State of Wisconsin Department of Health Services

HISTORY

The policy on this page is from a previous version of the handbook. 

25.2 Disabled Adult Child (DAC)

 

25.2.1 Disabled Adult Child Introduction

A DAC is:

• At least 18 years old at the time SSI was lost.
• Classified by SSA as disabled before age 22.
• Receives an OASDI (DAC) payment that is based on the earnings of a parent who is disabled, retired, or deceased.

 

Note: Receipt of Railroad Retirement is not considered OASDI for this policy.

 

• Was receiving SSI but lost SSI eligibility because the OASDI (DAC) payment or an increase in the OASDI (DAC) payment exceeded the SSI income limits.

 

Federal law requires that the IM agency provide Medicaid eligibility to any DAC for whom the following condition exists:

• Total countable income, excluding the "DAC" disregarded income, is less than or equal to the SSI-related categorical income limits.
• Total countable assets are less than or equal to the categorical asset limit for SSI-related Medicaid.

25.2.2 Disabled Adult Child Payment Disregard

When a Disabled Adult Child applies for Medicaid, disregard all OASDI (DAC) payments which caused him or her to lose SSI eligibility.

 

Example 1: Disregard the entire OASDI (DAC) payment when the initial OASDI (DAC) payment caused the member to be ineligible for SSI:   Harvey is an SSI recipient. While his father worked, Harvey received a monthly SSI payment of $686.78. When his father retired, Harvey began receiving an OASDI (DAC) payment of $900. He received an SSI payment and an OASDI (DAC) payment concurrently for one month. The next month, the $900 OASDI (DAC) payment made Harvey ineligible for SSI.   When Harvey applies for EBD Medicaid, the entire initial OASDI (DAC) payment of $900 will be disregarded when his EBD Medicaid eligibility is determined.

 

Example 2: George is an SSI recipient. While his father worked, George received a monthly SSI payment of $686.78.  When his father retired and began receiving social security retirement, George began receiving an OASDI (DAC) payment of $500 a month. While George’s SSI payment decreased, the initial OASDI (DAC) payment did not cause him to lose SSI eligibility.   When his father died, George began receiving an OASDI (DAC) payment of $750 a month. The increased amount put him over the SSI income limit, and he lost SSI.   George applies for EBD Medicaid. The IM worker must disregard the total increase of $250 ($750 - $500 = $250) because it was the increase that caused George to lose SSI eligibility.

 

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

25.2.3 COLA Disregard

When a Disabled Adult Child applies for Medicaid, disregard all OASDI COLAs since the last month he or she was eligible for and received both OASDI and SSI benefits.  Calculate the COLA disregard amount (25.1.2 Identifying a "503" AG).

 

If the Disabled Adult Child was receiving SSI-E , disregard both the state SSI-E Supplement (39.4 EBD Assets and Income Tables) and the COLA.

 

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

 

Example 3: In Example 1, because Harvey received SSI concurrently with the OASDI (DAC) payment, he is also eligible for a COLA disregard for any OASDI payments he receives.

 

Example 4: In Example 2, because George received SSI and an OASDI (DAC) payment concurrently and then lost SSI eligibility, he must also receive a COLA disregard on any OASDI payments he receives.

25.2.4 Disregards For People Who Lose SSI Eligibility As A Result of Initial Receipt Or An Increase in DAC Benefits

People who lose their SSI eligibility due to the receipt of an initial OASDI (DAC) benefit or increase in their current OASDI (DAC) benefit is entitled to the following disregards when their Medicaid eligibility is being determined:

1. The OASDI (DAC) payment, either the initial payment or the increase in payment, whichever made them ineligible for SSI.

2. The SSI-E supplement, if they were receiving the E supplement at the time they became ineligible for SSI.

3. All COLAs received since the last month that they were eligible for and received both OASDI (DAC) and SSI benefits.

 

 

 

This page last updated in Release Number: 17-01

Release Date: 05/05/2017

Effective Date: 05/05/2017

 

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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