426-2        ELIGIBILITY REQUIREMENTS FOR INTERIM ASSISTANCE

To be eligible for Interim Assistance, an individual must:

• Meet all APAAdult Public Assistance eligibility criteria except for receipt of SSISupplemental Security Income;
   
• Apply for SSISupplemental Security Income;
   
• Appear likely to meet Social Security disability requirements and be determined disabled by the Division, or be age 65 or older; and
   
• Agree to repay Interim Assistance from retroactive SSISupplemental Security Income benefits by completing an Interim Assistance Reimbursement (IARInterim Assistance Reimbursement) authorization form.
   

Note:

The IAInterim Assistance benefit start date is the month when all of the eligibility requirements are met and an IARInterim Assistance Reimbursement is signed.

These eligibility requirements are explained below.

426-2 A.   APPLICANTS MUST BE ELIGIBLE FOR APAAdult Public Assistance EXCEPT FOR A FINAL ELIGIBILITY DECISION BY SSISupplemental Security Income

With the exception of a final eligibility decision by SSISupplemental Security Income, all other APAAdult Public Assistance eligibility requirements apply to the determination of eligibility for IAInterim Assistance.  This means that the caseworker must make a full eligibility determination before Interim Assistance can be approved.  For blind or disabled applicants who are not eligible for Social Security disability benefits, a temporary disability or blindness decision must be made in accordance with the procedures described in this chapter.

426-2 B.   CONCURRENT SSISupplemental Security Income APPLICATION

Interim Assistance is available only to APAAdult Public Assistance applicants who are required to apply for SSISupplemental Security Income benefits; IAInterim Assistance payments will not be made to APAAdult Public Assistance applicants who have countable income or resources in excess of SSISupplemental Security Income program limits and are therefore not required to apply for SSISupplemental Security Income benefits.

To receive Interim Assistance, proof must be obtained that the applicant has submitted a signed SSISupplemental Security Income application to the Social Security office.

Because of the similarity between SSISupplemental Security Income and APAAdult Public Assistance eligibility criteria, the identification of potentially SSISupplemental Security Income -eligible applicants is relatively simple.  If the client appears to be APAAdult Public Assistance eligible, and to have countable income within the applicable SSISupplemental Security Income limit, the client may be eligible for SSISupplemental Security Income and must file for SSISupplemental Security Income if he or she does not already have an active claim.  If an applicant has income which changes from month to month and which is in some months within SSISupplemental Security Income limits, he or she must apply for the SSISupplemental Security Income program and may receive IAInterim Assistance payments until Social Security makes a final decision on the SSISupplemental Security Income application.

When an APAAdult Public Assistance applicant is identified as potentially SSISupplemental Security Income -eligible, the applicant has 30 days from the APAAdult Public Assistance application filing date to contact SSASocial Security Administration and file an SSISupplemental Security Income claim.  The contact establishes a ”protected filing” date for SSISupplemental Security Income benefits, and consists of an oral or written request for benefits.  This request for SSISupplemental Security Income benefits may be made in person, by mail, or by telephone.

The SSISupplemental Security Income application process requires that an SSISupplemental Security Income applicant must have an interview with an SSASocial Security Administration Field Office Claims Representative before a signed application for SSISupplemental Security Income benefits can be accepted.  Once the interview is completed, an applicant must submit a signed application to a SSASocial Security Administration office within 60 days of the date of the SSISupplemental Security Income interview, unless SSASocial Security Administration determines there is good cause for a delay.

If, without good cause, an APAAdult Public Assistance applicant does not submit a signed SSISupplemental Security Income application to a Social Security office within SSA's 60-day time limit, the APAAdult Public Assistance application will be denied.  If the individual wishes to reapply once the application has been denied, he or she must complete a new APAAdult Public Assistance application.  

426-2 C. INTERIM BLINDNESS OR DISABILITY DETERMINATION

The APAAdult Public Assistance program uses the same definitions of disability and blindness as SSISupplemental Security Income.  The Division will obtain and use medical and other information to determine whether an applicant is likely to meet the SSISupplemental Security Income disability/blindness criteria, and is eligible for Interim Assistance.  

If an individual becomes ineligible for IAInterim Assistance for any reason other than a final SSISupplemental Security Income decision, a new AB 3Review Report on Aid to the Blind, AD 2Preliminary Examination for Interim Assistance, APA 4Disability and Vocational Report or disability assessment by the Division’s Medical Reviewer is not required as long as the SSISupplemental Security Income application has remained active during the individual’s period of ineligibility.   IA benefits may be authorized again once the reason for the ineligibility ends.  If the applicant received a final SSISupplemental Security Income decision during the period of ineligibility, the individual must reapply for assistance and meet the criteria listed In APAAdult Public Assistance MSManual Section 426-2 before IAInterim Assistance benefits are again approved.

