OKLAHOMA CONVERTING TO SSI CRITERIA STATE

Narrator: Effective March 1, 2015, DHS has changed the way we process Medicaid applications for SSI recipients. The Oklahoma Health Care Authority is converting Oklahoma to an SSI-Criteria state. This means that DHS and Oklahoma Health Care Authority are modifying their policies to match SSI policy regarding income and resources. SSI recipients will still apply for Medicaid with DHS but they won't have to verify their information unless it's questionable. Workers won't have to spend as much time requesting verification and some rules will be less restrictive. Clients will see no changes in their Medicaid coverage. These changes apply to ABD-related cases only. 

The policy changes involve: the medical application process for SSI recipients, ABD-related Income, and ABD-related resources. 

Let's look at our current application process. When an SSI recipient applies for medical, a PS-1, FSS-1 and FSS-1B is completed. The worker then conducts a face-to-face or phone interview entering case notes tab-by-tab. The worker requests any needed verification and waits for it to be provided. Eligibility is then determined and a certification or denial is coded in FACS. 

Effective March 1, 2015, a PS-1, FSS-1 and FSS-1B must still be completed. The worker will continue to conduct a face-to-face or phone interview and enter case notes tab-by-tab. The worker will request verification only if the income and/or resources declared by the client, or information received through data exchange, is questionable. If so, the issue must be resolved before approving the client for Medicaid.If information gathered during the interview is not questionable an eligibility determination is not needed. If the client is applying for State Supplemental Payment, workers are still required to make an eligibility determination. The certification or denial is then coded in FACS. 

Now that we have talked about the Medicaid application process, let's discuss the income policy changes for the ABD-related population. We'll start with joint bank accounts. If an ABD-related client has a joint bank account with someone not receiving SSI, deposits into the account from the non-SSI recipient are no longer considered income but are considered a resource to our client. Here's an example. John and his daughter, Debbie, have a joint bank account. John's SSI is direct deposited to this account along with Debbie's weekly pay check. Debbie's income that is deposited is now considered a resource to John. 

Next, let's talk about changes related to the ineligible spouse. In the past, the definition of "ineligible spouse" was "the non-ABD-related spouse of an ABD-related client." Effective March 1st of 2015, if an SSI recipient has a spouse who does not receive SSI, the spouse is considered to be an ineligible spouse regardless if they are ABD-related. If both spouses are ABD-related but neither receives SSI, they are both considered an ineligible spouse. Let's look at an example of this change. Kate receives SSI. Her husband, Bob, is disabled and receives OASDI. Prior to March 1st Bob could not be considered an ineligible spouse because he is ABD-related. Effective March 1st, he will be considered an ineligible spouse. This is a significant change because now, as an ineligible spouse, we will be able to deduct the ineligible child allocation from his income. 

Another income change is how we consider earned income for students who receive SSI. Beginning March 1st, 2015, we can disregard up to $1,780 per month, not to exceed $7,180 per year, if the following criteria is met: the client is an SSI recipient, and under age 22, and attending 12 or more hours of high school or 8 or more hours of college per week. Let's look at an example of this. Jim is a 19-year-old SSI recipient taking 9 college hours. His gross earned income is $1,100 per month. His earned income will be disregarded for 6 months. $1,100 times 6 equals $6,600. This means Jim's earned income will be disregarded from March through August. Since the maximum annual disregard amount is $7,180 we will subtract the disregarded $6,600 leaving a balance of $580. This means in September, we will only be able to disregard $580 of Jim's earned income. There is no change in the way we calculate the earned income that is not disregarded. 

The next change we are going to cover deals with irregular and infrequent income. Effective March 1st, 2015 we can disregard irregular and infrequent unearned income of $60 or less per calendar quarter. This income can be disregarded if it is received only one time per quarter and is not received in consecutive months. If received in consecutive months, regardless if those months fall in two different quarters, the income is countable in the month it is received. For instance, Gina received $34 in mineral income in March and $20 in May. The total income is less than $60, was received in different quarters, and was not received in consecutive months. The payments will be disregarded income. However, if the second payment was received in April rather than May, the payments would be countable. Although the income is less than $60, was received in different quarters, but because it was received in consecutive months it is not considered infrequent and it is countable income. When unearned income is received from two different sources, the income is added together and the first $60 is disregarded. The remaining unearned income is countable in the month received.

