2683 Adult Disabled Children - Based on the Employment Opportunities for Disabled Americans Act of 1986, persons who qualify for Social Security benefits as "adult disabled children" may be eligible for medical assistance without a spenddown if the following criteria are met:
This provision is not applicable to those who (1) currently receive SSI or cash assistance or (2) reside in a nursing facility or state institution. Qualifying individuals must meet all Medically Needy nonfinancial eligibility factors including the general eligibility requirements of 2100 and the resource criteria of 5000 and subsections.
NOTE: Adult Disabled Child benefits can be identified by a Social Security Claim Number which ends with a "C".
For applicants who receive SSA benefits under the "adult disabled child" category, a determination of whether or not the individual had previously been an SSI client and, if so, whether or not the individual lost SSI eligibility on or after July 1, 1987 due to his or her adult disabled child benefit must be made. Verification of these qualifications along with the person's adult disabled child benefit level prior to SSI termination would be required. If the above conditions are met, a determination of the individual's financial and nonfinancial eligibility would then be completed.
All clients who lose SSI eligibility at the time he or she becomes eligible for Adult Disabled Child benefits are eligible for medical assistance without a spenddown. They would remain eligible for automatic medical as long as they would be otherwise eligible for SSI if not for the adult disabled child benefits.
To determine income eligibility for applicants as well as continuing eligibility for ongoing clients, the amount, if any, of the person's adult disabled child benefit in the month prior to the month of the increase which resulted in ineligibility for SSI must be verified. If the person became newly eligible for an adult disabled child benefit, this amount would be "0." This figure shall then be inserted on the Determination Worksheet for Pickle Eligibles and Other Protected Medical Groups (ES-3104.6) in Line 3 to determine total countable income. If the total countable income is less than the appropriate SSI benefit level, the person continues to qualify for medical eligibility without a spenddown. If the income is greater than the SSI level, the person would not qualify and a regular medical determination would be required. The income determination would not be required at the time an ongoing client loses SSI eligibility unless some other change in income occurred at the same time. This determination should occur on at least an annual basis as indicated below.
Persons eligible under this provision shall be reviewed on an annual basis in accordance with 9372. If there has been no change in circumstance such as an increase in other income or loss of disabled child status, such eligibility shall continue. Although qualifying persons are eligible for medical without a spenddown as though they were receiving SSI benefits, they are not to be viewed as SSI recipients for any other purpose. Thus the income and resources of a person receiving medical under this provision would be considered in determining the cash and medical eligibility of any spouse or children.
2684 Early or Disabled Widows and Widowers - Persons who lose their SSI eligibility (including eligibility under section 1619 per 2634) because they begin receiving early or disabled widow or widower Social Security benefits may qualify for medical assistance without a spenddown if they meet the following criteria:
This provision is not applicable to those who (1) currently receive SSI or cash assistance or (2) reside in a nursing facility or state institution. Qualifying individuals must meet all Medically Needy nonfinancial eligibility factors including the general eligibility requirements of 2100 and the resource criteria of 5000 and subsections.
For applicants who receive early or disabled widow or widower's benefits and meet the age and Medicare criteria described above, a determination of whether or not the individual has previously been an SSI client and, if so, whether the individual lost SSI eligibility due to the receipt of such benefits must be made. Verification of these qualifications along with the current widow/widower benefit amount would be required. A determination of the individual's financial and nonfinancial eligibility would then be completed.
Ongoing SSI clients who lose SSI eligibility due to becoming eligible for early or disabled widow/widower benefits shall be considered as having met items 2 and 3 in the above criteria (including financial and nonfinancial requirements). A determination of the age and Medicare eligibility criteria would then be made. Verification of the reason for SSI termination will be required. Qualifying individuals are would remain eligible for medical assistance without a spenddown as long as they continue to meet the above provisions.
To determine income eligibility,Determination Worksheet for Pickle Eligibles and Other Protected Medical Groups shall be used. All of the individual's nonexempt income except the widow/widower benefit would be inserted on Lines 4-6 of the worksheet and the resulting total countable income determined. If the total countable income is less than the appropriate SSI benefit level, the person would qualify for medical assistance without a spenddown. If the income is greater than the SSI benefit level, the person would not qualify and a regular medical determination would be required. An income determination would not be required at the time an ongoing client loses SSI eligibility as indicated above unless some other change in income occurred at the same time.
This determination should occur on at least an annual basis as indicated below.
Eligibility under this provision shall end in the month in which the individual turns 65 or becomes eligible for Medicare Part A, whichever occurs first. An annual review shall be conducted in accordance with 9372. If there has been no change in circumstance such as an increase in other income, such eligibility shall continue until the age limit or Medicare eligibility is reached.
Although qualifying persons are eligible for medical without a spenddown as though they were receiving SSI benefits, they are not to be viewed as SSI recipients for any other purpose. Thus the income and resources of a person receiving medical under this provision would be considered in determining the medical eligibility of any dependent children.