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Medicaid Eligibility - States with own Criteria

Although SSI recipients in most States are eligible for Medicaid coverage, the 11 States listed below have their own more restrictive criteria. Click on an underlined State name to view further details:

·                   Connecticut

·                   Hawaii

·                   Illinois

·                   Indiana

·                   Minnesota

·                   Missouri

·                   New Hampshire

·                   North Dakota

·                   Ohio

·                   Oklahoma

·                   Virginia

Additional Information

In providing Medicaid to individuals who are receiving SSI or deemed to be receiving SSI, States fall into one of three general categories:

1634(a) States

This terminology, referring to Section 1634 of the Social Security Act, means States have a contract with the Social Security Administration to determine eligibility for Medicaid at the same time a determination is made for receipt of SSI benefits. These 32 States and the District of Columbia also use the same Medicaid eligibility criteria for determining for their aged, blind and disabled SSI recipients as are used for the SSI program.

SSI-criteria States

This means States that use the same Medicaid eligibility criteria for their aged, blind, and disabled SSI recipients as are used for the SSI program, but require that these individuals apply to the State separately from their application for SSI to determine their Medicaid eligibility based upon that application. There are 7 States and the Commonwealth of Northern Mariana Islands that are categorized as SSI-criteria States.

209(b) States

This means States that use more restrictive Medicaid eligibility criteria for their aged, blind and disabled recipients than are used in the SSI program in one or more eligibility areas and which were in place in the State's approved Medicaid plan as of January 1, 1972, although some §209(b) States do use SSI's definition of disability in determining the Medicaid eligibility of disabled individuals in their State. There are 11 States that are categorized as 209(b) States (see above).

Source

The Centers for Medicare & Medicaid Services (CMS) website discusses Medicaid eligibility at:
http://www.cms.hhs.gov/MedicaidEligibility/

Medicaid eligibility determination for groups deemed to be receiving SSI is discussed in a CMS technical assistance publication (requires Adobe Acrobat) at:
http://www.cms.hhs.gov/MedicaidEligibility/downloads/DefinitionElig1902r2.pdf

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