SI CHI01310.207 Medicaid Eligibility Under a State Home Care Plan (RTN 373 -- 02/2008)

A. Background

Section 1915(c) of the Social Security Act allows the states to develop programs for medical assistance to certain groups of individuals in order to provide them with home and community based care.

B. Policy

Disabled children who are eligible for Medicaid under one of these state home care plans may be eligible for SSI benefits under the deeming waiver provisions (Section 8010 of Public Law 101-239) provided that they meet all the requirements described in SI 01310.201.A.1.

C. Verification Requirements

1. When to verify

For parental deeming of income development, see SI 01310.207B.1., which contains instructions on when to verify Medicaid eligibility under a state home care plan.

2. What to verify

Verify that the child is covered by a Medicaid state home care plan under either section 1915(c) or section 1902(e)(3) of the Social Security Act and the date coverage began. Also, verify whether there have been any changes in eligibility under the State home care plan during the review period, or whether any changes are expected in the near future.

3. How to verify

To verify Medicaid eligibility under either 1915(c) or 1902(e)(3), obtain from the individual/parent a copy of the Medicaid provider agreement form that was completed by the state agency or the institution. This document provides information on the financial arrangements, and it specifies which State agency is authorizing the Medicaid coverage.

D. Verification Procedures

1. More than one contact may be necessary

For several states, more than one contact is listed. This is because they are each responsible for verifying different groups of eligibles under the state's Medicaid home care plan. This means that more than one contact may be necessary to verify (in)eligibility. If one source cannot verify eligibility under a Medicaid state home care plan, the other must be contacted.

2. Use of telephone to verify

With the exception of Illinois, Indiana and Minnesota, who have specifically requested that SSA submit written requests for verification, telephone verification is preferred in all cases.

Addresses have been provided to better identify the state component providing verification and for use if telephone verification is not feasible.

If written verification is requested, include all of the following information in your request:

  • the child's name;

  • the child's' SSN;

  • the child's DOB;

  • the parents' names; and

  • address.

E. State Contacts

1. Illinois

a. 1915(c) only.

The state has requested that verification requests be in writing. The phone number is not for routine use. Follow-ups may be made by phone if a response to the written request has not been received within 10 working days.

Katherine Brennan
Bureau of Policy Development
Illinois Department of Human Services
100 S. Grand Avenue East
Springfield, IL 62762

Phone: (217) 782-1239

Fax: (217) 557-5850

Requests for verification may be faxed.

b. 1902(e)(3)

The state does not have this state plan option.

2. Indiana

a. 1915(c) only.

The state prefers that verification requests be made via email. Telephone requests are the secondary method for verification requests (e.g., on sensitive cases).

Sandy Owens
Indiana Family & Social Services Administration
Division of Disability, Aging and Rehabilitative Services
402 W. Washington Street
P. O. Box 7083, MS-21 IGCS-W454
Indianapolis, IN 46207-7083

Email: lsowens@fssa.state.in.us

Phone: (317) 232-7017

b. 1902(e)(3)

The state does not have this state plan option.

3. Michigan

a. 1915(c)

Debbie Millhouse
Department of Mental Health
Lewis Cass Bldg. - 5th Floor
Lansing, MI 48913

Phone: (517) 241-5757

b. 1902(e)(3)

Ka