Adult Medicaid Manual MA-2110 PASSALONG

IV. WIDOW(ER)S (INCLUDING SOME SURVIVING, DIVORCED SPOUSES) NOT RECEIVING MEDICARE

A. Eligibility Requirements

1. Lost SSI or SA benefits due to receipt of RSDI benefits;

2. Not yet eligible for Medicare Part A;

3. At least age 50, but not yet attained age 65; and

4. Would currently be eligible for SSI or SA benefits if they were not receiving RSDI benefits.

5. If passalong eligibility is based on prior receipt of SA (not SSI), the individual must currently reside in an adult care home.

B. Identify Individuals Potentially Eligible as Early Widow(er)s (Not Receiving Medicare).

Applicants/recipients 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 the eligibility status of “W” for a widow(er). SDX will not show SSI terminations that occurred 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.

3. Verify status by the case record or through the local SSA.

REVISED 11/01/11 – CHANGE NO. 17-11

(IV.B.)

4. For individuals in adult care homes who may have been terminated from Special Assistance, complete an inquiry into the Eligibility Information System (EIS).

C. Verify Early Widow(er)s Eligibility Factors.

1. The current amount of the a/r’s RSDI benefit.

2. The a/r’s current ineligibility for Medicare Part A.

D. If You Determine the Individual is Passalong Eligible, Disregard All the 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, determine eligibility excluding RSDI benefits. This person is eligible under Passalong.

2. If the countable income is above the current SSI or SA income limit, the individual is not entitled to passalong. DO NOT disregard the RSDI income. This person is ineligible under passalong. If ineligible, count the current RSDI income.

EXAMPLE: (Early Widow) Jan lives at home alone. She has assets worth less than $2,000. She gets Social Security widow’s benefits of $926/month in 2011, which is over the Categorically Needy income limit for Medicaid. She has been told by Social Services she has a huge deductible to meet to get Medicaid. Jan received SSI disability benefits beginning in 2005 until her husband died in 2006, when she became eligible for widow’s benefits. She doesn’t yet receive Medicare. Disregarding her entire Social Security check would make her eligible for SSI under current rules. Jane is eligible for CN MAD under the widow(er)s passalong.

F. Documentation

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 “PW” 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.

G. Redeterminations

At subsequent reviews, determine if the individual still qualifies as passalong. Evaluate the income of the recipient. If the individual would be ineligible for SSI or SA after disregarding the RSDI income, the individual is no longer eligible as passalong.

REISSUED 11/01/11 – CHANGE NO. 17-11