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COLA Adjustments

Adjustment by Program #

 

SNAP #

SNAP cases are adjusted for all eligibility units with SSA, SSI, VA, RR income update, or SMI change.

Note: SNAP Adjustments with CO income codes adjust in April with FPL.

 

TA #

TA cases are adjusted for all eligibility units with SSA, SSI, VA, or RR income update. Changes in TA grants resulting from the mass adjustment are included in the SNAP adjustments. If the TA case is closed, the grant is removed from SNAP budgets.

 

Non-MAGI #

The Families First Coronavirus Response Action of 2020 (FFCRA) requires MO HealthNet coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse actions to reduce or end MHN coverage due to the COLA changes until the PHE ends. Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for MHN programs with income eligibility based on federal poverty level (FPL) until the next FPL adjustment in April. All SSA, SSI, VA and RR income sources are updated with the income amount and verification code “CO” for COLA adjustment. For the following MHN programs, FAMIS disregards the new SSA and SSI amounts and uses the prior SSA and SSI amounts until the FPL adjustments. FAMIS adjusts the VA and RR income and uses the new amounts on the January budget:

    • MHABD Spend Down (MHSD) and Non Spend Down (MHNS)
    • Medicare Savings Programs (MSP)- Qualified Medicare Beneficiary (QMB), Specified Low Income Beneficiary (SLMB)
    • Blind Pension (BP)
    • Program for All-Inclusive Care for Elderly (PACE)
    • Ticket to Work Health Assurance (TWHA)

For the following MHN programs, FAMIS adjusts the SSA, SSI, VA, and RR income and uses the new adjusted SSA, SSI, VA, and RR amounts:

    • Supplemental Aid to the Blind (SAB)
    • Supplemental Nursing Care (SNC)
    • Vendor
    • Home and Community Based (HCB)
    • Missouri Children with Development Disabilities (MOCDD)

NOTE: Actions to reduce benefits will not be take until the COVID-19 PHE has ended. Actions to increase benefits will be taken.

 

 

Mass Adjustment Process #

The mass adjustment begins in FAMIS in December of each year.

Most cases with SSA/SSI/VA/RR income that were active by the end of a specific day in December with a certification ending January of the next year or later will adjusted to show the increased benefit amounts. FAMIS identifies any EU that has been previously adjusted by staff, if there is a January budget with an increased SSA/SSI/VA/RR income, FAMIS will not adjust the case.

 

Bendex #

FAMIS receives a BENDEX file from the Social Security Administration (SSA) containing SSA income information. Information from the file is transmitted to FAMIS during the mass adjustment, updating all cases with SSA income that have a matching Benefit Claim Number entered on the Income (FMX0) screen to the amount shown on the BENDEX file. Cases adjusted with income from the BENDEX file include the comment “SSA Income Adjusted by the – BENDEX File” on the Monthly Income Comment (FMF7) screen.

 

Note: This monthly file is sent to Central Office for assignment out to a local office for processing. Cases that do not contain the Benefit Claim Number and cases that the Benefit Claim Number does not match the BENDEX file will be increased by a percentage (This percentage may change each year. Please refer to the yearly memo for exact percentage amount).

 

SDX #

FAMIS receives an SDX file from SSA, containing SSI income information. Information from the file is transmitted to FAMIS during the mass adjustment, updating all cases with SSI income that have matching social security number (SSN). Cases adjusted with income from the SDX file include the comment, “SSI Income adjusted by the system – SDX File, “on the Monthly Income Comment (FMF7) screen.

 

Note: This monthly file is sent to Central Office for assignment out to a local processing center. When the SDX file shows SSI income has started or stopped, FAMIS adds or ends SSI income based on information transmitted in the file. When FAMIS adds an SSI income source, the comment, “New SSI Income Source Created by the system – SDX File,” is added to the Monthly Income Comment (FMF7) screen. When FAMIS end dates SSI income based on information from the SDX file, the comment, “SSI Income End dated by the system – system calculation, “is added to the Monthly Income Comment (FMF7) screen. Case that do not contain the SSN or the SSN does not match the SDX file will be increased by a percentage. A comment will be added to the Monthly Income Comment (FMF7) screen, “SSI Income Adjusted by the system – system calculation.”

 

VA and RR Income #

VA and RR income will be increased by a certain percentage each year. Please refer to the yearly COLA memo that is released in December each year for the percentage amount. The comment “Adjusted by the system – increased by the COLA Percentage,” will be added to the Monthly Income Comment (FMF7) screen.

 

NOTE: Vendor LOC active cases with previously verified reduction of VA Income:

    • Enter the monthly $90 reduced VA pension on the Income (FMX0) screen as type Unearned Income (UI), and source Veteran’s Administration (VA).
    • Show the full $90 as an expense to the income (14=INCEXP) using expense description Unusual Medical Expense (ME).

