DHS Eliminates Requirement to Pursue Potential Benefits in Order to Qualify for Medicaid
As of last month, County Assistance Offices (CAO) processing Medicaid applications can no longer require applicants to apply for other potential benefits in order to be eligible for most types of Medicaid. These potential benefits are primarily those that provide additional income, including:
- Social Security Retirement, Disability or Survivor’s benefits
- Supplemental Security Income (SSI)
- Unemployment Compensation
- Workers’ Compensation
- Retirement Benefits
- Disability Benefits
- Pensions and Annuities
- Veteran’s Benefits
This new policy is the result of a change in federal regulations and applies to all categories of Medicaid, except for GA-related Medicaid, which is a state-only program. Additionally, the change applies to people renewing their Medicaid, not just new applicants.
This change should help streamline and expedite the Medicaid application process and allow people to maximize their income when they are ready. It should have an immediate impact on people age 62 or older, most of whom previously were required to apply for Social Security retirement before their full retirement age as a condition of Medicaid eligibility. This meant people who wished to keep Medicaid received less than their full potential income for the remainder of their lives, since a person's Social Security amount is reduced if the benefit is taken before they reach full retirement age.
In Medicaid categories aimed at people with disabilities, individuals will no longer need to show they applied for Social Security Disability or SSI prior to authorization of Medicaid. However, the requirement to have a qualifying disability for these categories remains unchanged. If a person does not apply for SSD, as is their right, the state’s Medical Review Team will determine whether the person meets the disability requirement. The Department of Human Services has advised CAOs to refer people with disabilities whose current income is below the Substantial Gainful Activity (SGA) level apply for SSD. However, it is still up to the individual to decide whether to apply for SSD. Some individuals might have other reasons not to apply for SSD. For example, someone with higher assets might wish to stay in a Medicaid category that disregards those assets. If that person applies for SSD, they will have to move to a category of Medicaid that caps assets eventually, e.g. when they become eligible for Medicare.
Questions about the implementation of this new policy remain as of the date of this publication. We will continue to provide updates as we receive them.
