Medicaid For The Elderly And People With Disabilities


State Adoption Of Optional Eligibility Pathways Based On Old Age Or Disability And The Aca Medicaid Expansion

Free help to Enroll in Medicaid for Seniors and People with Disabilities

Greater shares of states that have adopted the ACA Medicaid expansion also have adopted key optional eligibility pathways based on old age or disability, compared to non-expansion states . To date, 37 states have adopted the ACA Medicaid expansion, and 14 have not.45 Just under half of expansion states46 elect the option to cover seniors and people with disabilities up to 100% FPL, compared to less than one-third of non-expansion states.47 Nearly three-quarters of expansion states48 also offer the optional medically needy pathway for seniors and people with disabilities, while just over one-third of non-expansion states49 do so. Over two in five expansion states50 elect the Katie Beckett state plan option for children with significant disabilities,51 compared to just over one-third of non-expansion states.52 Nearly all expansion states53 also elect the option to cover working people with disabilities, compared to less than two-thirds of non-expansion states.54 The two states opting to use Section 1915 as an independent eligibility pathway are both expansion states. All states adopt at least one of these optional age and disability-related state plan options, with the exception of Alabama.

Figure 7: State Adoption of Optional Medicaid Eligibility Pathways for Seniors and People with Disabilities, by ACA Expansion Status, 2018

About Medicaid For Elderly Or Adults With Disabilities

Medicaid covers adults with intellectual and development disabilities as well as adults with physical disabilities. Medicaid also covers elderly individuals who may need additional services to help them live as independently as possible. The goal of the Medicaid program is to get the right care at the right place at the right cost with the right outcomes. After Medicaid eligibility is determined, and individual will have an assessment regarding the level of care required to help meet individuals needs and care.

Required Regional Legal Review And Documentation

A legal review of the trust document is necessary. Contact with regional legal staff is based on regionally established procedures. Check with your supervisor for regionally established procedures. Send a copy of the documents to the regional attorney for review. Ask the attorney to review the documents and determine if the trust:

  • is a testamentary or inter vivos trust
  • is revocable or irrevocable
  • was established by someone other than the person such as a spouse, parent, grandparent, etc.
  • was established with someone else’s money other than the person’s money
  • restricts the person’s access or
  • names the person as the trustee.

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State Option To Adopt Streamlined Renewal Procedures For Pathways Based On Old Age Or Disability

Nearly all states have adopted at least one of the ACAs streamlined processes for Medicaid beneficiaries renewing coverage through an age or disability-related pathway, and over 60% have adopted both options . Aside from the Medicaid expansion, the ACA introduced other reforms that simplify and modernize Medicaid eligibility and enrollment processes. All states must adopt these reforms for poverty-related coverage pathways, and states can choose whether to apply them to age and disability-related pathways.105 Streamlined renewal polices can facilitate continuous coverage among eligible individuals, which helps prevent gaps in care and protects individuals from out-of-pocket costs that might be incurred if they experience a break in coverage. We surveyed states about whether they opt to send pre-populated eligibility renewal forms and whether they offer reconsideration periods for eligibility renewals in pathways related to old age or disability. The states that have not adopted either of these options are Alaska, New Hampshire, and Oregon.106

Figure 11: State Adoption of ACA Streamlined Renewal Options for Age and Disability-Related Pathways, 2018

Medicare Savings Programs For Dual Eligible Beneficiaries94

Nixon signs Medicaid expansion for Missouri

States must offer Medicare Savings Programs through which low-income Medicare beneficiaries receive Medicaid assistance with some or all of their Medicare out-of-pocket costs.95 Medicare beneficiaries include seniors as well as nonelderly people with disabilities receiving Social Security Disability Insurance, generally after a 24-month waiting period. Medicares out-of-pocket costs, including premiums, deductibles, and other cost-sharing, can be high. For example, Medicare Part A, which covers inpatient hospital services, has an annual deductible of $1,340 in 2018.96 Medicare Part B, which covers outpatient services, requires a monthly premium of $134 for most beneficiaries in 2018.97 Part B also requires an annual deductible of $183 in 201898 and co-insurance of 20% of the Medicare-approved cost of services after the deductible is met.99 Box 4 describes the MSP pathways.

