CFF 902-10 1 of 8 PR - SSI BENEFITS DETERMINATION CFB 2007-006

12-1-2007

SSI BENEFITS
DETERMINATION Children who have physical, emotional, or mental handicaps may be
potentially eligible for, or are currently receiving Supplemental Security
Income (SSI) benefits.

A child may be SSI eligible if:

• a child has a physical or mental condition or conditions that can be

medically proven and which result in marked and severe func-
tional limitations;

• the medically proven physical or mental condition or conditions

must last or be expected to last at least 12 months or be expected
to result in death;

• a child may not be considered disabled if he or she is working at a

job considered to be substantial work.

Children coming into care with SSI eligibility (PAMA Program E or B) or

who become eligible for SSI after entering care, automatically receive
Medicaid eligibility. Do not attempt to transfer the child's Medicaid
eligibility to PAMA program Q.

Youth who are in foster care or delinquency placement who appear to

meet the above definition of disability are to be screened for SSI eligibil-
ity with special attention given to the following youth.

1. Youth receiving a Determination of Care Supplement in Family

Foster Care.

2. Youth who, later in their placement, become disabled.

3. Youth approaching age 18 whose foster care funding will end

shortly and whose handicap prevents their becoming self-support-
ing. Within three months of a youth's 18th birthday, an application
should be initiated with the Social Security Administration. These
applications should be handled through the Adult Foster Care
worker in the local office and the Adult Foster Care procedure
is to be followed.

Note: Refer to “CFF 902-10” in instances where a new SSI appli-

cation is being filed. When a child (or parent/guardian on behalf of
the child) is currently receiving SSI; previously received SSI; or is
awaiting a decisions by SSA on a pending SSI application, refer to
“Change of Payee for SSI CFF 902-10” for the applicable proce-
dure.

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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Initial SSI Children that do not need to be screened for SSI benefits:
Application -
Procedures for • Children who have been in care for less than 3 months.
Determining
• Children currently receiving SSI benefits (can be determined by
Potential Disability
review of DHS-352, DHS-5S or DHS-3205 in the case record). SSI
eligibility is also indicated on CIS by program codes B or E. Go to
Change of Payee process CFF 902-10, step 1.

• Children currently pending SSI. The memo from the Reconciliation

and Recoupment in step 8 below will also indicate if an SSI appli-
cation has already been filed.

For those youth designated for SSI screening:

1. USE form DHS-4700, Children's SSI Screening Document - Sup-

plement, to determine if there are physical, mental or emotional
impairments (or a combination of conditions) present which indi-
cate a potential for SSI eligibility.

2. RECORD the results/findings for each completed case screening

on form DHS-4699, Children's SSI Screening Document:

• In cases where there is no evidence of a physical, mental or

emotional impairment, file copy of the DHS-4699 in the “med-
ical information” section of the child's case record.

• In cases where there is evidence of a physical, mental or

emotional impairment (or combination of impairments or con-
ditions) continue with step 3.

3. UPDATE Government Benefit form (DHS-3205) using SWSS/FAJ,

Foster Care/Delinquent Ward Benefit Eligibility Record with any
new information about the child's current physical placement and
cost of care. Complete new DHS-3205 (May, 1993 version or later.
Previous editions are obsolete) if form is missing from the case
record. Update the handicap code on the DHS-5S.

Note: When the child is in a Purchased Care placement, specify

both the daily cost of care and the administrative rate separately
when updating the DHS-3205. Also include the address of the
child's actual physical placement and telephone number in addi-
tion to the placement agency name and address.

4. ASSEMBLE a Referral Packet containing:

• DHS-4699 (original)
• Updated DHS-3205
• Court Order:

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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•• Court Ward - Original court order and most recent hear-

ing.

•• State Ward - Committing Order

A. For Fund Source 4 or 5 cases, go to step 12, or

B. For Fund Source 2 or 3 cases, go to step 5.

LOCAL OFFICE
DHS 5. FORWARD to R&R for processing:

• Bureau of Accounting Reconciliation & Recoupment (R&R)

235 S. Grand Avenue
P.O. Box 30025
Lansing, MI 48909

RECONCILIATION&
RECOUPMENT 6. RECEIVE Referral Packets from local office.

7. DETERMINE if SSI should be pursued for a child based on the

cost of care and fund source for the current foster care or delin-
quency placement.

8. RETURN SSI Determination memo to the local office. (R&R will

retain the Referral Packet and consolidate as part of the Applica-
tion Packet as referenced in step 17 below):

• If not pursuing SSI, the memo will indicate what additional

actions, if any, need to be taken by the local office.

• If pursuing SSI, the memo will contain:

•• SSA-8000, Application for Supplemental Security

Income (SSI)

•• SSA-3820, Medical History and Disability Report

•• SSA-3881, Questionnaire for Children Claiming SSI

Benefits

•• SSA Activities of Daily Living (ADL) form

•• Placement Memo from R&R

Note: For Fund Source 3 (County Child Care Fund) cases, R&R
will return only the SSI Determination memo. Depending upon
locally established procedures, either the DHS local office or fam-
ily court is responsible for filing the SSI Application on behalf of the
child. Follow the existing policy/procedure for handling Child Care
Fund referrals.

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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LOCAL OFFICE 9. RECEIVE SSI Determination memo(s) from R&R and forward to
appropriate Service Worker.

10. The worker will take one of the following actions based on the SSI
determination made by R&R:

• If SSI is not to be pursued:

•• Make follow-up to review placement and cost of care in

12 months.

•• File Referral Packet, including the R&R determination in

the “medical evidence” section of the child's foster care
or delinquency case record.

• If SSI should be pursued by Central Office (for Fund Source

2 [Title IVE] cases), go to step 11.

11. FILE copy of the R&R notification to pursue SSI on top of the “pay-
ment section” of the case record. All of the following changes must
be reported to R&R as soon as the change occurs:

• Change in physical placement

• Increase in the cost of care
• Adoptive placement (supervised or confirmed)
• Change in legal status
• Death

12. PHOTOCOPY all current, relevant, medical evidence from the

case record which documents the child's impairment(s). Include a
copy of all pertinent medical evidence requested on form DHS-
4779, SSI Evidence Profile. The types of medical evidence
include:

• Updated Service Plan

• Copy of Public Health Screening, including growth charts

• DHS-3307, Placement Outline and Information Record

• Medical/Psychological reports from doctors, clinics or hospi-

tals

• Denver Developmental Screening Test

• Summaries of educational planning and three-year evalua-

tion committee meetings (such as IEPC/MET)

• School psychologist reports (including IQ and subtest scores)

• School social worker and/or school counselor reports

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

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• Child behavior assessments (narrative reports or checklists).

• Include reports from parents, teachers and/or caregivers.

• Audiology and speech evaluations

Note: If the child is currently supervised by a placement agency,

the worker may need to obtain copies of medical documentation
from the placement agency.

13. Contact the care provider to obtain applicable information needed

to complete the SSI application process including completing
these forms:

• SSA-3820, Medical History and Disability Report

• SSA-3881, Questionnaire For Children Claiming SSI Benefits
• SSA Activities of Daily Living (ADL) - Age appropriate form
• SSA-8000 Application for Supplemental Security Income
(SSI)

14. FOLLOW UP as necessary to ensure that forms if mailed to pro-

vider are completed and/or returned.

15. ASSEMBLE Application Packet containing copy of all medical evi-

dence as indicated in step 12 and forms needed to complete the
SSI application as described in step 13.

Note: For cases where the Fund Source is either 4 or 5, include

the Referral Packet documents (i.e., DHS-4699, updated DHS-
3205 original and current court order) as part of the Application
Packet.

16. FORWARD Application Packets to R&R.

RECONCILIATION&
RECOUPMENT 17. RECEIVE the complete Application packet and file the application
for SSI on behalf of the child.

18. SEND copy of Notice of SSI Application Letter DHS local office
worker.

19. SEND notice of SSI approval or denial decision by SSA to local

office worker.

Note: For Title IVE-funded cases approved for SSI, send “fund
source change memo” to local office advising worker to do a new
funding redetermination in SWSS/FAJ to include the receipt of SSI
and change the Fund Source to 4 or 5. The effective date for the
fund source change will be the first day of the month. Add a level 1
DOC to the youths daily rate, if it has not already been done.

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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20. Report any of the following situations, IN WRITING, to R&R. IF the

local office or court are designated as representative payee, they
must report these changes to SSA:

• Change in physical placement of the child.

• Any replacement of a child by a child placing agency.

• Change in cost of care.

• A child has been adopted: Please indicate if this is a con-

firmed or supervised adoption. The adoptive parents should
only apply for SSI at confirmation.

• Closure (notify the parent or guardian to apply to be payee).

• Death of a child.

