Page 5

commercial plan – that serves as the principal payer for their health care, but that does not cover those benefits. 1.5 IHCC Groups Subject to the SSI Methodology A. The provisions of this Chapter govern the following eligibility pathways that use the SSI methodology in whole or in part to determine eligibility for Medicaid benefits: 1. Elders and Adults with Disabilities (EAD) – Low-income elders who are sixty-five (65) and older and adults living with disabilities who have income at or below one hundred percent (100%) of the Federal Poverty Level (FPL) and resources at or under $4,000 for an individual or $6,000 for a couple. 2. Medically Needy (MN) – Elders, adults with disabilities, children, parents and caretakers of Medicaid-eligible children, and pregnant people who do not qualify for eligibility on the basis of income but have high health expenses and must spend or contribute income and/or resources above the applicable income standard to obtain or retain Medicaid eligibility. Subchapter 05 Part 2 of this Chapter pertains to the MN eligibility pathway for Community Medicaid. 3. Supplemental Security Income (SSI) Recipients – All persons receiving SSI cash assistance based on age or as an adult with a disability, as determined by the federal Social Security Administration (SSA). SSI recipients are automatically eligible for Medicaid on this basis and are not required to apply for Medicaid health coverage through the State. Program-specific provisions for SSI recipients twenty-one (21) and older are included in this Chapter. The relevant provisions for Medicaid beneficiaries under twenty-one (21) are located in the sections pertaining to coverage for children and families. 4. State Supplement Payment (SSP) – Persons who qualify to receive the optional state-funded supplemental payment under 218-RICR-20-00-5 are automatically eligible for Medicaid health coverage under the Medicaid State Plan. 5. SSI Protected Status Beneficiaries – This group, sometimes referred to as “SSI-lookalikes,” includes persons who meet the age or disability criteria for SSI, but are ineligible for full SSI cash benefits or qualify for special treatment. To protect Medicaid health coverage for members of these coverage groups, federal law requires the application of special rules that confer or preserve Medicaid eligibility. 6. Medicaid Premium Payment Program (MPPP) for Medicare beneficiaries with income at or below one hundred thirty-five percent (135%) of the FPL.