(Revised 4/1/07 ML #3071)
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For aged, blind, or disabled individuals who are categorically needy SSI beneficiaries, the following procedures apply:
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SSI recipient living in their own home: All income, including deemable income, is normally considered by the Social Security Administration in determining the SSI benefit amount. In those situations it is not necessary to rebudget to determine Medicaid income eligibility. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.
A SSI recipient is considered part of the family unit as described below:
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A SSI recipient is included as part of the family unit when determining asset eligibility;
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A caretaker receiving SSI benefits is included in the family unit for budget purposes due to the caretaker’s financial responsibility for spouse and children; and
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A child receiving SSI benefits is not included in the family unit for budget purposes.
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SSI recipients residing in a nursing facility, an intermediate care facility for the mentally retarded (ICF-MR), the state hospital, the Anne Carlsen facility, the Prairie Psychiatric Center, the Stadter Psychiatric Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital: The SSI recipient is allowed the nursing care income level.
Parental and spousal income is not considered available to the recipient.
Individuals between the ages of 21 and 65 are not eligible for Medicaid in the state hospital.
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SSI recipients living in a specialized facility: All income is normally considered by the Social Security Administration in determining the SSI benefit amount. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.
If the individual is under 18 years of age and enters the specialized facility from a public institution or the parental home, consider the income of the individual and parents. If the Medicaid unit in the home is not receiving Medicaid, 75% of the excess income shall be disregarded in determining recipient liability.
If the individual is married, the income of the individual and of the spouse must be considered. If the Medicaid unit in the home is ineligible, a disregard of 75% of the excess income is allowed in determining recipient liability.
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SSI recipients electing to receive HCBS: Verification of SSI eligibility satisfies income eligibility for Medicaid, and it is not necessary to rebudget to determine Medicaid income eligibility. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.
The maintenance needs of the SSI recipient are considered met by virtue of receipt of SSI, so income of a spouse or parents cannot be deemed to bring the recipient up to the medically needy income level.
The recipient must be screened for and receiving HCBS.
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SSI recipients choosing to be eligible as a child or caretaker: The SSI recipient is not treated as aged or disabled for budgeting, but is treated as a child or caretaker as described in 05-90-50, Budgeting Procedures for the Family Coverage Group, or 05-90-55, Budget Procedures for Medically Needy and Poverty Level.
The recipient’s SSI payment is counted as unearned income in the budget process.