• Change in parent's situation that could affect the child's eligi-

bility for benefits (e.g., disability of a parent, death of a parent,
etc.)

Note: Questions concerning this procedure or the SSI referral and

application process can be directed to R&R, by calling 517-335-3674.

Change of Payee If a child (court ward or state ward) enters foster care or a delinquency
for SSI placement and is currently eligible for SSI,R&R must be notified by
completing form DHS-3205. Depending on the cost of care, the fund
source and the living arrangement, R&R will determine whether to
become payee for the SSI benefits (which may require a fund source
change by the local office) or contact SSA and request that the SSI ben-
efit be stopped for the child.

Note: The Court or the Local Office should not contact Social Security
Administration to request a change of payee for Title IVE or SWBC
funded children. All payee changes should be directed through R&R.

If the SSI payment is being sent to child's payee (parent, guardian, etc.)
the worker must instruct the payee to return all SSI payments to their
local Social Security Administration (SSA) office immediately up on
receipt.

LOCAL DHS
OFFICE 1. COMPLETE form DHS-3205, Foster Care/Delinquency Ward Ben-
efit Eligibility Record, using SWSS/FAJ for every child (see RFF
3205). When the child has a disabling handicap, the worker is to
check “yes” in the Funding determination of SWSS/FAJ to indicate
the receipt of or pending SSI. Attach a legible copy of the cur-
rent court order. If the SSI Application was made by the parent/

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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guardian but a decision has not been made by SSA. Complete the
appropriate following step.

• If Title IVE eligible and the placement is Title IVE eligible go

to step 2.

• If not Title IVE eligible or the placement is not Title IVE eligi-
ble go to step 5.

Note: If a DHS-3205 was previously completed and sent to R&R,

but no determination memo was received from R&R, update the
DHS-3205 if appropriate, with physical placement and cost of care
and forward to R&R with the indication “no SSI determination
received.”

2. FAX a completed DHS-3205 and court order to R&R requesting a

determination about continuing SSI, if a youth enters care from an
FIP home but is not included in the FIP grant solely because of the
receipt of SSI. Designate in “Comments” that the child is Title IVE
eligible. The FAX numbers are: 517-335-6147 or 517-241-7580.
Include the local office FAX number for R&R to respond.

RECONCILIATION &
RECOUPMENT 3. Receive FAX and review cost of care and current placement to
determine whether to continue or terminate SSI benefits.

4. R&R will FAX a Determination Memo back to the worker as soon

as possible following the decision. The original determination
memo will later be sent to the worker to replace the FAXED copy.
A placement memo will be attached for the worker to use in notify-
ing R&R of changes in physical placement and cost of care. Go to
step 8.

Note: If a rate adjustment, legal status and/or a funding source

change is needed, R&R will FAX a fund source memo to the
worker indicating that the worker must do a new redetermination in
SWSS/FAJ, then change the Fund Source to 4 or 5 and add a
determination of care if none is currently being paid.

5. FORWARD THE DHS-3205, for ineligible Title IVE wards and a

copy of the current court order to Central Office, Reconciliation &
Recoupment, where continued receipt of SSI will be determined.

6. SEND a memo to the worker indicating whether or not receipt of

SSI will continue and if so, who should be payee.

7. DECIDE if the court or local office should be payee for the SSI. If
so, instruct the court or the local DHS office to:

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES
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• File an SSA-11 to be payee of SSI on the child's behalf with

their local Social Security office. Attach a copy of the R&R
SSI determination memo and the DHS-3471, DHS/SSA
Referral (white copy), and

• File the pink copy of the DHS-3471 and the original copy of
the R&R determination memo in the youth's case record. Go
to step 8.

Reporting 8. Report any of the following situations, IN WRITING, to R&R. IF the

Responsibility for local office or court are designated as representative payee, they
Children Who are must report these changes to SSA:
SSI Eligible
• Change in physical placement of the child,

• Any replacement of a child by a child placing agency, includ-

ing a move from one foster home to another.

• Change in cost of care.

• A child has been adopted: Please indicate if this is a con-

firmed or supervised adoption. The adoptive parents should
only apply for SSI at confirmation.

• Case closure, Discharge, or release of the youth notify the

parent or guardian to apply to be payee.

• Death of a child.

• Change in parent's situation that could affect the child's eligi-

bility for benefits (e.g., disability of a parent, death of a parent,
etc.)

CHILDRENS FOSTER CARE MANUAL STATE OF MICHIGAN

DEPARTMENT OF HUMAN SERVICES