Special Considerations for SSI Applicants

The Social Security Administration (SSA) accepts and processes applications for Supplemental Security Income (SSI) at local SSA offices. Any individual applying for ABD Medicaid at DFCS who appears to be financially eligible for SSI should be referred to the local SSA office to file an application. DFCS will also accept the ABD application for a Medicaid determination and begin the SMEU process. An exception to this may be QMB in some situations.

SSI applicants have the right to have any month for which they have been determined ineligible for an SSI payment for a reason other than failure to meet the disability criteria examined for eligibility under ABD Medicaid. Refer to Section 2053 - Retroactive Medicaid .

DFCS is responsible for determining Medicaid eligibility on SSI applicants in the following circumstances:

the three months prior to the month of SSI application for SSI approvals and denials

months associated with an SSI application for which the applicant is ineligible for an SSI payment for a reason other than failure to meet disability

if an individual is alleging a disability regardless of SSI application status.

An SSI applicant who wants a determination of ABD Medicaid eligibility for months associated with a denied SSI application for reasons other than disability or prior months should contact DFCS to apply for that period of time. The prior months are protected indefinitely until such time as an eligibility determination has been made.

Refer to Section 2053 - Retroactive Medicaid , for processing procedures for retroactive months associated with an SSI application.

Chart 2060.2 - ABD MEDICAL ASSISTANCE FORM REQUIREMENTS

Form 216 - Declaration of Citizenship/Immigration status is not required if the A/R has declared their citizenship or immigration status on the eligibility application (94, 94A, 297, 508, 700 or via Gateway Customer Portal application) and signed application under penalty of perjury. Also, declaration of citizenship/immigration status/identity is not required if the A/R is determined under EMA procedures. Refer to Section 2215 - Citizenship/Immigration/Identity .