I am working with someone who is currently receiving SSI benefits (he became entitled in March of 2009). We just found out this person will probably become eligible for Disabled Widower’s Benefits, retroactive to September of 2008. His Disabled Widower’s Benefit will be about $847.00 per month. The consumer is very concerned about the potential loss of his Medicaid. He currently has no other income, although he is looking for work. He will turn 60 in August and has a 17-year old son who lives with him.

According to the Medicaid Eligibility Handbook, it appears this consumer would qualify for Special Status Medicaid as a Widower until he becomes eligible for Medicare Part A. Is it true that he will lose Special Status Medicaid once he becomes eligible for Medicare Part A? If he loses it and wants to keep Medicaid, would he have to choose between the Medicaid Deductible Program, BadgerCare Plus, and MAPP? I want to make sure I’m not missing anything for him, since I haven’t worked with Disabled Widow’s benefits very often.

Thanks for your time and assistance!
Karin, Green Bay

Dear Karin,

Your question is an excellent one. It looks like the gentleman you are working with should most definitely apply for Medicaid at his local office.

You are correct. A person cannot have the Widow(er) Special Status Medicaid coverage if they are getting Medicare Part A. When he becomes eligible for Medicare, he will no longer be eligible for this type of Medicaid. Also like you mentioned, his other options for Medicaid would be Medically Needy Medicaid (deductible), MAPP, or BadgerCare+ until his son ages out of the program. He is not likely eligible for HIRSP because he is eligible for Medicaid, but it might be worth checking out nonetheless. Also, he could review Medicare Supplement plans to see if there is one that is affordable and offers the coverage he needs. The best thing for this gentleman to do is to review all of his options and compare costs and coverage to determine what would work best for him.

I would love to hear how everything turns out. Keep us posted!

Sincerely,
Ben

Karin Zuleger

A sunset ride on the Erg Chebbi Dunes, in the Sahara, Morocco.

Hi Everyone:

It’s been difficult to stay in touch lately and I hope you are all doing well. Here’s a recent pic from my travels from the Erg Chebbi Dunes, in the Sahara, Morocco. It was a beautiful sunset but I don’t mind saying I was a little afraid of this camel who’s name was Fred – odd but there you have it! Here’s a question I received recently:

Dear Ben Spec,

I recently had a change to my benefits, and I am concerned about my Medicaid. I was getting SSI and a DAC payment concurrently. When my father passed away, my payment of $650 increased to $975. I am working and getting paid about $150 each month.

I was told that I would lose my Medicaid so I should apply at the county economic support office. I did this, but I was not put into a Special Status Medicaid Category as I had assumed I would. The office told me it has something to do with my shelter costs. My mother no longer makes me pay rent because I stopped receiving SSI. I was under the impression that paying shelter costs wouldn’t affect my Medicaid eligibility because it is no longer tied to SSI. Can you please explain to me why I am not eligible for EBD Medicaid with the DAC Special Status Disregard?

I have been enrolled in MAPP, and it’s free. This is great and I don’t mean to complain, but I am still confused about not being placed into the DAC Special Status Medicaid category.

Yours truly,
Sara of Melrose, WI

Dear Sara,

I am so glad you contacted me with this question. The Special Status Medicaid programs can be a bit trickier than they appear. Many people believe that someone is automatically eligible for Special Status DAC Medicaid if disregarding the DAC payment makes the person eligible for SSI. There is a little more to it.

First, an individual must have lost eligibility for SSI because of a DAC payment. The increase in your DAC payment caused you to lose eligibility for SSI, so you do meet this eligibility factor.

The second factor in eligibility is your countable income. Your DAC payment increase is disregarded because you were once getting concurrent benefits of SSDI and SSI at the same time. The disregard is applied to your full SSDI payment. After that, your countable income can be found.

Finally, your countable income is compared to your Personal Income Limit and/or the Med Needy Income Limit. If your countable income is below either of these limits, you are going to be eligible for this type of Medicaid. You will also be automatically eligible for the Medicare Savings Program, QMB.

Taking a glance at the information you sent, it looks like you do not have any shelter costs. This may be causing your Personal Income Limit to be lower than your countable income. Your countable income is definitely higher than the Med Needy Income Limit, so you wouldn’t be eligible through the use of that test. Again, from the information you sent, it looks like MAPP is your best option at this time.

If you paid toward shelter costs, there is a chance that you would be eligible for the Special Status DAC Medicaid. You can contact your local Economic Office or benefits specialist to find out more information.

