2684 Early or Disabled Widows and Widowers

Persons who lose their SSI eligibility (including eligibility under section 1619 per 2634) because they begin receiving early or disabled widow or widower Social Security benefits may qualify for medical assistance without a spenddown if they meet the following criteria:

They are currently receiving SSA widow's or widower's benefits under section 202(e) or 202(f) of the Social Security Act and have attained age 60 or have attained age 50 but have not obtained age 60 and are disabled;

They became ineligible for SSI benefits because they began receiving early aged widow or widower benefits;

They would be currently eligible for SSI if the amount of those benefits was disregarded; and

They are not eligible for Medicare coverage under Part A of Title XVIII.

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.

For applicants who receive early or disabled widow or widower's benefits and meet the age and Medicare criteria described above, a determination of whether or not the individual has previously been an SSI client and, if so, whether the individual lost SSI eligibility due to the receipt of such benefits must be made. Verification of these qualifications along with the current widow/widower benefit amount would be required. A determination of the individual's financial and nonfinancial eligibility would then be completed.

Ongoing SSI clients who lose SSI eligibility due to becoming eligible for early or disabled widow/widower benefits shall be considered as having met items 2 and 3 in the above criteria (including financial and nonfinancial requirements). A determination of the age and Medicare eligibility criteria would then be made. Verification of the reason for SSI termination will be required. Qualifying individuals would remain eligible for medical assistance without a spenddown as long as they continue to meet the above provisions.

To determine income eligibility, the ES-3104.6 shall be used. All of the individual's nonexempt income except the widow/widower benefit would be inserted on Lines 4-6 of the worksheet and the resulting total countable income determined. If the total countable income is less than the appropriate SSI benefit level, the person would qualify for medical assistance without a spenddown. If the income is greater than the SSI benefit level, the person would not qualify, and a regular medical determination would be required. An income determination would not be required at the time an ongoing client loses SSI eligibility as indicated above unless some other change in income occurred at the same time.

This determination should occur on at least an annual basis as indicated below.

Eligibility under this provision shall end in the month in which the individual turns 65 or becomes eligible for Medicare Part A, whichever occurs first. An annual review shall be conducted in accordance with 9372. If there has been no change in circumstance such as an increase in other income, such eligibility shall continue until the age limit or Medicare eligibility is reached.

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 medical eligibility of any dependent children.