Medicaid Policy
Medicaid Policy
Previous Policy for Protected Medicaid Group for Disabled Adult Children
Previous Policy for DAC Income Test
Previous Policy for Changes that Affect DAC
Disabled people age 18 or older receiving childhood disability benefits (CDB) from Social Security may qualify for the SSI Protected Medicaid Group for Disabled Adult Children (DAC).
DAC Eligibility Criteria
To qualify for the Protected Medicaid Group for Disabled Adult Children, the individual must meet all the following criteria:
1. Became disabled before reaching age 22, and
2. Received SSI in at least one month after July 1, 1987, and
3. Lost SSI eligibility after July 1, 1987 because the individual started receiving or received an increase in Childhood Disability Benefits, and
4. Have countable income, not including the Childhood Disability Benefit, that is less than the SSI payment for one person or the SSI payment for two people if married to an ineligible spouse with deemable income, and
5. Be receiving a CDB payment from SSA.
DAC Income Test
Unmarried individual/Married individual Whose Spouse does not have Deemable Income
Do not include the amount of the Childhood Disability Benefit in the income test. If the individual’s only income is the Childhood Disability Benefit, the individual is income eligible for protected Medicaid as a DAC.
Unearned Income
Subtract the $20 general income disregard from the individual’s unearned income, other than VA needs based payments.
Add the result to the amount of any VA needs based payments. The result is the countable unearned income.
Earned Income
Subtract Impairment related work expenses (431-2).
Subtract any part of the $20 general income disregard not used for unearned income.
Subtract $65 from the individual’s gross earned income.
Subtract ½ of the result of c(iii) from that result.
The result from c(iv) is the countable earned income.
Add the countable unearned income from b(ii) to c(v). The result is the total countable income.
Compare the countable income from d to the SSI payment for one person.
If the countable income is equal to or less than the SSI payment for one person, the individual is income eligible for protected Medicaid as a DAC.
If the countable income is more than the SSI payment for one person, the individual is not eligible for protected Medicaid as a DAC. Determine eligibility for other Medicaid programs.
Married individual Whose Spouse has Deemable Income
Do not include the amount of the Childhood Disability Benefit in the income test. If the individual’s spouse does not have deemable income, follow the procedure in #B1.
Unearned Income:
Subtract the $20 general income disregard from the unearned income, other than VA needs based payments.
Add the result to the amount of any VA needs based payments. The result is the countable unearned income.
Earned Income:
Subtract Impairment related work expenses (431-2)
Subtract any part of the $20 general income disregard not used for unearned income.
Subtract $65 from the gross earned income.
Subtract ½ of the result of c(iii) from that result.
The result from c(iv) is the countable earned income.
Add the countable unearned income from b(ii) to the countable earned income from c(v). The result is the countable income.
Compare the countable income from d to the SSI payment for two people.
If the countable income is equal to or less than the SSI payment for two people, the individual is income eligible for protected Medicaid as a DAC.
If the countable income is more than the SSI payment for two people, the individual is not eligible for protected Medicaid as a DAC. Determine eligibility for other Medicaid programs.
Changes That Can Affect DAC Protected Medicaid
Check the individual’s DAC protected Medicaid when these changes happen:
If the income of the individual or individual's spouse, other than the Childhood Disability Benefit, increases, use the DAC income test to find out if the individual is still income eligible for protected Medicaid.
If SSA decides the individual is no longer disabled and stops the Childhood Disability Benefit, decide the individual’s eligibility for other Medicaid programs.
If the individual marries, check to see if the Childhood Disability benefit stopped. If it is stopped, determine the individual’s eligibility for other Medicaid programs. If the Childhood Disability Benefit continues, the individual retains DAC protected Medicaid if the individual meets the DAC income test.