530 SSI AND APA RELATED CATEGORIES

530 SSI Supplemental Security Income AND APA Adult Public Assistance RELATED CATEGORIES

Recipients of Supplemental Security Income ( SSI Supplemental Security Income ), Adult Public Assistance ( APA Adult Public Assistance ), and persons who are eligible for those programs but choose not to receive cash may be eligible for Medicaid if they meet all other factors of eligibility.

Note: Effective October 1, 2026 SSI Supplemental Security Income and APA Adult Public Assistance related categories must also meet Medicaid qualified alien requirements. Refer to section 522 and MAGI Manual Section 808 for policy on U.S. citizenship and eligible alien status.

530 A. SSI Supplemental Security Income RECIPIENT

An individual verified as receiving SSI Supplemental Security Income cash assistance payment is eligible for Medicaid coverage, regardless of APA Adult Public Assistance eligibility. This includes an individual who is:

Receiving SSI Supplemental Security Income pending a final determination of blindness or disability, including a low-birth weight infant who is receiving presumptive disability payments. See APA Manual Section 425-2 B ;

Not receiving an SSI Supplemental Security Income check solely because of recoupment of an overpayment;

Receiving SSI Supplemental Security Income cash assistance under a conditional agreement with the Social Security Administration to dispose of resources that exceed the SSI Supplemental Security Income resource limit; and

A disabled child under age18 who is receiving SSI Supplemental Security Income .

EIS Eligibility Information System INFORMATION Eligibility code: 11 Pregnant woman, regardless of medical resources 20 No other eligibility codes apply 54 SSI Supplemental Security Income disabled child Medicaid subtype: SI Receiving SSI Supplemental Security Income DC Under age 18, receiving SSI Supplemental Security Income

530 B. APA Adult Public Assistance RECIPIENT

An individual eligible for and receiving an Adult Public Assistance ( APA Adult Public Assistance ) cash assistance payment is eligible for Medicaid coverage.

Note: This does not apply to an individual receiving Interim Assistance (IA) payments.

EIS Eligibility Information System INFORMATION Eligibility code: 11 Pregnant woman, regardless of medical resources 20 No other eligibility codes apply Medicaid subtype: SI Receiving SSI Supplemental Security Income ST Not Receiving SSI Supplemental Security Income

530 C. USE OF THE REFUSED CASH MEDICAID SUBTYPE

The Refused Cash ( RC Refused Cash ) Medicaid subtype is used for two groups of individuals starting January 2020:

An individual who is eligible for APA Adult Public Assistance cash assistance payments but chooses not to receive the cash payments. This individual must meet all the financial and non-financial requirements of the program; and

An individual who has countable income equal to or above the APA Adult Public Assistance need/payment standard shown in APA Adult Public Assistance Manual Addendum 1 but equal to or below the Expanded Refused Cash Income Limits shown in ADLTC Aged, Disabled, and Long Term Care Manual Addendum 1 . Although the individual is not eligible for an APA Adult Public Assistance cash payment, they will be eligible for Medicaid coverage using the Refused Cash ( RC Refused Cash ) Medicaid subtype.

Note: The Refused Cash category should not be used for individuals residing in a LTC Long Term Care facility or receiving HCB Home and Community-Based Waiver Services.

530 D. SSI Supplemental Security Income DISABLED ADULT CHILDREN

An individual is eligible for Medicaid if he or she meets all of the following conditions:

Is age 18 or older;

Was receiving SSI Supplemental Security Income or APA Adult Public Assistance benefits that began prior to age 22;

Lost eligibility for SSI Supplemental Security Income or APA Adult Public Assistance on or after July 1, 1987 when income increased solely because the individual became newly eligible for Social Security benefits as a "disabled adult child" or because of an increase in Social Security Title II benefits; and

Would qualify for SSI Supplemental Security Income or APA Adult Public Assistance if Social Security Title II benefits were disregarded.

Disabled adult children are blind or disabled individuals who receive special child's insurance benefits under the Social Security Act because their parent is retired or disabled and receive Social Security, or are deceased. These individuals may become newly eligible for disabled adult child benefits at any age over 18, depending on the parent's death, disability, or retirement.

Details regarding how to verify eligibility for this category can be found in EIS Procedure 2008-1 .

EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply Medicaid Subtype: PM Post Medicaid

530 E. SECTION 1619(b) ELIGIBLE

A blind or disabled individual who despite his or her work at a substantial gainful activity ( SGA ) has had their SSI Supplemental Security Income eligibility status maintained for Medicaid purposes by section 1619(b) of the Social Security Act is eligible for Medicaid. The Social Security Administration determines eligibility for this category. Computer printouts of these eligible individuals are provided to DPA Division of Public Assistance on a regular basis and distributed to the field. A person must be on this list or otherwise verified as in 1619(b) status by the Social Security Administration to be eligible for Medicaid under the 1619(b) provision.

EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply Medicaid Subtype: PM Post Med

530 F. DISABLED WIDOW(ER) WHO HAS LOST SSI Supplemental Security Income OR APA Adult Public Assistance DUE TO RECEIPT OF TITLE II BENEFITS

A widow(er) between the ages of 60 and 64 who has lost SSI Supplemental Security Income benefits as a result of becoming entitled to, or receiving, Title II SSA Social Security Administration early widow(er) benefits is eligible to continue receiving Medicaid until he or she becomes eligible for Medicare Part A.

The individual is deemed to be an SSI Supplemental Security Income recipient for the purposes of the Medicaid program if the individual meets all the following conditions:

Is age 60 years or older;

Is eligible for and receiving SSA Social Security Administration early widow(er) benefits;

Has no entitlement to Medicare Part A; and

Is ineligible for SSI Supplemental Security Income or APA Adult Public Assistance due solely to the receipt of SSA Social Security Administration Title II early widow(er) benefits.

The individual is deemed to be an SSI Supplemental Security Income recipient as long as he or she would be eligible for SSI Supplemental Security Income or APA Adult Public Assistance in the absence of their SSA Social Security Administration widow(er) benefits.

EIS Eligibility Information System INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: PM Post Med

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