Procedures

Follow the steps below to determine Medicaid eligibility under the Pickle COA.

Step 1 Accept the A/R’s Medicaid Application. Step 2 Obtain verification from SSA to verify the following: The date SSI benefits were terminated. The current amount of the A/R’s and/or his/her spouse’s RSDI. The amounts of all RSDI COLAs the A/R and/or his/her spouse have received since SSI was terminated. Step 3 Determine all basic eligibility criteria except LOS and LOC. Refer to Section 2200, Basic Eligibility Criteria. Step 4 Determine all basic eligibility using the current SSI income and resource limits. Refer to Section 2500, ABD Financial Responsibility and Budgeting, to determine the following: Whose income and resources to consider. Which SSI income and resource limit (individual or couple) to use Which eligibility budget to complete. Step 5 Determine the A/R’s countable income by disregarding the following amounts of RSDI income. The COLA that caused SSI termination OR The first COLA received after SSI was terminated for a reason other than receipt of a COLA, such as a resource ineligibility AND All subsequent COLAs. The COLAs of the A/R (individual or couple) and the A/R’s ineligible spouse can be disregarded in determining eligibility under the Pickle COA. Step 6 Approve Medicaid on the system using the Pickle COA if the A/R meets all the above eligibility criteria, including retroactive months if needed. Do not approve Medicaid using the Pickle COA for any month for which the A/R was eligible for and received an SSI payment.