Box 4: MSP Pathways

To help low-income enrollees afford Medicares out-of-pocket costs, state Medicaid programs must offer three MSPs:

Qualified Medicare Beneficiaries generally have incomes up to 100% FPL .100 Medicaid pays Medicare Parts A and B premiums and cost-sharing for QMBs.

Specified Low-Income Medicare Beneficiaries have slightly higher incomes and receive help with Medicare Part B premiums only.101 Most states set their SLMB income limits at 120% FPL .102

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Alien Status For Treatment Of An Emergency Medical Condition

Title XIX of the Social Security Act and 42 CFR §440.255 require the state to provide Medicaid for the treatment of an emergency medical condition to an alien who is ineligible for regular Medicaid due to immigration status. The Texas Health and Human Services Commission administers the program in Texas.

To qualify for Medicaid for the treatment of an emergency medical condition, an alien must:

a qualified alien as defined in 8 U.S.C. §1641 and not meet the requirements to receive Medicaid as described in 8 U.S.C. §1612 and §1613 or

an undocumented non-qualifying alien as described in 8 U.S.C. §1611

be otherwise eligible for regular Medicaid services and

require treatment of an emergency medical condition as described in 42 CFR §440.255.

An undocumented non-qualifying alien applying for Medicaid for the treatment of an emergency medical condition is exempt from providing proof of alien status or providing a Social Security number as described in 42 CFR §435.406.

Revision 09-4 Effective December 1, 2009

To lawfully remain in the U.S., a person who is not a U.S. citizen or a U.S. national and is present in the U.S. must have authorization from the Department of Homeland Security .

Reasons For Denial Of Aged Blind And Disabled Mao Applications And Cases

Reasons for denying applications or closing cases are classified into four major groups: death of applicant or recipient ineligible with respect to need ineligible with respect to requirements other than need and miscellaneous reasons.

Select the code reflecting the primary reason for denial. If a reason producing ineligibility with respect to need and reason producing ineligibility with respect to some requirement other than need occur at the same time, use the code for need. If several events occur simultaneously, none of which, alone, would produce ineligibility with respect to need, but collectively they do make the recipient ineligible, use the code for the reason having the greatest effect.

Although the applicant or recipient will receive a card explaining action taken on his/her case, the worker should make an adequate interpretation of the decision to the applicant or recipient.

Computer-printed reasons to the applicant or recipient will be initiated by use of the appropriate closing code and the computer will automatically print out the appropriate reason to the recipient corresponding to the code used.

The statements that are to be computer-printed to the applicant or recipient are listed after each closing code. The Spanish translations are to assist workers in completing FL-4 and Form h1801. The Spanish translation will not be included on the Form H1029 mailed by the State Office.

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Permanent Resident Card And Employment Authorization Document

As of May 1, 2017, the Permanent Resident Card and EADs:

  • display the individuals photos on both sides
  • show a unique graphic image and color palette:
  • Permanent Resident Cards have an image of the Statue of Liberty and a predominately green palette
  • EAD cards have an image of a bald eagle and a predominately red palette
  • have embedded holographic images
  • no longer display the individuals signature and
  • no longer have an optical stripe on the back.
  • Note: Permanent Resident Cards and EADs will remain valid until the expiration date shown on the card. Some older Permanent Resident Cards do not have an expiration date. The older Permanent Resident Cards without an expiration date also remain valid.

    Medicaid For The Elderly & People With Disabilities

    Medicaid for Seniors and Persons with Disabilities (SPD)

    Need Services?

    SNAP, TANF and Lone Star Card Information

    Seniors, adults with disabilities and some children with disabilities who don’t have health insurance might be able to get health coverage through the Medicaid for the Elderly and People with Disabilities program.

    You might be able to get Medicaid even if you’re already on Medicare. If you need help paying your Medicare premiums, click here.

    To learn more about all your options, contact your local Aging and Disability Resource Center or call 2-1-1.

