Categorical Medicaid eligibility for the aged, blind and disabled is directly related to receipt of SSI in most States. Loss of SSI payments can result in loss of Medicaid coverage. To preserve Medicaid coverage for certain groups of individuals who lose SSI payments, Congress enacted special Medicaid continuation provisions. These provisions require the State Medicaid agencies to continue to consider specified groups of former SSI beneficiaries as SSI beneficiaries for Medicaid purposes, as long as they would otherwise be eligible for SSI payments. In addition, Medicaid agencies are required to determine if the individual would be eligible for Medicaid under any other group.
Individuals who are utilizing the section 1619(b) work incentive provision do not receive SSI payments. In order to continue Medicaid eligibility, section 1619(b) participants are deemed by law to be receiving an SSI payment for Medicaid purposes. Congress also added a special rule for section 1619(a) and (b) participants in 209(b) States. If an individual received Medicaid coverage the month before the most recent period of participation in section 1619 (a or b) began in the 209(b) State, the State must continue coverage so long as the individual continues to be eligible under section 1619. This applies even when the 209(b) State has a more restrictive definition of disability than that of the SSI program. SSA notifies the States about members of this group through the State data exchange (SDX) . (NOTE: The NMI does not receive the SDX.) REMINDER: SSA promotes use of the SSI work incentives. If an FO discovers that a section 1619 participant does not have Medicaid coverage, and there is no Medicaid bar on the SSR (i.e., in 1634 States, the individual has no Medicaid qualifying trust, has agreed to the assignment of rights and to provide third party liability information), the FO should either contact the Medicaid agency by telephone or prepare a note for the beneficiary to take to the Medicaid agency.
Contains an explanation of the relationship of the 1619 work incentive to Medicaid using the paragraph “How it applies” on page 48 of the June 1991 edition of the “Red Book on Work Incentives” in 1634 States or SSI Criteria States. In 209(b) States, the FO could use the following sentence instead of the last one in “How it applies”: “People in 209(b) States continue to be eligible for Medicaid under the section 1619 work incentive as long as they were eligible for Medicaid in the month before they became eligible for section 1619.”
Explains that the individual is currently participating in the section 1619 work incentive; and Shows what date the most recent period of section 1619 participation began.Effective July 1, 1977, Medicaid eligibility was protected for SSI recipients who lost SSI or SSP eligibility because of title II cost-of-living adjustments ( COLAs).
Under section 503 of Public Law 94-566, the “Pickle Amendment,” title II beneficiaries who would continue to receive SSI/SSP payments (or would continue to be eligible for benefits under section 1619(b)) but for their title II COLAs continue to be considered SSI recipients for Medicaid purposes. If an individual's other income would not have precluded continuing SSI payments (or deemed payments under section 1619) without the title II COLAs, the State must continue to consider the individual to be an SSI recipient for Medicaid purposes.
When a State agency computes Pickle eligibility it uses the current SSI Federal benefit rate (FBR) plus any SSP and compares it with the beneficiary's other countable income plus the title II benefit “frozen” at the amount when SSI/SSP payment eligibility was lost without the current or subsequent COLAs after April 1977. If the FBR keeps going up as it has, the FBR can eventually overtake an individual's frozen title II plus other countable income level. Below are three examples of situations when Pickle applies:
Other Income — If an SSI recipient had title II and other income which resulted in loss of SSI, increases in the SSI FBR or a decrease in the other income can result in eligibility for Medicaid continuation under the Pickle amendment.
Windfall Offset — Windfall offset cases that receive SSI payment first and then lose SSI eligibility are like cases with other income. Rises in the SSI FBR can eventually overtake the frozen title II “yardstick”.
Reduced SSP — Several States (e.g., California, Michigan, Vermont) have reduced some optional supplementation levels. These reductions have caused SSI/SSP ineligibility for some recipients with other income. When the other income consists of at least some title II benefits, there is or will be potential Pickle eligibility as inflation increases the FBR.
SSA informs all States annually about potential members of this group at COLA time — each State gets two separate files to help them locate potential eligibles. SSI recipients who go into payment status EØ1 because of COLA's are also potential members of this group.
In 1983, Congress amended title II and eliminated the Additional Reduction Factor (ARF) for widow(er)s younger than age 60 (disabled widow(er)s, DWB's ). This increased title II benefits for some widow(er)s causing SSI ineligibility.
Congress added section 1634(b) of the Act to require the States to continue to consider widow(er)s otherwise eligible for SSI payments to be SSI recipients for Medicaid purposes if they: