531 DEEMED UNDER THE PICKLE

531 DEEMED AN SSI Supplemental Security Income / APA Adult Public Assistance RECIPIENT UNDER THE PICKLE AMENDMENT

Named after its congressional sponsor, J. J. Pickle (D-Texas), and enacted in 1976, the Pickle Amendment established a separate category of Medicaid eligibility. This amendment requires that an individual be deemed an SSI Supplemental Security Income or APA Adult Public Assistance recipient (and so eligible for Medicaid) if the individual meets the eligibility factors in subsection A below. This category applies to an individual who is Individualized Supports ineligible for SSI Supplemental Security Income or APA Adult Public Assistance because of cost-of-living adjustments in that individual’s Social Security, Title II Old Age, Survivors, and Disability ( OASDI ) benefits.

531 A. ELIGIBILITY FACTORS

An individual who has lost his or her SSI Supplemental Security Income or APA Adult Public Assistance benefits may qualify for Medicaid benefits if he or she:

Was entitled to receive both OASDI Old Age, Survivors, and Disability Insurance (Social Security) and SSI Supplemental Security Income or APA Adult Public Assistance cash benefits in at least one month after April 1977 (see Note below);

Is currently eligible for and receiving OASDI Old Age, Survivors, and Disability Insurance (Social Security) benefits;

Is currently ineligible for SSI Supplemental Security Income or APA Adult Public Assistance ;

Receives income that would allow the individual to qualify for SSI Supplemental Security Income or APA Adult Public Assistance after deducting all OASDI Old Age, Survivors, and Disability Insurance (Social Security) cost-of-living adjustments received since the last month in which the individual was eligible for both OASDI Old Age, Survivors, and Disability Insurance (Social Security) and SSI Supplemental Security Income ; and

Meets all other Medicaid eligibility requirements.

Note: The individual need not literally receive both SSI Supplemental Security Income and Social Security checks in the same month, but need only be entitled to both for the same month. There is a one-month lag in OASDI Old Age, Survivors, and Disability Insurance (Social Security) payments, which are not disbursed until the month after entitlement, while SSI Supplemental Security Income payments are paid in the month of entitlement. It is common for an individual to receive SSI Supplemental Security Income while awaiting receipt of OASDI Old Age, Survivors, and Disability Insurance (Social Security) payments. Once the monthly OASDI Old Age, Survivors, and Disability Insurance (Social Security) begins, if it exceeds the SSI Supplemental Security Income rate, he or she receives just OASDI Old Age, Survivors, and Disability Insurance (Social Security) thereafter. In such circumstances, even though the individual never actually received simultaneous payments from both programs in a single month, he or she meets the first Pickle requirement. This is true even if income from a retroactive OASDI Old Age, Survivors, and Disability Insurance (Social Security) payment exceeds the SSI Supplemental Security Income benefit level for all months in which SSI Supplemental Security Income was received.

531 B. SCREENING

The following screening process will eliminate most applicants from consideration of eligibility under this category without the need for performing any mathematical calculations. For those who pass Plan for Achieving Self-Support this initial screening, the Pickle Amendment table in Addendum 1 , page 2 provides a simple formula for performing the necessary mathematical calculations. The screening process is as follows:

Step 1:

Ask the applicant, are you now receiving a Social Security check? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 2.

Step 2:

Ask the applicant, after April 1977, did you ever get an SSI Supplemental Security Income check at the same time that you got Social Security, or did you get SSI Supplemental Security Income or APA Adult Public Assistance in the month just before your Social Security started? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go to step 3.

Step 3:

Ask the applicant, what is the last month in which you received SSI Supplemental Security Income ?

Step 4:

Look up the month in which the applicant last received SSI Supplemental Security Income or APA Adult Public Assistance in the Pickle Amendment Table in Addendum 1 , page 2. Find the percentage that applies to that month/year. Multiply the present amount of the applicants (and/or spouse’s) Social Security benefits by the applicable reduction factor.

Step 5:

Add the figure that you have just calculated to any other countable income the person may have. If the resulting total is less than the current APA Adult Public Assistance Need Standard, the applicant is income eligible for Pickle Medicaid benefits.

Note: Because rounding factors may make a difference, if the total is within $20 of the current APA Adult Public Assistance Need Standard, please email the Program Officer at dpapolicy@alaska.gov for guidance.

Step 6:

Review for all other factors of eligibility.

Example: Mrs. Lewis received both Social Security and SSI Supplemental Security Income checks in 1978-79. However, her SSI Supplemental Security Income / APA Adult Public Assistance was terminated in March 1979 because she started receiving a private pension that, added to her Social Security benefits, raised her income to an amount above the 1979 SSI Supplemental Security Income and APA Adult Public Assistance income limits. There have been gradual increases in her income since 1979. She now receives a Social Security benefit of $1050 per month. Her private pension is $270 a month, for a combined total of $1,320 monthly.

In 2004, the income limit for APA Adult Public Assistance is $1047 (plus a $20 general income disregard = $1067) for an individual. Thus, Mrs. Lewis’ income is over the income limit for persons who are aged, blind or disabled.

Screen Mrs. Lewis for Pickle eligibility as outlined above. Determining that the last month that she received both Social Security and SSI Supplemental Security Income or APA Adult Public Assistance was March 1979, look up that time period in the following table and find the corresponding reduction factor (.360). Multiply Mrs. Lewis’s current Social Security benefit of $1050 by that factor, to determine her current countable Pickle income.

$1050

x .360 (reduction factor)

$378 ( Pickled Social Security income, rounded downward)

$378 countable Social Security income

+ $270 private pension

$648 total countable Pickle income.

Since $648 is less than the current APA Adult Public Assistance income limit (including the standard $20 disregard) of $1067, Mrs. Lewis is eligible for Medicaid.

531 C. EIS INFORMATION

EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply Medicaid Subtype: BB Individual lost SSI Supplemental Security Income / APA Adult Public Assistance eligibility from 1977 SSA Social Security Administration COLA Cost of Living Allowance

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