Another income change affects cash and in-kind gifts. Each year, we can now disregard the first $2,000 in cash or in-kind gifts to a child under the age of 18, with a life-threatening illness. It is important to note that these gifts can only be disregarded if received from a 501(C)(3) tax exempt organization. A statement from the tax exempt organization is required. For example, Lori is a 5-year-old SSI recipient with a life-threatening illness. She was given a Disney cruise from the Make-A-Wish Foundation for herself and her parents. Each ticket has an in-kind value of $1,800. Lori's ticket is exempt because it is under $2,000 and was received from a 501(C)(3) tax exempt organization. The other tickets are for her parents and are excluded. 

Now, let's talk about the policy changes regarding earned income deductions. The cost of items purchased by a disabled person so they can work can now be deducted from their earned income. These deductions are given before the earned income deduction. The deductions are given only in the month of purchase. Some examples are vehicle modifications, transportation costs at the IRS rate, wheelchairs, pacemakers and medical supplies.These deductions are also allowed for a blind person so they can work. Additionally, a blind person can receive deductions for meals consumed during work, mandatory pension and disability contributions, union dues, uniforms and tool expenses. Federal, State, Social Security and Medicare taxes are also allowable deductions for a blind individual. For instance, Tim has been declared disabled by the Social Security Administration. In April he provided a receipt verifying his purchase of orthotic shoes which enable him to work. The cost of the shoes is now considered an allowable deduction from his April earnings. 

Now let's go over the resource policy changes. The first change affects vehicles. One vehicle is now automatically exempt for an ABD individual. The medical transportation requirement is no longer necessary for a vehicle to be exempt. All other vehicles will be considered a countable resource. Let's look at an example for this change. Doug owns a 2005 Jeep Cherokee and a 1982 Dodge pickup. Even though he does not use either vehicle for medical transportation, one vehicle can be exempt. 

Next, we will address the changes related to irrevocable burial policies. The first $10,000 of an irrevocable prepaid burial is disregarded. Anything above $10,000 is a countable resource. The $10,000 disregard includes the total value of the face value of the life insurance policy used to fund the prepaid burial, the value of any revocable burial funds, plus the cash value of any life insurance not being used to fund the burial. Let's look at an example of this policy change. John applied for Medicaid in March 2015. He had purchased a $7,000 irrevocable prepaid burial in 2010. In 2014, he assigned his $6,000 face value life insurance to the prepaid burial. Policy now allows us to disregard the first $10,000 of the irrevocable prepaid burial. Therefore, we will take the total value of $13,000 and subtract $10,000. This means only $3,000 is considered a countable resource. 

SSI-Criteria Policy also changes how burial funds are counted. If the client has no irrevocable pre-paid burial policy, $1,500 of funds set aside for burial purposes for each individual and spouse may be disregarded. The new SSI criteria policy identifies burial funds as: revocable burial contracts, revocable burial trusts, other revocable burial arrangements - including the value of certain installment sales contracts for burial spaces, cash set aside for burial purposes, financial accounts such as savings or checking accounts, or other financial instruments with a definite cash value such as stocks, bonds, certificates of deposit, etc. which are set aside for burial purposes. Let's look at an example of this change. Betty has a $1,200 revocable burial contract and $300 cash set aside for burial expenses. Because Betty does not have an irrevocable prepaid burial policy, the $1,500 of funds she has set aside for burial purposes are disregarded. 

Today you have learned about the changes to the medical application process for SSI recipients, as well as the ABD-related income and ABD-related resource changes. 

We hope it was helpful. 

This video was presented by the MET Unit and approved by the Training Unit and the HRMS Unit.