TN 5 (04-97)

A. Background

Due to system's limitations, manual notices are required in most cases where a child's claim is being denied — or where benefits are being suspended — due to excess parental deemed income or resources. Specifically, manual notices must be prepared in these situations:

• A child is determined to be ineligible for SSI due to deemed parental income or resources (initial claims and redeterminations).

• A child is determined to be eligible for the parental deeming waiver described in SI 01310.201.

• A child is determined to be ineligible for the parental deeming waiver described in SI 01310.201.

• There is a change in the child's eligibility under the parental deeming waiver described in SI 01310.201. (For example, a child who has been receiving SSI under the waiver provision becomes ineligible for Medicaid under a State home care plan (SI 01310.209)).

NOTE: The situations listed above are not mutually exclusive in a given case.

B. Procedure

1. General

NOTE: If the individual is blind or visually impaired, see instructions at NL 01001.010 for more information on the special blind or visually impaired notice options.

When required by A. above, issue a manual notice following standard manual notice procedures. Include in the notice the appropriate paragraphs listed in B.2. below.

NOTE: In posteligibility situations, use discretion in issuing multiple manual notices that reference the parental deeming waiver provision. For example, if a child loses SSI eligibility for one month because the parent deemor receives five paychecks instead of the usual four, issue a manual notice containing the appropriate paragraph concerning the parental deeming waiver provision. However, if the same situation occurs again three months later, you may elect not to issue a manual notice, since the child/payee was previously notified of the eligibility criteria for the deeming waiver.

2. Manual Notice Paragraphs

a. DCMM08

When Used: An individual has asked SSA to review a child's case to determine whether the parental deeming waiver provision applies in the case. SSA determines that the waiver provision applies and that the child is eligible for SSI. This paragraph is a lead-in for the decision notice.

You asked us to look at (1) case to see if (2) Supplemental Security Income (SSI) using special rules for counting (3) (4) income and resources.

After looking at the facts in (5) case, we decided that (6) SSI.

Fill-Ins:

1. Recipient's name (possessive case)

2. Choice 1 - she is eligible for
   Choice 2 - she is eligible for more
   Choice 3 - he is eligible for
   Choice 4 - he is eligible for more

3. Choice 1 - her
   Choice 2 - his

4. Choice 1 - parents'
   Choice 2 - parent's

5. Choice 1 - her
   Choice 2 - his

6. Choice 1 - she is eligible for
   Choice 2 - she is eligible for more
   Choice 3 - he is eligible for
   Choice 4 - he is eligible for more

b. DCMM09

When Used: The FO determines that a child is eligible based on the parental deeming waiver provision.

(1) PAYMENT IS BASED ON THESE FACTS (caption 1907)

For (2) all of the following are true:

• (3) is a disabled child who is eligible for Medicaid under an approved (4) home care plan.

• in the past, (5) received a reduced SSI benefit because (6) lived in a medical facility.

• (7) is not eligible for SSI using the regular rules for counting (8) (9) income and resources.

Based on the above facts, the most we can pay (10)   (11) . (12)

Fill-Ins:

1. Recipient's name (possessive case)

2. Choice 1 - month/year,
   Choice 2 - month/year on,
   Choice 3 - month/year through month/year,

3. Choice 1 - She
   Choice 2 - He

4. Choice 1 - Name of State
   Choice 2 - District of Columbia

5. Choice 1 - she
   Choice 2 - he

6. Choice 1 - she
   Choice 2 - he

7. Choice 1 - She
   Choice 2 - He

8. Choice 1 - her
   Choice 2 - his

9. Choice 1 - parents'
   Choice 2 - parent's

10. Choice 1 - beginning month/year is
    Choice 2 - for that month is
    Choice 3 - for each of those months is

11. money amount (that is, $30 plus State supplementary payment (if applicable))

12. Choice 1 - (omit)
    Choice 2 - She/He is receiving less than (11) because she/he has the following income:
    (Use paragraph 1232 (NL 00804.175).)

c. DCMM10

When Used: The FO determines that a child is ineligible for SSI based on deemed parental income or resources. The child does not meet the deeming waiver criteria.

WHY WE CANNOT PAY (1) (caption 1903)

Usually, we can pay SSI to a child if all the following are true:

• The child is disabled and is eligible for Medicaid under an approved (2) home care plan.

• In the past, the child received a reduced SSI benefit because (3) lived in a medical facility.

