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SSI Ineligibility - Social Security COLAs - Iowa

Medicaid is available under the 503 group guidelines to social security recipients who meet all the following conditions:

·           They were eligible for and received social security and SSI or State Supplemental Assistance benefits concurrently at some time since April 1977; and

·           They later lost eligibility for SSI or State Supplemental Assistance benefits (for any reason); and

·           They would now be eligible for SSI or State Supplemental Assistance if all social security cost-of-living adjustments (COLAs) since they were last concurrently eligible were deducted from income. This includes any COLA income received by the parent, spouse, or children since the applicant was canceled from SSI or State Supplemental Assistance when that income is considered through deeming.

This provision applies to any social security cost-of-living increase occurring after July 1, 1977. Two categories of people are affected:

·           Those who lose SSI or State Supplemental Assistance directly because of a social security COLA.

·           Those who become ineligible for SSI or State Supplemental Assistance for another reason, and are then ineligible only for SSI or State Supplemental Assistance only because of social security COLAs.

For example, a person who became ineligible for SSI or State Supplemental Assistance because resources exceeded limits may reapply when resources are under limits. The person may now be ineligible for SSI or State Supplemental Assistance because of COLAs. If the person was simultaneously eligible for social security and SSI or State Supplemental Assistance at some time since April 1977, eligibility for 503 coverage should be examined.

In either circumstance, the person can be eligible for Medicaid under the 503 group if there was concurrent eligibility and the person’s current income without COLAs is within current eligibility limits.

To qualify for Medicaid under this coverage group, a person must continue to meet all other SSI standards. If resources or income from other sources exceed SSI limits, Medicaid eligibility under this coverage group ceases. However, a person who loses eligibility under this coverage group may later become eligible when income or resources are again within limits.

4. Eligible Couple

Mr. and Mrs. B both received social security income and SSI in December 1990 and were canceled from SSI in January 1991. Mr. B’s gross social security in December 1990 was $333 and Mrs. B’s gross social security income was $165.

Mr. B’s current gross social security is $431 and Mrs. B now has gross social security of $213. Mr. B started to receive a veterans pension in 1994, which is now $150 per month. The worker has determined that there were no social security increases other than COLAs.

Income computation:

$ 333 + 165 = $ 498 + 150 = $ 648 - 20 = $ 628 Mr. B’s social security in 1/91 Mrs. B’s social security in 1/91

Veterans benefits

General income exclusion Net countable income

Mr. and Mrs. B are eligible for Medicaid under the 503 coverage group, since their countable income of $628 is less than their need standard of $751.

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: 42 CFR 435.135, 441 IAC 75.1(13)

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