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FAQs

Who are Special Medicaid Beneficiaries?

In most States, categorical Medicaid eligibility for the aged, blind and disabled is directly tied to receipt of SSI benefits. For this reason, loss of SSI payments often results in loss of Medicaid coverage. Over the years, Congress has enacted special Medicaid continuation provisions to preserve critical Medicaid coverage for certain special groups of individuals who lose SSI payments. For the purposes of these FAQs, a “special Medicaid beneficiary” is someone who lost SSI payments due to receipt of or increases in Title II benefits (SSDI, CDB, DWB), but who is allowed to retain Medicaid coverage.

The types of special Medicaid beneficiaries that Benefits Specialists could encounter are individuals who lost SSI eligibility because of:

  1. Any reason, but who are not currently entitled to SSI because of Cost-of-Living increases in Social Security benefits (including SSDI);
  2. Entitlement to or increase in Childhood Disability Benefits (CDB); or
  3. Entitlement to Disabled Widow(er)s Benefit (DWB) until Medicare starts.

When determining Medicaid eligibility for these special former SSI recipients, State Medicaid agencies must exclude all, of the individual’s Title II disability benefit that caused the loss of SSI payments. Essentially, if the individual would be entitled to SSI if those increases did not exist, that individual would be entitled to Medicaid under these provisions.

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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.