    To get MEPD, you must be a Texas resident and a U.S. citizen or qualified non-citizen. When you apply, we’ll ask about your income, your age, and your disability to see if you qualify.

    MEPD covers health care services, including:

    • Regular checkups at the doctor.
    • Medicine and vaccines.
    • Access to medical specialists and mental health care.
    • Treatment of special health needs and pre-existing conditions.

    MEPD also covers long-term services and supports, including:

    • Home care and personal care, like having someone help monitor your health and help you with daily activities.
    • Having somebody take your child to their medical appointments.
    • Nursing home care.
    • A hospital for mental illnesses.
    • A place of care for people with intellectual disabilities.

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    What Services Does Medicaid Cover For People With Dementia

    Though most Medicaid beneficiaries with dementia are dually eligible for Medicare, Medicare does not cover all of the services, particularly LTSS, that they may need. Medicare is the primary payer for dual eligible beneficiaries, with Medicaid providing wrap-around services and filling in coverage gaps.14 States participating in Medicaid are required to cover certain services and may provide other services at state option.15 Beneficiaries receive services based on medical necessity. Mandatory Medicaid services that may be relevant to people with dementia include inpatient and outpatient hospital services lab and x-ray nursing facility services home health aide services, including durable medical equipment physician services and non-emergency medical transportation. Optional Medicaid services that may be relevant to people with dementia include prescription drugs physical therapy and related services, including speech-language and occupational therapy private duty nursing personal care services hospice case management adult day health care programs and respite services. In addition, the Affordable Care Act offers states a new option, Community First Choice, to provide attendant care services and supports with enhanced federal matching funds as of September 2015, five states offer these services.16

    Text Box 2:Home and Community-Based Services Included in Massachusettsâ Frail Elder Waiver

    Treatment Of Trusts On And After August 11 1993

    Introduction. The Texas Health and Human Services Commission follows §1917 of the Social Security Act ) regarding the treatment of trusts established on or after August 11, 1993, using a person’s assets. The trust provisions apply to a person receiving benefits under a Medicaid-funded program for the elderly and people with disabilities , whether the person is in an institutional or a noninstitutional setting. However, transfer-of-assets provisions apply only to a person in an institutional setting.

    Limited partnerships.

    A limited partnership is a “similar legal device” to a trust. In accordance with the definition of a trust in §1917 of the Social Security Act ), HHSC treats a limited partnership as a trust and applies the provisions of this section to a limited partnership. The general partners of a limited partnership act as trustee, and the limited partners are the equivalent of beneficiaries of an irrevocable trust. To the extent that the general partners can make each limited partner’s ownership interest available to him, that interest is a countable resource and not a transfer of assets. However, a transfer of assets has occurred to the extent that:

    the value of the share of ownership purchased by the limited partner is less than the amount the limited partner invested and

    the general partners cannot make the limited partner’s share available to the limited partner.

    Qualified income trust .

    Characteristics of a QIT are as follows:

    The trust must be irrevocable.

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    Pathways To Full Medicaid Eligibility Based On Old Age Or Disability

    SSI Beneficiaries

    States generally must provide Medicaid to people who receive federal Supplemental Security Income benefits.7 To be eligible for SSI, beneficiaries must have low incomes, limited assets, and an impaired ability to work at a substantial gainful level as a result of old age or significant disability. The SSI federal benefit rate is $750 per month for an individual and $1,125 for a couple8 in 2018,9 which is 74 percent of the federal poverty level . The effective SSI income limit is somewhat higher than 74% FPL in four states, due to state supplemental payments and/or additional income disregards: 80% FPL in Idaho, 83% FPL in New York and Wisconsin, and 87% FPL in Missouri . Box 1 provides more information about disregards. SSI beneficiaries also are subject to an asset limit of $2,000 for an individual and $3,000 for a couple.

    Optional Pathways

    Seniors and people with disabilities up to 100% FPL

    Over 40 percent of states elect the option to expand Medicaid to seniors and people with disabilities whose income exceeds the SSI limit but is below the federal poverty level 12 .13 Eighteen of these states set the income limit at 100% FPL, the federal maximum for this pathway. In the other three states electing this option, the eligibility limit is 80% FPL in Arkansas, 81% FPL in Virginia, and 88% FPL in Florida. Twenty of the 21 states electing this option cover both seniors and people with disabilities, while Arkansas only covers seniors.

