SI NY01730.005 (New Jersey) — Medicaid Qualifying Trusts (TN 435 - 05/2013)
When an individual residing in a section 1634 State has a Medicaid trust, SSA determines
if the trust is countable for SSI purposes. The existence of a Medicaid trust results
in a referral to the Medicaid State agency for a Medicaid eligibility decision. See
SI 01730.048 for the definition of Medicaid trusts and procedures to determine if a trust is countable
for SSI purposes.
When a case with a trust or SLD is sent to the State, the FO must complete the MSSICS
ROTH screen per MSOM MSSICS 013.011C or in the paper environment input a "Q" in the
PT field of the SSR per POMS SM 01005.350 . Once the case is referred to the State,
they will make a determination as to whether the recipient can receive Medicaid.
The FO should make a photocopy of the trust or SLD and mail it under cover of Exhibit
I to the address below. The claimant should also be provided with a copy of Exhibit
I for his/her records.
EX.1 - (New Jersey) Medicaid Qualifying Trust Lead
TO: Catherine Gancarz
NJ Division of Medical Assistance and Health Services
Office of Legal and Regulatory Affairs
Building 7-2nd Floor, Mail Code 5
P.O. Box 712
Trenton, NJ 08625
(Social Security Number)
The above-mentioned individual filed for Supplemental Security Income on ______________.
_____ Attached is a copy of the trust or SLD that the person had with them when they
filed at the Social Security Office.
_____ We did not enclose a copy of the trust or SLD because the person did not have
it with them when they were in the Social Security office.
SSA Employee: ____________________________________________