2682 Qualifying Disabled Widows and Widowers

Based on a provision contained within the Consolidated Budget Reconciliation Act of 1985 (COBRA) persons who lose their SSI eligibility (including eligibility under section 1619 per 2634) because of an increase to their Social Security disabled widow's or widower's benefits may qualify for medical assistance without a spenddown if they meet all of the following criteria:

They were entitled to a monthly Social Security benefit for December 1983.

They were entitled to and received a Social Security widow's or widower's benefit for January 1984 based on a disability.

They became ineligible for SSI benefits because of an increase in the amount of their widow's or widower's benefit which was caused by the elimination of an eduction factor for disabled widows and widowers who became entitled before age 60.

They have been continuously entitled to a disabled widow's or widower's benefit since that increase was received; and

They would be eligible for SSI benefits now if the amount of that increase and any cost-of-living adjustments since then were deducted from their current income.

This provision is not applicable to those who (1) receive SSI or cash assistance or (2) reside in a nursing facility or state institution. Qualifying individuals must meet all Medically Needy nonfinancial eligibility factors including the general eligibility requirements of 2100 and the resource criteria of 5000 and subsections.

Application for eligibility under this provision must be made prior to July 1, 1988. Each state received information from SSA identifying all persons residing in that state who potentially qualified under this provision. Thus, persons applying for eligibility under this provision in Kansas must present evidence of having been notified of their potential eligibility or of having qualified for assistance under this provision. Persons who qualified prior to July 1, 1988, in another state and who move to Kansas can be determined eligible here if continued coverage under this provision is requested.

Verification of their eligibility status in the other states is required. Persons who were notified of their potential eligibility in another state but did not apply and who later move to Kansas must apply for benefits under this provision prior to July 1, 1988.

If the above evidence is presented, an income determination shall be completed. The amount of the person's Social Security benefit prior to the reduction factor increase and any subsequent COLAs must be verified. This amount shall be added together with all other current nonexempt gross income. The Medically Needy income disregards as described in 7240 shall be applied to the total income. The countable income obtained shall then be compared to the current SSI benefit level for 1 person (either the full amount or the prorated amount if living in someone else's household).

The ES-3104.6 shall be used for determining countable income by using Lines 3-9. The person's Social Security benefit prior to the reduction factor increase would be inserted on Line 3.

If the total countable income is less than the appropriate SSI benefit level, the person qualified for medical eligibility without a spenddown. Such eligibility shall begin with the first eligibility base period (including prior medical, if requested).

If the total countable income is greater than the appropriate SSI benefit level, the person does not qualify, and a regular medical determination shall be developed.

Persons eligible under this provision shall be reviewed on an annual basis in accordance with 9372. If there has been no change in circumstance such as an increase in other income or loss of disabled widow or widower status, such eligibility shall continue. Although qualifying persons are eligible for medical without a spenddown as though they were receiving SSI benefits, they are not to be viewed as SSI recipients for any other purpose. Thus, the income and resources of a person receiving medical under this provision would be considered in determining the cash and medical eligibility of any dependent children.