Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits under PICKLE.

Current Policy Effective Date: January 1, 2022

Date Last Reviewed:

Previous Policy: July 1, 2018

POL M1005D: DETERMINING ELIGIBILITY FOR PICKLE

1. Applicants Must be Receiving RSDI Benefits

2. Applicants Must Have Received SSI Anytime Since 1977

3. Applicants Must Meet Income Requirements

Require the applicant’s income to be less than or equal to the current SSI income standard, after Cost Of Living Adjustments (COLAs) are subtracted. Refer to Table 4 for COLAs.

Refer to Table 1A to determine the SSI payment standards.

4. Applicants Must Meet Resource Requirements

Resources must be within the SSI guidelines. Refer to Table 7 to determine the SSI resource standards.

5. Benefits Begin First Day of the Application Month if Determined Eligible

6. Clients May Receive Retroactive Medicaid

Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.

Both approved and denied applicants must be reviewed for retroactive Medicaid. Verify and determine eligibility separately for each retroactive month.

7. Clients Must Be Reviewed

Clients must be reviewed every 12 months to determine continued eligibility. Refer to Section M1403 for information on reviewing eligibility.

Clients must be reviewed for other Medicaid program eligibility before closing cases.

8. Clients May Lose Benefits

The case will close on the first day of the next month when any of the following occur:

Client does not complete a review. Client dies. Client determined no longer eligible.