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10 TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE

17800 Medical Assistance during Transition to Medicare

42 CFR 435.232

Medicaid may be provided to individuals who receive only an optional State supplement and who would be eligible for SSI except for the level of their income.

The rules in this section set forth the eligibility requirements for coverage under this state-administered Optional State Supplementation group - Medical Assistance during Transition to Medicare (MAT). The MAT group is implemented March 1, 2001. Effective January 1, 2025, this group is eligible for retroactive eligibility. 12 DE Reg. 788 (12/01/08) 28 DE Reg. 48 (07/01/24)

17801 Status Eligibility

In addition to the general Medicaid eligibility requirements listed in DSSM 14000 - 14960, the individual meets all the conditions listed below must meet the following conditions:

a) received SSI, and

b) lost eligibility for SSI due to the receipt of Social Security Disability Insurance, and

c) is not yet eligible for Medicare.

Effective September 1, 2008, coverage under the MAT group is extended to an individual who:

a) lost eligibility for Medicaid on or after January 1, 2008, due to the receipt of Social Security Disability Insurance, and

b) is not yet eligible for Medicare. 12 DE Reg. 788 (12/01/08)

17802 Financial Eligibility

All income and resources are excluded.

17803 Eligibility Determination

When an individual loses Medicaid eligibility, a redetermination will be completed to the extent possible based on information contained in the individual's file. An application form may be required if additional or updated information is needed for the redetermination. 12 DE Reg. 788 (12/01/08)

17804 Income Standard

The income standard is $5.00.

17805 Payment Level

Countable income is deducted from the income standard.

17900 Medicaid for Workers with Disabilities

The Ticket to Work and Work Incentives Improvement Act of 1999 established an optional categorically needy eligibility group under Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act. This eligibility group provides Medicaid coverage to certain employed individuals with disabilities. The rules in this section set forth the eligibility requirements under this group entitled Medicaid for Workers with Disabilities (MWD). The effective date for MWD is October 1, 2009. 12 DE Reg. 446 (10/01/08) 13 DE Reg. 654 (11/01/09)

17901 General Eligibility Requirements The Medicaid rules at Section 14000 of the Division of Social Services Manual (DSSM) also apply to MWD except as provided in this section.

17902 Alien Status

Repealed 14 DE Reg. 1361 (06/01/11)

17903 Age Requirement

The individual must be at least 16 but less than 65 years old.

17904 Disability Requirement

The individual must be disabled as defined under the Supplemental Security Income (SSI) program except that being engaged in substantial gainful activity will not preclude a determination of disability.

17905 Employment Requirement

The individual must be engaged in paid employment and document Federal Insurance Contributions Act (FICA) withholding from income.

17906 Resources All resources are excluded.

17907 Income