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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
When you are calculating a Medicaid deductible, a patient liability amount, a community waivers cost share or a community waivers spenddown for a "503" AG, a DAC Disabled Adult Child, or a widow or widower, use the total income before any COLAs or OASDI ( DAC or widow/widower) increases were subtracted.
25.1.3 Calculating the COLA Disregard
Federal law requires that the IM Agency provide Medicaid ( Medicaid ) eligibility to any applicant for whom the following two conditions exist:
He or she is receiving Old Age, Survivors, Health and Disability Insurance ( OASDI ) Benefits .
He or she was receiving Supplemental Security Income ( SSI ) concurrently with OASDI but became ineligible for SSI.
Total countable income, excluding the 503 disregarded income, is within the program limits.
Note: The notion "concurrent" includes situations in which OASDI eligibility is granted retroactively for months in which the person was also receiving SSI. It also includes situations where SSA recovers the SSI payment because the OASDI payment covers the same time period for which the person received SSI. On the other hand, "concurrent" does not include situations in which SSI eligibility is granted retroactively for a period in which the person was also receiving OASDI benefits.
An assistance group ( AG ) with these two characteristics is often referred to as a "503" AG. The name comes from Section 503 of the Medicaid Law.
When a "503" AG applies for Medicaid, disregard all OASDI COLAs the AG has received since the last month s/he was eligible for and received both OASDI and SSI benefits.
To identify a "503" AG, do the following:
Determine whether, after April 1977, there has ever been a month in which one of the following conditions existed:
Was eligible for both OASDI and SSI ( a person who received SSI fraudulently doesn’t qualify as a 503 case), or
Received an OASDI check or a retroactive OASDI check and a SSI check for the same month in which s/he was eligible for both OASDI ( or retroactive OASDI) and SSI.
If "no", s/he is not a "503" AG. If "yes" and is no longer receiving SSI, do the following:
Determine if s/he is now receiving an OASDI check. If s/he is not, s/he is not a "503" AG. If s/he is, s/he is a "503" AG. S/he will receive a COLA disregard. Enter “Y” on the Individual Nonfinancial> Prior SSI page in the CWW.
If s/he was receiving SSI-E, the state SSI-E Supplement (39.4.1) will also be deducted.
SSI-E AGs are SSI recipients who receive a higher state supplement than regular SSI. Persons who receive SSI-E payments must live:
In substitute care, or
At home and need more than 40 hours a month of primary long term support services.
To calculate the Cost-of-Living Adjustment ( COLA ) disregard amount, do the following:
Find the AG's current gross OASDI income. The gross OASDI income is the amount of the OASDI check plus any amount that has been withheld for a Medicare premium plus any amount withheld to repay an earlier overpayment.
Do not include in the gross income any Medicare Plan B premiums, which the State has paid for the AG.
On the COLA Disregard Amount Table (39.6 COLA) find the last month in which the person was eligible for and received a check for both OASDI (or retroactive OASDI ) and SSI.
Find the decimal figure that applies to this month.
Multiply the person's current gross OASDI income by the applicable decimal figure. The result is the COLA disregard amount.
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Example 1: Newby's current gross OASDI income is $700. He is not currently receiving SSI benefits. The last month in which he was eligible for both OASDI and SSI, and received benefits from both was April 1991. On the COLA Disregard Amount Table (39.6), April 1991 falls between January 1991 - December 1991.
Therefore, the decimal figure that applies to April 1991 is 0.239033048. Multiply 0.239033048 x $700 to find Newby's COLA disregard amount. |
Periods of Medicaid ineligibility do not affect this disregard. When the person reapplies, give the disregard again.
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