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West Virginia Income Maintenance Manual Chapter 10

West Virginia Income Maintenance Manual Page 65 Chapter 10 The Case Maintenance Process

When an individual no longer receives SSI because SSA determines he is no longer disabled, SSI Medicaid must be continued for 60 days from the date of the SSA notification that SSI will be stopped. It is continued after the 60-day period when: • The individual is not eligible under any other full-coverage Medicaid group without a spenddown; and • The individual has requested an appeal of the decision in a timely manner, as determined by SSA. The SSI Medicaid continues until a decision is made after the SSA hearing, regardless of whether or not the individual continues to receive an SSI payment. A decision after the hearing occurs when the SSI Medicaid client has no right to further administrative appeal. See Chapter 7 for verification of appeal status. Special Procedure Example: When a recipient fails to appeal an adverse SSA Administrative Law Judge (ALJ) decision to the Appeals Council and the Appeals Council decides not to review the case, the ALJ decision is final for purposes of continued Medicaid, if the 60-day deadline for requesting an appeal has expired. If, however, a timely request is made for a review, the final decision is the Appeals Council’s decision to either deny a review or make a decision on the appeal.

10.14.3 Special Procedure: ABLE Accounts If the ABLE account balance reaches $100,000 and the beneficiary is receiving SSI benefits, any monthly SSI benefits will be placed in suspension. If the assets in the ABLE account balance drops back below $100,000, the SSI benefit suspension ceases and monthly SSI payments resume. A beneficiary will not lose eligibility for Medicaid based on assets held in the ABLE account, even during the time the SSI benefits are suspended.