Effective Date - January 1, 2009

1808 State Supplemental Payments

Medicaid only - 20 CFR 416.2001; W.S. 42-2-103; Senate Enrolled Act 43 (SF002)

A. Purpose:
State Supplemental payments are required in order to receive federal match for the Medicaid program. These payments are intended to complement the federal benefit amount thereby increasing the amount of income available to the SSI recipient.

B. Eligibility:

1. Require the client to receive a SSI Payment as a sole source of income; and

2. a Resident of Wyoming;

3. Eligibility is retained for individuals who are temporarily away from the state until their intent to change residence is received by SSA;

4. The payment can be made part of the estate if the client dies after the first of the month.

C. Services:

1. State Supplements are paid at four different rates based on information provided by SSA through the SDX.

2. The system looks at two fields on the SDX, the SSI Living Arrangement and the Record Identification Codes:

a. SSI Living Arrangement Code (LA) assigned to all individuals:

CODE	LIVING ARRANGEMENT
A	Own Household
B	Another's household
C	Parent's household (child cases only)
D	Title XVI Institution
BLANK	Individual is in a non-Title XIX institution, living arrangement change in progress or outside the U.S.

NOTE: A person living in someone else's household and paying all of their own expenses is considered by SSA as being in their own household.

b. Record Identification Code (RIC) assigned to all individuals:

CODE	RECORD IDENTIFICATION
I	Individual (with or without Ineligible spouse)
C	Couple (eligible individual with eligible spouse)
M	Child Claim with mother
F	Child claim with father
P	Child claim with parents
X	State to SSA record exception

3. Payment amounts:
Realize the payment rates are as follows:

$25.00	for an individual living in their own household OR for children living in their parent's household
$27.80	for each member of a couple living in their own household
$28.72	for an individual living in the household of another
$30.57	for each member of a couple living in the household of another
$20.00	for each individual receiving an SSI reduced payment ($30) while in a facility.

4. Retroactive payments:

a. Authorize retroactive supplemental payments upon request;

b. Forward all requests for retroactive payment, along with Verification of eligibility, to the DFS-FO to process payment.

D. Benefit processing:

1. Realize the following will occur automatically:

a. Eligibility for State Supplemental payments is determined by using the information SSA provides through an interface between the SDX and EPICS;

b. Payments are mailed by DFS-FO (BPU) by the 15th of each month;

c. The State Supplement Voucher Summary provides a list of all individuals who were issued a payment during each month;

d. A copy of the State Supplement Voucher Summary, State Treasury Exchange File and State Update Exchange File printouts are sent to each DFS-CO for informational purposes.

2. Take the following actions when an address change occurs or the client fails to receive the payment:

a. Address changes MUST be made with both SSA and DFS-FO and may require several months for SSA to correct in the SDX to be passed through for the State Supplement payment process;

b. Report address changes to DFS-FO (BPU) so the address on the warrant can be corrected prior to mailing or returned checks can be remailed to the client;

c. Check the State Treasury Exchange File and the State Update Exchange File for the individual's name when the client reports s/he failed to receive the payment:

(1) Have the individual contact SSA when NOT listed;

(2) Check the State Supplement Voucher Summary to ensure a check has been issued if the individual is listed:

(a) Determine if the individual is eligible and the payment amount;

(b) Submit a signed approval memo and verification of eligibility to the Medical Unit in DFS-FO when the individual is eligible;

(c) Process a replacement when the check is not received by the client or the DFS-CO after ten days;

(d) Assist the recipient in completing a WOLFS 106, Warrant Cancellation Replacement Request, and submit to DFS-FO (BPU).

E. Benefit processing:
Examine the following flow chart which outlines the above procedures.

STATE SUPPLEMENTAL PAYMENTS

BENEFIT PROCESSING FLOW CHART

Automatic Process

¯

Eligibility determined by SSA and

passed to the agency VIA interface

¯

Payments are mailed by Benefits Processing

by the 15th of each month

¯

Copy of the State Supplemental Voucher Summary,

State Treasury Exchange File

and State Update Exchange File printouts are

sent for informational purposes

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NOTES:

STATE SUPPLEMENTAL PAYMENTS
BENEFIT PROCESSING FLOW CHART cont.
PROBLEMS
Address Changes
¯
Must be made with both SSA
and DFS-CO
¯
Client claims to be eligible and fails to
receive a supplemental payment
¯
Check State Treasury Exchange File for
individual's name
		å	æ
IF NOT LISTED			IF LISTED
¯			¯
Have Client Contact			Check State Supplemental Voucher
SSA			DFS Summary to ensure check
			has been issued
			å			æ
	NO CHECK ISSUED				CHECK ISSUED
	¯				¯
	Determine eligibility
	¯				¯
	YES
	¯				¯
	Submit memo and verifications
	to DFS-FO, Medical Unit				CHECK RETURNED
	¯			å	¯
	NO				YES
	¯				¯
	After 10 days				Send to new address
	¯				¯
	Assist recipient in completing a				Check remailed
	WOLFS 106 to replace
	¯
	Submit to Benefits Processing