 

Pending Applications #

FAMIS does not complete the eligibility determination for applications in the controlled flow. For pending SNAP recertification’s, if the last month of certification is January or February of the next year, the SS/SSI/VA/RR amount is adjusted by the system. Review the SSA/SSI/VA/RR amount prior to authorizing benefits. If the SSA/SSI/VA/RR amount is not correct, follow instructions in the Manual Adjustments by Field Staff section of the memorandum.

 

SMI Premiums #

To adjust the SMI amount, FAMIS compares the new SMI amount with the amount listed on the Medical Expense (MEDEXP/FMXA) screen. If the new expense is:

    • less than current expense – case will be added to an error report and MEDEXP will not be updated
    • equal to current expense – no update will be made to MEDEXP
    • greater than current expense – MEDEXP will be updated with the new SMI amount and FAMIS will check for active QMB, SLMB1, or SLMB2.
      • If active QMB, SLMB1, or SLMB2 case will be added to an error report. If the current expense is not equal to the old SMI standard expense the case will be added to the error report.

Note: FAMIS will NOT add or end the SMI expense when BENDEX conflicts with what is currently listed on the Medical Expense (MEDEXP/FMXA) screen. These cases will be added to an error report for staff to review.  On the SNAP budget, if there was a medical expense entered which did not have an allowable verification code, the FA-150 Action notice notifies the EU that the expense will not be considered in the budget. This includes medical expenses other than mileage or transportation costs verified by client statement (CS). Medical expenses should be reviewed and discussed with the household at the next contact.

 

Review of Actions Taken During Mass Adjustment: #

If an active FAMIS case is adjusted or closed, the EU Action Log (FM40) screen displays the action taken by the system and the benefit amount for the benefit month of January of the next year.

 

Example: If active FAMIS case is adjusted due to the mass COLA adjustment in 12/2021, the EU Action Log screen display the benefit amount for the benefit month 012022.  To review the action, select the action and press F17=INQAUTH. The Action Authorization (FM3H) screen is displayed. Press F16=BUDSUM to access the Budget Summary screen for each program type. From the Budget Summary screen, press F14=INCSUMM to access the Income Summary Detail (FM33) screen. The income types, sources, and gross amounts are displayed for budget January of the next year. The expense classes, types and amount are displayed for the January budget month.

 

Eligibility determination which were incomplete prior to the mass adjustment will be completed during the mass adjustment. This may result in the creation of RTA (ready to authorize) status. An alert “OUTSTANDING ELIGIBILITY DETERMINATION” is generated and must be resolved.

 

NOTE: Review income from SSA/SSI/VA/RR, and SMI Premiums at next contact to confirm the correct amounts.

 

 

Reports With Actions Needed #

Reports with action needed are distributed to the SNAP, TA and MHN Program Managers for assignment. Following are instructions on how to process each type of report.

 

Conflicts of Actions #

FAMIS completes the COLA adjustments for cases with a pending adverse action at the time of the mass adjustment. This results in a conflict of actions because one adverse action must be completed or voided before the other can be taken. The alert “ADVERSE ACTION NEEDS RESOVLVING” is generated and must be resolved. To resolve the conflict:

    • Access the Action Resolution (ACTRES or FM50) screen and void the pending adverse action. Refer to user guide ‘Changing an Adverse Action Status’ for instructions.
    • Void the adverse action, access the Eligibility Determination Resolution (EDRES or FM3Y) screen, and run a new eligibility determination.
    • Authorize the new adverse action

 

Managed Reporting/Cost of Living Adjustment Needing Review #

There is no longer an ‘error’ report for the COLA adjustment in the Managed Reporting system. Some cases being adjusted require review to ensure accurate eligibility determinations were made. FAMIS  generates reports in Managed Reporting system of active EUs that need review. It is important to review and take the necessary actions for each case on the report to ensure accurate eligibility determinations. To review the reports:

    • From the FSD Intranet page, click on the Systems header, and click on Managed Reporting.
    • Log into the Managed Reporting
    • Click on the appropriate domain (FAMIS Caseworker Supervisor Reports)

 

NOTE: The report is also located in FAMIS Eligibility Specialist Reports, FAMIS Manager Level 2 Reports, and FAMIS County Office Reports.

    • Click on Cost of Living Adjustments Needing Review.
    • Select SSA/SSI/VA/RR Needing Review to request the online reports.

 

Staff must access the report assigned to them by the Program Manager. A reason for review is included for each EU member on the report. More than one reason may appear for each EU on the report. Review all EU information to ensure correct data is in the eligibility system. NOTE: If staff discover the case did not adjust as expected or did not adjust correctly, immediately report the case information to FSD Program and Policy through normal supervisory channels.

