Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits under PICKLE.
Current Policy Effective Date: September 1, 2010
Date Last Reviewed: March 15, 2010
Previous Policy: April 1, 2009
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POL M1005D: Determining PICKLE Eligibility
1. Applicants Must be Receiving RSDI Benefits
2. Applicants Must Have Received SSI Anytime Since 1977
3. Applicants Must Meet Income Requirements
Require the applicant’s income to be less than or equal to the current SSI income standard, after Cost Of Living Adjustments (COLAs) are subtracted. See Medicaid Table 4 for COLAs.
Reference Section M901 to determine the SSI income standards.
4. Applicants Must Meet Resource Requirements
Resources must be within the SSI guidelines. Reference Section M801 to determine the SSI resource standards.
5. Benefits Begin First Day of the Application Month if Determined Eligible
6. Clients May Receive Retroactive Medicaid
Applicants may receive retroactive Medicaid benefits if they incurred medical bills during any of the three months prior to application.
Both approved and denied applicants must be reviewed for retroactive Medicaid. Verify and determine eligibility separately for each retroactive month.
7. Applicant Potentially Eligible Under Another Medicaid Coverage Group
If the SDX shows a Medicaid test indicator code “S,” the client must complete an EC-200 EqualityCare (Medicaid) Application to determine if eligible under another Medicaid coverage group.
8. Clients Must Be Reviewed
Clients must be reviewed every 12 months to determine continued eligibility. Reference Section M1403 for information on reviewing eligibility.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
9. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
· Client no longer receives RSDI.
· Client dies.
· Client determined no longer eligible.
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Reference:
Defining Group: 42 CFR 435.135
Clarifying Information:
1. PICKLE is defined as a federal law based on a court order of Lynch vs. Rank covering an individual who lost SSI for any reason and would
remain eligible for SSI if the RSDI cost of living adjustment (COLA) was deducted from the income.
Training Link: Not available at this time.
Worker Responsibilities:
Determining Countable Income
1. Determine the income eligibility using the DFS 414.
2. Refer to Section M901 for information on determining countable income.
Determining Countable Assets
1. Refer to Section M801 for information on determining countable assets.
Verifying Eligibility
1. Verify the applicant was receiving SSI & entitled to RSDI concurrently anytime since 1977.
2. Verify the applicant has lost SSI.
Approving Benefits
1. Enter program type “ME SS” on SEPA screen in EPICS
2. Enter subtype “PP” on MERE screen in EPICS for all months including the retroactive period.
3. Enter the RSDI payment on SSRM in the need standard/CAP field in EPICS.
4. List COLA deduction in the “other” space in EPICS.
5. Send EPICS M102 approval notice.
Denying Benefits
1. Enter program type “ME SS” on SEPA screen in EPICS.
2. Enter subtype “PP” on MERE screen in EPICS.
3. Deny case on SSRM screen in EPICS, using appropriate code from Medicaid Table 15.
4. Send denial notice from Medicaid Table 16.
Reviewing Cases
1. Refer to Section M1403 for information on reviewing cases.
Closing Cases
1. Close case on SSRM screen in EPICS for the appropriate benefit month, using appropriate code from Medicaid Table 15.
2. Send 10-Day closure notice from Medicaid Table 16 when an adverse action has occurred.
Determining Eligibility When Clients on SDX With Test Indicator Code “S”
1. Require an EC-200 EqualityCare (Medicaid) Application.
2. Determine potential eligibility under another Medicaid coverage group.