531           DEEMED AN SSISupplemental Security Income /APAAdult Public Assistance RECIPIENT UNDER THE PICKLE AMENDMENT

Named after its congressional sponsor, J. J. Pickle (D-Texas), and enacted in 1976, the Pickle Amendment established a separate category of Medicaid eligibility.  This amendment requires that an individual be deemed an SSISupplemental Security Income or APAAdult Public Assistance recipient (and so eligible for Medicaid) if the individual meets the eligibility factors in subsection A below.  This category applies to an individual who isIndividualized Supports ineligible for SSISupplemental Security Income or APAAdult Public Assistance because of cost-of-living adjustments in that individual’s Social Security, Title II Old Age, Survivors, and Disability ( OASDI ) benefits.  

531 A.      ELIGIBILITY FACTORS

An individual who has lost his or her SSISupplemental Security Income or APAAdult Public Assistance benefits may qualify for Medicaid benefits if he or she:

1. Was entitled to receive both OASDIOld Age, Survivors, and Disability Insurance (Social Security) and SSISupplemental Security Income or APAAdult Public Assistance cash benefits in at least one month after April 1977 (see Note below);

2. Is currently eligible for and receiving OASDIOld Age, Survivors, and Disability Insurance (Social Security) benefits;

3. Is currently ineligible for SSISupplemental Security Income or APAAdult Public Assistance;

4. Receives income that would allow the individual to qualify for SSISupplemental Security Income or APAAdult Public Assistance after deducting all OASDIOld Age, Survivors, and Disability Insurance (Social Security) cost-of-living adjustments received since the last month in which the individual was eligible for both OASDIOld Age, Survivors, and Disability Insurance (Social Security) and SSISupplemental Security Income ; and

5. Meets all other Medicaid eligibility requirements.

Note:  

The individual need not literally receive both SSISupplemental Security Income and Social Security checks in the same month, but need only be entitled to both for the same month.  There is a one-month lag in OASDIOld Age, Survivors, and Disability Insurance (Social Security) payments, which are not disbursed until the month after entitlement, while SSISupplemental Security Income payments are paid in the month of entitlement.  It is common for an individual to receive SSISupplemental Security Income while awaiting receipt of OASDIOld Age, Survivors, and Disability Insurance (Social Security) payments. Once the monthly OASDIOld Age, Survivors, and Disability Insurance (Social Security) begins, if it exceeds the SSISupplemental Security Income rate, he or she receives just OASDIOld Age, Survivors, and Disability Insurance (Social Security) thereafter. In such circumstances, even though the individual never actually received simultaneous payments from both programs in a single month, he or she meets the first Pickle requirement. This is true even if income from a retroactive OASDIOld Age, Survivors, and Disability Insurance (Social Security) payment exceeds the SSISupplemental Security Income benefit level for all months in which SSISupplemental Security Income was received.

531 B.      SCREENING

The following screening process will eliminate most applicants from consideration of eligibility under this category without the need for performing any mathematical calculations. For those who passPlan for Achieving Self-Support this initial screening, the Pickle Amendment table in Addendum 1, page 2 provides a simple formula for performing the necessary mathematical calculations.  The screening process is as follows:

Step 1:

Ask the applicant, are you now receiving a Social Security check?  If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 2.

Step 2:

Ask the applicant, after April 1977, did you ever get an SSISupplemental Security Income check at the same time that you got Social Security, or did you get SSISupplemental Security Income or APAAdult Public Assistance in the month just before your Social Security started?  If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 3.

Step 3:

Ask the applicant, what is the last month in which you received SSISupplemental Security Income?

Step 4:

Look up the month in which the applicant last received SSISupplemental Security Income or APAAdult Public Assistance in the Pickle Amendment Table in Addendum 1, page 2.  Find the percentage that applies to that month/year.  Multiply the present amount of the applicants (and/or spouse’s) Social Security benefits by the applicable reduction factor.

Step 5:

Add the figure that you have just calculated to any other countable income the person may have. If the resulting total is less than the current APAAdult Public Assistance Need Standard, the applicant is income eligible for Pickle Medicaid benefits.

Note:  

Because rounding factors may make a difference, if the total is within $20 of the current APAAdult Public Assistance Need Standard, please email the Program Officer at dpapolicy@alaska.gov for guidance.

Step 6:

Review for all other factors of eligibility.

Example:

Mrs. Lewis received both Social Security and SSISupplemental Security Income checks in 1978-79.  However, her SSISupplemental Security Income /APAAdult Public Assistance was terminated in March 1979 because she started receiving a private pension that, added to her Social Security benefits, raised her income to an amount above the 1979 SSISupplemental Security Income and APAAdult Public Assistance income limits. There have been gradual increases in her income since 1979.  She now receives a Social Security benefit of $1050 per month.  Her private pension is $270 a month, for a combined total of $1,320 monthly.

In 2004, the income limit for APAAdult Public Assistance is $1047 (plus a $20 general income disregard = $1067) for an individual.  Thus, Mrs. Lewis’ income is over the income limit for persons who are aged, blind or disabled.

Screen Mrs. Lewis for Pickle eligibility as outlined above.  Determining that the last month that she received both Social Security and SSISupplemental Security Income or APAAdult Public Assistance was March 1979, look up that time period in the following table and find the corresponding reduction factor (.360).  Multiply Mrs. Lewis’s current Social Security benefit of $1050 by that factor, to determine her current countable Pickle income.

                               $1050

                              x   .360 (reduction factor)

                                  $378 (Pickled Social Security income, rounded downward)
 

                                  $378 countable Social Security income

                               + $270 private pension

                                  $648 total countable Pickle income.

Since $648 is less than the current APAAdult Public Assistance income limit (including the standard $20 disregard) of $1067, Mrs. Lewis is eligible for Medicaid.

531 C.       EIS INFORMATION