TN 26 (07-95)

1140. Situation Where Used:

Alerts individuals who become ineligible for SSI due to title II childhood disability benefits that they may continue to receive Medicaid. We include it on notices to all individuals age 18 or older who become ineligible because of income and who become entitled to, or receive an increase in, their title II child benefits. (This language was automated in May 1995.)

(You) may be receiving Medicaid from (1) . If (you are), (you) may be able to keep
(your) Medicaid coverage under special rules even though (your) SSI payments are stopping. (You) may receive Medicaid under these special rules if all of the following are true:

• (You) are disabled or blind and age 18 or older;

• (You) became disabled or blind before age 22;

• (You no longer receive) SSI because (your) Social Security payments started or increased; AND

• (You meet) the other State rules for Medicaid coverage.

Even if these statements are not true about you,   you may still be able to receive Medicaid under other State rules.

Fill-ins:

1. Choice 1 - (your) State

   Choice 2 - the District of Columbia

   Choice 3 - the Northern Mariana Islands

    

1141. Situation Where Used:

Always follows paragraph 1140. (This language was automated in May 1995.)

To apply for Medicaid, call or visit (1) . If you visit, please bring this letter. If you call, tell them you received a childhood disability Medicaid letter. That will help them answer your questions.

Fill-ins:

1. Choices under paragraph 1144(1).

    

1142. Situation Where Used:

Alerts individuals who become ineligible for SSI due to title II widow(er)s benefits that they may continue to receive Medicaid. We include it on notices to all individuals between age 50 and 65 who become ineligible because of income and who receive title II benefits. This replaced paragraph 1143 in January 1992.

(You) may be receiving Medicaid from (1) . If (you) are, (you) may be able to keep
(your) Medicaid coverage under special rules even though (your) SSI payments are stopping. (You) may receive Medicaid under special rules if all of the following are true:

• (You) are a (2) age 50 through 64;

• (You) no longer receive SSI because of (your) Social Security payments;

• (You) do not have hospital coverage insurance under Medicare; AND

• (You) meet the other State rules for Medicaid.

If these are not true about (you) , (you) may still be able to receive Medicaid under other State rules.

Fill-ins:

1. Choice 1 - (your) State

   Choice 2 - the District of Columbia

   Choice 3 - the Northern Mariana Islands

2. Choice 1 - widow

   Choice 2 - widower

   Choice 3 - surviving divorced spouse

1144. Situation Where Used:

Always follows paragraph 1142.

To apply for Medicaid, call or visit (1) . If you visit, please bring this letter. If you call, tell them you received a widow's or widower's Medicaid letter. That will help them answer your questions.

Fill-ins:

1. Choice 1 - (Alabama) — the State agency which handles eligibility for medical assistance

   Choice 2 - (Alaska) — the district office of the Alaska Division of Public Assistance

   Choice 3 - (Arizona) — the Arizona Health Care Cost Containment System (AHCCCS) Administrator

   Choice 4 - (Arkansas) — the local social services office

   Choice 5 - (California) — the county welfare department

   Choice 6 - (Colorado) — the County Department of Social Services

   Choice 7 - (Connecticut) — the Connecticut State Department of Social Services District Office

   Choice 8 - (Delaware) — the Division of Social Services for the State of Delaware

   Choice 9 - (District of Columbia) — the Department of Human Resources, Income Maintenance Administration, which handles eligibility for medical assistance

   Choice 10 - (Florida) — the State of Florida local Office of Health and Rehabilitation Services

   Choice 11 - (Georgia) — the local Department of Family and Children Services

   Choice 12 - (Hawaii) — the Hawaii Department of Social Services and Housing, Public Welfare Division

   Choice 13 - (Idaho) — the local office of the Idaho Department of Health and Welfare

   Choice 14 - (Illinois) — the State agency which handles that program

   Choice 15 - (Indiana) — the local County Welfare department

   Choice 16 - (Iowa) — the local Department of Human Services Office

   Choice 17 - (Kansas) — the Department of Social and Rehabilitation Services

   Choice 18 - (Kentucky) — the Kentucky Department for Community Based Services

   Choice 19 - (Louisiana) — the parish office of the Louisiana Office of Family Security

   Choice 20 - (Maine) — the nearest State Welfare office

   Choice 21 - (Maryland) — the local Department of Social Services which handles eligibility for medical assistance

   Choice 22 - (Massachusetts other than blind) — the nearest Massachusetts Department of Public Welfare office

   Choice 23 - (Massachusetts blind only) — the Massachusetts Commission for the Blind

   Choice 24 - (Michigan) — the local Department of Social Services

   Choice 25 - (Minnesota) — the County Welfare Department or Social Services Agency

