TN 10 (06-96)

SI 01730.035 Medicaid/Supplemental Security Income Eligibility Determinations


Social Security Act, Sections 1613(c), 1634(a), 1902(a)(25), 1912(a), 1917

A. Introduction

Even when a State has chosen to use SSI eligibility criteria for its Medicaid decisions, the Medicaid program has a number of eligibility requirements in addition to those of the SSI program. Under the terms of the Medicaid State plans, some of these eligibility requirements may only apply to individuals in certain circumstances (e.g., only the institutionalized).

B. Policy — medicaid-only requirements

Section 1613(c) requires SSA FOs to explain the transfer of assets rules at initial claims and redeterminations in all States. This explanation requirement applies regardless of the existence of a section 1634 Agreement with the State.

In section 1634 States, in addition to addressing transfer of assets, FOs explain (as required) and obtain from SSI individuals the assignment of their rights to medical support and third party payments for medical care. FOs also investigate and obtain information about any third party health insurance the SSI individual might have as well as any Medicaid trusts and provide this information to the State.

SSA does not determine Medicaid eligibility for individuals who refuse assignment of rights (in States where they can make such a refusal), refuse to provide third party insurance information, or who appear to have a Medicaid trust.

C. References

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SI 01730.035 - Medicaid/Supplemental Security Income Eligibility Determinations - 06/10/1996
Batch run: 10/31/2014