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3. Financial eligibility requirements may not conflict with the requirements of section 1924 of the Act, which governs the eligibility and post-eligibility treatment of income and resources of institutionalized individuals with community spouses. 4. The more restrictive criteria cannot conflict with the more liberal requirements applied by the state in accordance with 42 C.F.R. §435.601 or the more liberal requirements applied under 42 C.F.R. §435.234(c) to determine eligibility for state supplementary payments.

Within these limitations, 209(b) states can have more restrictive definitions of blindness or disability, more restrictive income and/or resource standards, and more restrictive income and/or resource methodologies than those used by the SSI program.

More Restrictive Treatment of Income If a 209(b) state elects to apply more restrictive income requirements than SSI, these requirements may take the form of an income standard that is lower than the SSI or Optional State Supplement standard, a more restrictive income counting methodology, or both. For example, a state’s income standard for its mandatory eligibility group serving individuals who are age 65 or older, or who have blindness or a disability, may be lower than the SSI federal benefit rate. Additionally, or alternatively, the state may limit its general monthly income disregard to $10, or not apply one at all, in contrast to the $20 general monthly income disregard applied by SSI. As described above, any such more restrictive criteria may be no more restrictive that those applied by the state under its 1972 state Medicaid plan.

More Restrictive Treatment of Resources Just as with income, if a 209(b) state elects to apply more restrictive resource requirements than SSI, these requirements may take the form of a resource standard that is lower than SSI’s standard, a more restrictive resource counting methodology, or both. For example, a state’s resource standard for a single individual may be lower than SSI’s $2,000 resource standard. Additionally or alternatively, a state may choose to limit SSI’s resource disregard of an individual’s home and all contiguous property to a limited amount of acreage. As described above, any such more restrictive criteria may be no more restrictive than those applied by the state under its 1972 state Medicaid plan.

Determining Income Eligibility and Spenddown of Excess Income In 209(b) states, receipt of SSI does not guarantee eligibility for Medicaid. Non-209(b) states cover all SSI recipients through the mandatory eligibility group for individuals receiving SSI, which is described at 42 C.F.R. §435.120. But 209(b) states do not cover this group. Instead, they impose more restrictive criteria through the mandatory eligibility group for individuals in 209(b) states who are age 65 or older or who have blindness or disability (“the mandatory 209(b) group”). This group is described at 42 C.F.R. §435.121. A person receiving SSI can still be eligible for Medicaid in the mandatory 209(b) group, but that person must also meet the more restrictive eligibility requirements imposed by the state.

As described at 42 C.F.R. §435.121(f), when a 209(b) state uses more restrictive requirements to determine eligibility, it must also apply three special income deductions. The state must deduct: 1. SSI payments received by the individual,