 

Reasons for Review #

The following reasons for review are displayed in the SSA/SSI/VA/RR Needing Review online report in Managed Reporting. It is important to review every eligibility unit displayed and take the following actions to ensure accuracy of the FAMIS record and correct eligibility determinations for these individuals.

 

  • CHECK JANUARY INCOME – The mass adjustment was unable to update the income for January, or the SSA/SSI/VA/RR income was entered for January and used in an eligibility determination prior to the COLA mass adjustment.
    • NOTE: Cases with this reason type require immediate review as these cases did not adjust during the COLA mass adjustment. Verify the current SSA/SSI/VA/RR income amount, update if necessary using “CO” verification code and complete an eligibility determination.

 

  • VENDOR LEVEL OF CARE EU MEMBERS – There is an active Nursing Home Level of Care for an individual receiving SNAP benefits.
    • Review the living arrangement of the individual.  If the individual is not in an allowable living arrangement, update the living arrangement on the Address Screen (FM0A), and complete an eligibility determination. If the individual is in an allowable living arrangement, review the Income (FMX0) screen to ensure the system has entered the Supplemental Nursing Case (N1) grant on the SNAP budget until the Supplemental Nursing LOC has been closed. The system should automatically process this change. Some individuals are required to pay a larger Medicare premium due to late enrollment. The mass adjustment cannot automatically adjust these premiums. Review the IIVE interface to verify the SMI premium and adjust, if necessary. Complete an eligibility determination.
    • NOTE: BENDEX and SDX reports are sent to Central Office for appropriate distribution.

 

  • BENDEX SMI Not Found – There is an SMI premium amount in FAMIS, but the BENDEX file does not show an SMI premium
    • Review the IIVE interface to verify SMI premium information. Remove or update the SMI expense, if needed, and complete an eligibility determination.

 

  • CLAIM NUMBER IS BLANK – There is no claim number for the SS/SSI/VA/RR and the income has been adjusted by percentage.
    • Review the IIVE interface to verify the claim number and enter it in the Benefit Claim Number field on the INCOME (FMX0) screen in FAMIS. Although this is not a mandatory field, capturing accurate claim numbers in FAMIS for every person receiving SSA/SSI/VA/RR benefits improves accuracy during mass adjustments, such as COLA.

 

  • BENDEX SSA INCOME NOT FOUND – SSA income verified on the BENDEX file, however, there is no SS income type in FAMIS. Verify receipt of SSA income and budget in FAMIS as appropriate.
    • Review the IIVE interface to verify income from Social Security and make the appropriate entries in FAMIS. Complete an eligibility determination.

 

  • Multiple SSI for Individual – An individual has more than one sources of SSI. This usually occurs when an individual has SSI and SSA and the SSA was incorrectly entered into FAMIS as SSI.
    • Review the IIVE interface to verify the income sources and make appropriate entries in FAMIS. Enter the SSA claim number on the Income (FMX0) screen. Complete an eligibility determination.

 

  • CURRENT INCOME AMOUNT IS ZERO – SSI/SSA/VA/RR income code is on the Income (FMX0) screen with zero amounts on the Income Amount (FMX3) screen.
    • Verify the income amount, using electronic sources if possible. If the participant is no longer receiving this income, make the appropriate entries to end the income source in the eligibility system. If the individual is receiving the income, make the appropriate entries in the eligibility system and complete an eligibility determination.

 

  • NOT ADJUSTED – There is SSA/SSI/VA/RR income in FAMIS which was not adjusted on an active case.
    • For some cases, the SSA/SSI/VA/RR income could not be adjusted during the mass adjustment. Verify the correct amount of income and review the eligibility unit to determine if action is needed. Make appropriate entries in the eligibility system and complete an eligibility determination.

 

Manual Adjustments by Staff #

To manually adjust the SSA/SSI/VA/RR income in FAMIS, first attempt to verify the new amount by reviewing the IIVE Interface. If not available, compute the new SSA/SSI/VA/RR amount by multiplying the original amount by the percentage identified in the yearly COLA memo and round down to the nearest dollar. Staff must enter the new SSA/SSI/VA/RR amounts for new applications processed after December.

 

Staff must us the verification code “CO” – COLA when updating SSA/SSI/VA/RR income in FAMIS for all programs if the income increased due to the COLA increase, but was not adjusted during the mass adjustment. FAMIS uses the CO verification code to determine whether to use the December or January SSA/SSI/VA/RR for the period between the COLA adjustment and the FPL adjustment in April. For assistance making these entries, see Budget Month Entries for Income Affected by COLA.

 

Controlled Flow #

If a SNAP, TA, or MHABD application is in the controlled flow, review the SSA/SSI/VA/RR benefit prior to authorizing benefits. Determine the correct SSA/SSI/VA/RR benefit amount and manually adjust the benefit amount effective January and later months when completing the application/controlled flow.

