2117 Disabled Widow(er) | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Disabled Widow(er)

Effective Date:

December 2022

Chapter:

2100

Policy Number:

2117

Previous Policy Number(s):

MT 58

Updated or Reviewed in MT:

MT-68

Requirements

The Disabled Widow(er) class of assistance (COA) provides Medicaid for an individual whose SSI was terminated because of his/her entitlement to an RSDI disabled widow(er) benefit.

Basic Considerations

To be eligible under the Disabled Widow(er) COA the A/R must meet the following conditions:

The A/R is a disabled widow(er) or a disabled surviving divorced spouse between the ages of 50-59
The A/R is currently receiving RSDI as a disabled widow(er)/disabled surviving divorced spouse.
The A/R is currently ineligible for Medicare Part A coverage.
The A/R previously received SSI or a Mandatory State Supplement (MSS) that was terminated on or after 1/1/91 because of his/her initial entitlement to RSDI as a disabled widow(er)/disabled surviving divorced spouse.
The A/R is eligible for SSI or MSS if the initial entitlement to RSDI as a disabled widow(er) and all subsequent COLAs are disregarded.
The A/R meets all basic and financial eligibility criteria.

Length of Stay (LOS) and Level of Care (LOC) are NOT requirements for this COA.

A disabled Widow(er) is an individual who applies for RSDI between the ages of 50-59 and is determined to meet RSDI disability criteria.

A widow(er) who applies for RSDI at age 60 or older can receive RSDI without meeting disability requirements. SSA will accept a disability application on these individuals after age 60 only for the purpose of establishing Medicare entitlement. These individuals are not eligible for Medicaid under the Disabled Widow(er) COA. Consider eligibility under all other COAs, including Widow(er) Age 60 to 64 COA.

Disabled widow(er)s whose SSI was terminated on or after 1/1/91 are allowed to count previous months of SSI eligibility toward the 24-month waiting period for Medicare entitlement.

Procedures

Follow the steps below to determine Medicaid eligibility under the Disabled Widow(er) COA:

Step 1

Accept the A/R’s Medicaid application.

Step 2

Obtain information required to complete the eligibility determination.

Step 3

Obtain the following verification from the Social Security Administration:

The date SSI/MSS benefits were terminated
The current amount of the A/R’s RSDI Disabled Widow(er) benefit
The amounts of the RSDI initial entitlement that caused SSI/MSS termination and all COLAs received since SSI/MSS was terminated
The A/R’s current ineligibility for Medicare Part A coverage

Step 4

Determine all basic eligibility criteria except LOS and LOC. Refer to Chapter 2200, Basic Eligibility Criteria.

Step 5

Determine financial eligibility using the current SSI income and resource limits. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting, to determine the following:

Whose income and resources to consider
Which SSI income and resource limit (individual or couple) to use
Which eligibility budget to complete

Determine the A/R’s countable income by disregarding the following amounts of RSDI income:

The initial entitlement to RSDI as a disabled widow(er) that caused SSI termination

AND
All subsequent COLAs

The RSDI claim number will end with a beneficiary identification code (BIC) that includes “W” if the A/R receives RSDI as a disabled widow(er) or surviving divorced spouse.

Step 6

Approve Medicaid under the Disabled Widow(er) COA if the A/R meets all the above eligibility criteria, including retroactive months if needed.

Do NOT approve Medicaid using the Disabled Widow(er) COA for any month for which the A/R was eligible for and received an SSI payment.

Step 7

Terminate Medicaid under this COA as soon as the A/R becomes entitled to Medicare Part A. Complete a CMD. Refer to 2052 Continuing Medicaid Determination.