2630 SSI Recipients (SI) - SSI recipients, persons determined by the Social Security Administration to be eligible for an SSI payment, and persons who qualify for continuing SSI recipient status are eligible for medical assistance if the requirements specified below are met. In addition, individuals who qualify for continuing SSI recipient status are eligible for Child Care subsidy under the provisions of section 4420 (2). Individuals who receive only state supplemental payments or who meet section 1619 guidelines are included in this provision. (See 2633 and 2634 respectively.) There is no eligibility under this section for other persons in the household unless they qualify in their own right.
Elderly or disabled persons who have not applied for SSI and who appear to be potentially eligible should be referred to SSA for a determination. For cases in which an SSI determination of disability is pending, DDS may be contacted when additional information is needed related to the disability determination or a decision is still pending at the end of 90 days.
SSI provisions do not allow for payment to start to an eligible individual until the month following the month of application for SSI. However, the SSI application month shall still be treated as though an SSI payment had been provided and SI eligibility granted for that month.
NOTE: For persons who have applied or been approved for SSI disability, Form DD-1106 may be submitted to DDRS in order to determine the medical onset date of disability. This date would be necessary if retroactively claiming FFP on medical expenditures or determining eligibility prior to the effective date of SSI eligibility. DDRS will return the completed original with the onset date information.
2631 Other Eligibility Factors - The cooperation, transfer of property (institutional/HCBS recipients only), and residence requirements contained in 2100 must be met and the trust provisions of 5620 and subsections are applicable in determining eligibility. In addition, persons convicted of medical fraud or who have a special spenddown may not be eligible based on the provisions of 11221 (5) and 11126.1 (5) respectively.
2632 Prior Eligibility - Eligibility under this section extends to any of the 3 months prior to application for medical if the applicant was determined eligible for SSI by the SSA for that time. If the applicant desires coverage for prior months in which he was not eligible for SSI, a determination of other eligibility under another category (such as MS, poverty level coverage for pregnant women and children, etc.) is required.
2633 Recipients of State Supplemental Payments - Former recipients of Aid to the Aged, Blind, or Disabled (ABD) who were converted to the SSI program in 1974 with a state supplemental payment are eligible for medical as long as they continue to receive such payment and meet the eligibility requirements of 2631. This includes the converted essential persons whose needs were included in determining the previous ABD payment.
2634 1619 Status - Individuals eligible for SSI under the provisions of section 1619 of the Social Security Act are eligible for medical assistance as indicated above. Section 1619 permits disabled individuals to work at the "substantial gainful activity" level (currently defined as receiving gross earnings in excess of $740/month) without jeopardizing their SSI disability status. 1619 (a) eligibles continue to receive a cash benefit as their earnings do not exceed the SSI benefit levels. They are identified on the State Data Exchange Interface (SDX) as in current pay status. 1619(b) eligibles do not receive a cash benefit as their earnings exceed SSI benefit levels but continue to be eligible for medical assistance. They are identified on the SDX Interface as terminated individuals with a Medicaid Indicator code of "B." However, this code will only be reflected at the time SSI benefits are terminated and will not otherwise be reflected on an ongoing basis. It may be necessary to verify 1619(b) status with SSA.
Because 1619(b) status is determined, in part, by a person's need for ongoing Medicaid coverage, SSA may need to verify how extensively a person has used Medicaid. General payment information may be released to SSA upon request. However, data on specific medical services utilized may not be released unless the client has consented to such a release.