State of Wisconsin Department of Health Services

Release 24-01 April 03, 2024

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25.0 Special Status Medicaid Introduction

Federal provisions require DHSDepartment of Health Services to continue to consider specified groups of former 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. beneficiaries as SSI beneficiaries for Medicaid purposes, as long as they would otherwise be eligible for SSI payments “but for” the income disregards required to be given in each special status group.

These “special status” Medicaid groups include the following:

• 503 cases (see Section 25.1 "503" Eligibility)
• DACDisabled Adult Child (see Section 25.2 Disabled Adult Child)
• Widows and widowers (see Section 25.3 Widows and Widowers)
• 1619 cases (see Section 25.5 1619 Cases)

When determining the eligibility for Special Status Medicaid applicants and members, the appropriate COLAcost-of-living adjustment. An increase in income to compensate for inflation. and OASDIOld Age, Survivors, and Disability Insurance Program. Old-Age, Survivors, and Disability Insurance Program payments, known as “Social Security” by the Social Security Administration (SSA) include SSA Retirement, Disability, Survivors benefits, and any other benefits covered in Title II of the Social Security Act. income disregards, as described in the policy for each group, must be given.  

Each Special Status Medicaid group has a specific set of requirements that must be met before the member can be considered a Special Status MA member (see sections listed above). Simply losing SSI or receiving a DAC or Widow/Widower payment does not automatically qualify a member for a Special Status disregard. To receive the Special Status Medicaid considerations, the individual must have received SSI income in the month prior to the month in which he or she began to receive OASDI, DAC, or Widow/Widower payment. Sometimes payments will be received concurrently, but not always.

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.

"Concurrent" does not include situations in which SSI eligibility is granted retroactively for a period in which the person was also receiving OASDI benefits. 

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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