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

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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 MT 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.