI benefit) – $468 (adjusted SSI benefit)]

Step 3: Make a change in the Financial section for the next effective month.

Step 4: **SAVE the Case and push completely through**

Step 5: Refresh FACS.

Step 6: After the case has been pushed through, make a change in the Finance tab and remove the special medical coding in the Special Medical Indicator block.

Step 7: **SAVE the Case and push completely through**

If necessary, use F17C for the months where payments were missed.

** NOTE: If you need to issue SSP supplements for more than two months, email the HRMS mailbox for permission before issuing anything.**

Example

John Q Adams’ annual review was in November. He is on SSI and started a new job at the beginning of November. His SSI benefit was adjusted for the new income on the case to keep the SSP open. (The income was reported to SSI.) The December Overall put the January SSI benefit on the case which made the case over income. Because of this, the case was put into Special Medical status. Gross earned income is $650. The SSI standard for 2018 will be $750. In this example the worker was notified in January. The change will be made for February 2018 and an F17C issued for the month of January.

Determining if client is eligible for the SSP.

Refer to article ABD: Income – Adjusting SSI for New or Increased Income

(General Income Exclusion)

$650 – $20 = $630

Earned Income Formula:

$630 – $65 = $565/2 = $282.50

Adjusting SSI: $750 – $282.50 = $467.50. The adjusted SSI benefit will keep the countable income under the SSP standard, so he is eligible.

Step 1: On the Fin. Assistance Tab in Eligibility Notebook:

SECTION B – FIN ASSISTANCE – TYPE ACTION TAKEN = Change of action which does not affect section status (C).

Effective Date = Enter next effective month.

**SAVE the case and PUSH CASE completely through**

Next, make a C Change and Remove the Special Medical in block B70. Be sure to update (resend) the income and the deductions when you remove the Special Medical Indicator.

If it is necessary to issue the SSP payment for missed payments, you will use the F17C transaction in IMS to complete this. Remember to send email to request permission from HRMS if more than two months of SSP need to be issued.