These determinations are made as follows:

1. APAAdult Public Assistance applicants who are eligible to receive Social Security disability insurance benefits

Persons who receive SSASocial Security Administration disability payments, and persons who have been determined eligible to receive SSASocial Security Administration disability benefits but are serving their five-month waiting period, meet the blindness/disability criteria for IAInterim Assistance.  These individuals are not required to have a medical exam or an assessment by the Division’s Medical Reviewer, as described below.

2. Blind APAAdult Public Assistance applicants required to submit an AB 3Review Report on Aid to the Blind form

An individual who is blind must be examined by a licensed physician, advanced practice registered nurse, or physician assistant within their licensed scope of practice as specified in Manual Section 425-2A. The results of this examination must be provided on a Review Report on Aid to the Blind (AB 3) form.  If a medical provider refuses to complete the AB 3Review Report on Aid to the Blind form, the caseworker should advise the applicant to go to a different provider for completion of the form.

The AB 3Review Report on Aid to the Blind form must be checked "Yes" or "No."  A "Yes" is evidence of blindness for Interim Assistance.  A "No" shows ineligibility for Interim Assistance.  When determining blindness for Interim Assistance, only the AB 3Review Report on Aid to the Blind form needs to be completed.  The caseworker will accept the judgment of the medical provider as noted on the AB 3Review Report on Aid to the Blind.  It is not reviewed by any other authority.

If Interim Assistance is not approved, the APAAdult Public Assistance application must be pended for an eligibility decision from the SSISupplemental Security Income program so that eligibility for regular APAAdult Public Assistance and Medicaid can be determined.

3. Disabled APAAdult Public Assistance applicants required submit an AD 2Preliminary Examination for Interim Assistance form

An individual who has a disability other than blindness must be examined by a licensed physician, psychiatrist, advanced practice registered nurse, or physician assistant within their licensed scope of practice as specified in Manual Section 425-2A.  The results of this examination must be provided on a Preliminary Examination for Interim Assistance AD 2Preliminary Examination for Interim Assistance form.  If a medical provider refuses to complete the AD 2Preliminary Examination for Interim Assistance form, the caseworker should advise the applicant to go to a different provider for completion of the form.

In some cases, the Medical Reviewer may need to ask a medical provider for information.  To assist in this process the caseworker should obtain a completed Authorization for Release of Protected Health Information (GEN 150 IAAuthorization for Release of Protected Health Information) form.  See section 4 below for instructions on how to complete this form.

The Medical Reviewer will assess the individual’s disability using the examination results reported on the AD 2Preliminary Examination for Interim Assistance form and any supporting documents or information, and decide whether the applicant meets SSISupplemental Security Income disability criteria.

When making a disability assessment, the Medical Reviewer will consider whether the:  

• Applicant’s condition meets the SSISupplemental Security Income presumptive disability criteria or another impairment category used by Social Security to determine a person’s disability status;
   
• Medical information provided by the applicant or received by the Department documents the applicant’s impairment;
   
• Impairment affects the individual’s activities of daily living;
   
• Applicant can work, including sedentary work;
   
• Impairment has lasted, or is expected to last, for a continuous period of at least 12 months.

Once the assessment is completed, the Medical Reviewer will document the disability decision on the AD 2 form and advise the caseworker of the approval or denial by fax or e-mail.

•    IAInterim Assistance Disability Approved

If approved, the caseworker will open an Interim Assistance case if the individual meets all other factors of eligibility for IAInterim Assistance .  The APAAdult Public Assistance application is pended for an eligibility decision from the SSISupplemental Security Income program so that eligibility for regular APAAdult Public Assistance and Medicaid can be determined.  

•    IAInterim Assistance Disability Denied

If denied, the caseworker will pend the APAAdult Public Assistance application, giving the individual 30 days to be in pay status with SSISupplemental Security Income.

4. Authorization for Release of Protected Health Information (GEN 150 IAAuthorization for Release of Protected Health Information)

The GEN 150 IAAuthorization for Release of Protected Health Information form must be properly completed before it is sent to the Medical Reviewer.  If information is being requested from more than one medical provider, a separate form must be completed for each provider.

The information requested on the front page of the form must be filled in before the applicant signs the form.  The form is not valid if the applicant signs the form before it is filled out.  The form should be completed as follows:

• Name: The applicant's printed name.

• SSN:  The applicant's Social Security Number.

• Case # or Client ID:  The applicant's EIS case number or Client ID.

• Date of Birth:  The applicant's date of birth.

• Other Names Under Which Records Might Be Filed:  If applicable, enter any other names under which medical records might be filed.

• Organization Releasing Information:  Provide the name of the medical provider from whom we may request information.  The provider must be clearly identified with a complete name.  For example, "Providence" is not enough information because there are numerous providers with that name, such as Providence Mat-Su, Providence Behavioral Health, Providence Family Practice, etc.

