Medicaid Policy
Medicaid Policy
Effective Date: November 1, 2017
Previous Policy for Protected Medicaid for the Pickle Amendment Group
Previous Policy for Single Persons Age 18 and Older
Previous Policy for a Married Couple
Previous Policy For a child
The Pickle Amendment Protected Groups
Currently receives RSDI, and
Was eligible for and received SSI, then, lost SSI eligibility for any reason after April 1977, and
Was eligible for SSI and RSDI in at least one concurrent month, and
Would have countable income less than the SSI payment level if you deducted from current RSDI benefits, the RSDI COLA’s paid after the last month the person was eligible for and received SSI and was also eligible for RSDI. Deduct COLA’s from the RSDI of the person and the RSDI of the person’s spouse or financially responsible parents, and
Meets the other Medicaid eligibility requirements now.
Eligibility for the Pickle Amendment Group for Single Persons Age 18 and Older
Verify that the individual was eligible for and received SSI and lost eligibility for SSI after April 1977 and that the person receives RSDI now. The reason for losing SSI eligibility does not matter.
Determine the last month the individual was eligible for and received SSI and was also eligible for RSDI.
Deduct from the individual’s current RSDI benefits, the RSDI COLA’s the individual received after the last month the individual was eligible for and received SSI and was also eligible for RSDI (Table XI).
Use the reduced RSDI amount and any other income the individual has to determine countable income.
If the countable income is less than the SSI payment for one person, the individual is income eligible for protected Medicaid.
If the countable income is more than the SSI payment for one person, the individual is not income eligible for protected Medicaid. Determine eligibility for other Medicaid programs.
Eligibility for the Pickle Amendment Group for a Married Couple
Eligibility for the Pickle Amendment Group for spouses who are both eligible.
Verify that both spouses were eligible for and received SSI, lost eligibility for SSI after April 1977, and that both spouses receive RSDI now (Social Security RSDI--retirement, survivor's, disability insurance). The reason for losing SSI eligibility does not matter. They did not necessarily have to be married at the time they lost SSI eligibility.
Determine the last month the spouses were eligible for and received SSI and were also eligible for RSDI.
Deduct from both spouses’ current RSDI benefits, the RSDI COLA’s received after the last month they were eligible for and received SSI and were also eligible for RSDI. If the couple lost SSI at different times, use the larger reduction factor based on the date the first spouse lost SSI. Use the same reduction factor for both spouses (Table XI).
Use the reduced RSDI amount plus any other income the couple has to determine countable income. Use the worksheet for a Married Couple Both on Medicaid in section 443 except that you compare income to the SSI payment rate instead of 100% of poverty.
If the countable income is less than the SSI payment for two people, the couple is income eligible for protected Medicaid.
If the countable income is more than the SSI payment for two people, the couple is not income eligible for protected Medicaid. Determine eligibility for other Medicaid programs.
If one spouse chooses to not receive Medicaid coverage, then treat the spouse who wants Medicaid as a potential Pickle eligible individual whose spouse did not receive SSI in the past. See section 2 below.
Eligibility for the Pickle Amendment Group when one spouse did not receive SSI after April 1977
Verify that the eligible spouse who received SSI lost eligibility for SSI after April 1977 and receives RSDI now. The reason for losing SSI eligibility does not matter. The spouse who never received SSI in the past may or may not receive RSDI now, but protected status is not available because he or she has never received SSI.
Decide the last month the spouse who received SSI was eligible for and received SSI and was also eligible for RSDI. Use the Pickle Reduction Factor Table to reduce the only the former SSI recipient's current RSDI benefits. If the ineligible spouse receives RSDI, back out any COLA increases from the ineligible spouse's RSDI benefits before applying the income deeming deductions in 410-6. Use the same reduction factor used for the former SSI recipient spouse (Table XI).
After reducing the RSDI of the ineligible spouse (if applicable), determine the deemable income from the ineligible spouse. Follow policy in 410-6 to decide how much income to deem from the ineligible spouse.
If the ineligible spouse has deemable income, add the deemable income to the former SSI recipient's reduced RSDI and any other income the former SSI recipient spouse has. Deduct the $20 general disregard, and the earned income disregards if applicable, from the combined income. Compare countable income to the SSI payment for two people.
If the countable income is less than the SSI payment for two people, the spouse who received SSI is eligible for protected Medicaid. The other spouse may qualify under a different Medicaid coverage group.
If the countable income is more than or equal to the SSI payment for two people, the spouse who received SSI is not eligible for protected Medicaid. Determine eligibility for other Medicaid programs.
If the ineligible spouse does not have deemable income, compare countable income of the former SSI recipient spouse to the SSI payment for one person. Deduct the $20 general disregard, and the earned income disregards if applicable, to determine the countable income.
If the countable income is less than the SSI payment for one person, the spouse who received SSI is eligible for protected Medicaid.
If the countable income is more than or equal to the SSI payment for one person, the spouse who received SSI is not eligible for protected Medicaid. Determine eligibility for other Medicaid programs.
Eligibility for the Pickle Amendment Group for a Child
If a child under age 18 used to receive SSI, and now receives Social Security survivor's benefits, the child might qualify for Medicaid under the Pickle Amendment. The child had to be eligible for SSI and RSDI benefits in at least one concurrent month. If the disabled child is over age 18 and lost SSI due to receipt of Social Security survivor's benefits, see section 330-1 for Disabled Adult Children.
Use this policy only if the child is unmarried and under age 18.
Verify that the child was eligible for and received SSI, lost eligibility for SSI after April 1977 and receives RSDI now. A child under age 18 may qualify for survivor's benefits if the child's parent is deceased or disabled. The reason for losing SSI eligibility does not matter, unless the child was determined no longer disabled.
Determine the last month in which the child was eligible for and received SSI and was eligible for RSDI. Use the applicable reduction factor from the Pickle Reduction Factor Table to reduce the child’s current RSDI benefit.
If a parent receives RSDI now, deduct from that parent’s current RSDI benefits, the RSDI COLA’s that parent received after the last month the child was eligible for and received SSI and was eligible for RSDI.
Determine the parents' deemable income. Use the parents' reduced RSDI income (if applicable) and any other income they have (410-5).
Use the child's reduced RSDI amount and any other income of the child. Add the parents' deemable income to determine countable income (443). Deduct the $20 general disregard, and earned income deductions if applicable.
If the countable income is less than the SSI payment for one person, the child is income eligible for protected Medicaid.
If the countable income is more than the SSI payment for one person, the child is not income eligible for protected Medicaid. Determine eligibility for other Medicaid programs.