Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits under Supplemental Security Income (SSI Eligible).

Current Policy Effective Date: September 1, 2018

Date Last Reviewed: August 15, 2018

Previous Policy: July 1, 2011

POL M1005F: DETERMINING ELIGIBILITY FOR SSI ELIGIBLE

1. Social Security Administration (SSA) Determines Eligibility

The State Data Exchange(SDX) shows eligibility with a payment code of “CO1.”

Accept verification from SSA as proof of eligibility when the client does not appear on the SDX.

2. Benefits Must Begin First Month Client Is Eligible for SSI

Benefits will automatically authorize in WES through the SDX.

3. Applicants May Be Eligible For Retroactive Benefits

Retroactive benefits may be available to an individual who applied for SSI and incurred medical bills within two calendar months prior to the date of application with SSA. Each month must be reviewed and verified separately to determine whether the case would have been eligible if an application had been submitted.

Retroactive benefits may be authorized when the client meets the following:

Disability onset date is within the retroactive month. SSI Income Requirements Refer to Section M901 and Medicaid Table 1A . SSI Resource Requirements Refer to Section M801 and Medicaid Table 7 .

4. Applicants May Have Eligibility For 12 Continuous Months

Eligibility continues for 12 months from the effective date of eligibility, or for 12 months from the last periodic review, for children under the age of 19.