POL M1005A: DETERMINING ELIGIBILITY FOR DISABLED ADULT CHILD (DAC)

1. Applicants Must Meet Basic Eligibility Factors

Refer to Section M600 for a description of all basic eligibility factors.

2. Social Security Administration (SSA) Determines Eligibility

The State Data Exchange (SDX) shows eligibility with a Medicaid eligibility code of “D.” Applicant is eligible for the Disabled Adult Child (DAC) program without a Medicaid application.

3. Applicants May be Eligible For Disabled Adult Child (DAC)

When the SDX shows a Medicaid test indicator code “R” or applicant is not on the SDX, a Medicaid application is required to determine if the client meets the eligibility for DAC.

Require Applicants to meet the following criteria to be eligible for the DAC Program:

• • • Age 18 or Older

    • Disability began before age 22

    • Lost Supplemental Security Income (SSI) due to the entitlement to or an increase in DAC benefits. Verify using one of the following:

      • SOLQ;

      • Letter from SSA; Or

      • Collateral Contact with SSA.

4. Meets Income Requirements

Require the countable income, excluding the DAC payment, to be within the maximum Supplement Security Income (SSI) payment standard. Refer to Medicaid Table 1A for income standards. Refer to Section M901 to determine if income is countable.

5. Meets Resource Requirements

Require countable resources to be within the maximum SSI resource standard. Refer to Medicaid Table 7 for resource standards. Refer to Section M801 to determine if resources are countable.

6. Clients Must Be Reviewed

Clients must be periodically reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

Clients must be reviewed for other Medicaid program eligibility before closing case.

7. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

• Client does not complete a review

  • Client enters a public institution, excluding the Geriatric Hall at the State Hospital in Evanston.

  • Client dies.

  • Client determined no longer eligible.