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• Determined, even if retroactively, by the Social Security Administration (SSA) to have had an onset of disability prior to age 22; and • Based on that disability, received Supplemental Social Security (SSI) as a child or would have been eligible to do so. Furthermore, these individuals subsequently: • Become eligible for new or increased payment of Retirement, Survivors, and Disability Insurance (RSDI) • The new payment occurs during a month when also eligible for SSI • The total compensation from RSDI is more than the SSI benefit the individual would otherwise receive • Therefore, SSI payments are reduced to $0 and the larger RDSI payment becomes the new monthly benefit amount. These applicants/recipients must be treated as SSI recipients for Medicaid purposes and must not be denied/closed for being in DAC status. DAC status can be identified by a Social Security Claim Number (CAN) which is different than the individual’s own SSN and ends in the Beneficiary Identification Code (BIC) “C.” The member will also have a disability date which was prior to the 22nd birthday, and the Medicaid Eligibility Code received from SSA will indicate referral to the state for Medicaid determination due to entitlement or increase in DAC benefits.

The disability determination remains valid, and income will not count in the Medicaid budget, so long as DAC status remains active. For DAC members residing in the community, and not in an institution or on a HCBS waiver, the entire RSDI amount should be entered as SSI income to ensure that it is disregarded for MED 1 but will be budgeted/excluded correctly for other assistance groups and programs which have different budgeting rules for SSI income and/or DAC status. The modification of unearned income for the DAC needs to be clearly documented in the eligibility system’s note section. These members are not opened automatically into MASI coverage and should not be placed into the MASI category due to resource requirements and the need for an annual redetermination to verify eligibility factors including continuing DAC status. They must apply if not an ongoing recipient of Indiana Medicaid, and applicants/recipients must verify all eligibility factors including resources.

Individuals with DAC status are not eligible for MAGI processing47 and must receive coverage in another MED 1 category. Receipt of Medicare does not disqualify the DAC from these special provisions, and they are potentially eligible under MED 4 as well.