Aged, Blind, and Disabled
Medicaid Eligibility Survey

MANDATORY GROUPS

States are required by federal law to offer coverage to certain groups of aged, blind, or disabled individuals.

Cash Assistance Group

Supplemental Security Income (SSI) is 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. In general, federal law requires that states provide Medicaid coverage to persons receiving cash assistance under the SSI program. When SSI was enacted in 1972, however, states were given the option to continue to use the Medicaid eligibility standards they had in place at that time. Those policies are generally more restrictive than the SSI eligibility rules. Eleven states, called the “209(b) states” still operate under that option. In return for being allowed to use the more restrictive criteria, however, §209(b) states are required to allow all aged, blind, and disabled residents to spend-down to Medicaid eligibility levels in a program that essentially mimics the medically needy program explained later in this paper.

Forty states enroll all SSI recipients in Medicaid automatically each month. Thirty-three of these forty states rely on the Social Security Administration to determine Medicaid eligibility for the SSI beneficiaries in their state; they are referred to as §1634 states because that is the section of the Social Security Act that governs this process. Seven of the forty states (Alaska, Idaho, Kansas, Nebraska, Nevada, Oregon, Utah) require SSI beneficiaries to file a separate Medicaid application with the state, which allows the state itself to determine eligibility for Medicaid; these states are referred to as SSI-criteria states.

Dual Eligibles

Many individuals receiving SSI benefits are also eligible for automatic coverage under Part A of the federal Medicare program and could purchase the optional Part B Medicare coverage. For such individuals, the state Medicaid agency pays the Part B premium and the beneficiary’s deductibles and co-payments. In addition, beginning in 1988, Congress has enacted various provisions requiring the states to purchase Medicare coverage or assist in the cost of such coverage for certain lower income seniors or disabled individuals who are not eligible for SSI benefits.

These people fall into a variety of Medicaid eligibility categories including, but not limited to, the Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Medicare Beneficiaries (SLMBs), Qualified Disabled and Working Individuals (QDWIs), and Qualifying Individuals (QIs). Collectively, they are known as dual eligibles.

Title XIX sets specific income and resource standards for each dual eligible category with each category providing different benefits to its population. For a complete list of dual eligible categories, please visit the Centers for Medicare and Medicaid Services website at http://www.hcfa.gov/medicaid/dualelig/bbadedef.htm.

Income standards range up to 200% of the federal poverty level (FPL) and the resource standard for all dual eligible groups is $4,000 per individual and $6,000 per couple. However, §1902(r)(2) of the Medicaid statute gives states the option of using less restrictive income and resource methodologies—methodologies that allow additional individuals to be eligible for assistance and that do not cause any individuals who would otherwise be eligible to be made ineligible. Our database highlights the states that have taken advantage of this option.

Some consider the phrase "dual eligible" a misnomer for the “Qualified” groups because these people are not eligible for full Medicaid coverage. Rather, Medicaid provides some premium and/or or cost sharing assistance.