25.0 Special Status Medicaid

When you are calculating a Medicaid deductible, a patient liability amount, or a community waivers cost share for a "503" AG , a DAC , or a widow or widower, use the total income before any COLA s or OASDI (DAC or widow or widower) increases are subtracted.

25.1 "503" Eligibility

25.1.1 "503" Introduction

Federal law requires that the IM agency provide Medicaid eligibility to any applicant for whom the following conditions exist:

He or she is receiving OASDI benefits.
He or she was receiving SSI concurrently with OASDI but became ineligible for SSI.
Total countable income, excluding the "503" disregarded income, is within the program limits.

Note: "Concurrent" includes situations in which OASDI eligibility is granted retroactively for months in which the person was also receiving SSI. It also includes situations in which 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 AG with these two characteristics is often referred to as a "503" AG. The name comes from Section 503 of the Medicaid Law.

25.1.2 Identifying a "503" Assistance Group

When a "503" AG applies for Medicaid, disregard all OASDI COLAs the AG has received since the last month he or she 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 does not qualify as a "503" case)
Received an OASDI check or a retroactive OASDI check and a SSI check for the same month in which he or she was eligible for both OASDI (or retroactive OASDI) and SSI.

If, no, he or she is not a "503" AG. If, yes, and he or she is no longer receiving SSI, do the following:

Determine if he or she is now receiving an OASDI check. If he or she is not, he or she is not a "503" AG. If he or she is, he or she is a "503" AG. He or she will receive a COLA disregard. Enter “Y” on the Individual Nonfinancial>Prior SSI page in CWW .

If he or she was receiving SSI-E , the state SSI-E (see Section 39.4.1 Elderly, Blind, or Disabled Assets and Income Table) 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 one of the following:

- In substitute care
- At home and need more than 40 hours a month of primary long-term support services.

25.1.3 Calculating the Cost-of-Living Adjustment Disregard

To calculate the 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 (see Section 39.6 Cost-of-Living Adjustment), 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.

Example 1: Newby's current gross OASDI income is $820. 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 2013. On the COLA Disregard Amount Table (see Section 39.6 Cost-of-Living Adjustment), April 2013 falls between January – December 2013.

The decimal figure that applies to April 2013 is 0.031247. Multiply 0.031247 by $820 to find Newby's COLA disregard amount of $25.62. Subtract the $25.62 disregard amount from the $820 OASDI. Newby’s income is then $794.38. This amount is below the EBD income limit of $816.78, which makes him eligible.

Periods of Medicaid ineligibility do not affect this disregard. When the person reapplies, give the disregard again.

This page last updated in Release Number: 16-01

Release Date: 06/10/2016

Effective Date: 01/01/2016