Special Assistance SA-3310 CHANGES IN SITUATION

IV. TERMINATION OF SA PAYMENT

A. Evaluate for Medicaid

When an SA payment terminates, always evaluate ongoing eligibility for Medicaid prior to terminating Medicaid coverage.

B. Medicaid Passalong

The evaluation of terminated SA cases for Medicaid must include evaluating eligibility for Medicaid passalong protection. Special Medicaid eligibility provisions allow certain groups of recipients whose SA terminates to retain their Medicaid coverage through a disregard of certain RSDI benefits if they remain in the adult care home. This is called Medicaid passalong. Refer to MA-2110, Passalong, in the Aged, Blind, and Disabled Medicaid manual for instructions on evaluating and documenting passalong eligibility when an SA payment terminates.

The following are two examples of Medicaid passalong for terminated SA cases. Note that there are a number of passalong provisions applicable to SA that are explained in detail in the Aged, Blind, and Disabled Medicaid manual.

Example 1: (COLA Passalong): Mr. Stokes is an SAA recipient living in an SA facility. He received $1,210 RSDI in 2008. After the 2009 COLA, his RSDI increased to $1,281. The RSDI COLA increase caused his countable monthly income to exceed the SA/ACH Basic monthly rate, making him ineligible for SA. Under Medicaid passalong regulations, he is eligible for continuation of his Medicaid coverage (if he remains in the SA facility) because after disregarding the COLA his countable income is less than the current SA income limit.

Example 2: (DAC Passalong): Ms. Alleghany is an SAD recipient living in an SA facility. She receives a monthly annuity payment of $600. In March 2009 her father died and she became eligible for RSDI of $1,400 on his record based on her disability. She is no longer eligible for SA due to excess income. Under Medicaid passalong regulations, she is eligible for continuation of her Medicaid (if she remains in the SA facility) because disregarding her RSDI check leaves countable income that is less than the SA income limit.