State of Wisconsin Department of Health Services

HISTORY

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

21-01 Version of 25.1 "503" Eligibility

25.1.1 "503" Introduction

Federal law requires that the IMincome maintenance agency provide Medicaid eligibility to any person for whom the following conditions exist:

• He or she is receiving OASDI benefits.
• He or she was receiving SSISupplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. concurrently with OASDI but became ineligible for SSI for any reason.
• Total countable income, excluding the "503" disregarded income, is less than or equal to the categorical income limits for SSI-related Medicaid.
• Total countable assets must be below the categorical asset limits for SSI-related Medicaid.

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 SSASocial Security Administration. A federal agency which administers the SSI, OASDI, and Medicare programs. 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. To receive the 503 eligibility considerations, the individual must have received SSI income in the month prior to the month in which he or she began to receive the OASDI, DAC, or Widow/Widower payment. Sometimes payments will be received concurrently, but not always.

An assistance group with these two characteristics is often referred to as a "503" assistance group. The name comes from Section 503 of the law that implemented this policy (Public Law 94-566).

Example 1:

Kathy received SSI and SSSS (Social Security Surviving Spouse) payments for five years. She lost her SSI payment due to an increase in unearned income when she began receiving a pension payment in January of this year. While an increase in the COLA was not the reason for her loss of the SSI payment, she is still entitled to receive a COLA disregard on any OASDI payments she receives because she received OASDI concurrently with SSI and lost SSI. Kathy will receive COLA disregards on her SSSS payment in order to determine her eligibility for special status Medicaid.

25.1.2 Identifying a "503" Assistance Group

When a "503" assistance group applies for Medicaid, disregardAn amount not counted when determining a person's total net income. all OASDI COLAs the assistance group has received since the last month he or she was eligible for and received both OASDI and SSI benefits.

To identify a "503" assistance group, complete the following steps:

1. Determine whether, after April 1977, there has ever been a month in which one of the following conditions existed for the applicant or member:
   • He or she was eligible for both OASDI and SSI (a person who received SSI fraudulently does not qualify as a "503" case).
   • He or she 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.
   1. If the answer to both questions is "No," the applicant or member is not considered a "503" assistance group.
   2. If the answer to either of the questions is "Yes," the applicant or member is no longer receiving SSI. Proceed to Step 2.
2. Determine if the applicant or member is now receiving an OASDI check.
   1. If the answer is "No," he or she is not a "503" assistance group.
   2. If the answer is "Yes," he or she is a "503" assistance group and will receive a COLA disregard. Enter “Y” on the Individual Nonfinancial>Prior SSI page in CWWCARES Worker Web.

If the applicant or member was receiving SSI-ESupplemental Security Income Exceptional Expense, the state SSI-E will also be deducted (see Section 39.4.1 Elderly, Blind, or Disabled Assets and Income Table). SSI-E assistance groups are SSI recipients who receive a higher state supplement than regular SSI. People 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:

1. Find the assistance group'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 assistance group.
2. On the COLA Disregard Amount Table (see Section 39.6 COLA Disregard), find the last month in which the person was eligible for and received a check for both OASDI (or retroactive OASDI) and SSI.
3. Find the decimal figure that applies to this month.
4. Multiply the person's current gross OASDI income by the applicable decimal figure. The result is the COLA disregard amount.

Example 2:

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 COLA Disregard), 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.

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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