SI PHI01310.207 Medicaid Eligibility Under a State Home-Care Plan
See SI 01310.207
Section 1915(c) of the Social Security Act allows states to waive SSI deeming rules for certain home and community-based Medical Assistance programs.
Section 1902(e)(3) of the Social Security Act allows a state to amend its State Plan to include the category of disabled children age 18 or younger who would be eligible for Medicaid if in a medical institution, by considering these children to be SSI recipients.
In the Philadelphia region, the states provide coverage as follows:
District of Columbia
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 provision (Section 8010 of Public Law 101-239), provided that they meet all the requirements described in SI A01310.201.
1. When to Verify
See SI A01310.207 B.1. for instructions on when to verify Medicaid eligibility under a State Home-Care Plan.
2. What to Verify
Verify that the child is covered under a Medicaid State Home-Care Plan and the date the 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
a. States of: Delaware, District of Columbia, Maryland, Pennsylvania and West Virginia
For the residents of these States, telephone the SSI Program Section staff in the regional office (RO) to verify that an individual is eligible for Medicaid under a State Home-Care Plan. The RO telephone number is 215-596-1547 or FTS 596-1547. Document on a Report of Contact the information you receive as a result of the RO contact.
b. State of Virginia
For the residents of this State, telephone Charlotte Carnes, Manager of Community Based Care, Department of Medical Assistance Services. The telephone number is 804-786-1465. Document on a Report of Contact the information you receive as a result of this contact.
If you have any questions about these instructions, or if you have any problems in verifying eligibility for residents of Virginia, contact the SSI Program Section staff at 215-0596-1547/FTS 596-1547.