2683 Adult Disabled Children

Based on the Employment Opportunities for Disabled Americans Act of 1986, persons who qualify for Social Security benefits as "adult disabled children" may be eligible for medical assistance without a spenddown if the following criteria are met:

Currently receive Social Security benefits as an "adult disabled child" ;

received SSI benefits based on disability or blindness and that disability or blindness onset date was prior to age 22 (SSI benefit payment may begin after age 22);

They lost eligibility for SSI benefits (including eligibility under section 1619 per 2634) on or after July 1, 1987 solely because they became newly eligible for benefits as an "adult disabled child" or because of an increase in such benefits; and

They would be eligible for SSI benefits now if not for the amount of the "adult disabled child" benefit.

This provision is not applicable to those who (1) currently 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.

NOTE : Adult Disabled Child benefits can be identified by a Social Security Claim Number which ends with a "C".

For applicants who receive SSA benefits under the "adult disabled child" category, a determination of whether or not the individual had previously been an SSI client and, if so, whether or not the individual lost SSI eligibility on or after July 1, 1987 due to his or her adult disabled child benefit must be made. Verification of these qualifications along with the person's adult disabled child benefit level prior to SSI termination would be required. If the above conditions are met, a determination of the individual's financial and nonfinancial eligibility would then be completed.

All clients who lose SSI eligibility at the time he or she becomes eligible for Adult Disabled Child benefits are eligible for medical assistance without a spenddown. They would remain eligible for automatic medical as long as they would be otherwise eligible for SSI if not for the adult disabled child benefits.

To determine income eligibility for applicants as well as continuing eligibility for ongoing clients, the amount, if any, of the person's adult disabled child benefit in the month prior to the month of the increase which resulted in ineligibility for SSI must be verified. If the person became newly eligible for an adult disabled child benefit, this amount would be "0." This figure shall then be inserted on the ES-3104.6, Determination Worksheet for Pickle Eligibiles and Other Protected Medical Groups in Line 3 to determine total countable income. If the total countable income is less than the appropriate SSI benefit level, the person continues to qualify for medical eligibility without a spenddown. If the income is greater than the SSI level, the person would not qualify and a regular medical determination would be required. The income determination would not be required at the time an ongoing client loses SSI eligibility unless some other change in income occurred at the same time. This determination should occur on at least an annual basis as indicated below.

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 child 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 spouse or children.