Off to new adventures!
Ben

Aloha from Kauai, Hawaii

Happy belated Thanksgiving everyone! As I indicated in my last post, some warmth was in the plans for my next travel destination. I’m happy to be checking in with you from paradise – Kauai, Hawaii. Even more exciting, my sister Quimby was able to join me for part of this trip and experience her first surf lesson – not bad for a beginner – keep up the good work Sis. We look forward to your reports on what’s happening in Washington next year. Here’s a question I received recently.

Dear Ben,

I receive both regular social security disability (SSDI) benefits and SSI disability payments. Earlier this year I was overpaid the regular social security benefits, and I just agreed to have $50 a month taken out of my SSDI benefit to repay the money I owe.

I know that SSA counts the gross amount of my SSDI benefit against my SSI payment, so I was wondering how much will SSA use in figuring my SSI payment now: the amount I actually get after the $50 repayment is taken out, or the full benefit amount I normally received before I started repaying the overpayment?

Jesse
Seneca WI

Dear Jesse,

The full amount of any Title II (regular social security) benefit before any deductions normally counts as unearned income in computing a monthly SSI payment. However, an exception applies when the Title II overpayment occurred while the person was receiving SSI and when the overpaid amount was included in the countable unearned income during that time. In such a case, SSA will count just the amount of the Title II payment after overpayment withholding and not the full, regular amount. This is called the “double counting” exception because SSA cannot count your Title II against your SSI twice.

It looks like this exception applies to your case, that the overpayment occurred while you were receiving SSI and the overpaid money was already taken into account when SSA computed your SSI earlier. So while you’re repaying the overpaid amount, SSA will use the lower SSDI amount you actually receive in figuring your SSI payment.

Ben

References: POMS SI 00830.110B2 | SI 00830.115 | SI 00830.210

Quimby's surfing lesson

Antarctica

My friend Nate from ERI is always asking me when I’m going to take a trip to someplace interesting like Antarctica so I’m very excited to give him a shout out from that very place! “Hey Nate! Thanks for the suggestion.” I can report that I have not seen any polar bears from land, air or sea so far. As a matter of fact, from what I understand and from personal experience, spotting polar bears is not very easy. What is easy is keeping in touch with what’s happening at home. I received this excellent question recently – a topic that comes up frequently.

Dear Ben,

I have a client who is disabled and receives both SSDI disability benefits and SSI disability payments. His aunt is 85 years of age and is planning to move out of her house that she owns (worth about $80,000) and into an apartment. She wants to give the house to my client to live in. If she does this and he moves into the house, would he lose his SSDI and SSI?

Neil
Greendale, WI

Dear Neil,

Receiving a house or any other gift does not affect a person’s Social Security Disability Income (SSDI) benefits. And there is no asset limitation for entitlement to SSDI.

On the other hand, there are rules regarding how much in income and resources a person can have and be eligible for Supplemental Security Income (SSI.) The month your client receives ownership of the house, Social Security considers its value as income to him that month because the house provides him shelter; however, the value of shelter is capped at the Presumed Maximum Value (PMV) for in-kind support, which in 2009 is $224.66 (one-third the Federal Benefit Rate for an individual of $674.). So he would be charged with $224.66 as income for that month.

The month after that, the house becomes a resource that he owns. The countable resource limit for an individual for SSI is $2000, however, a home a person owns and resides in is not a countable income so does not count toward that $2000 limit. So as long as he still meets all the other SSI eligibility qualifications, your client will be eligible again with that month. (Source: Social Security Administration POMS SI 00815.550C2 | SI 01120.005 | SI 00835.300)

Please make sure your client contacts his local Social Security office when he receives ownership of the house.

All the best, I’m definitely going to choose someplace warm next!
Ben

CN Tower, Toronto, Ontario, Canada

Hi Ben,

I have a question about 1619b, earning and CIP1b funding. If a single adult on SSI earns approximately $20,000 per year and has the option of taking company “private” insurance would this person be ineligible for Medicaid (1619b)? Let’s consider this person meets all other eligibility requirements for MA. Also, If this person private insurance covers all medical costs, but MA is needed to cover CIP1b waiver services would he be in jeopardy to loose his waiver services?

I want to make sure my client does not loose his CIP1b waiver services if he would receive private insurance through his employer.

Thank you,
Brian

Hi Brian,

Your question is an excellent one. Hopefully you will be able to attend the WDBN webcast featuring Social Security Administration’s Bob Monahan and Connie DaValt next month on September 17th – go to the WDBN Training page for more information. They will be talking about 1619(b) in their presentation.

