540 GRANDFATHERED ELIGIBILITY CATEGORIES

540 GRANDFATHERED ELIGIBILITY CATEGORIES

The following eligibility categories have been grandfathered into Medicaid by Congress. Encountering one of these individuals will be rare.

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.

Email hss.dpa.policy@alaska.gov if you are uncertain whether an applicant qualifies under one of these categories.

540 A. INDIVIDUALS ELIGIBLE FOR AFDC Aid to Families with Dependent Children EXCEPT FOR 1972 SOCIAL SECURITY INCREASE

Medicaid eligibility is available to an individual who would be eligible for AFDC Aid to Families with Dependent Children (if the program still existed) except for the 20 percent increase in Social Security old age, survivors, and disability insurance ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) ) that occurred in 1972 as a result of Public Law 92-336, provided that in August 1972 the individual was eligible for AFDC Aid to Families with Dependent Children . Being eligible for AFDC Aid to Families with Dependent Children includes those who would have been eligible had they applied or had they not been in a medical institution or an intermediate care facility.

EIS Eligibility Information System INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: SS Individual eligible in 1972, grandfathered

540 B. ELIGIBLE FOR SSI Supplemental Security Income OR APA Adult Public Assistance PAYMENTS EXCEPT FOR 1972 SOCIAL SECURITY INCREASE

Medicaid eligibility is available to an individual who would be eligible for SSI Supplemental Security Income or APA Adult Public Assistance payments today, except for the 20 percent increase in Social Security old age, survivors, and disability insurance ( OASDI Old Age, Survivors, and Disability Insurance (Social Security) ) that occurred in 1972 as a result of Public Law 92-336, provided that in August 1972 the individual was eligible for the state’s Senior Benefits ( SB Senior Benefits ), Aid to the Blind ( AB ), or Aid to the Permanently and Totally Disabled (APTD). Being eligible for one of those programs includes those who would have been eligible had they applied or had they not been in a medical institution or an intermediate care facility.

EIS Eligibility Information System INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: SS Individual eligible in 1972

540 C. INDIVIDUALS ELIGIBLE FOR MEDICAID IN 1973

Individuals entitled to a mandatory state supplement based upon their receipt, in December 1973, of a cash payment through the state's Senior Benefits ( SB Senior Benefits ), Aid to the Blind ( AB ), or Aid to the Permanently and Totally Disabled (APTD) Programs are eligible for Medicaid.

Institutionalized individuals who were eligible for Medicaid in December 1973, as inpatients in Medicaid-approved medical or intermediate care facilities, and who have continuously met the Medicaid eligibility criteria for December 1973, remain institutionalized, and continue to need institutional care, are eligible for Medicaid.

Blind or disabled individuals who meet all current Medicaid eligibility criteria except those for blindness or disability, who were eligible as blind or disabled in December 1973, and continuously have met the December 1973 criteria, are eligible for Medicaid.

EIS INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: GF Individuals eligible for Medicaid in 1973

540 D. CHILDREN WHO LOST SSI Supplemental Security Income IN 1996 BECAUSE OF THE CHANGE IN DEFINITION OF DISABILITY

Children that were receiving SSI Supplemental Security Income on August 22, 1996, the date of enactment of the Personal Responsibility and Work Opportunity reconciliation Act of 1996, and lost SSI Supplemental Security Income because of the change in the definition of disability for children, continue to be eligible for Medicaid if they continue to meet all other factors of eligibility.

Note: This does not change the definition of disability established in that law or give Medicaid eligibility to children who were not receiving SSI Supplemental Security Income on August 22, 1996.

EIS INFORMATION Eligibility Code: 20 No other eligibility codes apply Medicaid Subtype: NS Ineligible for SSI /APA – Requirements do not apply to Medicaid.

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