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More Restrictive Requirements than SSI under 1902(f) – 209(b) States

POLICY CITATION

Statute: 1902(f)

Regulations: 42 C.F.R. §435.121

BACKGROUND

Overview This reviewable unit (RU) describes the more restrictive methodology applied in 209(b) states to determine Medicaid eligibility for individuals who are age 65 or older or who have blindness or a disability. The RU provides details on the more restrictive criteria and the populations subject to these criteria.

When determining eligibility for groups that are exempted from the use of modified adjusted gross income, the Medicaid statute requires states to use the rules of the most closely related cash assistance program. For individuals who are age 65 or older or who have blindness or a disability, the most closely related cash assistance program is the Supplemental Security Income (SSI) program. However, section 1902(f) of the Social Security Act (the Act) provides states the authority, under certain conditions, to apply more restrictive eligibility criteria than are used by the SSI program. States that elect this option are called 209(b) states.

The 209(b) option applies only to eligibility for individuals who are age 65 or older or who have blindness or a disability. This option does not affect eligibility for families/adults groups in any way.

Option: Populations Subject to More Restrictive Criteria. A 209(b) state may elect to impose more restrictive eligibility criteria on the following populations:  Individuals who are age 65 or older,  Individuals who have blindness, and  Individuals who have a disability. The state may apply the more restrictive eligibility criteria to one or more of these populations. For the population(s) above that are not subject to the more restrictive criteria, the state would use SSI criteria as the basis for determining financial eligibility. For example, a state may employ eligibility requirements that are more restrictive than SSI for individuals who are age 65 or older or who have a disability, but provide Medicaid to all SSI recipients who have blindness.

More Restrictive Criteria In establishing more restrictive eligibility criteria, the following limitations apply: 1. Eligibility criteria cannot be more restrictive than the eligibility requirements in the state’s Medicaid plan as of January 1, 1972. 2. The basic age eligibility requirement (age 65 or older) must be used in 209(b) states just as it is under SSI. States cannot establish a higher age standard.