Eligibility Online Manual

M1005F SSI Eligible

Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits under Supplemental Security Income (SSI Eligible).

Current Policy Effective Date: September 1, 2018

Date Last Reviewed: August 15, 2018

Previous Policy: July 1, 2011


1. Social Security Administration (SSA) Determines Eligibility

The State Data Exchange(SDX) shows eligibility with a payment code of “CO1.”

Accept verification from SSA as proof of eligibility when the client does not appear on the SDX.

2. Benefits Must Begin First Month Client Is Eligible for SSI

Benefits will automatically authorize in WES through the SDX.

3. Applicants May Be Eligible For Retroactive Benefits

Retroactive benefits may be available to an individual who applied for SSI and incurred medical bills within two calendar months prior to the date of application with SSA. Each month must be reviewed and verified separately to determine whether the case would have been eligible if an application had been submitted.

Retroactive benefits may be authorized when the client meets the following:

4. Applicants May Have Eligibility For 12 Continuous Months

Eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.


Defining Group: 42 CFR 435.120

Clarifying Information:

SSI Payments Begin First Day of Following Month Client Meets All Eligibility:

  • The date the application is filed.

  • OR

  • If later, the date the person first meets all eligibility factors for SSI

Worker Responsibilities:

Verifying Eligibility When Clients Do Not Appear On SDX

1. Seek verification from SSA.

2. Add client to WES manually, once eligibility has been verified.

Determining Retroactive Medical

1. Contact SSA to determine the disability onset date or verify through the SDX.

2. Consider the disability criteria met if this date is within the same period as the retroactive month(s).

3. Require a DHCF-300 Disability Application when the disability onset date is not established within the same period as the retroactive month(s).

4. Determine if applicant meets the SSI income standard. Refer to Sections M901 to determine if income is countable and Medicaid Table 1A for the SSI Income Standard.

5. Determine if applicant meets SSI resources standard. Refer to Section M801 to determine if resources are countable and Medicaid Table 7 for SSI Resource Standards.

6. Find the client eligible for the entire month when eligibility is found to exist for any portion of the month.

7. Document in the case records the information used to establish or deny retroactive eligibility.

8. Send a notice of approval or denial of retroactive benefits.