How
does Special Medicaid Benefits apply to Benefits Planning Assistance
and Outreach (BPAO) activities?
It is essential that Benefits Specialists establish good working
relationships with the local Medicaid agencies. Benefits Specialists
need to know what Medicaid eligibility groups and income limits
exist in the state, especially how individuals with disabilities
may become entitled or may lose entitlement. Benefits Specialists
should recognize situations where special Medicaid involvement is
likely. If, for example, a beneficiary states that the beneficiary
used to receive SSI, but lost it because of an increase in benefits,
and still has Medicaid, it may be possible that work income could
affect Medicaid entitlement. The Benefits Specialist’s role
in that situation is to fully investigate other options to meet
the beneficiary’s medical needs.
An Important
Reminder
Because
these groups are based on deemed SSI entitlement, the individual
must still meet all of the non-income rules for SSI. For example,
the individual’s Resources must be below the SSI Resource
limits, and the person must continue to have a disability, blindness
or be 65 or older. In addition, for individuals who have only an
exclusion of the cost-of-living increases under the Pickle Amendment,
the person must be entitled to both Social Security and SSI cash
benefits for at least one month before the SSI cash payments were
lost.
Consideration
of Special Medicaid Benefits must be integrated into benefits analysis
and advisement.
For Example:
How
long do these special Medicaid exclusions last?
Once
entitlement to Medicaid as a special Medicaid beneficiary
is established for someone under these provisions, the Medicaid
agency can use the exclusion whenever it results in Medicaid
entitlement. In other words, there is no established time
limit. The exception is, of course, for DWB beneficiaries
who have become entitled to Medicare. Once Medicare occurs,
DWB beneficiaries are no longer eligible to exclude income
under these provisions.
What
happens if someone receives Medicaid through the 1619(b) provision
when they lose entitlment to SSI because of a Titlie II cost-of-living
increase, or lose SSI due to entitlement to CDB or DWB benefits?
If
a person is eligible under 1619(b) and loses that eligibility
because of receipt of or increases in benefits under one of
the pertinent “deemed” SSI groups, the title II
benefit deductions applicable to the deemed group in question
would apply. In these circumstances, the person may earn up
to the state 1619(b) threshold without losing Medicaid entitlement.
If the person has high Medicaid costs, that individual may
also establish a higher, individualized threshold. Medicaid
entitlement under the 1619(b) provision is only conferred
on individuals who were already receiving Medicaid under 1619(b)
at the point their Social Security income increased and caused
loss of SSI entitlement. If the individual was receiving an
SSI cash benefit when the Social Security increase caused
the loss of SSI, the 1619(b) provision does not apply.
Can
a state Medicaid agency allow an individual to earn more and
retain Medicaid as a Special Medicaid beneficiary if the individual
has a Plan for Achieving Self-Support (PASS)?
No,
in fact in 1634, or SSI eligibility States, a PASS and special
Medicaid eligibility are mutually exclusive. One of the primary
requirements for PASS eligibility is that an individual is
eligible for SSI, or becomes eligible for SSI for the duration
of the PASS. That means that as long as someone has a PASS
in effect in a 1634 or SSI eligibility state, that person
would also have Medicaid, either as an SSI cash recipient,
or under the 1619(b) provision. Special Medicaid eligibility
would not be an issue when a PASS was possible.
I
have heard of these types of exclusions referred to as Pickle
exclusions. Where does that Title originate?
Pickle refers to the surname of the Congressman who introduced
the legislation that allowed Medicaid to continue when someone
lost SSI eligibility due to a SSDI cost-of-living raise. This
legislation is also referred to as Section 503, referring
to the section of the Social Security Act that requires States
to continue Medicaid in these circumstances. The exclusions
for CDB and DWB beneficiaries are actually not “Pickle”
provisions.
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.
