Adult Medicaid Manual MA-2110 PASSALONG
III. DAC PASSALONG
A. Eligibility Requirements
1. Currently entitled to and receives RSDI benefits as a disabled adult child (DAC) on a parent’s record due to the retirement, death or disability of a parent (over age 18);
2. Has blindness or a disability which began before age 22 (RSDI benefits did not have to begin prior to age 22);
3. Lost SSI or SA due to receipt of or increases in the RSDI benefit; and
4. Would currently be eligible for SSI or SA if you disregard the current RSDI benefit.
5. If DAC passalong eligibility is based on former receipt of SA (not SSI), the individual must currently reside in an adult care home.
B. Identify Individuals Who Lost SSI or SA Eligibility Due to Receipt of DAC RSDI Benefits.
Applicants/beneficiaries need not claim passalong status. However, many individuals may not be able to remember when or if they received SSI or Special Assistance. Fully investigate passalong eligibility in every case where the individual is otherwise over income for CN MAD because of income from Social Security. If the individual clearly states he has never received SSI or SA, then document in the record that there is no passalong eligibility.
Use the following resources to identify individuals who lost SSI or SA eligibility:
1. SDX - The Medicaid Eligibility Code field indicates an eligibility status code of “D” for a Disabled Adult Child. SDX will not show SSI terminations prior to
01-01-95. If an SSI termination may have occurred prior to that date, call SSA.
2. SSI Termination Report – Refer to MA-1000, SSI Medicaid – Automated Process, and EIS-4200, Part Eight.
REVISED 04/01/12 – CHANGE NO. 06-12
3. For individuals receiving RSDI DAC benefits who may have lost SSI prior to January 1, 1995, verify through the case record or the local Social Security Office. The Social Security Claim Number suffix is “C” if the a/b receives as a disabled adult child. However, children other than DAC’s can also have a “C” suffix.
4. For individuals in assisted living who may have been terminated from Special Assistance, complete an inquiry into the Eligibility Information System (EIS).
C. Verify DAC Passalong Eligibility Factors.
1. The date SSI or SA benefits were terminated.
2. The current amount of the a/b’s RSDI disabled adult child benefit.
D. Once You Determine the Individual is Passalong Eligible Disregard All the Current RSDI Income.
E. Compare Other Countable Earned and Unearned Income to the Current SSI or SA Income Limit. (Use the 1/3 Reduced Income Limit If Appropriate).
1. If the countable income does not exceed the current SSI or SA income limit, continue to evaluate as categorically needy determining eligibility without counting RSDI. The person is eligible under passalong.
2. If the countable income is above the current SSI or SA income limit, determine eligibility counting RSDI benefits. DO NOT disregard the RSDI income. This person is ineligible under passalong. If ineligible, document the case record and count current RSDI income.
EXAMPLE: (DAC Passalong) Jean is an adult living alone at home who receives RSDI benefits on the record of her deceased father based on her disability, which began before she was age 22. She has no assets. The amount of her RSDI benefit is $1,200. She also receives a private pension of $500 per month. Jean received SSI until her father died in 1995. Her SSI then stopped because of her receipt of RSDI benefits. Jean is eligible for CN MAD under the DAC passalong because after disregarding her entire Social Security check, her other income of $500, minus $20 disregard, is under the current SSI limit. The SDX also shows her status as “D.”
Use DMA-5150, Documentation of Passalong Eligibility or Ineligibility, to document whether or not that the individual is passalong eligible. If eligible as passalong, code the individual as “PD” in the Individual Special Use field on the individual level in EIS. If you find an individual who is eligible for passalong due to loss of SA and who is currently residing in an adult care home, contact the EIS Unit for procedures to follow to put this person in EIS.
REISSUED 04/01/12 – CHANGE NO. 06-12
At subsequent reviews, determine if the individual still qualifies as passalong. Evaluate the income of the beneficiary. If the individual would be ineligible for SSI or SA under current income standards even after deducting the entire current RSDI benefit, the individual is no longer eligible as passalong.