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Appendix A-16-7-RB293

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5. You once received SSI and were terminated for one of the following reasons but would still be eligible for SSI if we disregard the income that made you ineligible such as:

a. A cost-of-living increase in Social Security.

b. Entitlement to or an increase in Social Security disabled

adult child benefits after July 1, 1987.

c. Entitlement to Social Security widow(er) benefits for those

between age 50-65 who are not eligible for Medicare.

6. You are disabled and working at least 40 hours per month. Your

gross monthly income cannot exceed 250% of the federal poverty level

for an individual or couple. Your unearned income cannot exceed 135%

of the federal poverty level for an individual or couple. Resources

cannot exceed $24,000 for an individual and $26,000 for a couple. A

monthly premium is payable for an individual or couple whose

earnings exceed 150% of the poverty level for Working Disabled

coverage.

7. You are disabled and not eligible for Medicare. Your income cannot

exceed 135% of the federal poverty level for an individual or

couple. Your resources must not exceed $4000 for an individual or

$6000 for a couple for coverage in the Healthier MS Waiver program.

8. You are a pregnant woman with household income that does not exceed

194% of the federal poverty limit.

The income limits referred to above can be found on the Division of

Medicaid’s website at www.medicaid.ms.gov under “see if you qualify for

Mississippi Medicaid health benefits,” or you may call the Regional Office

to get income and other information about Medicaid coverage.

If you believe that you may be eligible under one of the groups described

above, you should contact:

ADDRESS: REGIONAL OFFICE DIVISION OF MEDICAID (ADDRESS) (CITY,STATE,ZIP)

TELEPHONE: _______________________

within ten (10)days for a redetermination of your eligibility.

FOR AGED AND DISABLED ONLY

If you believe that you would continue to be eligible for Medicaid under one of the Medicaid groups described above, complete the attached SSI Review Form and take or mail it in to the Medicaid Regional Office shown above within 10 days.

Enclosure: Medicaid Notice of Non-Discrimination

SSI Review Form