Budgeting Procedures for SSI Recipients 510-05-90-45

(Revised 7/1/14 ML #3406)

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For aged, blind, or disabled individuals who are categorically needy SSI beneficiaries, the following procedures apply:

SSI recipient living in their own home : All income, including deemable income, is normally considered by the Social Security Administration in determining the SSI benefit amount. In those situations it is not necessary to rebudget to determine Medicaid income eligibility. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.

A SSI recipient is considered part of the family unit as described below:

A SSI recipient is included as part of the family unit when determining asset eligibility;

A caretaker receiving SSI benefits is included in the family unit for budget purposes due to the caretaker’s financial responsibility for spouse and children; and

A child receiving SSI benefits is not included in the family unit for budget purposes.

SSI recipients residing in an intermediate care facility for the intellectually disabled (ICF-ID) (including the Anne Carlsen facility) are allowed the ICF-ID income level. Those residing in a nursing facility, the state hospital, the Prairie at Saint John's Center, the Stadter Center, a Psychiatric Residential Treatment Facility (PRTF), or receiving swing bed care in a hospital: The SSI recipient is allowed the nursing care income level. Also see State LTC Subsidy Program 510-05-95-45.

Parental and spousal income is not considered available to the recipient.

Individuals between the ages of 21 and 65 are not eligible for Medicaid in the state hospital.

SSI recipients living in a specialized facility : All income is normally considered by the Social Security Administration in determining the SSI benefit amount. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.

If the individual is under 18 years of age and enters the specialized facility from a public institution or the parental home, consider the income of the individual and parents. If the Medicaid unit in the home is not receiving Medicaid, 75% of the excess income shall be disregarded in determining client share ( recipient liability ).

If the individual is married, the income of the individual and of the spouse must be considered. If the Medicaid unit in the home is ineligible, a disregard of 75% of the excess income is allowed in determining client share.

SSI recipients electing to receive HCBS : Verification of SSI eligibility satisfies income eligibility for Medicaid, and it is not necessary to rebudget to determine Medicaid income eligibility. There are situations, however, when the Social Security Administration may be unaware of income. In such cases, the county agency must take the necessary steps to insure that the individual is eligible for SSI if all income is considered before certifying the individual as categorically eligible for Medicaid.

The maintenance needs of the SSI recipient are considered met by virtue of receipt of SSI, so income of a spouse or parents cannot be deemed to bring the recipient up to the medically needy income level .