State of Wisconsin |
Release 24-02 |
Federal law requires that the IM agency provide Medicaid eligibility to any person for whom the following conditions exist:
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. 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. |
When a "503" assistance group applies for Medicaid, disregard 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:
If the applicant or member was receiving SSI-E , 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:
To calculate the COLA disregard amount, do the following:
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 0.382657. Multiply 0.382657 by $820 to find Newby's COLA disregard amount of $313.78. Subtract the $313.78 disregard amount from $820. Newby’s countable OASDI income is $506.22. |
Periods of Medicaid ineligibility do not affect this disregard. When the person reapplies, give the disregard again.
This page last updated in Release Number: 23-02
Release Date: 04/17/2023
Effective Date: 04/17/2023
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