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.

A fiscal group with countable net income that does not exceed the categorically needy income limit passes the Medicaid SSI-related categorically needy income test.

If a fiscal group’s countable net income exceeds the categorically needy income limit, their income is then compared to a medically needy limit of 100% FPL, which is found in Section 39.4 Elderly, Blind, or Disabled Assets and Income Tables. If the fiscal group’s countable net income is between the categorically needy limit and the medically needy limit, the group passes the Medicaid SSI-related medically needy income test.

If a fiscal group fails the medically needy income test because their countable 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 for more information.

This page last updated in Release Number: 20-03
Release Date: 08/03/2020
Effective Date: 08/01/2020

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