 

Blank Verification Code – Pending Status #

During the mass adjustment, FAMIS sets the status to PEN (Pending) for cases with an unacceptable or blank verification code. The system generates the alert – “Action Not Authorized”. If no action is taken, FAMIS send an FA-510 or FA-420 Adverse Action notice to reduce or close as appropriate, as the pending verification has not been resolved. Review the case to determine if the pending information is in the participant’s file in the ECM or is available from an electronic data source.  If verification is available, make the appropriate system entries, including the accurate verification code, and authorize the eligibility determination. If the verification has not been previously requested, request the verification using an FA-325 Request for Information form.

 

Notices #

  • The Adverse Action Notices are dated in December, refer to the COLA Adjustment Memo for specific date.
  • Authorized Representative Cover Letter (AR-100) accompanying the Adverse Action Notices, are dated the same date as Adverse Action Notices.
  • The Action Notice generated by the mass adjustment is dated in December, to allow adequate mail time due to large volume of cases affected.
  • Notices are not generated for no change (NOCH) actions in FAMIS.

 

  • Non-MAGI: An FA-420 Adverse Action Notice is generated for any MHABD programs whose benefits are reducing or closing due to the mass adjustment. An FA-460 Action Notice is generated for mass adjustment actions after the Adverse Action Notice expires, if the EU has not requested a hearing, including a request to continue receiving at the current rate pending the hearing decision.
  • SNAP: An FA-150 Action Notice is generated for mass adjustments that result in a reduction (REDU), or closing (CLOS).
  • TA: An FS-150 Action Notice is generated for a Temporary Assistance EU due to the mass adjustment, unless there is a pending adverse action at the time of the mass adjustment. If there is a pending adverse action at the time of the mass adjustment, refer to the Conflict of Actions section in the guide.

 

Interim Changes After Mass Adjustment #

There are times when SSA and SSI have changes in the amounts that are not related to a COLA adjustment (i.e: one spouse dies and the other has SSA and/or SSI adjustment). When a budget adjustment is necessary, staff can enter the verification (HC or TC) as appropriate. FAMIS adjusts the budgeted SSA and SSI income appropriately. When completing budget adjustments after mass adjustment, if the verification code is “CO’ and there has been no other change to SSA and SSI amounts, leave the verification code “CO” in verification field. Changing the verification code to any other code incorrectly budgets the SSA and SSI COLA amount prior to the FPL adjustment in April.

 

Request for Hearing/Continued Benefits #

If the EU requests a fair hearing, submit hearing request through the Hearing Hand-off for procedures for submitting the hearing request. Any EU receiving an Adverse Action or Action Notice may request a hearing on the mass adjustment action within 90 days from the date of the notice.

  • Non-MAGI: The Families First Coronavirus Response Action of 2020 (FFCRA) requires MO HealthNet (MHN) coverage for individuals be maintained at the same level or better for the duration of the Public Health Emergency (PHE). FAMIS will not act on adverse action to reduce or end MHN coverage due to the COLA changes until the PHE is ended. When the PHE is ended, actions will be taken to update coverage for individuals whose coverage was maintained due to FFCRA requirements. The following paragraphs may or may not be accurate dependent on when the PHE is officially ended. If the EU receiving an FA-420 Adverse Action Notice requests a hearing on the MHN adjustment prior to the adverse action expiring, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. Staff should inform the EU if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment. To continue the MHN benefits at a higher amount for EUs who received an FA-420 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HLD) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions. If the EU requests a hearing after the adverse action has expired, the EU is not eligible for continuation of benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decision is rendered, take steps to process the EU’s eligibility according to the Decision and Order.
  • SNAP: EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment.
  • TA: EUs receiving the FA-150 Action Notice of a reduction (REDU) or closing (CLOS) due to the cost of living mass adjustment alone are not eligible for continued benefits at the level before the mass adjustment. If the EU receives an FA-510 Adverse Action Notice based on a previous determination in which a Conflict of Action was resolved due to the COLA mass adjustment and they request the hearing prior to the expiration of that FA-510 Adverse Action Notice, they may continue at the level before the mass adjustment until the hearing decisions is made. Staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment. To continue Temporary Assistance benefits at a higher amount for EUs who received an FA-510 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions. If the EU requests a hearing after the FA-510 expires, the EU is not eligible for continuation of the benefits at the level before the mass adjustment, but is still entitled to the fair hearing. Once the Hearing Decisions is rendered, take steps to process the EU’s eligibility according to the Decision and Order.

 

 

Comment #

Enter a detailed comment on the appropriate Eligibility Unit Member Role (EUMEMROL) screen regarding action(s) taken on COLAs

 

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