Spell out acronyms on the release form.  If the provider does not accept an acronym, then we must get a new release form - creating a delay for both the caseworker and the applicant.

If the applicant comes from another state, ask the applicant for identifying information for any out-of state providers, such as a valid phone number, fax number, or mailing address.  The release form is useless if the Medical Reviewer is unable to contact the provider.

• Organization Receiving Information:  This section is pre-filled with:  "Division of Public Assistance".

• Description of Information To Be Released:  This section is pre-filled with:  ”All medical records supporting disability or incapacity due to mental illness, physical illness, and/or substance abuse.”

• Signature:  The applicant or their personal representative must sign the form.

• Date:  The date the form is signed.

• Revocation Date(s):  If the applicant enters a revocation date on either the front or back of the form, please review that date.  An applicant may sometimes enter a revocation date that is the same as the signature date.  When this happens, a new release form will be needed because the applicant has essentially revoked the current form.    

5.  Disability and Vocational Report (APA 4Disability and Vocational Report)

The APA 4Disability and Vocational Report asks the client to give information about their disability, their medical provider's name and contact information, and information about past work and education.  The information provided on the form will help the Medical Reviewer determine IAInterim Assistance eligibility.

The APA 4Disability and Vocational Report must be completed to the extent possible before it is sent to the Medical Reviewer.  Sending incomplete documentation to the Medical Reviewer may result in a delay in the disability decision.  For additional guidance on how to complete the APA 4Disability and Vocational Report see Administration Manual section 115-9D(2).

426-2 D.  AGED APPLICANTS

Processing times for SSISupplemental Security Income applications based on age are usually much faster than for individuals applying based on disability or blindness.  In most cases, the SSISupplemental Security Income decision for old age cases will be made within the 30-day APAAdult Public Assistance application processing timeframe, and eligible cases can be opened in regular APAAdult Public Assistance coverage.  If, however, no SSISupplemental Security Income decision is reached within the APAAdult Public Assistance application processing timeframe, aged applicants may receive Interim Assistance pending the SSISupplemental Security Income eligibility decision.  An interim blindness or disability determination is not required for aged applicants.

426-2 E.     IARInterim Assistance Reimbursement AUTHORIZATION REQUIREMENT

APAAdult Public Assistance applicants must sign an Interim Assistance Reimbursement (IARInterim Assistance Reimbursement) authorization form to receive Interim Assistance benefits.  The IARInterim Assistance Reimbursement authorization is not, however, an eligibility requirement for regular APAAdult Public Assistance benefits.  The signed IARInterim Assistance Reimbursement authorization is necessary only if the applicant wishes to receive IAInterim Assistance benefits while waiting for a decision on his or her SSISupplemental Security Income application.   APA applicants who appear eligible for Interim Assistance must be given the choice of either signing or not signing the IARInterim Assistance Reimbursement authorization form.

The IARInterim Assistance Reimbursement authorization may be provided to the APAAdult Public Assistance applicant during the interview process, or if this is not possible, the caseworker may send EISEligibility Information System notice, P021, IARInterim Assistance Reimbursement Authorization Needed, and mail the IARInterim Assistance Reimbursement authorization form separately to the client at the same time.

When a signed IARInterim Assistance Reimbursement authorization is received, the caseworker must:

• Complete and sign the "State Representative Signature" and "Date Received by State" fields at the bottom of the form and send the original copy to the appropriate SSASocial Security Administration office within 30 calendar days of the date the signed authorization was received by DPADivision of Public Assistance.  (The date the authorization was received by DPADivision of Public Assistance is entered on the form as the date received.)  If these fields are not completed, the SSASocial Security Administration office will return the form to DPADivision of Public Assistance.

• Enter the date the authorization was received by DPADivision of Public Assistance into EISEligibility Information System on the APASAPA Authorization Screen screen.  (The Claims Unit will use this date when calculating an IAInterim Assistance recipient's reimbursement obligation.)

If otherwise eligible, Interim Assistance under this provision begins the month a signed IARInterim Assistance Reimbursement authorization is received in a DPADivision of Public Assistance office.  APA applicants who do not sign an IARInterim Assistance Reimbursement authorization are not eligible for Interim Assistance.

426-2 F.    CONTACTING THE MEDICAL REVIEWER

Once all the necessary forms are complete, the caseworker must immediately notify the Medical Reviewer by sending an email to hss.dpa.interim.assist@alaska.gov.  The email must include the client's name and client ID.  The Medical Reviewer will find the documents in ILINX with this information.

NOTE:  

If an IAInterim Assistance applicant is terminal, staff should indicate this on the IAInterim Assistance packet being sent to the Medical Reviewer.