5101:1-39-02.3 Medicaid: SSI recipients qualifying under section 1619 of the Social Security Act for continued medicaid coverage.

(A) Section 1619 of the Social Security Act comprises two basic provisions:

(1) Section 1619(a) extends special SSI cash to individuals whose earnings preclude eligibility for regular SSI cash benefits. Individuals in 1619(a) may still receive an SSI cash benefit in addition to the individual's earned income.

(2) Section 1619(b) extends medicaid coverage to individuals whose earnings, although high enough to preclude eligibility for regular SSI cash benefits or special SSI cash benefits under section 1619(a), may not be enough for medical care.

(B) To determine initial medicaid eligibility for sections 1619(a) and 1619(b), the CDJFS shall:

(1) Verify that the individual is currently in 1619(a) or 1619(b) status.

(a) The individual's current 1619 status shall be verified by using the CRIS-E screen DESX and the SVES screens whenever possible.

(b) The CRIS-E screens and information from the social security administration do not definitively show the first month of the most recent period that an individual went into 1619 status. The CDJFS must use the applicant or other source to verify the first month of 1619 eligibility.

(c) The CDJFS should assist the individual in obtaining the necessary verification from the social security administration when necessary or when requested.

(d) The eligibility worker may contact the social security administration and obtain verbal confirmation of the beginning date of 1619 eligibility. The contact must be documented in CRIS-E running record comments (CLRC)

(2) Determine that the individual was eligible for medicaid the month prior to the month he qualified for section 1619(a) or 1619(b).

(a) The CDJFS must use the month immediately preceding the first month of the most recent period of eligibility under section 1619.

(b) The individual will be determined eligible for medicaid for purposes of this rule if the individual met all of the medicaid eligibility requirements for the month prior to the month of 1619 eligibility except for meeting his or her spenddown obligation that is defined in rule 5101:1-39-10 of the Administrative Code.

(C) When determining medicaid eligibility for an individual in 1619(a) or (b) status or for an eligible couple when one spouse is eligible under 1619 provisions and the other spouse is not, the spenddown medicaid policy shall not apply to either spouse even though the couple's budget would result in a spenddown liability.

(D) Individuals or couples eligible for medicaid through the spenddown provision and who become eligible under the 1619 provisions will no longer be required to meet a spenddown regardless of their source(s) of income as long as they remain eligible under the 1619 provisions.

(E) Once it is determined that the individual is in section 1619 status and that he was eligible to receive medicaid in the month prior to the first month of the most recent period of qualifying for section 1619, the individual is protected from losing medicaid benefits under this provision as long as he remains in 1619(a) or (b) status. The individual may have income or resources in excess of the medicaid requirements and remain eligible for regular medicaid, i.e., no spend-down liability, under the 1619 provision. However, if the individual's income or resources disqualifies him for 1619 status, the individual's medicaid protection is lost.

(F) A pretermination review of continuing medicaid eligibility must be completed when it has been determined that the individual or couple is no longer eligible for medicaid under the 1619 provisions.

Eff 7-1-87 (Emer.); 8-3-87; 1-1-88; 4-1-89 (Emer.); 6-18-89; 9-1-93; 10-1-02
Rule promulgated under: RC 111.15
Rule authorized by: RC 5111.01 , 5111.011
Rule amplifies: RC 5111.01 , 5111.011
Replaces: 5101:1-39-41
R.C. 119.032 review dates: 10/01/2007