413.00 Supplemental Security Income Medical Assistance Only (SSI MAO)

 

A. General Description

 

The SSI Medical Assistance Only (SSI MAO) program is for customers who are age 65 or older, blind, or disabled and do not receive SSI cash.

 


 

B. Who Determines Eligibility?

 

The AHCCCS SSI MAO Office determines eligibility for:

 


 

C. General Conditions of Eligibility

 

The general conditions of eligibility applicable to SSI Non-cash, Disabled Adult Child (DAC), Disabled Child (DC), Disabled Widow Widower (DWW), and Pickle are:

 


 

D. Special Conditions of Eligibility

 

In addition to meeting the general conditions of eligibility listed above, the special conditions of eligibility for SSI Non-cash, Disabled Adult Child (DAC), Disabled Child (DC), Disabled Widow Widower (DWW), and Pickle are listed below:

 

IF the customer... THEN the customer qualifies under...

Has countable income less than or equal to 100% of the FPL.

SSI Non-cash

  • Is under age 18 (MS 502.00);

  • Received SSI Cash as a child before 8/22/96 (MS 527.00);

  • Continues to meet disability requirements established as of 8/22/96 (MS 511.00); and

  • Has countable income less than or equal to 100% of the Federal Benefit Rate (FBR) (MS 621.00).

Disabled Child (DC)

  • Is over age 18 (MS 502.00);

  • Received SSI Cash in the past;

  • Became ineligible for SSI-Cash on or after July 1, 1987, due to entitlement to or an increase in Title II (SSA) payments as a disabled adult child (MS 527.00);

  • The WTPY shows a "C" claim number that is either credited or not credited; and

  • Has countable income less than or equal to 100% of the Federal Benefit Rate (FBR) (MS 621.00).

 

Disabled Adult Child (DAC)

  • Is age 50 or older, but not yet 65 (MS 502.00);

  • Not entitled to Part A Medicare (MS 521.00);

  • Not currently married;

  • Received prior SSI Cash disability payment (MS 527.00);

  • The WTPY shows a “D” or “W” claim number that is either credited or not credited; and

  • Has countable income less than or equal to 100% FBR (MS 621.00).

 

Disabled Widow Widower (DWW)

  • Is receiving Social Security Title II (MS 528.00);

  • Received prior SSI Cash payment (MS 527.00);

  • Received both SSI Cash and Title II payments in the same month for at least one month; and

  • Has countable income less than or equal to 100% FBR (MS 621.00).

 

Pickle Amendment

 


 

E. Service Package

 

Customers eligible for SSI MAO receive AHCCCS Medical Services (MS 302.01).

 

If the customer meets all eligibility requirements except U.S. citizenship or appropriate non-citizen status, the customer is eligible to receive emergency services only (MS 302.03).

 


 

F. Customer Cost

 

The customer does not pay a premium for AHCCCS Medical Services. However, the customer may be responsible for co-payments for certain services (MS 1205.00).

 


 

G. Enrollment

 

Customers approved for coverage under SSI MAO are enrolled in an AHCCCS Health Plan. Use the following tables to determine where to refer customers with questions about enrollment.

 

BEFORE ENROLLMENT

IF the customer has questions about...

THEN the customer can...

Choosing a Health Plan

  • Call the eligibility SSI MAO where;

  • Review the AHCCCS Application for Health Insurance (Page D); or

  • Call the AHCCCS Communications Center

Doctors, other providers, or available services

  • Call the Health Plans

 

AFTER ENROLLMENT...
IF the customer has questions about... THEN the customer can...
Changing a Health Plan
  • Call the AHCCCS Communications Center

Choosing a doctor

  • Call the Health Plan

Other providers, or available services

  • Call the Health Plan

 

The AHCCCS Communications Center telephone numbers:

 


 

H. Legal Authorities

 

The table below shows the legal authorities and the references applied to SSI MAO eligibility.

 

Category

Legal Authority

Reference

SSI Non-Cash United States Code Title 42, Chapter 7, Subchapter XIX
Code of Federal Regulations (CFR) Title 42, Chapter IV, Part 435

Arizona Revised Statutes (ARS)

Title 36, Chapter 29, Article 1

Arizona Administrative Code (AAC)

Title 9, Chapter 22, Article 15
  • DAC

  • DWW

United States Code

Title 42, Section 1383c

Code of Federal Regulations (CFR)

Title 42, Chapter IV, Part 435.210

Arizona Revised Statutes (ARS)

Title 36, Chapter 29, Article 1

Arizona Administrative Code (AAC)

Title 9, Chapter 22, Article 1505
Pickle

United States Code

Title 42, Section 1383c

Code of Federal Regulations (CFR)

Title 42, Chapter IV, Part 435.135

Arizona Revised Statutes (ARS)

Title 36, Chapter 29, Article 1

Arizona Administrative Code (AAC)

Title 9, Chapter 22, Article 1505

 


 

I. PMMIS Key Codes

 

Listed below are the PMMIS eligibility key codes and a description of each.

 

Code

Description - All Key Codes are SSI MAO

370

Over Age 65, Income Less than 100% FBR

371

SSI MAO AHCCCS Care/MI, Income Less than 40% FPL, DES Determined Eligibility

372

SSI MAO AHCCCS Care Expanded, Income Between 40% FPL and 100% FPL, DES Determined Eligibility

375

Over Age 65, Income between 100% FBR and 100% FPL

380

Over Age 65, Pickle, Countable Income Less Than 100% FBR

382

Over Age 65, Exparte Redetermination of AHCCCS

390

Blind, Income Less than 100 % FBR

392

Blind, Exparte Redetermination of AHCCCS

394

Blind, Appeal of Termination of SSI Cash Benefits Pending

395

Blind, Income Between 100% FBR and 100% FPL

400

Blind, Pickle, Countable Income Less Than 100% FBR

410

Disabled, Income Less Than 100% FBR

415

Disabled, Income Between 100% FBR and 100% FPL

420

Disabled, Pickle, Countable Income Less Than 100% FBR

422

Disabled, Exparte Redetermination of AHCCCS

424

Disabled, Appeal of Termination of SSI Cash Benefits Pending

426

Disabled, Disabled Adult Child (DAC), Countable Income Less Than 100% FBR

428

Disabled, Disabled Child (DC), Income Less Than 100% FBR

430

Disabled, Disabled Widow / Widower (DWW), Countable Income Less Than 100% FBR

431

Over Age 65, Widow / Widower, FBR

432

Blind, Disabled Widow / Widower (DWW), Countable Income Less Than 100% FBR

450

Deemed Newborn

470

Over Age 65, Income Less Than 100% FBR, 6-Month Guarantee

471

Over Age 65, Income Between 100% FBR and 100% FPL, 6#Month Guarantee

480

Blind, Income Over 100% FBR, 6-Month Guarantee

481

Blind, Income Between 100% FBR and 100% FPL, 6-Month Guarantee

490

Disabled, Income Less Than 100% FBR, 6-Month Guarantee

491

Disabled, Income Between 100% FBR and 100% FPL, 6-Month Guarantee

910

Over Age 65, Income Less Than 100% FBR, Emergency Services

911

Over Age 65, Income Between 100% FBR and 100% FPL, Emergency Services

915

Blind, Income Less Than 100% FBR, Emergency Services

916

Blind, Income Between 100% FBR and 100% FPL, Emergency Services

920

Disabled, Income Less Than 100% FBR, Emergency Services

921

Disabled, Income Between 100% FBR and 100% FPL, Emergency Services