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Supplemental security income (SSI) recipients

Revised Date:

December 5, 2014

Purpose: To explain Apple Health coverage for recipients of Supplemental Security Income (SSI) recipients.

WAC 182-510-0001 Supplemental security income and associated categorically needy coverage.

Effective July 11, 2015.

Supplemental security income (SSI) is a federal cash benefit administered by the Social Security Administration (SSA) under the Social Security Act, 42 U.S.C. Sec. 1381-1383f. The SSI program replaces state programs for the aged, blind and disabled individuals beginning January 1974. An individual who received state assistance in December 1973 who became eligible for SSI in January 1974 is considered a grandfathered client by the medicaid agency, and a mandatory income level (MIL) client by SSI. The individual must continue to meet the definition of blind or disabled that was in effect under the state plan in December 1973. See chapter 182-500 WAC for additional definitions.
An essential person is someone needed in the home to care for an SSI recipient. An essential person is eligible for categorically needy (CN) coverage as long as he or she has lived continuously with the eligible person since January 1974.
An ineligible spouse is the spouse of an SSI recipient who is not eligible for SSI-related CN coverage. An ineligible spouse must have his or her eligibility for Washington apple health (WAH) determined separately under WAC 182-519-0100.
When an individual receives SSI, the agency accepts the SSA's determination of medicaid entitlement. The individual is eligible for CN coverage without submitting an additional application as long as he or she:
1. Remains entitled to SSI;
2. Is no longer entitled to SSI, but the SSA is in the process of determining eligibility under the Social Security Act, 42 U.S.C. Sec. 1619(b); or
3. Currently has 1619(b) status as described in WAC 182-512-0880(3).
An SSI recipient may be terminated from CN coverage when he or she:
1. Does not provide the agency with information necessary for the agency to determine if he or she has other medical insurance; or
2. Does not assign the right to recover insurance funds to the agency as required in WAC 182-503-0540.
CN coverage eligibility continues if the SSA stops an individual's SSI for one of the following reasons:
1. The individual's countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA) under WAC 182-512-0880(1);
2. The individual is a "deemed" eligible SSI recipient on the basis of eligibility for a special income disregard under WAC 182-512-0880; or
3. The individual has an appeal of an SSA termination pending which has not yet resulted in a final determination.
If an individual's SSI stops due to an SSA determination that the individual is no longer disabled, and any appeal of this determination has resulted in a final decision, the agency:
1. Redetermines eligibility for all other WAH programs that are not based on receipt of SSI; and
2. Continues CN coverage until the agency completes the redetermination process described in WAC 182-504-0125.
If an individual's SSI stops for a reason not addressed elsewhere in this section, the agency considers the individual to meet disability requirements through the SSA's original disability review date. The agency:
1. Redetermines eligibility for other WAH programs, which may or may not be based on disability; and
2. Continues CN coverage until the agency completes the redetermination process in WAC 182-504-0125.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

SSI Background
1. SSI provides federal cash benefits for basic needs to individuals, couples, and children who meet the federal disability criteria as aged, blind, or disabled and have limited income and resources.
SSP Background
1. When federal SSI began, the SSI payment was less than the state disability payment. The state supplemented the SSI payment to make up the difference. We call these SSI individuals Mandatory Income Level (MIL) SSI individuals.
2. The state must guarantee that these SSI recipients never receive less than they received from the state in December 1973.
Federal Disability Criteria - Refer to WAC 182-512-0050
Other SSI Criteria
1. Essential Person
  - A person living in the home and needed in the home to care for the SSI individual. SSI included essential persons in the federal benefit payment.
2. An Ineligible Spouse is a spouse of an SSI individual, who is not eligible for SSI benefits. This may include:
  1. A spouse who is relatable to SSI but chooses to be an ineligible spouse, or
  2. A spouse who has not applied for SSI, or
  3. A spouse who has applied for SSI and is waiting for Social Security to make a decision.
3. Citizenship
  1. SSI individuals must meet SSI citizenship criteria, or
  2. SSI individuals must meet SSI lawful admittance status criteria.
4. Refer to WAC 388-474-0015 for more SSI eligibility criteria.
SSP Benefit Amount
1. The department determines the SSP benefit amount. Refer to WAC 388-478-0055.
2. The SSI payment and the ineligible spouse or essential person SSP payments belong to the SSI individual.
SSI and SSP Issuances
1. SSA issues SSI payments to individuals, and
2. DSHS issues SSP payments to individuals.

