Page 20

Chapter: 2000 Coverage Groups Program: MSSI, SFP 16 2040.0802.10 Budgeting (MSSI) Determine gross monthly income per the policy in Chapters 1800 and 2400, applying the applicable income deductions and exclusions.

Measure the countable income against the current SSI FBR. If the countable income does not exceed the current SSI FBR, the individual is eligible for Medicaid under the Protected Medicaid provision. 2040.0803 Ex Parte to Medically Needy (MSSI) Cases that meet the Protected Medicaid or MEDS-AD criteria but have too much income must be considered under the Medically Needy Program. COLAs are not disregarded in the MEDS-AD or Medically Needy income determination. 2040.0804.01 Regular COLA Protected Medicaid (MSSI) To be eligible for this Regular COLA Protected Medicaid, the individual must meet all the SSI criteria, with the exception that the Title II COLAs will be disregarded in determining eligibility on the factor of income.

The individual must also meet the following special requirements:

1. is currently receiving Title II (Social Security benefit); 2. was concurrently receiving Title II benefits and SSI benefits in any month subsequent to April 1977; 3. lost SSI eligibility for any reason; and 4. would now be eligible for SSI if the Title II COLAs, which they received after they were last eligible for (and received) SSI and Title II benefits concurrently, were deducted from their countable income. 2040.0804.02 Effective Date of Coverage (MSSI) The individual must have concurrently received Title II and SSI benefits in any month subsequent to April 1977. The first month of entitlement cannot be previous to April 1977.

An individual may apply for up to three months retroactive Medicaid based on the month of application under this coverage group. 2040.0805.01 Protected Medicaid for Disabled Widows(ers) I (MSSI) Individuals who make application for Medicaid prior to July 1, 1987, may be eligible for Protected Medicaid for Widow(er)s if the individual:

1. was entitled to a monthly insurance benefit under Title II of the Social Security Act of December 1983; 2. was entitled to and received a widow's or widower's benefit based on a disability under the Social Security Act of January 1984; 3. because of the increase in the amount of widow's or widower's benefit which resulted from the elimination of the reduction factor for disabled widows and widowers entitled before age 60, became ineligible for SSI in the first month in which that increase was paid (and in which a retroactive payment of that increase for prior months was not made); or 4. has been continuously entitled to a widow's or widower's benefit from the first month that increase in the widow's or widower's benefits were disregarded. 2040.0805.02 Written Application Necessary for Widows(ers) I (MSSI) Individuals who are eligible under this coverage group must have filed a written application for Medicaid before July 1, 1987.