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5.11.1  "503" Eligibility

5.11.1.1 Identifying a "503" AG

5.11.1.2 Calculating the COLA Disregard

 

Federal law requires that the IM Agency  provide Medicaid ( MA ) eligibility to any applicant for whom the following two conditions exist:

 

  1. S/he is receiving Old Age, Survivors, Health and Disability Insurance (OASDI) Benefits .
     

  2. S/he was receiving Supplemental Security Income Income is anything you receive in cash or in kind that you can use to meet your needs for food, clothing, and shelter. ( SSI ) concurrently with OASDI but became ineligible for SSI.
     

Note:  The notion "concurrent" includes situations in which OASDI eligibility is granted retroactively for months in which the person was also receiving 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.

 

Example: Elmo Tanner was receiving SSI in February, 1996, the month he had a disabling accident.  In February, after the accident, he applied for OASDI.  In April, 1996, SSA notified him that he had been determined disabled. The notice informed him that his OASDI eligibility extended back to the onset date of his disability in February, 1996.  Along with the notice was a check for retroactive OASDI benefits back to the February date.  The amount of the OASDI check made him immediately ineligible for SSI.  There was no period of time when he was actually receiving both SSI and OASDI benefits at the same time.  Nevertheless, Elmo meets the requirement of concurrently receiving both SSI and OASDI benefits from February through April.

 

On the other hand, if Elmo had been receiving OASDI benefits, and was then granted retroactive SSI benefits for the same period, he would not meet the definition of "concurrent."  

 

An assistance group ( AG ) with these two characteristics is often referred to as a "503" AG.  The name comes from Section 503 of the Medicaid Law.

5.11.1.1 Identifying a "503" AG

When a "503" AG applies for MA, disregard all OASDI COLAs the AG has received since the last month s/he was eligible for and received both OASDI and SSI benefits.

 

To identify a "503" AG, do the following:

 

  1. Ask him/her whether, after April 1977, there has ever been a month in which one of the following conditions existed:
     

    1. Was eligible for both OASDI and SSI, or
       

    2. Received an OASDI check or a retroactive OASDI check and a SSI check for the same month in which s/he was eligible for both OASDI ( or retroactive OASDI) and SSI.

 

If s/he says "no", s/he is not a "503" AG.  If s/he says "yes" and is no longer receiving SSI, do the following:

 

  1. Ask if s/he is now receiving an OASDI check.  If s/he is not, s/he is not a "503" AG.  If s/he is, s/he is a "503" AG.  Enter “Y” on screen ANPS.  S/he will receive a COLA Cost of Living Adjustment disregard.

 

If s/he was receiving SSI-E, the state SSI-E Supplement (8.1.5) will also be deducted.  

 

SSI-E AGs are SSI recipients who receive a higher state supplement than regular SSI. Persons who receive SSI-E payments must live:
 

    1. In substitute care of eight or fewer beds, or
       

    2. At home and need more than 40 hours a month of primary long term support services.

 

5.11.1.2 Calculating the COLA Disregard

To calculate the Cost-of-Living Adjustment ( COLA ) disregard amount, do the following:

 

  1. Find the AG'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 AG.

 

  1. On the COLA Disregard Amount Table (8.1.7) find the last month in which the person was eligible for and eligible for and received a check for both OASDI (or retroactive OASDI ) and SSI.
     

  2. Find the decimal figure that applies to this month.
     

  3. Multiply the person's current gross OASDI income by the applicable decimal figure.  The result is the COLA disregard amount.

 

Example:  Newby's current gross OASDI income is $700.  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 1991.  On the COLA Disregard Amount Table (8.1.7), April 1991 falls between January 1991 - December 1991.

 

Therefore, the decimal figure that applies to April 1991 is 0.262741.  Multiply 0.262741 x $700 to find Newby's COLA disregard amount.

 

Periods of MA ineligibility do not affect this disregard.  When the person reapplies, give the disregard again.

 

This page last updated in Release Number : 03-03

Release Date: 09/22/03

Effective Date: 09/22/03