PAYMENT-STATUS

Payment Status Code. This three-digit alpha/numeric code identifies the current SSI/SSP eligibility and payment status of an individual and the reason for the status. MEDS uses this code in combination with the ‘SDX Transaction’ and ‘Medicaid Eligibility’ codes to determine a recipient’s eligibility for Medi-Cal. The 1st position of the payment status code identifies the eligibility/payment status and the 2nd and 3rd positions indicate the reason for the status.

The eight (8) payment status categories are as follows:

Status

(1st Position)

Description

C

Indicates the recipient is eligible for SSI and/or SSP and payment is due.

E

Indicates eligibility for Federal and/or State benefits based on eligibility computation, but no payment is due based on the payment computation.

H

Indicates the case is in a “hold” status, final disposition is pending.

M

Indicates the case is under manual control. Case is known as “forced payment” although payment may not be involved.

N

Indicates the claimant/recipient is not eligible for SSI/SSP or that a previously eligible recipient is not currently eligible.

P

Indicates suspension with the probability of reinstatement. “P” is obsolete since June 1987.

S

Administrative suspension. Indicates recipient may still be eligible for SSI and/or SSP, but payment is being withheld.

T

Indicates SSI and/or SSP eligibility is terminated. A record may be terminated and a new record established in certain situations.

 

Values

Definition

C01

ELIGIBLE - Current Pay

E01

ELIGIBLE, NO PAYMENT DUE - Eligible for federal and/or state benefits based on eligibility computation, but no payment is due based on payment computation.

E02

ELIGIBLE, NO PAYMENT DUE - Eligible for benefits but not payable in that month due to the new application date.

H10

HOLD - Living arrangement change is in progress

H20

HOLD - Marital Status change is in progress

H30

HOLD - Resource change is in progress

H40

HOLD - Student status change is in progress

H50

HOLD - Head of Household change is in progress

H60

HOLD - Pending receipt of date of death

H70

HOLD - Pending transmission of one-time payment data

H80

HOLD - Early input

H90

HOLD - Systems limitation. SSA District Office must manually compute

M01

FORCE PAYMENT - Recipient may be in payment or non-payment status. See SSI-ELIG-AMT and SSP-ELIG-AMT fields for eligible amounts. These two fields contain zeros if the recipient is in non-payment status.

M02

FORCE PAYMENT - Force due

N01

NONPAY - Recipient's countable income exceeds Title XVI payment amount and his/her State's payment standard.

N02

NONPAY - Recipient is an inmate of public institution.

N03

NONPAY - Recipient is outside of United States

N04

NONPAY - Recipient's non-excludable resources exceed Title XVI limitations

N05

NONPAY - Unable to determine if eligibility exists

N06

NONPAY - Recipient failed to file for other benefits

N07

NONPAY - Cessation of recipient's disability

N08

NONPAY - Cessation of recipient's blindness

N09

NONPAY - Recipient refused vocational rehabilitation without good cause

N10

NONPAY - Recipient refused treatment for drug addiction

N11

NONPAY - Recipient refused treatment for alcoholism

N12

NONPAY - Recipient voluntarily withdrew from program

N13

NONPAY - Not a citizen or eligible alien

N14

NONPAY - Aged claim denied for age.

N15

NONPAY - Blind claim denied, applicant not blind

N16

NONPAY - Disability claim denied, applicant not disabled

N17

NONPAY - Failure to pursue claim by applicant

N18

NONPAY - Failure to cooperate

N19

NONPAY - Recipient voluntarily terminated participation in the SSI program

N20

NONPAY - Recipient failed to furnish a required report

N22

NONPAY - Inmate of a correctional institution

N23

NONPAY - Not a legal resident in the United States

N24

NONPAY - Convicted of felony of fraudulently misrepresenting residence in two or more states

N25

NONPAY - Claimant is fleeing to avoid prosecution for, or custody or confinement after con- viction for, a crime which is a felony under the laws of the place from which he/she flees, or is violating a condition of probation or parole imposed under Federal or State law.

N27

NONPAY - Disability terminated due to Substantial Gainful Activity (SGA)

N30

NONPAY - Slight impairment, medical condition alone, no visual impairment

N31

NONPAY - Capacity for SGA, customary past work, no visual impairment.

N32

NONPAY - Capacity for SGA, other work, no visual impairment

N33

NONPAY - Engaging in SGA despite impairment, no visual impairment.

N34

NONPAY - Impairment is no longer severe at time of adjudication and did not last 12 months, no visual impairment.

N35

NONPAY - Impairment is severe at time of adjudication but not expected to last 12 months, no visual impairment.

N36

NONPAY - Insufficient or no medical data furnished, no visual impairment

N37

NONPAY - Failure or refusal to submit to consultative examination, no visual impairment.

N38

NONPAY - Applicant does not want to continue development of claim, no visual impairment.

N39

NONPAY - Applicant willfully fails to follow prescribed treatment, no visual impairment.

N40

NONPAY - Impairment(s) does not meet or equal listing (disabled child under age 18 only), no visual impairment.

N41

NONPAY - Slight impairment, medical condition alone, visual impairment

N42

NONPAY - Capacity for SGA, customary past work, visual impairment

N43

NONPAY - Capacity for SGA, other work, visual impairment.

N44

NONPAY - Engaging in SGA despite impairment, visual impairment.

N45

NONPAY - Impairment no longer severe at time of adjudication and did not last 12 months, visual impairment.

N46

NONPAY - Impairment is severe at time of adjudication but not expected to last 12 months, visual impairment.

N47

NONPAY - Insufficient, or no medical evidence furnished, visual impairment.

N48

NONPAY - Failure or refusal to submit to consultative examination, visual impairment.

N49

NONPAY - Applicant does not want to continue development of claim, visual impairment.

N50

NONPAY - Applicant willfully fails to follow prescribed treatment, visual impairment.

N51

NONPAY - Impairment(s) does not meet or equal listing, disabled child under age 18 only, visual impairment.

N52

NONPAY - Deleted from State rolls before 12/73 payment

N53

NONPAY - Deleted from State rolls after 12/73 payment

N54

NONPAY - District office unable to locate applicant

N55

NONPAY - Impairment due to DAA, no visual impairment

N56

NONPAY - Impairment due to DAA, visual impairment

S01

SUSPENDED - Death reported by Treasury, potential automated death case

S04

SUSPENDED - System is awaiting disability determination, system generated

S06

SUSPENDED - Recipient's address unknown

S07

SUSPENDED - Returned check for other than death, address, payee change or death of payee

S08

SUSPENDED - Representative payee development pending

S09

SUSPENDED - Miscellaneous suspense code

S10

SUSPENDED - Adjudicative suspense (systems generated)

S20

SUSPENDED - Potential rollback case or no disability made prior to 7/73, inactive

S21

SUSPENDED - Recipient is presumed disabled or blind and has received three months pay- ments

T01

TERMINATED - Death of recipient

T20

TERMINATED - Received payment under two different numbers

T22

TERMINATED - Same definition as code T20 except that termination resulted from elec- tronic screening

T30

TERMINATED - Manual termination, payment previously made. Change in record composi- tion requires termination of existing record.

T31

TERMINATED - System generated termination, payment previously made

T32

TERMINATED - System generated termination of large records

T33

TERMINATED - Manual termination, no previous payment made. Will eventually replace T30.

T50

TERMINATED - Manual termination, no previous payment made

T51

TERMINATED - System generated termination, no previous payment made