Assisting Customers in Accessing Programs and Benefits a. Referrals for Public or Private Programs and Benefits
i. When an individual contacts, or is referred to, the ADRC and appears to be eligible for or interested in receiving public program services or benefits, the ADRC shall refer the individual to the appropriate benefit specialist and/or the local, state, and/or federal agency responsible for determining the individual’s eligibility. Programs and benefits to which individuals shall be referred include, but are not limited to, Medicaid, Medicare, Social Security, SSI, SSDI, SSI-E, FoodShare, Veterans benefits, mental health services, and other public programs and benefits.
ii. When an individual contacts, or is referred to, the ADRC and appears to be eligible for or interested in receiving private program services or benefits, the ADRC shall refer the individual to the appropriate benefit specialist and/or the private agency responsible for determining the individual’s eligibility.
Assisting Customers in Accessing Programs and Benefits. When an individual contacts, or is referred to, the ADRC and appears to be eligible for or interested in receiving public program services or benefits, the ADRC will refer the customer to the appropriate benefit specialist or the local, state, or federal agency responsible for determining the customer’s eligibility. Programs and benefits to which customers will be referred include, but are not limited to, Medicaid, Medicare, Social Security, Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), SSI Exceptional Expense Supplement (SSI-E), FoodShare, veterans benefits, mental health services, and other public programs and benefits. When an individual contacts, or is referred to, the ADRC and appears to be eligible for or interested in receiving private program services or benefits, the ADRC will refer the customer to the appropriate benefit specialist or the private agency responsible for determining the customer’s eligibility. The ADRC will assist customers applying for home and community based long-term care Medicaid consistent with the requirements relating to access to publicly funded long-term care. Assistance with Medicaid applications not involving access to publicly funded long-term care will be provided as follows:
i. ADRCs do not have the primary responsibility for assisting with Medicaid applications. The ADRC will provide customers who appear likely to be eligible or want to apply for Medicaid with basic information about how to apply for Medicaid and refer them to the appropriate agency for application assistance, eligibility determination, and enrollment.
ii. The ADRC will assist customers with the Medicaid application when it determines that the assistance that is available from the local or regional income maintenance agency or other sources is not timely or sufficient to ensure access.
iii. The ADRC is not responsible for assisting with Medicaid applications for nursing home residents unless they are relocating to the community. The ADRC may perform initial SSI-E eligibility determinations and certifications for both managed care and IRIS enrollees if so directed by the county or Tribe. If an ADRC provides initial SSI-E eligibility determinations it must inform DHS of this in its Annual Update. The ADRC will refer customers to appropriate county or Tribal mental health and substance use services but will not provide either eligibility screening or intake for these programs.