   Choice 26 - (Mississippi) — the Mississippi Medicaid Commission

   Choice 27 - (Missouri) — the local Division of Family Services office

   Choice 28 - (Montana) — the County Welfare Office

   Choice 29 - (Nebraska) — the local office of the Department of Social Services

   Choice 30 - (Nevada) — the Nevada State Welfare Division district office

   Choice 31 - (New Hampshire) — the local Division of Welfare district office

   Choice 32 - (New Jersey) — the local Medicaid office in the area

   Choice 33 - (New Mexico) — the local county Income Support Division office of the Department of Human Services

   Choice 34 - (New York) — the local Social Services District Office

   Choice 35 - (North Carolina) — the local social services office

   Choice 36 - (North Dakota) — the County Social Service Board which handles that program

   Choice 37 - (Ohio) — the County Welfare Department

   Choice 38 - (Oklahoma) — the Oklahoma Department of Institutions, Social and Rehabilitation Services

   Choice 39 - (Oregon) — the local Oregon State Senior and Disabled Services Division

   Choice 40 - (Pennsylvania) — the County Assistance Office

   Choice 41 - (Puerto Rico) — Null

   Choice 42 - (Rhode Island) — the nearest State welfare office

   Choice 43 - (South Carolina) — the local County Department of Social Services

   Choice 44 - (South Dakota) — the local office of the Department of Social Services

   Choice 45 - (Tennessee) — the Tennessee Department of Human Services

   Choice 46 - (Texas) — the Texas Department of Human Resources

   Choice 47 - (Utah) — the local District Office of the Utah State Department of Workforce Services

   Choice 48 - (Vermont) — the Social Welfare District Office serving the town

   Choice 49 - (Virgin Islands) — Null

   Choice 50 - (Virginia) — the local welfare/social service office

   Choice 51 - (Washington) — the local office of the Washington State Department of Social and Health Services

   Choice 52 - (West Virginia) — the local Department of Welfare

   Choice 53 - (Wisconsin) — the County Department of Social Services or Public Welfare

   Choice 54 - (Wyoming) — the County Department of Public Assistance and Social Services

   Choice 55 - (Northern Marina Islands) — the Department of Public Health and Environmental Services

1146. Situation Where Used:

When an applicant or recipient refuses to provide third party liability information.

We cannot decide if (you) are eligible for Medicaid because:

• (You) did not tell us if (you) have insurance or another person available to pay for (your) medical care, or

• (You) told us that (you) have an available source of payment, but would not give us information about it.

   

The Social Security Administration cannot make a decision about Medicaid without this information. However, (you) still may be able to receive Medicaid if (you) apply for it by contacting (1) .

Fill-ins:

1. Choices under paragraph 1144 (1).

1147. Situation Where Used:

Field office refers a case to a State for a Medicaid entitlement determination because it appears that a Medicaid Qualifying Trust is involved. This paragraph tells the recipient to contact the State Medicaid agency for Medicaid entitlement information. Use only for individuals living in States where SSA makes the Medicaid eligibility determination.

We are currently unable to decide if (you) are eligible for Medicaid because (you) may be the beneficiary of a trust or similar legal arrangement that can affect Medicaid.

(1) (2) will decide if the trust or similar legal arrangement affects Medicaid. To find out if (you) can get Medicaid, please contact (3) . If (you) visit that agency, please take this letter with (you) . It will help the people there answer your questions.

1149. Situation Where Used:

When an applicant or recipient refuses to assign rights to payments for medical support from any third party to the State.

We cannot decide whether (you) are eligible for Medicaid because (you) did not agree that the State can collect any money it may be due from (your) insurance or another person who should be paying for (your) medical care.

The Social Security Administration cannot make a decision about Medicaid without (your) agreement about this. However, (you) still may be able to receive Medicaid if (you) apply for it by contacting (1) .

1150. Situation Where Used:

IC: Claimant resides in or moves to a State (or the District of Columbia) for which SSA makes Medicaid determinations; claimant becomes eligible for payment. Two States (Alabama and Louisiana) and the District of Columbia use this paragraph for both award and denial notices.

PE: Recipient moves to a State (or the District of Columbia) for which SSA makes Medicaid determinations; recipient is eligible for Medicaid.

An agency of (1) will advise (you) about the Medicaid program. If (you) have any questions about (your) eligibility for Medicaid or (2) immediate medical assistance, (you) should get in touch with (3) .

1151. Situation Where Used:

IC: Claimant resides in a State in which only the State makes Medicaid determinations.

