Page 4

5

C. Verify and Document the Following Factors for Potential COLA Pass-along Eligibility 1. The applicant/beneficiary (a/b) statement.

2. The date SSI or SA benefits were terminated on or after April 1977.

3. The current amount of the applicant’s/beneficiary’s RSDI. 4. The amounts of all RSDI COLA increases the a/b received since SSI or SA was terminated.

5. If the a/b lost SSI due to receiving RSDI:

a. Use the factor found in the Pickle Amendment chart below.

b. Find the year in which the individual lost SSI and multiply the factor by the current RSDI amount.

c. Compare the result to the current SSI Federal Benefit Rate (FBR) to determine eligibility.

6. If the a/b lost SA due to RSDI benefit increase:

a. Use the factor found in the Pickle Amendment chart below. Find the year in which the individual lost SA and multiply the factor by the current RSDI amount.

b. Compare the result to the current Special Assistance (SA) income standard to determine Medicaid eligibility. Beneficiary must reside in an ACH to be eligible.

Reference Special Assistance policy regarding income standards.

7. When an a/b’s RSDI increase caused them to

a. Lose SSI and become ineligible for Medicaid using Pass-along eligibility rules, and

b. The a/b is later determined to be eligible for SA and

c. The same a/b later loses SA benefits due to an RSDI increase,

the caseworker must determine which Pass-along group criteria should be used to evaluate for Pass-along eligibility and document the case record.

Example: The caseworker is completing a review for an a/b currently residing in an ACH. The a/b receives RSDI, and the most recent COLA increase resulted in the