Under section 1634 of the Social Security Act (theact) the Social Security Administration (SSA) may enter into an agreement to make Medicaid eligibility determinations for a State
providing the individual is supplemental security income (SSI)/State supplementary payment ( SSP) eligible and meets all Medicaid eligibility factors (assigns rights, provides third
party liability (TPL) information, and meets other requirements for Medicaid mandated by Federal law as
specified in the agreement). In these States, an SSI application is also an application
for Medicaid. In all other States, an individual must file an application with the
State/local Medicaid agency to be eligible for Medicaid even if he/she receives a
federally administered payment (SSI/SSP).
For determining whether SSA will make a Medicaid eligibility determination in a 1634
State, the term “eligible individual” means either an eligible individual or an eligible spouse as defined in SI 00501.001 and SI 00501.060. An essential person is not an eligible person with respect to SSI or SSP's, and
SSA does not make Medicaid eligibility determinations concerning essential persons.
2. Receiving an SSI Payment
“Receiving an SSI payment” means that the individual has established SSI eligibility and meets all requirements
to receive an SSI and/or federally administered SSP payment for one or more months.
Consider a person to be receiving an SSI payment if the claim or case is in payment
status. This is true even if SSA is:
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Withholding payment solely to recover an overpayment or assess a penalty.
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Making payments under the terms of an agreement to dispose of excess resources (SI 01130.100).
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Making an emergency advance payment based on a finding of presumptive eligibility.
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Making payments based on a determination of presumptive disability or blindness.
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Making payment as a disabled individual under section 1619(a) of title XVI.
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Continuing SSI eligibility as if a payment were being received under Section 1619(b)
(see SI 02302.010 ff.).
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Continuing payments while an adverse decision is under appeal.