530           SSISupplemental Security Income AND APAAdult Public Assistance RELATED CATEGORIES

Recipients of Supplemental Security Income (SSISupplemental Security Income), Adult Public Assistance (APAAdult Public Assistance), and persons who are eligible for those programs but choose not to receive cash are automatically eligible for Medicaid.  Other eligibility categories explained in this manual do not give automatic Medicaid eligibility, but they do use SSISupplemental Security Income and APAAdult Public Assistance financial and nonfinancial methodology to determine eligibility.

530 A.      SSISupplemental Security Income RECIPIENT

An individual verified as receiving SSISupplemental Security Income cash assistance payment is eligible for Medicaid coverage, regardless of APAAdult Public Assistance eligibility.  This includes an individual who is:

1. Receiving SSISupplemental Security Income pending a final determination of blindness or disability, including a low-birth weight infant who is receiving presumptive disability payments.  See APAAdult Public Assistance Manual Section 425-2 B;

2. Not receiving an SSISupplemental Security Income check solely because of recoupment of an overpayment;

3. Receiving SSISupplemental Security Income cash assistance under a conditional agreement with the Social Security Administration to dispose of resources that exceed the SSISupplemental Security Income resource limit; and

4. A disabled child under age18 who is receiving SSISupplemental Security Income.

530 B.     APAAdult Public Assistance RECIPIENT

An individual eligible for and receiving an Adult Public Assistance (APAAdult Public Assistance) cash assistance payment is eligible for Medicaid coverage.  

Note:

This does not apply to an individual receiving Interim Assistance (IA) payments.

530 C.      USE OF THE REFUSED CASH MEDICAID SUBTYPE

The Refused Cash (RCRefused Cash) Medicaid subtype is used for two groups of individuals starting January 2020:

1. An individual who is eligible for APAAdult Public Assistance cash assistance payments but chooses not to receive the cash payments.  This individual must meet all the financial and non-financial requirements of the program; and

2. An individual who has countable income equal to or above the APAAdult Public Assistance need/payment standard shown in APAAdult Public Assistance Manual Addendum 1 but equal to or below the Expanded Refused Cash Income Limits shown in ADLTC Manual Addendum 1.  Although the individual is not eligible for an APAAdult Public Assistance cash payment, they will be eligible for Medicaid coverage using the Refused Cash (RCRefused Cash) Medicaid subtype.

Note:

The Refused Cash category should not be used for individuals residing in a LTCLong Term Care facility or receiving HCBHome and Community-Based Waiver Services.

530 D.      SSISupplemental Security Income DISABLED ADULT CHILDREN

An individual is eligible for Medicaid if he or she meets all of the following conditions:

1. Is age 18 or older;

2. Was receiving SSISupplemental Security Income or APAAdult Public Assistance benefits that began prior to age 22;

3. Lost eligibility for SSISupplemental Security Income or APAAdult Public Assistance on or after July 1, 1987 when income increased solely because the individual became newly eligible for Social Security benefits as a "disabled adult child" or because of an increase in Social Security Title II benefits; and

4. Would qualify for SSISupplemental Security Income or APAAdult Public Assistance if Social Security Title II benefits were disregarded.

Disabled adult children are blind or disabled individuals who receive special child's insurance benefits under the Social Security Act because their parent is retired or disabled and receive Social Security, or are deceased.  These individuals may become newly eligible for disabled adult child benefits at any age over 18, depending on the parent's death, disability, or retirement.

The SDXState Data Exchange printout displays a D indicator under the Medicaid eligibility code, field 50, and record layout position 428, to indicate Medicaid eligibility for a disabled adult child.

530 E.      SECTION 1619(b) ELIGIBLE

A blind or disabled individual who despite his or her work at a substantial gainful activity (SGA ) has had their SSISupplemental Security Income eligibility status maintained for Medicaid purposes by section 1619(b) of the Social Security Act is eligible for Medicaid.  The Social Security Administration determines eligibility for this category.  Computer printouts of these eligible individuals are provided to DPADivision of Public Assistance on a regular basis and distributed to the field.  A person must be on this list or otherwise verified as in 1619(b) status by the Social Security Administration to be eligible for Medicaid under the 1619(b) provision.

530 F.      DISABLED WIDOW(ER) WHO HAS LOST SSISupplemental Security Income OR APAAdult Public Assistance DUE TO RECEIPT OF TITLE II BENEFITS

A widow(er) between the ages of 60 and 64 who has lost SSISupplemental Security Income benefits as a result of becoming entitled to, or receiving, Title II SSASocial Security Administration early widow(er) benefits is eligible to continue receiving Medicaid until he or she becomes eligible for Medicare Part A.

The individual is deemed to be an SSISupplemental Security Income recipient for the purposes of the Medicaid program if the individual meets all the following conditions:

Is age 60 years or older;
 

Is eligible for and receiving SSASocial Security Administration early widow(er) benefits;
 

Has no entitlement to Medicare Part A; and
 

Is ineligible for SSISupplemental Security Income or APAAdult Public Assistance due solely to the receipt of SSASocial Security Administration Title II early widow(er) benefits.

The individual is deemed to be an SSISupplemental Security Income recipient as long as he or she would be eligible for SSISupplemental Security Income or APAAdult Public Assistance in the absence of their SSASocial Security Administration widow(er) benefits.