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A Word About States and Medicaid.

Before we explain and use examples to demonstrate how these special Medicaid rules work, it is important to understand that States use different approaches to establishing Medicaid eligibility related to SSI. There are basically 3 different ways that States may function:

States that Use the SSI Income Rules.

For Medicaid eligibility purposes, States may elect to enroll SSI recipients who meet certain Medicaid-only tests (e.g., providing third-party insurers information automatically in Medicaid.) The States that elect to do this are called “1634 States”. This Title refers to the part of the Social Security Act that authorizes the States to enter agreements with SSA to make Medicaid eligibility decisions.

Instead of having the SSA make the decisions, States may require that recipients apply directly to the state Medicaid agency, even though the state uses the same rules as SSI for determining eligibility for Medicaid. These States are called “SSI eligibility States”.

States that Do Not Use SSI Income Rules

Eleven States have elected to have at least one more stringent requirement than the SSI rules for Medicaid eligibility. These States are known as “209(b) States”. This number refers to the part of Public Law 92-603 that authorized the States to make more strict requirements for Medicaid entitlement. The original 209(b) language has been incorporated and amended in section 1902(f) of the Social Security Act. It is important to understand the 209(b) state distinction, because it is possible for the income and resources limits to vary greatly in States that have elected to create their own eligibility rules. Although special Medicaid groups may exist in 209(b) States, the Title II income may not be treated in the same manner as discussed in the examples below. Benefits Specialists must check with the local Medicaid agency to learn exactly what income limits apply to these special Medicaid groups.

209(b) States

Connecticut	Illinois	Minnesota	New Hampshire
Ohio	Virginia	Hawaii	Indiana
Missouri	North Dakota	Oklahoma

All 209(b) States are required to apply the same rules under these special Medicaid groups that the state would apply to SSI recipients as stated in POMS SI 01715.010 Medicaid and the SSI Program”

“If the agency uses more restrictive eligibility requirements than are used by the SSI program (i.e. 209(b) States, it must provide Medicaid to individuals ...using the same eligibility criteria basis as Medicaid is provided to individuals who receive SSI benefits. ...the state has the option of disregarding part, all, or none of the Title II benefit or increases in that benefit that make the individual ineligible provided that the same amount is disregarded for all members of the group.”

POMS Resources:

FAQ Disclaimer: The VCU-BARC FAQ Pages are general information provided as a public service. The contents do not necessarily represent the policy, interpretations or opinion of the Social Security Administration (SSA). The information contained here is intended to inform readers of issues that may affect Social Security and/or other public assistance benefits. Because individual circumstances differ, the reader should not rely on any information here as being specifically applicable to an individual's situation.