Revision 13-4; Effective December 1, 2013

 

HHSC determines eligibility for MEPD for a person who falls into at least one of the following mandatory coverage groups:

 

A-2100 Supplemental Security Income (SSI)

Revision 11-4; Effective December 1, 2011

 

The Social Security Administration (SSA) administers the SSI program. Texas entered into an agreement with SSA under Section 1634 of the Social Security Act for SSA to make Medicaid eligibility determinations. Persons found eligible for SSI cash payment are automatically determined eligible for Medicaid. SSA notifies the state through a computer network called the State Data Exchange System (SDX). HHSC sends a Your Texas Benefits Medicaid card to the person based on the computer file information from SSA. Either SSA or the state in which a person resides determines eligibility for SSI. Medicaid is administered by each state in which a person resides. See the following items for residence related issues and eligibility for Medicaid services.

Section D-3600, Interstate Issues
Section D-3610, Interstate Requests for Assistance
Section D-3620, Out-of-State Medicaid and Texas Medicaid Recipients
Section D-3630, Texas Applicant Outside the State of Texas
Section D-3640, Applicant from Another State
Section D-3650, Out-of-State Recipient Visiting Texas
Section D-3660, SSI Recipient Visiting in Texas

Note:
Automated System Program Identifier
TIERS – ME-SSI

 

A-2200 Emergency Medicaid Coverage for Aliens

Revision 12-3; Effective September 1, 2012

 

Certain aliens with an emergency medical condition who meet all SSI criteria, except citizenship, may be eligible for Medicaid coverage for the medical emergency. Coverage is for the duration of the emergency period. It is not considered as a "prior" medical, though prior months may be covered.

Automated System Program Identifier
TIERS – ME-A and D Emergency

 

A-2300 RSDI Cost of Living Adjustment (COLA) Increase

Revision 09-4; Effective December 1, 2009

 

Medicaid eligibility for the aged, blind and disabled is directly related to receipt of SSI in most states. Loss of SSI payments can result in loss of Medicaid coverage. To preserve Medicaid coverage for certain groups of persons who lose SSI payments, Congress enacted special Medicaid continuation provisions. Persons denied SSI due to certain increases in Social Security benefits may continue to be eligible for Medicaid coverage. SSA informs HHSC through automated files to help locate potential eligible persons who may apply for continued Medicaid.

 

A-2310 Disabled Adult Children (DAC)

Revision 11-4; Effective December 1, 2011

 

This applies to persons denied SSI after July 1, 1987, and who meet SSI eligibility criteria when qualifying RSDI disabled adult children's benefits are excluded from countable income (OBRA 1986). These persons were denied SSI benefits because of an increase in or receipt of RSDI disabled children's benefits. These persons may continue to be eligible for Medicaid if they:

  • are at least 18;
  • become disabled before they are 22;
  • are denied SSI benefits because of entitlement to or an increase in RSDI disabled children's benefits received on or after July 1, 1987, and any subsequent increase; and
  • meet current SSI criteria, excluding the children's benefit specified above.

Automated System Program Identifier
TIERS – ME-Disabled Adult Child

Note: Based on SSA information, adult disabled child benefits generally end if the person gets married. There are exceptions such as marriage to another adult disabled child. This is an SSA requirement and not part of MEPD policy.

 

A-2320 Historical 1972 Income Disregard

Revision 11-4; Effective December 1, 2011

 

This applies to persons who were receiving both public assistance and Social Security benefits in August 1972. These persons must meet current SSI or MEPD eligibility criteria, with the exclusion from income of the amount of the October 1972, 20% Social Security cost of living adjustment (COLA) increase.

Automated System Program Identifier
TIERS – ME-Pickle

 

A-2330 Pickle

Revision 11-4; Effective December 1, 2011

 

This applies to persons denied SSI cash benefits for any reason since April 1977. They must meet all current SSI eligibility criteria, with the exclusion of any Social Security COLA increases received since they were eligible for and entitled to both SSI and Social Security benefits in the same month. The earliest COLA increase that can be excluded is the increase received in July 1977. There are two files received from SSA for Title II COLA denials. The 503 file identifies "Pickle" potentials and is received late November of each year. The Lynch vs. Rank file is usually received mid-December.

Automated System Program Identifier
TIERS – ME-Pickle

 

A-2340 Widow(er)s

Revision 11-4; Effective December 1, 2011

 

This applies to persons age 60 to 65 who are ineligible for Medicare and who are denied SSI due to excess widow/widower's RSDI benefits. They must meet SSI eligibility criteria, with the exclusion of their RSDI benefit and any subsequent COLA increases from countable income (OBRA 1987).

Automated System Program Identifier
TIERS – ME-Early Age Widow(er)

This applies to persons age 50 to 60 who are ineligible for Medicare and who are denied SSI due to excess disabled widow/widower's and surviving divorced spouse's RSDI benefits. They must meet SSI eligibility criteria, with the exclusion of their RSDI benefit and any subsequent COLA increases from countable income (OBRA 1990).

Historically this also applies to persons denied SSI due to a recomputation of their Social Security disabled widows/widowers benefits for January 1984. They must meet SSI eligibility criteria, with the exclusion of the recomputation increase and any subsequent Social Security COLA increases from countable income. Persons had to have filed an application before July 1, 1998, to be eligible under this program. Enrollment for this program ended June 30, 1998 (OBRA 1985).

Automated System Program Identifier
TIERS – ME-Disabled Widow(er)

 

A-2350 SSI Denied Children

Revision 13-4; Effective December 1, 2013

 

Note: This program is retired.

This program continues Medicaid benefits for children who were receiving SSI and were denied on or after July 1, 1997, because of the change in disability criteria. To be eligible for SSI Denied Children, the person must continue to meet all SSI criteria, including the disability criteria in effect before Aug. 22, 1996, and must be under age 18. SSA informs HHSC through automated files to assist with continued Medicaid for these persons (Public Law 104-193).

Automated System Program Identifier
TIERS – ME-SSI Denied Children