Identification Number:
HI 00801 TN 43
Intended Audience:See Transmittal Sheet
Originating Office:Centers for Medicare & Medicaid Services (CMS)
Title:Hospital Insurance Entitlement
Type:POMS Transmittals
Program:Medicare,Medicaid
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part HI – Health Insurance
Chapter 008 – Requirement for Entitlement and Termination
Subchapter 01 – Hospital Insurance Entitlement
Transmittal No. 43, 02/12/2021

Audience

PSC: BA, CA, CS, DS, IES, ILPDS, IPDS, ISRA, PETE, RECONR, SCPS, TSA, TST;
OCO-OEIO: BET, CR, CTE, EIE, ERE, FCR, FDE, PETL, RECONE, RECONR;
OCO-ODO: BET, BTE, CCE, CR, CST, CTE, CTE TE, DEC, PAS, PETE, PETL;
FO/TSC: CS, CS TII, CSR, CTE, DRT, FR, OA, OS, RR, TA, TSC-CSR;

Originating Component

CMS

Effective Date

Upon Receipt

Background

This is a Quick Action Transmittal and does not change or introduce new policy or procedure.

Summary of Changes

HI 00801.154 SSI/SSP Credit for Disabled Widow(er)s

Updated new language to the policy.

HI 00801.154 SSI/SSP Credit for Disabled Widow(er)s

A. Background

Section 5103 of P.L. 101-508 changed the disability standard for Disabled Widow (er)'s Benefits (DWB) to conform with the disability standard for disabled workers effective January 1991. Section 5103 includes a provision that permits months of eligibility for SSI or federally administered State supplementary payments (SSP) to be counted toward the 5-month DWB waiting period and the 24-month D-HI qualifying period.

B. Policy

When a current or former Supplemental Security Income (SSI) or Federally administered SSP recipient becomes entitled (or deemed entitled for Medicare purposes only) to DWB under the revised disability standard. The, DWB will receive credit for all months in an SSI/SSP period of eligibility beginning with the first month for which the individual is eligible to receive any payment up to the month of (deemed) DWB entitlement. We count all , beginning with the first month of eligibility, including all months , of nonpayment, suspension and termination.

The same months of SSI/SSP, that are credited toward the 5-month DWB waiting period may also be credited toward the 24-month D-HI qualifying period.

The first possible month of entitlement to D-HI under this provision is January 1991.

Example: Ms. Jones became eligible for SSI/SSP on January 1, 2017. She had a period of nonpayment March through June 2017 and a suspension period May through July 2018. When calculating Ms. Jones 24-month D-HI qualifying period, include all months beginning with January 2017, regardless of any periods of non-entitlement.

 

C. References


HI 00801 TN 43 - Hospital Insurance Entitlement - 2/12/2021