Eligibility Online Manual
Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits under PICKLE.
Current Policy Effective Date: July 1, 2018
Date Last Reviewed: June 19, 2018
Previous Policy: April 1, 2012
POL M1005D: DETERMINING ELIGIBILITY FOR PICKLE
1. Applicants Must be Receiving RSDI Benefits
2. Applicants Must Have Received SSI Anytime Since 1977
3. Applicants Must Meet Income Requirements
Require the applicant’s income to be less than or equal to the current SSI income standard, after Cost Of Living Adjustments (COLAs) are subtracted. Refer to Table 4 for COLAs.
Refer to Table 1A to determine the SSI payment standards.
4. Applicants Must Meet Resource Requirements
Resources must be within the SSI guidelines. Refer to Table 7 to determine the SSI resource standards.
5. Benefits Begin First Day of the Application Month if Determined Eligible
6. Clients May Receive Retroactive Medicaid
Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.
Both approved and denied applicants must be reviewed for retroactive Medicaid. Verify and determine eligibility separately for each retroactive month.
7. Clients Must Be Reviewed
Clients must be 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 cases.
8. 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 as the State Hospital.
Client determined no longer eligible.
Defining Group: 42 CFR 435.135
PICKLE is defined as a federal law based on a court order of Lynch vs. Rank covering an individual who lost SSI for any reason and would remain eligible for SSI if the RSDI cost of living adjustment (COLA) was deducted from the income.
Determining Countable Income
Refer to Section M901 for information on determining countable income.
Determining Countable Assets
Refer to Section M801 for information on determining countable assets.
1. Verify the applicant was receiving SSI & entitled to RSDI concurrently anytime since 1977.
2. Verify the applicant has lost SSI.
Refer to Section M1403 for information on reviewing cases.
1.Finalize eligibility and close benefits in WES when the application is no longer eligible.
2. Allow 15-day closure notice when and adverse action has occurred.