State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

View History

25.1 Special Status Medicaid

25.1.1 Special Status Medicaid Introduction

SSI recipients in Wisconsin are automatically enrolled in SSI Medicaid and remain eligible for SSI Medicaid as long as they continue to receive SSI. Loss of SSI payments can result in loss of Medicaid coverage.

There are special federal Medicaid continuation provisions to protect health care benefits for certain groups of former SSI recipients who receive Social Security payments. These “special status” groups are:

• Disabled adult child (DAC) group (see SECTION 25.2 DISABLED ADULT CHILD (DAC) GROUP)
• 503 group (see SECTION 25.3 503 GROUP)
• Widow/Widower group (see SECTION 25.4 WIDOW/WIDOWER GROUP)

When determining eligibility for former SSI recipients who belong to one of these special status groups, the appropriate amount of Social Security income must be disregarded, as described in the policy for each group (see sections linked above). Each group has a specific set of requirements that a person must meet to qualify for a special status income disregard. Simply losing SSI or receiving a certain type of Social Security payment does not automatically qualify someone for a special status disregard.

IM agencies are responsible for:

1. Determining whether Social Security beneficiaries who received SSI in the past qualify for special status disregards as a DAC, 503, or Widow/Widower group.
2. Calculating and applying the appropriate Social Security income disregards for these groups when applicable.

Note	Medicaid eligibility is also protected for “Section 1619” participants (see SECTION 25.5 SECTION 1619 GROUP). IM workers do not determine Medicaid eligibility for Section 1619 participants, who are automatically enrolled in SSI Medicaid.

25.1.2 Special Status Medicaid Income and Asset Limits 

Special Status Medicaid has the same income and asset limits as SSI-Related Medicaid:

• The assistance group must have countable income at or below 100% FPL after “special status” Social Security disregards.
• The assistance group must have countable assets at or below $2,000 for an unmarried person or $3,000 for a married couple.

Note	DAC and 503 groups who are eligible for Special Status Medicaid are categorically eligible for QMB (see Section 32.2 QMB) if they receive Medicare. Section 1619 groups who receive Medicare receive QMB benefits as part of their SSI Medicaid benefit package.

---

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