TN 13 (09-95)

A. Background

Beginning September 8, 1995, field offices (FOs) must adjudicate the Supplemental Security Income (SSI) claim before authorizing payment of the retroactive Title II benefits in concurrent Title II/XVI claims. In addition to initial claims, these instructions apply to hearings and reconsiderations as well, where neither Title has been previously adjudicated. This ensures that the Title II benefits, when great enough to cause ineligibility for an offset month if paid first, will not cause ineligibility. As a result, SSI claims that previously would not have been paid now will be, although only for the retroactive period.

Full development of these additional SSI allowances would significantly increase FO workloads. However, since any SSI benefits paid for an offset month will be reimbursed from the Retirement and Survivors Disability Insurance (RSDI) Trust Funds, with no effect on total Trust Fund expenditures, full development is not necessary to safeguard the integrity of the General Revenues or the Trust Funds in certain cases as explained in B. below. For this reason, adjudicators will have the authority to forego full development under certain conditions, intended primarily to minimize the risk of Medicaid coverage based on an incorrect SSI allowance.

B. Policy

In Title II offset cases, an adjudicator may, at his/her discretion, forego verifying an applicant's allegations concerning any or all factors of SSI eligibility for an offset month if:

• the Title II benefit due for each offset month would preclude SSI eligibility if paid first, considering the effect of attorney fee recomputation of Title II income, if applicable; and

• there is no Interim Assistance Reimbursement (IAR) agreement involved; and

• the individual alleges having no unpaid Medical expenses for the retroactive period, i.e., prior to payment of the Title II CMA (see C.2. below).

C. Procedure

1. General

Follow normal procedure, except with respect to verification requirements following a favorable medical determination.

2. Verification

When completing the SSA-8000-BK in simultaneous-development claims, or the SSA-8203-BK in deferred-development claims, ask (in all States) if the claimant has any unpaid medical expenses since filing for SSI. Document in Remarks. Note that this question is different from the question regarding unpaid medical expenses prior to filing which is required in some 1634 States.

• If yes, apply normal verification procedures.

• If no, and there is no IAR agreement involved,base your determination regarding any factor of eligibility on the claimant's allegation if, in your judgment, full development would be unlikely to show that the individual is ineligible.

D. References

• Adjudicating SSI Claims — General, SI 00601.080

• SD Claims — Updates After Medical Allowance, SI 00603.020

• DD Claims — Process After Medical Allowance, SI 00603.035

• The Windfall Offset Provision, SI 02006.001 ff.

• Interim Assistance Payments, SI 02003.001 ff.

• Windfall Offset, GN 02610.005 ff.