Aged, Blind, and Disabled
Medicaid Eligibility Survey

• 1634 state – state that relies on the Social Security Administration to determine Medicaid eligibility for the SSI beneficiaries in their state

• 209(b) state - state that opted to continue to use the Medicaid eligibility standards it had in place when SSI was enacted in 1972. Those policies are generally more restrictive than the SSI eligibility rules

• 300% of SSI rule – another name for the special income rule

• community spouse – community-dwelling spouse of an institutionalized person

• community spouse protected resource amount – amount to which the spousal share is compared for protection against spousal impoverishment. The amount actually protected for the community spouse is the greater of either the spousal share or the CSRA.

• “countable” – amount of income or resources left after applying all eligibility methodologies

• dual eligibles - individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit

• income standard - the maximum amount of income a person can have and still be eligible

• methodology - process used to determine a person’s countable income or resources, which are then compared against the appropriate standard

• Miller trust - trust designed to hold and apportion the individual’s excess income according to need and for the express purpose of becoming eligible for Medicaid, subject to Medicaid estate recovery

• personal needs allowance – limited amount of income a nursing facility resident is allowed to keep for monthly expenses

• resource standard - the maximum amount of resources a person can have and still be eligible

• special income rule – state option to provide Medicaid to persons in institutions who have too much income to qualify for SSI benefits, but not enough income to cover their expensive long-term care

• spend-down – process in which individuals become Medicaid-eligible by incurring high medical bills which reduce the individual’s income below the state-determined income eligibility limit

• spousal impoverishment protections – process designed to ensure that when one spouse is institutionalized for at least 30 days, the other spouse does not lose all income and resources, thereby becoming impoverished and needing public assistance

• spousal share – amount determined when the couple’s resources (excluding home, household goods, one automobile, and burial funds) are combined and then halved for the spousal impoverishment protection

• SSI-criteria state – state that requires SSI beneficiaries to file a separate Medicaid application with the state, which allows the state itself to determine eligibility for Medicaid

• state supplementary payments – amount by which a state may opt to supplement the basic SSI cash assistance

• Supplemental Security Income – cash benefit available under Title XVI of the Social Security Act to certain persons who are aged, blind, or disabled and whose income and resources fall below the SSI standards set by the federal government