In the meantime, let’s take a look at your question.

Individual’s who have Medicaid are able to have private insurance simultaneously. 1619(b) does require that a person need Medicaid in order to work, and that can still be done even though the primary payer is the Private Health Insurance. It is quite often that an individual will still need Medicaid to pay for some services that the Private Insurance does not.

Also, the individual is getting CIP1b which shows that the individual needs Medicaid.

As long as the person you are working with continues to have a disability and have assets under $2,000, he should be eligible for 1619(b). Also, he must have earnings below the annual threshold. In 2009 that is $32,156 or $34,459.48 for someone who receives the E-Supp, or higher yet for someone who has an individualized threshold. He will remain eligible for CIP1b in Financial Group A and have no cost share.

If he is interested in having assets higher than $2,000 he may want to consider MAPP. He could have MAPP and CIP1b. In this situation, he would not have a cost share, and with his projected earnings from your example, he would have a premium of $25 (unless he has IRWE or MRE). Remember with MAPP, if he stops working and wishes to return to SSI, he would first need to spend down his assets. You can have him contact his local MAPP/HEC Specialist if he is considering this.

The last option I can think of is that he doesn’t take the private health insurance. I have seen this happen with no negative impact. The gentleman you are working with can review the services he needs and compare that to what he receives with Medicaid. It is important to investigate the costs that he may incur with Private Health Insurance before taking it. In some cases, the costs of Private Health Insurance are higher with no additional services.

Niagara Falls

Hi Ben

I am working with a couple who are planning to get married in August. They are both working and are both in 1619(b) status. He also receives an SSDI payment on his own record of $618.00. She is earning around $1450 per month and he is earning around $450 per month.

They want to know what affect marriage will have on their benefits.

I am thinking that they would both be able to stay in 1619(b) status so that wouldn’t change. Is that right? If he stopped working though he would lose 1619(b) but she would still keep it since she is working right? If she stopped working, they would both be eligible for a small SSI payment and Medicaid.

They would have the $3,000 asset limit as opposed to the $2,000. Am I on the right track? Am I missing any important things?

Thanks for your assistance!
Amber

Hi Amber,

This is a timely question as I am visiting one of the most popular wedding and honeymoon destinations. You are on the right track. Both members of an SSI couple are eligible for Medicaid under 1619(b) if they are both working and their total combined income causes ineligibility for payment (POMS SI 02302.010C.2) Of course, both still need to meet the other requirements for 1619(b): being disabled and meeting all the other SSI eligibility factors, needing Medicaid to work, and having gross earned income below the yearly threshold amount.

If he stopped working and she kept working at the same level, she would be eligible for 1619(b) but he would not; a non-working spouse loses Medicaid when the earned income of his or her SSI spouse causes ineligibility for payment. If she stopped working and he continued at his current level, they both would be eligible for a federal payment, the state supplement, and Medicaid.

You should remind them that as an eligible couple their Federal Benefit Rate (FBR) will be $1,011 per month rather than the FBR of $674 for each as individuals; and that for a couple the $20 general and $65 earned income exclusions are applied only once to their combined income.

As you stated, their resource limit will be the couple’s $3000. Note that at marriage their resources will be combined, and that the resource exclusions (one home, one auto, etc.) apply to their combined resources.

Another possibility is that if his SSDI payment is a Disability Insurance Benefit (DIB), she could be potentially entitled to wife’s benefits at age 62 or with a child of her husband’s in her care.

I hope this answers their questions, and congratulate them for me on their betrothal.

Ben

Beijing, China at Tiananmen Square

Visiting Tiananmen Square in Beijing, China where they recently marked the 20th anniversary of the military crackdown on student protesters who gathered demanding democracy. Tiananmen Square is the world’s largest public square, and the very heart of modern China. Oddly, we lunched at a McDonald’s nearby which sported a “famous western people” theme – including images of Jim Morrison and Sean Connery. Not exactly what I expected. Speaking of students…here’s a question I recently received:

Hi Ben:

I have a follow-up question to the presentation John Benbow did at the last WDBN meeting. If a person is using a Student Earned Income Exclusion, should they avoid using the telephone reporting system?

Thanks!
Stephanie

Here’s my response

Stephanie,

Social Security’s SSI Automated Telephone Wage Reporting system (SSITWR) does have certain technical limitations, but a recipient having the Student Earned Income Exclusion (SEIE) work incentive can still use the new telephone system.

