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SSI Ineligibility - Actuarial Change to Widow Benefits - Iowa

Medicaid is available to all current social security recipients who meet the following conditions:

·           They were eligible for social security in December 1983.

·           They were eligible for and received a widow’s or widower’s disability benefit and SSI or State Supplemental Assistance for January 1984

·           They became ineligible for SSI or State Supplemental Assistance because their widow’s or widower’s benefit increased as a result of the elimination of the reduction formula in January 1984. This must be the sole reason they lost eligibility for SSI or SSA.

·           They would be eligible for SSI or State Supplemental Assistance benefits if the increase resulting from the elimination of the reduction factor and later cost-of-living adjustments were disregarded.

·           They have been continuously eligible for a widow’s or widower’s benefit from the first month the increase was received.

·           They applied for Medicaid before July 1, 1988.

In January 1984, the Social Security Administration eliminated a "reduction formula" that had been used to calculate social security benefits for disabled widows and widowers. As a result, social security benefits increased. The increase caused some members of this group to lose eligibility for SSI, SSA, and Medicaid. Congress established a new eligibility group to allow ongoing Medicaid eligibility for these persons.

No new persons can enter this coverage group after July 1, 1988. For those who applied before July 1, 1988, and were approved under this group, review whether the person has been continuously eligible for social security widow’s or widower’s benefit. Also review whether the person still meets SSI or State Supplemental Assistance standards, including income, if the specified social security increases are disregarded.

Determine countable income using SSI policies. Deduct from current gross social security income the amount of the increase resulting from the elimination of the reduction factor. (The Social Security Administration provided this reduction factor.) Add all countable income to the remainder. Compare this sum to the SSI or State Supplemental Assistance income limit.

Example:

Mrs. M, a 63-year-old widow living alone in her home, received SSI and social security income in 1983. Mrs. M became ineligible for SSI in February 1984 due to the increase in social security benefits due to elimination of the actuarial reduction formula. Medical eligibility was then established under the coverage group for widowed persons ineligible for SSI or State Supplemental Assistance due to the social security actuarial change.

Mrs. M’s current gross monthly income is $425.00 in social security benefits and $169 civil service income. The increase in social security benefits from elimination of the actuarial reduction formula is $35. The COLA increases amount to $110.70.

$ 425.00 - 35.00 - 110.70 = $ 279.30 + 169.00 = $ 448.30 - 20.00 = $ 428.30 Current gross social security Actuarial increase COLA Civil service income.

General income exclusion: The worker compares this computed income to $500 (current SSI benefit level for one).

Mrs. M continues to be eligible for this coverage group, since her income is less than the SSI benefit rate.

See Also:

·           Overview of Medical Assistance in Iowa

·           Welcome and Introduction to Benefits in Iowa

Source: Iowa Dept of Human Services Employees’ Manual

Title 8 Medicaid

·                        Chapter F, Coverage Groups, SSI-Related Coverage Groups, People Ineligible for SSI (or SSA)

Legal reference: 441 IAC 75.1(23), P.L. 99-272, 42 CFR 435.137

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