Procedures

Follow the steps below to determine Medicaid eligibility under the Widow(er) Age 60 – 64 COA.

Step 1 Accept the A/R’s Medicaid application. Step 2 Obtain information required to complete the eligibility determination. Step 3 Verify that the A/R is age 60 – 64. Step 4 Obtain the following verification from the Social Security Administration: The date SSI benefits were terminated. The current amount of the A/R’s RSDI Widow(er) benefit. The amounts of the RSDI initial entitlement that caused SSI termination and all COLAs received since SSI was terminated The A/R’s current ineligibility for Medicare Part A coverage. Step 5 Determine all basic eligibility criteria except LOS and LOC. Refer to Chapter 2200, Basic Eligibility Criteria. Verify blindness or disability if the A/R does not have prima facie evidence of blindness or disability, such as receipt of an RSDI disability benefit. Refer to Section 2205, ABD Requirement. Step 6 Determine financial eligibility using the current SSI income and resource limits. Refer to Chapter 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. Determine the A/R’s countable income by disregarding the following amounts of RSDI income: The initial entitlement to RSDI as a widow(er) that caused SSI termination AND All subsequent COLAs The RSDI claim number will end with a beneficiary identification code (BIC) that includes “D” if the A/R receives RSDI as a widow(er)/surviving divorced spouse. Step 7 Approve Medicaid, including prior months if needed, under the Widow(er) Age 60 - 64 COA if the A/R meets all the above eligibility criteria. Do NOT approve Medicaid using the Widow(er) Age 60-64 COA for any month for which the A/R was eligible for and received a SSI payment. Step 8 Terminate Medicaid under this COA as soon as the A/R becomes entitled to Medicare Part A. Complete a CMD. Refer to Section 2052, Continuing Medicaid Determination.