413 Supplemental Security Income Medical Assistance Only (SSI MAO)

Policy

The general conditions of eligibility for the Supplemental Security Income Medical Assistance Only (SSI MAO) program are:

·        Valid application (MA533);

·        Categorical element:

o       Age 65 or older (MA501);

o       Blindness (MA504); or

o       Disability (MA509);

·        Resident of Arizona (MA531);

·        Social Security number (MA532);

·        US citizen (MA507) or qualified noncitizen status (MA524);

·        Not incarcerated (MA525);

·        Apply for potential benefits (MA526);

·        Assignment of rights to medical benefits and cooperation (MA503); and

·        Income at or below 100% of the FBR or 100% of the FPL (MA615.2).

Specialty Categories

In addition to the general conditions of eligibility listed above, a customer may be eligible for SSI MAO under one of the following categories:

·        Disabled Adult Child (DAC);

·        Disabled Widow/Widower (DWW); or

·        Pickle.

1) Disabled Adult Child (DAC)

To qualify under this category, a customer must also meet the following:

·        Age 18 or older (MA501);

·        Received SSI Cash benefits on the basis of blindness or disability before reaching age 22 (MA529);

·        Lost SSI Cash benefits due to getting new or increased Title II Social Security benefits for an adult child with a disability (MA529);

·        Have countable income less than or equal to 100% of the FBR (MA615.2).

2) Disabled Widow/Widower (DWW)

To qualify under this category, a customer must also meet the following:

·        Be at least age 50, but under age 65 (MA501);

·        Not entitled to Medicare Part A (MA523);

·        Not currently married;

·        Have a Social Security claim number with a “D” or “W” Beneficiary Identification Code (BIC);

·        Have countable income less than or equal to 100% of the FBR (MA615.2); and

·        Have met ALL of the following conditions at any time since January 1, 1991:

o       Received SSI Cash or State Supplementary Payments (SSP);

o       Received an SSI or SSP benefit for the month before the customer began receiving Title II (SSA) payments as a disabled widow/widower (MA529); and

o       Became ineligible for the SSI or SSP benefit due to the amount of the Title II SSA payment as a disabled widow/widower (MA529).

3) Pickle

To qualify under this category, a customer must also meet the following:

·        Receive Title II Social Security payments (MA530);

·        Have countable income less than or equal to 100% of the FBR (MA615.2); and

·        At any time since April 1, 1977:

o       Have received both SSI Cash or SSP benefits AND Title II Social Security payments at the same time for at least one month; AND

o       Have become ineligible for the SSI Cash or SSP benefits while receiving both Title II Social Security payments AND SSI Cash or SSP benefits.

Definitions

Service Package

Customers who meet all requirements for the SSI MAO program receive full AHCCCS Medical Assistance coverage.

Customers who meet all requirements except U.S. citizenship or qualified non-citizen status receive emergency services only.

For a description of the AHCCCS Medical Assistance service packages, see MA302.

Enrollment

AHCCCS enrolls customers approved for coverage under the SSI MAO program in an AHCCCS Health Plan (MA1102).

AHCCCS pays for Emergency Services on a fee-for-service basis (MA1103).

Customer Costs

Customers do not pay a premium for coverage under the SSI MAO program. However, the customer may have co-payments for certain services (MA1202A).

Legal Authority

This requirement applies to the following programs: