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1138 Chapter 7:Worker guides • Section 7: OSIPM worker guides (07/2026) eligibility, you need to determine eligibility for other Medicaid programs. An individual who has lost 1619(b) status because of their earnings should be looked at for EPD. Disabled adult child status This is a protected eligibility category, which means we make certain concessions by disregarding all or part of the individual’s SSB, but the individual must still meet all other financial and non-financial eligibility requirements. Section 1634(c) of the Social security act and 42 U.S.C (United States Code) 1383c provide Medicaid eligibility for Disabled Adult Children (DAC). In order for an individual to qualify for this program, they must meet the following eligibility components: • The individual must be over 18 years old; • The individual was determined to be blind or disabled as defined by SSA before they were 22 years old; • The individual was receiving SSI at age 18 or older and lost that eligibility after July 1, 1987 (they only have to receive one month of SSI at age 18 to be eligible but they must have been receiving SSI and lost it) • The individual lost their SSI because they started receiving benefits on a deceased, disabled or retired parent. The loss of SSI can be due to receipt of this benefit or because the benefit increased. Clues that an individual might be DAC eligible. These are just clues. You cannot be certain that an individual meets the criteria as a Medicaid protected DAC unless all eligibility components have been verified. • Individual is receiving benefits under an SSN that is not their own • Individual is over 18 years old • There is a ‘C’ code after the SSN they are receiving benefits under (ex. xxx-xxx-xxxxC3) It is important to note that SSA has their own eligibility criteria for individuals they refer to as DAC’s or CDB’s (Childhood Disability Beneficiaries). When determining eligibility for a Medicaid protected DAC, unless all eligibility components can be verified by other means, SSA must be contacted and asked specific questions related to eligibility for the program we offer. The specific questions staff should ask SSA are as follows: • Was this individual determined to be disabled or blind prior to age 22? • Did this individual receive SSI (title XVl) payments at age 18 or older (only one month of payment is needed to meet the requirement)? • Did this individual lose their SSI on or after July 1, 1987? • Was the loss of the SSI due to receipt of or an increase in child’s insurance benefits (DAC payments)? If the answer to each question listed above is yes, staff can look at DAC eligibility. The individual must ALSO meet the other eligibility requirements in order to be considered a Medicaid protected DAC. Other eligibility requirements that must be met: • The individual would continue to be eligible for SSI if they were not receiving the DAC benefit:
This means the financial group’s adjusted income is below the current OSIPM standard. If the individual (or a spouse in the financial group) has other income besides SSB, they could potentially be over income (and thus ineligible) for OSIPM.
After the appropriate amount of DAC payments are excluded (see Calculating Countable Income) and the