400.03.01 SSI APPLICATION EFFECTIVE DATE AND RETROACTIVE MEDICAID

The month SSI payments can begin is referred to as the SSI application effective date. It is the first day of the month following the later of the date the: • Application is filed; or • Individual becomes eligible for SSI benefits. Medicaid eligibility is dependent on receipt of the SSI payment which begins as of the SSI application effective date. The gap month created by the first month of the SSI payment rather than the first month of SSI eligibility is referred to as the E02 month. E02 is the payment status code that appears on the SDX for the SSI application month if the SSI applicant is otherwise eligible for that month. For SSI purposes, the individual is eligible for the E02 month but does not receive an SSI payment. Medicaid will automatically cover the E02 month in the majority of cases, since SSI eligibility has been established for this month. However, if the E02 gap month or any other intervening months of ineligibility for SSI exists prior to the month the SSI payment begins, it is possible for the E02 month and any other ineligible SSI months to be included in an SSI retroactive application. Refer to Chapter 101 at 101.10.06, Retroactive Medicaid for SSI Eligibles and Filling in Gaps of Missing Months of SSI Eligibility. An SSI Retro application is filed on an ABD Medicaid application form because it is tied to the SSI application and/or SSI eligibility. Usually, someone eligible for SSI ongoing will be eligible for Medicaid using SSI rules, which is the reason for the SSI retro COE-002 (a worker-entered COE). However, it is not required that an application for retroactive Medicaid for a SSI applicant be considered only under COE-002 using SSI income and resource rules for the retroactive period. If the individual is not eligible for the retro period using SSI rules, the individual may qualify for another ABD COE, e.g., the Healthier MS Waiver or Working Disabled, for the retroactive period using liberalized income and resource rules. Using an alternate ABD COE for retroactive eligibility is permissible, provided all needed verifications are obtained. The individual would then be placed in the ABD COE for which he/she qualifies for the retroactive month(s).