400.04.02 DISABLED ADULT CHILD (DAC) ELIGIBILITY CRITERIA (COE-094)

Section 6 of Public Law 99-654, The Employment Opportunities for Disabled Americans Act, specifies that effective July 1, 1987, when SSI recipients become ineligible for SSI due to entitlement to or an increase in title II child’s insurance benefits (also known as disabled adult child benefits), Medicaid eligibility must continue if these individuals continue to meet SSI criteria except for the change in their title II benefits. The specific requirements for DAC eligibility are: • The individual is at least age 18; and • Disability began before age 22, and • The individual received SSI on or after July 1, 1987, and • Lost SSI eligibility due to receipt of child’s insurance benefits or due to an increase in child’s insurance benefits (these are benefits payable from a parent’s record). The SDX may identify DAC’s with a Medicaid Eligibility code of “D.” In addition, the individual will have a Beneficiary Identification Code (BIC) of “C,” indicating entitlement to a child’s insurance benefit from a parent’s record (the full BIC may be C1, C2, C3, etc. indicating the number of children drawing from the parent’s record). A DAC is entitled to a disregard of income of either: • The full amount of the child’s insurance benefit received; or • The increase in the child’s insurance benefit. Whichever amount caused SSI to terminate is the amount of the disregard awarded the DAC. Income of the DAC is “frozen” at the amount it was prior to SSI termination. The DAC may have other income, including drawing title II benefits on his/her own record, but the DAC disregard is based only on the child’s insurance benefit amount or the increase in the child insurance benefit amount resulting in SSI termination. DAC’s must be otherwise eligible for SSI, meaning SSI rules are used to determine non- financial, income and resource eligibility. The DAC disregard must bring countable income below the individual SSI FBR (unless both members of a couple are DAC’s, in which case the combined DAC disregard must bring combined countable income below the couple SSI FBR). NOTE: All DAC applications must be referred to the Central Office for review prior to approval. Central Office staff will determine the DAC disregard, if needed. Although SSI terminations receive a Medicaid notice of termination advising the individual to apply for Medicaid under this provision, it is important for Specialists to review ABD applications and the SSI record on SVES carefully for indications of potential DAC eligibility, as outlined above. An adult receiving a child’s insurance benefit may have Medicare and may erroneously be placed in a Medicare cost-sharing COE. Entitlement to Medicare does not interfere with the individual’s right to qualify as a DAC and full-service eligibility as a DAC is preferred over reduced coverage in a Medicare cost-sharing COE. In addition, an individual eligible for Medicaid as a DAC qualifies for waiver services in the following waivers without a separate HCBS eligibility determination: • Independent Living Waiver, • Traumatic Brain Injury/Spinal Cord Injury Waiver, and • Intellectual Disabilities Waiver.