101.02.02 MANDATORY CATEGORICALLY NEEDY - ABD

The following are ABD coverage groups that must be covered, as required by federal law: Mandatory Coverage of SSI Recipients Coverage is mandatory for individuals receiving Supplemental Security Income (SSI) in Mississippi. This includes individuals receiving SSI pending a final determination of blindness or disability, those receiving SSI under an agreement to dispose of resources that exceed the SSI resource limit, and those receiving benefits under section 1619(a) or considered to be receiving SSI under 1619(b) of the Social Security Act. Coverage also includes those who would be eligible for SSI except for an eligibility requirement used in the SSI program that is specifically prohibited under title XIX. Eligibility for SSI is determined by the Social Security Administration. No separate application for Medicaid is required unless the individual needs to apply for retroactive Medicaid for up to three (3) months prior to the month of the SSI application, in which case the individual must apply with the Division of Medicaid for the retroactive period of eligibility. Mandatory Coverage of Certain Former SSI Recipients Certain former SSI recipients qualify for Medicaid to continue once their SSI terminates if the use of specific income disregards allows Medicaid eligibility. Medicaid eligibility is based on SSI income and resource limits. The Division of Medicaid certifies eligibility for all the former SSI groups, as follows: • Cost of Living Individuals – these are former SSI recipients who become ineligible for SSI cash assistance because of a cost-of-living increase in title II benefits received after April 1977. These individuals must be granted Medicaid coverage if the sole reason for the loss of SSI was an increase in RSDI benefits received by the individual and/or his or her financially responsible spouse. • Disabled Adult Children – these are former SSI recipients age 18 or over whose disability onset date was prior to turning age 22. SSI must have been paid at any time after July 1987 and closed when title II benefits from a parent’s record began or increased, whichever caused the SSI to terminate. • Coverage is mandatory for certain disabled widows and widowers who would be eligible for SSI except for receipt of Social Security widow(er) benefits that terminated SSI. The individual must be age 50 through 64 and not eligible for Medicare to be evaluated for coverage under this provision. Mandatory Coverage of Certain Medicare Cost-Sharing Groups The Division of Medicaid certifies eligibility for all the Medicare cost-sharing groups: • Qualified Medicare Beneficiaries (QMB) must be entitled to Medicare Part A and have income that does not exceed 100% of the federal poverty level. Medical assistance is limited to payment of Medicare cost-sharing expenses that includes premiums, co-insurance and deductible charges. Note: The only exception to the requirement of entitlement to Part A is made for individuals entitled to Medicare Part B-ID. Medicare Part B-ID, implemented January 2023 from the Consolidated Appropriations Act 2021, is solely for coverage of immunosuppressive drugs. Part B-ID may be awarded to individuals who lose Medicare entitlement based on end stage renal disease (ESRD) 36 months following a successful kidney transplant. Individuals are ineligible for Part B-ID if they have full Medicaid coverage that includes coverage for immunosuppressive drugs or other health insurance. • Specified Low-Income Medicare Beneficiaries (SLMB) must be entitled to Medicare Part A and have income greater than 100% of the federal poverty level but less than 120% of the federal poverty level. Medical assistance for this group is limited to payment of Medicare Part B or Medicare Part B-ID premiums. • Qualifying Individuals (QI) must be entitled to Medicare Part A and have income that is at least 120% of the federal poverty level but less than 135% of the federal poverty level. Medical assistance for this group is limited to payment of Medicare Part B or Medicare Part B-ID premiums under a federal allotment of funds. Eligibility for coverage as a QI is dependent on the availability of federal funds. • Payment of the Medicare Part D pharmacy plan premium is applicable to the Medicare cost-sharing groups of QMB, SLMB and QI provided the beneficiary enrolls in a benchmark or $0 premium pharmacy plan. Benchmark plans are subject to change each calendar year based on plans that choose to participate within Mississippi. • Qualified Disabled and Working Individuals must be entitled to Medicare Part A and have income that does not exceed 200% of the federal poverty level whose return-to-work results in the loss of coverage for Medicare. Medical assistance is limited to payment of the Part A premium.