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Medicaid Extension


What is the Medicaid Extension program?

What are the eligibility requirements?

How do I apply?

Are there other requirements?

What benefits will I receive?


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What is the Medicaid Extension program?

Medicaid provides coverage to certain individuals who have received supplemental security income (SSI) benefits, but have lost the SSI benefits for certain reasons. To be eligible for Medicaid Extension, an individual must be aged, blind, or disabled as defined by the Social Security Administration prior to making an application for Medicaid Extension benefits. See information on Medicaid Healthcare Benefits for those with Supplemental Security Income.

What are the eligibility requirements?

To determine eligibility, ISD will determine why SSI benefits were lost. There are certain circumstances in which you may still be eligible for Medicaid, even if you are not receiving SSI. This includes:

  1. Individuals who were eligible for SSI benefits but lost eligibility due to cost of living (COLA) increases.
  2. Individuals who lost eligibility for SSI for reasons other than cost of living increases if:
    • the reason for loss of SSI no longer exists; and
    • the adjusted income after applying the applicable income disregards is under the current SSI income celing.
  3. Individuals, termed "early widow(er)," who are between the ages of 60 and 64 who:
    • are current Title II (Social Security) recipients who were entitled to and received SSI benefits;
    • subsequently lost eligibility for SSI due to initial receipt of or increase in early widow's or widower's benefits; and
    • are not entitled to Medicare Part A hospital coverage.
  4. Individuals who lost eligibility for SSI due to an increase in Title II (Social Security) benefits for an adult disabled child. This is labeled C01 status.
  5. Individuals who are disabled widow(er)s or disabled surviving adult divorced spouses who lost eligibility for Title II benefits due to definition changes. These individuals must meet these conditions:
    • received SSI for the month prior to the month in which they began receiving Title II benefits;
    • would continue to be eligible for SSI if the amount of the Title II benefit were not counted as income; and
    • are not entitled to Medicare Part A.
  6. Individuals who lost eligibility for SSI due to initial receipt of Title II benefits in an amount exactly equal to the current income ceiling of the SSI program and are not residing in an institution. This is labeled E01 status.
  7. Individuals whose status "ping-pongs" between C01 and E01.
  8. Individuals who lost SSI eligibility due to:
    • countable income exceeds the SSI payment amount;
    • non-excludable resources exceed SSI limitations;
    • voluntary termination of participation in SSI; or
    • non-appearance on the state's reconciliation statement for the month.
  9. Children who lost eligibility for SSI solely due to a change in disability criteria under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. These children must have met criteria in effect prior to PRWORA.

To be eligible for Medicaid Extension, individuals must meet SSI resource limits. To view other eligiblity requirements for SSI, see Supplemental Security Income.

Individuals who received Medicaid-covered services during the three months prior to their initial Medicaid application, may apply for up to three months of retroactive coverage. Applications for retroactive benefits must be made within six months (or 180 days) of the initial application for coverage. Applicants must demonstrate that they qualified for Medicaid Extension during the months for which they are applying for retroactive benefits.

Medicaid recipients must report to your local ISD office any change in circumstances that might affect your eligibility within 10 days of the change.

To be eligible for Medicaid, an individual must be a citizen of the United States, or a qualified alien. Contact your local ISD office if you are unsure if you qualify.

How do I apply?

Individuals who lost SSI eligibility due to cost of living increases will be automatically provided notice of eligibility for Medicaid extension the month following the loss of benefits.

Individuals who qualify for Medicaid Extension based on varying status between C01 and E01 are referred by the Social Security Administration to the Income Support Division.

Other individuals applying for Medicaid Extension need to apply at their local Income Support Division office. A caseworker is able to help you sort out the requirements for coverage under Medicaid Extension and fill out the application.

Are there other requirements?

Individuals who receive Medicaid Extension under the disabled widow(er)/surviving divorced spouse and the early widow(er) provisions lose eligibility for Medicaid once they are eligible for Medicare Part A benefits. See information on Medicare.

Individuals who receive Medicaid Extension due to voluntary discontinuation of SSI participation, an increase in countable income, an increase in resources in excess of the limit, or non-appearance on the state's reconciliation statement may only receive Medicaid Extension benefits for one month. This is to allow the individual time to apply under a different Medicaid category.

What benefits will I receive?

Applicants/recipients who are eligible for SSI may receive full Medicaid benefits. For those who are also eligible for Medicare, Medicaid will pay the Medicare premium amounts. Generally, full Medicaid benefits include the following:

  • Inpatient hospital services
  • Transplant services (heart, lung, heart-lung, liver, bone marrow, kidney, and corneal)
  • Outpatient hospital services
  • Case management services and specific case management programs
  • Emergency services
  • Physical health services
  • Laboratory services
  • Diagnostic imaging and therapeutic radiology services
  • Anesthesia services
  • Vision services
  • Audiological services
  • Dental services
  • Dialysis services
  • Pharmacy services
  • Durable medical equipment and medical supplies
  • Early periodic screening, diagnostic and treatment services (EPSDT) for young children
  • Tot-to-teen health checks
  • Services provided in schools
  • Nutritional services
  • Home health services
  • Hospice services
  • Ambulatory surgical services
  • Rehabilitation services
  • Reproductive health services
  • Pregnancy termination procedures
  • Emergency and non-emergency transportation services for medically necessary health services
  • Prosthetics and orthotics
  • Behavioral health services

 


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