The application (you) filed with us is not an application for medical assistance — Medicaid. If (you) need medical assistance or (you) have any questions about (your) eligibility for Medicaid, (you) should get in touch with (1) .

1152. Situation Where Used:

PE: Claimant moves to a State for which SSA makes Medicaid determinations and eligibility for payments is suspended or terminated.

For information about any change in (your) Medicaid eligibility caused by this action, (you) should get in touch with (1) .

1154. Situation Where Used:

IC and PE: Claimant/recipient moves to a State that makes its own Medicaid determinations.

The Medicaid program for the State (you) now live in may differ from the State (you) lived in formerly. If (you) have any questions about eligibility for Medicaid or (1) medical assistance, (you) should get in touch with (2) .

1155. Situation Where Used:

NOTE: When a claimant resides in Texas, use Paragraph 1170.

IC and PE: Claimant resides in a State in which SSA makes the Medicaid determinations and is found ineligible.

Since (you) are not receiving Supplemental Security Income payments, (you) are not automatically eligible for medical assistance under the Medicaid program. However, if (you) need help with medical bills, (you) still may be eligible for medical assistance. Contact (1) about the eligibility requirements of the State's medical assistance programs.

1156. Situation Where Used:

When payment is awarded and suspended or suspended and the blind/disabled person is potentially eligible for Medicaid because of earnings (section 1619(b)). Medicaid continues because the field office has not yet made the final 1619(b) decision. This should be the first paragraph under caption 1915, “Information About Medicaid.” Use on an SSA-L8025 (Notice of Award).

(You) may be getting Medicaid from (1) . If (you) are, (you) may be able to keep (your) Medicaid coverage even though (your) SSI checks are stopping.

We will be in touch with (you) soon about (your) Medicaid coverage. In the meantime,
(your) Medicaid coverage should not change until we talk to (you) .

1157. Situation Where Used:

PE: Recipient is suspended. Because the recipient is blind/disabled and has earnings above a certain level, he/she is potentially eligible for Medicaid (section 1619(b)).

If a Federal Medicaid determination State, this paragraph is preceded by caption 1915 and paragraph 1197. If a State determination State, use 1915 and 1198.

This paragraph is used under the caption (1925) “Please Remember This” as a lead-in for paragraphs 1191, 1192, and 1193. The notice also contains caption 1927 and paragraph 1190.

Even though (you) are not getting SSI checks now, you should report any change that might let us start (your) checks again. You also need to report any change that might affect (your) Medicaid coverage. This is a list of some changes you should report.

1158. Situation Where Used:

IC: In award notices (SSA-L8025) with payment suspension for CCM. Used only in States with Federal Medicaid decisions, where the blind/disabled person may be eligible for Medicaid on this basis. Used as lead-in for paragraphs 1191, 1192, and 1193 under caption 1915. The notice also contains caption 1927 and paragraph 1190.

Even though (you) are not getting SSI checks now, (you) do qualify for Medicaid based on SSI rules. For that reason, you need to report any change that might affect (your) Medicaid coverage. You should also report any changes that might let us start (your) checks again. This is a list of some of the changes you should report.

1159. Situation Where Used:

IC: Claimant lives in a State in which the State makes the Medicaid determination. Used in the award notice (SSA-L8025) where payment is suspended for CCM and a blind/disabled person who works is eligible for 1619(b) status, and thus may be eligible for Medicaid. Used with caption 1915, and as lead-in to paragraphs 1191, 1192, and 1193. This notice also contains caption 1927 and paragraph 1190.

Even though (you) are not getting SSI checks now, (you) may qualify for Medicaid based on SSI rules. The people in (1) will make the final decision, and they should be doing this soon. They have to check to see if (you) had Medicaid coverage when (you) were last due SSI checks.

If (you) did, then (your) Medicaid coverage will continue, even though (your) SSI checks have stopped.

Because (you) qualify for Medicaid based on SSI rules, you need to report any change that might affect (your) Medicaid coverage. You should also report any changes that might let us start (your) checks again. This is a list of some changes you should report.

1166. Situation Where Used:

IC: Use this paragraph on award notices for a closed period of SSI eligibility when:

• The claimant resides in a 1634 State;

• Third party liability, assignment of rights and Medicaid qualifying trusts are not issues;

• 1619(b) status does not apply; and

• Paragraphs 1142 and 1144 do not apply.

Since (you) are not eligible now for SSI, (you) are also not eligible now for Medicaid based on SSI. However, if (you) need help with medical bills, (you) may still be eligible for medical assistance. Also, (you) may be eligible for Medicaid for the months we paid you SSI.