WAC 182-510-0005 Supplemental security income, essential person, and ineligible spouse.

Effective July 11, 2015

If you are a supplemental security income (SSI) recipient, you automatically get categorically needy (CN) coverage (WAC 182-512-0100) unless you:
1. Refuse to provide private medical insurance information; or
2. Refuse to assign the right to recover insurance funds to the agency (WAC 182-503-0540).
If you are an essential person as described in WAC 182-510-0001 you get CN coverage as long as you continue to live with the SSI recipient.
If you are an ineligible spouse you are not considered an SSI recipient. You must have your Washington apple health eligibility determined separately.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Worker Responsibilities

For ACES Information, see ACES Manual SSP Chapter.

When SSI benefits begin
1. SSA does not pay SSI cash benefits the first month of SSI eligibility;
2. SSI individuals are CN Apple Health eligible from first of the month using the date of SSI eligibility;
3. SSI eligibility date is on the SDX 1 screen or the SDX page on ACES Online;
4. Open CN Apple Health using the first of the month listed in the SSI eligibility date field.
  Example: Individual gets first SSI cash payment in October 2014. Individual’s date of SSI eligibility is September 2, 2014. Open CN Apple Health effective September 1, 2014.
Medical eligibility for ineligible spouse
1. The ineligible spouse cannot get SSI related CN Apple Health;
2. Determine MN eligibility for an ineligible spouse applying for medical and meeting SSI related criteria.

WAC 182-510-0010 Eligibility after supplemental security income ends.

Effective July 11, 2015

Your categorically needy (CN) coverage (WAC 182-512-0100) continues after supplemental security income (SSI) ends if:
1. Countable income exceeds the SSI income standard due solely to the annual cost-of-living adjustment (COLA); or
2. A timely request for a hearing has been filed. CN coverage is continued until the Social Security Administration (SSA) makes a final decision on the hearing request and on any subsequent timely appeals.
If your SSI ends, your CN coverage continues for a period of up to one hundred twenty days while the agency reviews your eligibility for other cash or medical programs.
If you are a terminated SSI or SSI-related recipient, the agency will review your disability status when:
1. You present new medical evidence;
2. Your medical condition changes significantly; or
3. Your termination from SSI was not based on a review of current medical evidence.
Children terminated from SSI due to loss of disabled status may be eligible for medical benefits under WAC 182-505-0210.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

When ACES closes SSI-related CN benefits:

SSA ends or transfers SSI benefits when the eligible SSI individual:
1. Is deceased;
2. No longer lives in the state (SSA transfers the individual to the new state and ACES closes the AU);
3. Fails to apply for and, if eligible, obtain benefits or accept services as specified by SSA;
4. Lives in a public institution, such as jail, or prison for a full calendar month;
5. Enters a Long Term Care facility and is expected to be there longer than 90 days and has income from another source of $50 or more; or
6. Begins receiving money from another source over the SSI income standard.
Essential person and ineligible spouse SSP benefits terminate when the SSI individual’s SSI benefits terminate.

Worker Responsibilities

Medical redetermination when SSI ends:

Continue CN coverage until eligibility for other health care programs has been determined WAC 182-504-0125.
Refer the individual to Disability Determination Services (DDS) only when SSI ends due to not meeting the federal disability criteria and:
1. There is evidence that the individual’s condition has changed; or
2. There is a new disability; and
3. Review eligibility for another health care program.
When SSI ends due solely due to excess income;
1. Make a referral to DDS for the end date of their disability approval; and
2. Do not delay approval for SSI-related coverage while waiting for DDS disability end date; and
3. Make appropriate changes to the DEM 2 when DDS provides the information.