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
POL M1005F: DETERMINING ELIGIBILITY FOR SSI ELIGIBLE
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
SSI Payments Begin First Day of Following Month Client Meets All Eligibility:
The date the application is filed.
If later, the date the person first meets all eligibility factors for SSI
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).
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.