531           DEEMED AN SSI /APA 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 SSI or APA recipient (and so eligible for Medicaid) if the individual meets the eligibility factors in subsection A below.  This category applies to an individual who is ineligible for SSI or APA 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 SSI or APA benefits may qualify for Medicaid benefits if he or she:

 

  1. Was entitled to receive both OASDI and SSI or APA cash benefits in at least one month after April 1977 (see Note below);

 

  1. Is currently eligible for and receiving OASDI benefits;

 

  1. Is currently ineligible for SSI or APA;

 

  1. Receives income that would allow the individual to qualify for SSI or APA after deducting all OASDI cost-of-living adjustments received since the last month in which the individual was eligible for both OASDI and SSI ; and

 

  1. Meets all other Medicaid eligibility requirements.

 

Note:  

The individual need not literally receive both SSI 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 OASDI payments, which are not disbursed until the month after entitlement, while SSI payments are paid in the month of entitlement.  It is common for an individual to receive SSI while awaiting receipt of OASDI payments. Once the monthly OASDI begins, if it exceeds the SSI rate, he or she receives just OASDI 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 OASDI payment exceeds the SSI benefit level for all months in which SSI 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 pass 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 SSI check at the same time that you got Social Security, or did you get SSI or APA 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 SSI?

 

Step 4:

Look up the month in which the applicant last received SSI or APA 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 APA 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 APA 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 SSI checks in 1978-79.  However, her SSI /APA 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 SSI and APA 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 APA 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 SSI or APA 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 APA income limit (including the standard $20 disregard) of $1067, Mrs. Lewis is eligible for Medicaid.

 

531 C.       EIS INFORMATION

 

 

EIS INFORMATION

Eligibility Code:

11

Pregnant woman

20

No other eligibility codes apply

Medicaid Subtype:

BB

 Individual lost SSI /APA eligibility from 1977 SSA COLA

 

 

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MC #5 (01/07)