2119 Disabled Widow(er) Age 60-64 (Public Law 100-203) | Medicaid

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Disabled Widow(er) Age 60-64 (Public Law 100-203)

Effective Date:

February 2020

Chapter:

2100

Policy Number:

2119

Previous Policy Number(s):

MT 10

Updated or Reviewed in MT:

MT-58

Requirements

Widow(er) Age 60 – 64 (PL 100-203) is a class of assistance (COA) that provides Medicaid for a widow(er) who applies for an RSDI widow(er) benefit at age 60 or older and subsequently has his/her SSI terminated because of his/her entitlement to an RSDI widow(er) benefit.

Basic Considerations

To be eligible under the Widow(er) Age 60 – 64 COA the A/R must meet the following conditions:

The A/R is a disabled or blind widow(er) aged 60 – 64.
The A/R is currently receiving an RSDI widow(er)/surviving divorced spouse benefit.
The A/R is currently ineligible for Medicare Part A coverage.
The A/R previously received SSI that was terminated because of his/her initial entitlement to RSDI as a widow(er)/surviving divorced spouse.
The A/R is eligible for SSI if the initial entitlement to RSDI as a widow(er)/surviving divorced spouse 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.

When the A/R becomes Medicare eligible at age 65 or after 24 months as disabled, s/he is NO longer eligible under this COA. Complete a CMD. Refer to Section 2052, Continuing Medicaid Determination.

Refer to Section 2117, Disabled Widow(er), for information on Medicare entitlement based on disability for an individual receiving an RSDI widow(er) benefit.

Procedures

Follow the steps below to determine Medicaid eligibility under the Widow(er) Age 60 – 64 COA.

Step 1

Accept the A/R’s Medicaid application.

Step 2

Obtain information required to complete the eligibility determination.

Step 3

Verify that the A/R is age 60 – 64.

Step 4

Obtain the following verification from the Social Security Administration:

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

Step 5

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

Verify blindness or disability if the A/R does not have prima facie evidence of blindness or disability, such as receipt of an RSDI disability benefit. Refer to Section 2205, ABD Requirement.

Step 6

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 widow(er) that caused SSI termination

AND
All subsequent COLAs

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

Step 7

Approve Medicaid, including prior months if needed, under the Widow(er) Age 60 - 64 COA if the A/R meets all the above eligibility criteria.

Do NOT approve Medicaid using the Widow(er) Age 60-64 COA for any month for which the A/R was eligible for and received a SSI payment.

Step 8

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