    Special Groups Of Former Ssi Recipients

    Elderly, Disabled, Medicaid, ADA Rides

    The pathways for Special Groups of Former SSI Recipientsextend Medicaid coverage to special former SSI/SSP recipients who would continue to be eligible for SSI/SSP if not for receipt of certain Social Security benefits.63 Special former recipients are deemed to be receiving SSI/SSP for Medicaid eligibility purposes however, unlike 1619 participants, they no longer have a current connection to the SSI program . In determining Medicaid eligibility, most states must disregard the applicable Social Security benefit or increases in that benefit from the special former recipient’s countable income. In most instances, 209 states have the option to disregard all, some, or none of the applicable Social Security benefit or increases in that benefit from the special former recipient’s countable income in determining Medicaid eligibility. However, 209 states must provide Medicaid coverage for special former recipients on the same basis as they provide Medicaid coverage for individuals who receive SSI/SSP.

    Recipients of Social Security COLAs After April 1977

    Section 503 of P.L. 94-566 generally requires states to provide Medicaid coverage for individuals who would continue to be eligible for SSI/SSP if not for increases in their Social Security benefits due to COLAs.64 Individuals qualify under this pathway it they

    Disabled Widows Receiving Benefit Increases Under P.L. 98-21

    Disabled Adult Children

    Widows Not Entitled to Medicare Part A

    Recipients of a 1972 Social Security COLA

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    Via A Formal Report Of Change Form

    Form H0025 will be mailed to the applicant or recipient at the new address. If the person contacts the local office to decline the opportunity to register to vote after receipt of Form H0025, mail Form H1350 to obtain the person’s signature. File Form H1350 in the case record when the person returns the form, and retain the form for 22 months.


    • This does not apply to Form H3618-A, Resident Transaction Notice for Designated Vendor Numbers, or Form H0090-I, Notice of Admission, Departure, Readmission or Death of an Applicant/Recipient of Supplemental Security Income and/or Assistance Only in a State Institution, submitted by nursing facilities, intermediate care facilities for persons with mental retardation, or state supported living centers reporting admissions/discharges.
    • As a result of the initiative to integrate application and eligibility determination processes, a face-to-face interview is no longer required in determining eligibility for Medicaid programs within this handbook. See Section B-6100, Face-to-Face and Telephone Interviews.

    Revision 10-2 Effective June 1, 2010

    Applying For Apple Health Coverage

    • Online: Visit
    • Paper application:. Mail the form to the Washington State Department of Social and Health Services : DSHS Community Services Division, P.O. Box 11699, Tacoma, WA 98411-6699.
    • In person: Visit a Community Services Office near you. Visit the DSHS site for locations.
    • Phone: Call DSHS at 1-877-501-2233.

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    Treatment Of Annuities With A Purchase Or Transaction Date On Or After February 8 2006

    This section describes the Texas Health and Human Services Commission’s treatment of nonemployment-related annuities purchased or having a transaction date on or after February 8, 2006. In this section, a nonemployment-related annuity means a revocable or irrevocable annuity a person may purchase to provide income.

    A nonemployment-related annuity is not a countable resource if the annuity:

    is irrevocable

    is nonassignable

    provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made

    is guaranteed to return within the person’s life expectancy at least the person’s principal investment and

    names the state of Texas as the remainder beneficiary in the first position for at least the total amount of Medicaid paid on behalf of a person in an institutionalized setting.

    If a person in an institutionalized setting is married and the spousal impoverishment provisions of §358.413 of this subchapter apply, a nonemployment-related annuity is not a countable resource if the annuity meets the requirements of subsection – of this section and the annuity:

    names the state of Texas as the remainder beneficiary in the first position for at least the total amount of Medicaid paid on behalf of the person in an institutional setting or

    names the state of Texas in the second position if the community spouse or a minor or disabled child is named in the first position.

    uses fair market value to determine the value of the resource and


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