Presentation on theme: "PASS THROUGH Individuals who previously received Medicaid as a Supplemental Security Income (SSI) or State Supplementation (SSP) recipient may be eligible."— Presentation transcript:
PASS THROUGH Individuals who previously received Medicaid as a Supplemental Security Income (SSI) or State Supplementation (SSP) recipient may be eligible to continue receiving Medicaid through the Pass Through category. Federal law protects their Medicaid eligibility if they lost their SSI or SSP benefits due to an increase in or entitlement to RSDI benefits and they meet the eligibility requirements of this program. Medicaid Policy concerning these individuals changed effective 10/1/02. The information contained in this presentation represents Pass Through eligibility and processing based on these changes.
Pass Through Qualifiers To be eligible for Pass Through participants must meet all Adult Medicaid Technical and Resource Eligibility requirements and qualify in one of the following categories: Concurrent SSI/SSP Disabled Adult Child Disabled Early Widows and Widowers or Disabled Surviving Divorced Spouses with no Medicare Part A
Concurrent SSI / SSP Individuals under this qualifier are current RSDI recipients who (after April 1977) correctly received RSDI concurrently with SSI or SSP. If the individual lost their SSI/SSP due to a COLA increase, receipt of another COLA is not required. If the individual lost their SSI/SSP due to an increase in any type of income other then RSDI, at least one COLA must be received since termination of SSI/SSP.
Concurrent SSI / SSP (cont.) If the individual has a spouse receiving RSDI the spouse’s COLAs can be deducted from the individual’s countable income when determining eligibility. If individual is a child, whose responsible relative receives RSDI, the responsible relative’s COLAs can deducted from the child’s countable income when determining eligibility. Retroactive eligibility is limited to 3 months
Disabled Adult Child Individuals under this qualifier are current RSDI DAC (Disabled Adult Children) recipients who have lost their SSI as a result of entitlement to or an increase in RSDI DAC Benefits. Concurrent receipt of RSDI and SSI is not required. Receipt of a COLA is not required Retroactive eligibility is limited to 3 months A quarterly listing of potential applicants will be provided to each local office.
Disabled Early Widows/Widowers or Disabled Surviving Divorced Spouses With No Medicare Part A These individuals are: Prior SSI or SSP recipients, age 60-64, who have lost these benefits as a result of entitlement to RSDI Early Widow’s / Widower’s benefits, and are not yet entitled to Medicare Part A. OR Prior SSI or SSP recipients who have lost these benefits as a result of entitlement to RSDI Disabled Widow’s/ Widower’s or Disabled Surviving Divorced Spouse’s Benefits, and are not yet entitled to Medicare Part A.
Disabled Early Widows/Widowers or Disabled Surviving Divorced Spouses With No Medicare Part A (cont.) The following criteria apply to these individuals. Their Pass Through eligibility is terminated once entitlement to Medicare Part A is established. Receipt of a COLA is not required. Concurrent receipt of SSI/SSP and RSDI is not required. Set a Spot check for the case if the individual will reach age 65 or become entitled to Medicare Part A prior to the next case recertification. If individual fails to enroll in Medicare once entitlement is established Pass Through eligibility is terminated. Retroactive eligibility is limited to 3 months.
Verifying Pass Through Eligibility Utilize form PA-9 to verify the individuals receipt of benefits from the Social Security Administration. ( if the individual is applying immediately following receipt of a COLA increase, benefits may be verified on Program SDX) Form PA-9 is immediately sent to Frankfort SSA at application. (a new PA-9 is required at recertification or interim change if PA-9 on file is a version older then the 10/02 update, pull 10/02 version PA-9 forward at each case action) Allow three weeks for completed PA-9 to be returned form Frankfort. (Direct questions concerning the status of a PA-9 to your Regional Office, DO NOT contact SSA directly.)
Utilizing A Completed Form PA-9 Section I of form PA-9 will indicate which Pass Through Qualifier the applicant meets. If all qualifiers are marked “no” in Section I, A and B then the individual is not Pass Through eligible.
Utilizing A Completed Form PA-9 Section II of the Form PA-9 will provide the needed information for determining eligibility. Section II A,B or C will provide this information according to which qualifier the applicant meets.
Utilizing A Completed Form PA-9 Section III will verify any information needed to calculate deductions that may be available because of a spouse our parents COLA’s
Utilizing Form PA-9 To Complete Form PA-1A Sup. A Section I of the PA-9 is utilized to complete Part I on the PA-1A Sup. A
Utilizing Form PA-9 To Complete Form PA-1A Sup. A Section II A1,B1 or C1 of the PA-9 is utilized to complete Part II Current RSDI Benefit on the PA-1A Sup. A
Utilizing Form PA-9 To Complete Form PA-1A Sup. A Section II A2,B2 or C2 of the PA-9 is utilized to complete Part II RSDI Benefit received when SSI or SSP discontinued on the PA-1A Sup. A
Completing Form PA-1A Sup. A Part II of the PA-1A is completed by performing the calculation indicated. This will determine the Pass Through amount to be utilized in the completion of Part III.
Completing Form PA-1A Sup. A Based on the type of income that was terminated, determine if Part III or Part IV is to be utilized to determine applicants Pass Through eligibility.
Completing Form PA-1A Sup. A Complete calculations in Part III or IV as directed utilizing the Pass Through amount determined in Part 2. If a Pass Through amount for parent(s) or spouse is to be allowed as a deduction from the applicants countable income, calculate as follows: complete the same calculations utilized in Part II However utilize the parent(s) our spouse’s information from Part III of the PA-9
PASS THROUGH Correct Concurrent Receipt Required Receipt of RSDI COLA Required Limit Retroactive Eligibility to 3 Months Spouse/Parents COLA’s Allowable Deduction Concurrent SSI/SSP Due to COLA Increase YESNOYES Concurrent SSI/SSP Due To Increase In Other Income YES Disabled Adult ChildNO YES Disabled Early Widow / Widowers or Disabled Surviving Divorces Spouses With No Medicare Part A NO YES