1619B and "Deemed Eligible" Clients (after DAC, Pickle/COLA, Widower exclusion)

Revised March 25, 2011

1619B and "Deemed SSI eligible" clients

• SSI deemed eligible clients (countable income is under the SSI standard after DAC, Pickle/COLA exclusion AND SSI was closed due to the receipt of DAC, COLA income) don’t pay service participation. They DO pay room and board in an ALF
• 1619B clients are considered the same as an “SSI client” SSI payments have stopped due to earnings. SDX indicates continue Medicaid on SDX 1 in the Med Elig field. 1619B clients don’t pay service participation. They DO pay room and board in an ALF.

Deemed SSI eligible clients.  What does that mean?

Clients who have COUNTABLE income under the SSI standard after allowing the exclusion for Disabled Adult Child (DAC), Pickle/COLA,  Widow/Widowers AND their SSI was closed because of the receipt of the DAC/COLA/Widow(er) income.  These exclusions are described in the SSI related Medicaid chapter.  Clients continue to receive CN-P Medicaid as long as they meet resource criteria. Not every client receiving DAC or Widower income is eligible for this exclusion. 

Deemed SSI eligible clients should NOT pay Waiver (COPES) service participation, they do pay room and board if living in an ALF. 

Deemed SSI eligible clients DO participate toward the cost of care when living in a medical institution. 

If countable income is over the SSI standard after the exclusion then all income is counted in post eligibility in determining participation including DAC income.

Instructions are found in WAC 388-475-0880  Special income disregards for SSI-related medical programs.

In other words, an individual who would be eligible for CN-P/S02 in ACES

A client who would otherwise qualify for S02/CN SSI related medicaid because their countable income is at or below the SSI standard does not participate towards personal care under the Waiver program.  (but they are responsible to pay room and board when living in an ALF). 

These clients do need to meet the same criteria for long-term care services as other Waiver clients and may be subject to transfer of asset penalties or excess home equity described in WAC 388-513-1350  (7)

Let the SW/Case manager know if client would be eligible for a non institutional CN-P program so MPC can be considered.  MPC is considered a priority over the Waiver (COPES) program.

1619B status, what does it mean? 

SSI clients whose earnings put them over the SSI cash benefit standard but Social Security continues their SSI eligibility.  They are considered a SSI recipient and continue to send in reviews to Social Security.  The SDX indicates continued Medicaid when a client is 1619B.  1619B clients don’t pay service participation because they are considered to be an SSI client.  Follow the same instructions as SSI clients on COPES for 1619B clients.  Code SI on UNER to prevent an eligibility review from being generated for the C01.  Clients would pay the ADSA room and board amount if residing in an ALF.  Clients can have GROSS income over the SIL  and continue to receive COPES as long as Social Security maintains their 1619B status. 

Worker Responsibilities-SSI Redetermination

Medical Redeterminations

SSI redetermination

SSI-related Special Income Disregards

ACES

Instructions on ACES coding are described in ACES release document BD October 19, 2009.  This document can be found at ACESonline under ACES release.

Section is called SSI-Related Special Income Disregards and SSI Medical Redetermination and includes attachments in the instruction.

A link will be provided once this information has been incorporated into the ACES manual.