532 SSI OR APA INELIGIBLE NOT MEDICAID

532 SSI Supplemental Security Income OR APA Adult Public Assistance INELIGIBLE FOR REASONS THAT DO NOT APPLY TO MEDICAID

Medicaid is available to an individual who would be eligible for SSI Supplemental Security Income / APA Adult Public Assistance except that they do not meet an SSI Supplemental Security Income / APA Adult Public Assistance rule that is specifically prohibited in the Medicaid program.

Note: Effective October 1, 2026 individuals 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.

Example: Mr. Gibson has been determined disabled by the State Disability Determination Service ( DDS ) and meets APA Adult Public Assistance financial eligibility criteria. However, he chooses not to apply for SSI Supplemental Security Income . Because pursuit of SSI Supplemental Security Income is not required for Medicaid-only cases, Mr. Gibson may be determined eligible for Medicaid.

These individuals, including low-birth weight infants, must still meet APA Adult Public Assistance criteria for blindness, disability, or age.

532 A. LOW BIRTH WEIGHT INFANT

Before a low-birth weight infant can be found eligible for APA Adult Public Assistance -related Medicaid, a DDS Disability Determination Service determination of presumptive disability must be made.

532 B. QUALIFIED ALIEN

This category should be used for a qualified alien who lost SSI Supplemental Security Income because of his or her alien status under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. This category cannot be used for non-qualified aliens. See APA Manual Section 421-7 .

532 C. QUALIFYING INCOME TRUSTS

An individual who meets all other SSI Supplemental Security Income or APA Adult Public Assistance eligibility requirements, except for excess income may qualify for Medicaid-only by limiting their countable income using a Qualifying Income Trust. See Section 526 .

532 D. EIS Eligibility Information System INFORMATION

EIS Eligibility Information System INFORMATION Eligibility Code: 11 Pregnant woman 20 No other eligibility codes apply 24 LTC Long Term Care (300%) institutionalized Medicaid Subtype: NS Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of requirements that do not apply to Medicaid SA Ineligible for SSI Supplemental Security Income / APA Adult Public Assistance because of alien sponsor deeming ST QIT Qualifying Income Trust established for Medicaid eligibility

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