• The child is not eligible for SSI using the regular rules for counting (4) (5) income and resources, and

• The child meets all other eligibility factors. (6) does not meet all these requirements for (7) because (8) .

Fill-Ins:

1. Recipient's name

2. Choice 1 - Name of State
   Choice 2 - District of Columbia

3. Choice 1 - she
   Choice 2 - he

4. Choice 1 - her
   Choice 2 - his

5. Choice 1 - parents'
   Choice 2 - parent's

6. Choice 1 - She
   Choice 2 - He

7. Choice 1 - month/year
   Choice 2 - month/year on
   Choice 3 - month/year through month/year

8. Choice 1 - she/he is not eligible for Medicaid under an approved (2) home care plan.
   Choice 2 - she/he has not received a reduced SSI benefit because she/he lived in a medical facility.

d. DCMM11

When Used: SSA is taking action to pay a child a higher SSI benefit. The child meets the deeming waiver criteria but will receive less than the maximum benefit payable under the waiver.

(1) PAYMENT IS BASED ON THESE FACTS (caption 1907)

For (2) all of the following are true:

• (3) is a disabled child who is eligible for Medicaid under an approved (4) home care plan.

• in the past, (5) received a reduced SSI benefit because (6) lived in a medical facility.

• (7) can get more SSI using special rules for counting (8) (9) income and resources.

  Based on the facts, the most we could pay (10) (11) . (12)

Fill-Ins:

1. Recipient's name, possessive case

2. Choice 1 - month/year
   Choice 2 - month/year on
   Choice 3 - month/year through month/year

3. Choice 1 - She
   Choice 2 - He

4. Choice 1 - Name of State
   Choice 2 - District of Columbia

5. Choice 1 - she
   Choice 2 - he

6. Choice 1 - she
   Choice 2 - he

7. Choice 1 - She
   Choice 2 - He

8. Choice 1 - her
   Choice 2 - his

9. Choice 1 - parents'
   Choice 2 - parent's

10. Choice 1 - beginning month/year is
    Choice 2 - for that month is
    Choice 3 - for each of those months is

11. money amount (that is, $30 plus State supplementary payment (if applicable))

12. Choice 1 - (omit)
    Choice 2 - She/He is receiving less than (11) because
    she/he has the following income:
    (Use paragraph 1232 (NL 00804.175).)

e. DCMM05

When Used: A child who is SSI-eligible based on the parental deeming waiver provision is receiving a Federally- administered optional State supplementary payment.

(1) PAYMENT IS BASED ON THESE FACTS (caption 1907)

For purposes of the money we pay (2) for (3) State, (4) is a disabled child eligible for Medicaid under an approved (5) home care plan.

Fill-Ins:

1. Recipient's name, possessive case

2. Choice 1 - her
   Choice 2 - him

3. Choice 1 - her
   Choice 2 - his

4. Choice 1 - she
   Choice 2 - he

5. Choice 1 - Name of State
   Choice 2 - District of Columbia

f. DCMM06

When Used: The FO determines that a child can no longer receive SSI based on the parental deeming waiver provision. The reason the child no longer qualifies under the waiver is that the child is no longer eligible for Medicaid under a State home care plan.

OUR DECISION IS BASED ON THESE FACTS (caption 1906)

(1) (2) Medicaid under an approved (3) home care plan (4) .

Fill-Ins:

1. Recipient's name

2. Choice 1 - is no longer eligible for
   Choice 2 - was no longer eligible for
   Choice 3 - will no longer be eligible for

3. Choice 1 - Name of State
   Choice 2 - District of Columbia

4. Choice 1 - beginning month/year
   Choice 2 - for month/year on
   Choice 3 - for month/year through month/year

g. DCMM07

When Used: The FO determines that a child is SSI- ineligible due to parental deeming (and does not meet the parental deeming waiver criteria). This paragraph addresses the Medicaid implications.

INFORMATION ABOUT MEDICAID (caption 1915)

Although (1) is not eligible for SSI, (2) may be able to get help with medical expenses. To find out about this help, you may contact (3).

Fill-Ins:

1. Recipient's name

2. Choice 1 - she
   Choice 2 - he

3. Use appropriate Choice in paragraph 1144 included in NL 00804.110.

C. References

• Suppressing automated denial notices, SM 01005.535

• Suppressing automated Goldberg/Kelly notices, SM 01305.530 and SM 01305.540

• Standard manual notice paragraphs, NL 00804.100 ff.