Contact (1) for information about (your) State's medical assistance programs and (your) eligibility for Medicaid. When you visit that agency, please take this letter with you. It will help the people there answer your questions.

1167. Situation Where Used:

IC: Use this paragraph on award notices for a closed period of SSI eligibility when:

• The claimant resides in a non-1634 State;

• 1619(b) status does not apply; and

• Paragraphs 1142 and 1144 do not apply.

The application (you) filed with us is not an application for Medicaid. However, if (you) need help with medical bills, (you) may be eligible for medical assistance. Also, (you) may be eligible for Medicaid for the months we paid you SSI.

Contact (1) for information about your State's medical assistance programs and your eligibility for Medicaid. When you visit that agency, please take this letter with you. It will help the people there answer your questions.

1170. Situation Where Used:

IC Denials and PE: Claimant resides in Texas and is found to be ineligible for SSI. This paragraph replaced paragraph 1155 in January 1990 in initial claim and posteligibility suspension situations when a claimant/recipient resides in Texas.

Since (you) are not receiving SSI payments, (you) cannot get Medicaid based on SSI. Usually, people who live in Texas get Medicaid only if they receive SSI payments or Aid to Families with Dependent Children. However, Texas does offer Medicaid to others, such as:

• children with low incomes,

• women who are pregnant,

• people in nursing homes, and

• people who have Medicare Part A and meet certain income and resource rules.

   

Please contact the Texas Department of Human Services if you have any questions about their Medicaid program.

1190. Situation Where Used:

Used with paragraphs 1157 or 1158 or 1159. Use under caption 1927, “We Will Review Your Case.”

Since (1) for Medicaid based on SSI rules, we will review (your) case (2) to see if (you) are still (3) under our rules.

When we do this, we will only look to see if (your) health has improved. We will not consider the amount of (your) earnings when we decide if (you) are still (4) .

1191. Situation Where Used:

Use as the first paragraph under paragraphs 1157, 1158, or 1159.

If (your) income changes, by going up or down, (you) should let us know.

1192. Situation Where Used:

Used as the second paragraph under paragraphs 1157, 1158, or 1159.

If the money, property and other things (you) own increases, please let us know.

1193. Situation Where Used:

Used as the third paragraph under paragraphs 1157, 1158, or 1159.

If (your) address changes, or if other people move either into or out of (your) household, you should let us know.

1195. Situation Where Used:

Under caption 1925 “Please Remember This” when we find ineligibility for 1619(b) because of the use and/or insufficiency test. (Used with paragraph 1199 under caption 1915.)

In the future (1) again for SSI or for Medicaid based on SSI rules. This could happen if one of the following is true.

• (You) meet the rules for getting SSI checks again.

   

  OR

• (You) need more help in paying for (your) medical expenses.

   

If either or both of these things are true, please contact us right away . This is important, because if we can start (your) SSI checks by (2) , (you) will not have to file a new claim.

1197. Situation Where Used:

IC & PE: First paragraph under caption 1915 “Information About Medicaid” when an individual is eligible for 1619(b) status in a State with Federal Medicaid determinations.

(You) will still get Medicaid even though (your) SSI checks have stopped. (Your) coverage will continue because (you) qualify for Medicaid under special SSI rules.

1198. Situation Where Used:

PE: First paragraph under caption 1915 “Information About Medicaid” when an individual is eligible for 1619(b) status in a State with State Medicaid determinations.

(You) may be able to qualify for Medicaid based on SSI rules, even though (your) SSI checks have stopped. The people in (1) will make the final decision, and they should be doing this soon.

The people in (2) have to look to see if (you) had Medicaid coverage when (you) were last due SSI checks. If (you) did, then (your) Medicaid coverage will continue, even though (your) SSI checks have stopped.

1199. Situation Where Used:

IC & PE: First paragraph under caption 1915 “Information About Medicaid” when an individual is ineligible for 1619(b) because the use and/or insufficiency tests are not met. (Used with paragraph 1195 under caption 1925.)

We have decided that (you) are not eligible for Medicaid based on SSI rules. (1)

(2) may be able to help (you) with other kinds of medical assistance. You can contact (3) at any time to see if the people there can help (you) with (your) medical expenses.

2163. Situation Where Used:

Sent to cases when limit on LA-D changed from $25 to $30.

(1) because of a new law. The new law increases the limit on the SSI we can pay someone when:

• They live in a medical care facility, like a hospital or a nursing home,

• Medicaid pays for more than half the cost of their care,

   

  AND

• They have lived there for at least a full month.

   

The new law affects (2) because these facts apply to (you) .

REFERENCES:

1619 Medicaid eligibility, SI 02302.310, Exhibits 1-6