24.1 SSI Related Medicaid Introduction

SSI related Medicaid is the original, basic Medicaid program for individuals who are elderly , blind, or disabled. SSI related individuals must meet all appropriate Medicaid nonfinancial eligibility requirements. SSI related Medicaid has the lowest income and asset limits of all EBD Medicaid programs/categories. It has two income limits which are referred to as the Categorically Needy limit and the Medically needy limit.

Allow the following income disregards to the fiscal group's income in the order below to determine the countable net income.

The 65 & ½ earned income disregard ,
Special exempt income (15.7.2 Special Exempt Income),
$20.00 SSI general income disregard.

The EBD categorically needy income limit consists of two components; an income amount plus a shelter/utility amount. The EBD fiscal group’s total actual shelter, fuel, and utility expenses are compared to a maximum allowance that is found in Section 39.4 Elderly, Blind, or Disabled Assets and Income Tables. The actual shelter/utility costs or the shelter/utility maximum, whichever is less, is added to the categorically needy income amount (see Section 39.4 Elderly, Blind, or Disabled Assets and Income Tables), and this total becomes the EBD categorically needy income limit. A fiscal group with countable net income that does not exceed the categorically needy income limit passes the Medicaid EBD categorically needy income test.

If an EBD related fiscal group’s income exceeds the categorically needy income limit, their income is then compared to a medically needy limit, which is found in Section 39.4 Elderly, Blind, or Disabled Assets and Income Tables. If the fiscal group’s income is between the categorically needy limit and the medically needy limit, the group passes the Medicaid EBD medically needy income test.

If an EBD fiscal group fails the medically needy income test because their net income exceeds the medically needy income limit, they can still qualify for Medicaid if they can meet a Medicaid Deductible. Refer to chapter 24.2 Medicaid Deductible Introduction for more information about Medicaid Deductibles and to chapter 24.5 Calculating the Deductible for instructions on how to calculate a Medicaid Deductible.

See Section 39.4 Elderly, Blind, or Disabled Assets and Income Tables.

This page last updated in Release Number: 15-01

Release Date: 06/10/2015

Effective Date: 06/10/2015

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030