POMS Reference

SI 02309: Critical Birthday and Insured Status Diaries

TN 5 (09-03)

A. Introduction

The system identifies critical birthdays to:

  • Change the type of master record of a disabled or blind child who will attain age 18 and is or is not a student from DC/BC/DM/DF/DB/BM/BF/BB to that of a disabled or blind individual (DI/BI);

  • Determine potential entitlement of ineligible individuals at age 65 to title XVI and/or title II benefits (diary development may also result in title II entitlement for the eligible individual);

  • Determine potential entitlement of a member of an eligible couple at age 62 or older to title II spouse’s benefits;

  • Initiate development of multicategory eligibility for disabled individuals who will attain age 65 and reside in Nevada (see SI 00501.300);

  • Determine if Title XVI recipients age 100 or older are alive and develop any additional poste-eligibility issues (e.g., capability, change in payee, living arrangements, income and resources).

NOTE: None of the critical birthday diaries establish protective filing for benefits.

B. Process

1. Setting and Maturation of Critical Birthday Diaries

  1. At the beginning of the fiscal year (FY) in which an individual attains a critical birthday, the system sets a critical birthday diary (KB, KC, KE, K8, K9, or KP) on records in current payment status (PSY: C01). The KB diary is also set for individuals attaining age 18 within the fiscal year. The diary is set in the monthly redetermination merge runs.

  2. Diaries mature in the month of age attainment. Attainment occurs on the day preceding the birthday (see GN 00302.400).

2. Selection of a KB Diary

The Post Entitlement Operational Data Store (PE ODS) system selects a record with a KB diary as a middle-error profile (MEP) scheduled redetermination (RZ), profile K, in the month a recipient attains age 18. However, a KB diary does not preclude selection of a record as:

  • A profile D RZ, either prior to or at the time the system would normally select the case as a profile K RZ; or

  • A limited-issue diary case before the month of age attainment.

3. Selection of a KC Diary

The system selects a KC diary as a limited issue when a recipient attains age 90 in fiscal year 2015 or is already over age 90. Follow procedures in SI 02309.006.

4. Selection of a KE Diary

The system selects a KE diary as a limited issue when certain eligible individuals who reside in either Massachusetts (see SI 01415.035F) or Nevada (see SI 01415.035I) attain age 65 (follow procedures in SI 00501.300E.1.).

5. Selection of a K8/K9 Diary

The system selects a K8/K9 diary as a limited issue when an ineligible individual attains age 65. A K8 is set when the ineligible individual is a father, spouse, or essential person. The K9 is set when the ineligible individual is a mother or essential person. Prior to 10/93, a diary was set when the ineligible individual received a Veterans Affairs pension based on need (type E income).

6. Selection of a KP Diary

The system selects a KP diary as a limited issue when one member of an eligible couple attains age 62 to 64 and does not receive title II benefits, but the other member of the couple receives title II benefits. The diary will be set to a record every fiscal year that the record meets the criteria. For instance, if a member of a couple attains age 62 and is not receiving title II benefits while the other member of the couple is receiving title II benefits, the diary will be set. If no title II entitlement is found, the diary will be set again the following fiscal year.

C. Reference

Overview of Redetermination Related Diaries and Alerts, SM 01501.250