On the other hand, if a recipient has Impairment Related Work Expenses (IRWE) or a Plan to Achieve Self Support (PASS) work incentives reporting via phone is an exclusion. Someone with multiple employers in a month is also an exclusion.

For clarification or more details, contact your local Social Security office.

Ben

Appalachian Trail

Hi Ben!

I had a question recently about State-Only 1619(b) and assets. In getting the answer I was told State-Only 1619(b) works “just like federal 1619(b)” yet I am unclear exactly how that works as well. So, my question is this: If a person is receiving Medicaid under 1619(b) and goes over $2,000 in assets one month but then is back under $2,000 three months later can that person go back onto 1619(b)?

Thanks for all your help, Ben! Enjoy whatever destination you find yourself in next! Terri

Terri,

The short answer to your question is: yes, the person in the situation you described would regain 1619(b) status.

The reason has to do with the distinction between “suspension” of SSI and “stop payment” of SSI.

Suspension occurs when a person becomes ineligible for SSI; for example, having excess resources at the beginning of a calendar month. Generally an SSI recipient has twelve (12) consecutive months after the effective date of suspension to be reinstated (without a new application) if eligible again.

More from the Appalachian Trail!

Stop payment status is an interruption in SSI payments and not the loss of eligibility; 1619(b), not receiving payments due to work earnings, is a stop pay situation so eligibility continues. Cash payments may be reinstated on a stop pay record regardless of how long the recipient has been in non-pay.

If a recipient becomes ineligible during a stop pay period (such as in your case), the payments are suspended and the principle stated above applies: the recipient has 12 consecutive months to be reinstated to pay status or stop pay status (1619b) if eligible again. Of course, to regain 1619(b) eligibility, the person would also need to meet the other 1619(b) requirements. (POMS SI02301.201)

To put it another way, an SSI recipient who does not meet a nondisability requirement in a month (other than excess income due to work) goes into suspense status and stays there until the first month within the next 12 in which all requirements are met for 1619(b) or regular payments. (POMS SI 02302.010E.1)

I’m responding to you from Max Patch (near Hot Springs, NC); I am hiking on the Appalachian Trail where the mountains are high and smoky. I was playing a little mandolin (see Mom I do practice!) and these two fellow hikers stopped to listen for a while!

Ben

Great Barrier Reef

It’s always been a dream of mine to explore the Great Barrier Reef in the Coral Sea along Australia’s northeastern coast. This week, I am doing just that! Yesterday, I sailed off the coast of Cairns and did some diving with a crew of eight. I saw some amazing things including a giant sea turtle that floated by in what seemed like slow motion within 6 inches of my head. Back at the hotel and breathing a little easier, I received the following question:

Hi Ben,

I have a question about SSI and a change in in-kind living arrangement. One of my consumers, “Charlie,” who receives SSI, has been living in an apartment for which his parents paid the monthly rent. Because of his parents’ support, the SSA calculates his maximum SSI payment as $449.34 (instead of the FBR, $674).

Starting July 1st, Charlie will start a part-time job and also begin paying rent on his own. What is the best way to alert SSA of this change? (That is, do they need to see a copy of a rent check or a signed statement from his parents?)

Also, will the change in living status affect the maximum payment rate in the same month as the change or does RMA apply?

Thanks Ben! Happy travels! Britta

Here’s my response:

Britta,

The Social Security Administration (SSA) considers the free rent Charlie has been receiving as what is called “In Kind Support and Maintenance” (ISM) which is a type of unearned income for SSI. In his situation SSA values the ISM at one-third of the Federal Benefit Rate (FBR) plus $20 which is called the “Presumed Maximum Value” (PMV.) (See POMS SI
00835.370)

If Charlie begins paying his own rent in its entirety and otherwise pays his other household expenses, he will no longer be charged with ISM and be eligible for the entire FBR (as long as he has no countable income.)

He should contact his local SSA office (preferbly by phone initially) and talk to a Claims Representative (CR) who will go over the situation with him. Depending on the cirumstances of the case, the CR will take Charlie’s statement and possibly contact the landlord for verfication.

Under the Retrospective Monthly Accounting (RMA) system that SSA uses to determine SSI elgibility and payment, SSA includes PMV as countable income in the Budget Month so it will affect Charlie’s payment computation for two more months after the month of change. (POMS SI 02005.001E.4.a)

I hope Charlie finds success in his work and his independence.
Ben