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1. An a/b receiving Social Security as Widow(er)s or as Disabled Adult Children, are evaluated under Disabled Adult Children (DAC), Early Widow(er)s, or Disabled Widow(er)s (as applicable) before evaluation under COLA/ Pickle Amendment Group.

2. The caseworker must document whether or not the individual is Pass-along eligible, the SSI/SA termination date and resources used to verify Pass-along status in NC FAST.

3. Maintain a copy of the following completed forms:

a. DHB-5150A Pass-along Screening Guide This form is completed when evaluating Pass-along groups of former Supplemental Security Income (SSI) and Special Assistance (SA) beneficiaries under categorically needy (C/N) criteria.

b. DHB-5150B Screening Guide for Medicaid Eligibility under the COLA Pass-along This form is completed when determining if an a/b qualifies for COLA Pass- along status under the Pickle Amendment.

II. COLA PASS-ALONG/ PICKLE AMENDMENT GROUP

A. Eligibility Requirements 1. Currently receives RSDI (Social Security) benefits;

2. Was eligible for and received RSDI and either SSI or State/County SA concurrently for at least one month after April 1, 1977 (or is treated as having received them concurrently under II.A.4. below); and

3. Lost SSI or SA benefits for any reason but would currently be eligible if the total amount of all COLA increases, since losing SSI or SA benefits, were excluded from countable income.

4. An a/b who received SSI and then were found retroactively eligible for RSDI are considered to have received SSI and RSDI concurrently.

5. If Pass-along eligibility is based on prior receipt of SA (not SSI), the a/b must currently reside in an adult care home.

B. Verify and Document an Applicant/Beneficiary (A/B) Who Lost SSI or SA Eligibility 1. If an a/b is in assisted living/adult care home (ACH) the caseworker must:

a. Check all available sources including NC FAST case records and