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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 1 DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF SOCIAL SERVICES

17000 SSI Related Programs

17000 Family and Community Medical Assistance - SSI Related Programs (Repealed) [Repealed, effective August 11, 2019.] 23 DE Reg. 127 (08/01/19)

17100 SSI Beneficiaries

Any individual aged 65 years or over, blind, or permanently disabled (i.e. unable to engage in substantial gainful activity), receiving a benefit through the Supplemental Security Income program, is automatically eligible for Medicaid in Delaware. Because Delaware covers all SSI beneficiaries, it is known as a "1634" state. Other states, commonly referred to as "209-b" states, have more restrictive criteria for eligibility than the SSI program.

17110 Individuals Who Would Be SSI Beneficiaries Except for the July, 1972 Increase in OASDI Benefits

These are individuals who were receiving OASDI and would be a SSI recipient now if the July 1972 increase in OASDI were deducted from the individual’s income.

17120 Recipients of Mandatory State Supplementary Payments

When the Federal SSI program was implemented in 1974, states were mandated to provide supplemental payments to aged, blind, and disabled individuals who would get less money under SSI than they got under the Old Age Assistance (OAA), Aid to the Blind (AB), and Aid to the Disabled (AD) programs formerly administered by the states. Delaware still has a few individuals who get mandatory state payments and they are eligible for Medicaid.

17130 1619 (b) Eligibles

Individuals with Disabilities* who lose their financial eligibility for SSI due to obtaining employment may continue to be eligible for Medicaid if:

·the individual continues to be blind or continues to have the disabling physical or mental impairment on the basis of which he was found to be eligible for SSI, and

·the individual, except for his earnings, continues to meet all non- disability- related requirements for eligibility for SSI, and

·the loss of Medicaid benefits would seriously inhibit his ability to continue employment, and

·the individual's earnings are not sufficient to allow him to provide for himself a reasonable equivalent of the benefits available under Medicaid. *Effective May 1991, the age restriction was lifted. 1619(b)'s will not lose their Medicaid eligibility at age 65. 15 DE Reg. 202 (08/01/11)

17130.1 Eligibility Determination

The SSI Medicaid Unit receives the names of these individuals via the State Data Exchange (SDX). They have a payment status code of "NO1" and code "C" in Medicaid eligibility field.

The "C" means - Federally administered Medicaid coverage should be continued regardless of payment status code.

SSA monitors 1619(b) clients to assure they still meet the eligibility criteria for the 1619(b) program. An annual Medicaid redetermination consists of obtaining verification from Social Security that the client is still 1619(b) eligible.

17140 "Pickle Amendment" - Loss of SSI Benefits Due to COLA Increases Medicaid benefits are continued for certain aged, blind or persons with disabilities who become ineligible for SSI benefits or State Supplementary Payments (SSP) due to cost of living adjustments (COLA) in RSDI benefits paid under Title II of the Act. For purposes of this provision, "supplementary payments" include any optional or mandatory State Supplementary Payments. 15 DE Reg. 202 (08/01/11)

17140.1 Eligibility Determination Effective July 1, 1977, Medicaid coverage will be provided (under the same terms and conditions as for SSI/SSP recipients in the State) to an aged, blind or person with a disability who: ·is currently eligible for RSDI benefits under Title II of the Act, ·becomes ineligible for SSI benefits or State Supplementary Payments (SSP), ·received SSI and Title II (SSA) benefits concurrently, and ·would still be eligible for SSI/SSP benefits if the amount of his/her (or spouse's) COLA were deducted from income.

Office of the Registrar of Regulations, Legislative Council, State of Delaware