2639 Special Provisions for Children Terminated from SSI Due to Changes in Disability Criteria

Based on the provisions of the Budget Reconciliation Act of 1997, children who lose eligibility for SSI benefits due to changes in the SSI childhood disability criteria resulting from the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) shall continue to be eligible for medical assistance as long as they would be otherwise eligible for SSI except for the loss of disability status. See also 2636 regarding children whose termination of benefits is timely appealed. This group of children is limited to those receiving SSI benefits as of August 22, 1996, including those who have been receiving SSI in another state and subsequently move to Kansas. Documentation of SSI termination due to the new disability criteria is required as well as verification that the individual was receiving SSI on August 22, 1996. The Social Security Administration provides periodic lists of individuals who no longer meet disability criteria under these provisions.

In order to continue medical coverage under this provision, the general eligibility requirements of cooperation and residency contained in 2100 must be met. In addition, financial eligibility must be redetermined on a yearly basis. This can be accomplished in one of two ways. First, a Medicaid poverty level determination in accordance with the Kansas Family Medical Assistance Manual is to be done and children meeting this criteria set up under the Poverty level program. If the child does not meet the financial criteria for Poverty level program, falls into CHIP or loses poverty level coverage, an SSI financial determination is to be done. Countable resources of the custodial parent(s) and the child must be below the appropriate resource standard per 5130 . Countable income shall be determined through use of the electronic SSI eligibility worksheet. The income of the custodial parents (including any stepparents) and the child, and any of the child's natural or adoptive siblings is to be considered on this worksheet. If the countable income obtained is less than current one-person SSI beneficiary level, the child remains eligible. Procedures set forth in Policy Memo 1999-09-01, re: Self-Employment, Assistance Planning, Adding Child to Plan, Newborns, Retroactive Coverage, IM-3160 Revision regarding ex parte redeterminations shall be utilized to the extent possible when completing the financial determination.

Coverage under this provision is available through the month the child turns age 18. Continued medical eligibility after this time would then have to be determined under other existing categories (e.g., Medically Needy if person meets adult disability criteria).