TN 12 (05-14)

A. Medicaid Information for Region I Boston

1. State of Connecticut

The following describes the State’s Medicaid program:

• Name of Administering State Agency

  HUSKY Health Program - Connecticut

• Medicaid Determinations
  The State makes Medicaid determinations for Supplemental Security Income (SSI) recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions
  SSA does not obtain answers to the questions on unpaid medical expenses and third party coverage.

• Medicaid Referrals
  Refer SSI claimants to the nearest Connecticut State Department of Social Services office for determination of eligibility for Medicaid per local procedures.

2. State of Maine

The following describes the State’s Medicaid program:

• Name of Administering State Agency
  Maine Department of Health and Human Services, Office of MaineCare Services (OMS)

• Medicaid Determinations
  SSA makes Medicaid determinations for SSI recipients. The State makes Medicaid determinations for all other groups.

• Additional Medicaid Questions
  SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage at the initial SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals
  When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the Office of MaineCare Services for determination of eligibility for Medicaid per local procedures.

3. State of Massachusetts

The following describes the State’s Medicaid program:

• Name of Administering State Agency
  Massachusetts’ Executive Office of Health and Human Services (EOHHS), MassHealth

• Medicaid Determinations
  SSA makes Medicaid determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions
  SSA obtains answers to the questions regarding unpaid medical expenses at the initial application and third party coverage at the initial application and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

  Prepare and fax the Massachusetts Medicaid Referral form (MA-R-3/2017) to the MA State Supplement Program (SSP) for all those individuals who require immediate medical assistance and for those whom SSA does not make determinations of eligibility for Medicaid. Fax the Massachusetts Medicaid Referral form (MA-R-1 3/2017) to fax number: 617-886-8198.

4. State of New Hampshire

The following describes the State’s Medicaid program:

• Name of Administering State Agency
  New Hampshire’s Department of Health and Human Services (DHHS)

• Medicaid Determinations
  The State makes Medicaid determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions
  SSA does not obtain answers to the questions on unpaid medical expenses and third party coverage.

• Medicaid Referrals
  Refer SSI claimants to the local Department of Health and Human Services Office for a Medicaid eligibility determination per local procedures.

5. State of Rhode Island

The following describes the State’s Medicaid program:

• Name of Administering State Agency
  Rhode Island’s Executive Office of Health and Human Services (EOHHS)

• Medicaid Determinations

  SSA makes Medicaid determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes Medicaid determinations for all other groups.

• Additional Medicaid Questions

  SSA obtains answers to the questions regarding unpaid medical expenses at the initial application and third party coverage at the initial application and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

  When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the nearest Rhode Island Department of Human Services (DHS) for determination of eligibility for Medicaid per local procedures.

6. State of Vermont

The following describes the State’s Medicaid program:

• Name of Administering State Agency

  Department for Children and Families, Economic Services Division (ESD)

• Medicaid Determinations

  SSA makes Medicaid determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes Medicaid determinations for all other groups.

• Additional Medicaid Questions

  SSA obtains answers to the question regarding third party coverage at the initial application and at all redeterminations. SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

  When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the nearest ESD Office for determination of eligibility for Medicaid per local procedures.

B. Region II New York

1. State of New Jersey

The following describes the State’s Medicaid program:

• Name of Administering State Agency

New Jersey Department of Human Services, Division of Medical Assistance and Health Services

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Medical Assistance Customer Center or New Jersey Department of Human Services for determinations of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. State of New York

The following describes the State’s Medicaid program:

• Name of Administering State Agency

New York Department of Social Services

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local medical assistance agency for determinations of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

C. Region III Philadelphia

1. State of Delaware

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Delaware Health and Social Services

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local medical assistance office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. District of Columbia

The following describes the District of Columbia’s Medicaid program:

• Name of Administering State Agency

District of Columbia Department of Health Care Finance

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The District makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the nearest Economic Security Administration (ESA) Service Center for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

3. State of Maryland

The following describes the State’s Medicaid program

• Name of Administering State Agency

  Maryland Department of Human Resources

• Medicaid Determinations

  SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

  SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

  When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the Local Department of Social Service (LDSS) for determination of eligibility for Medicaid.

4. State of Pennsylvania

The following describes the State’s Medicaid program:

• Name of Administering State Agency

  Pennsylvania Department of Public Welfare

• Medicaid Determinations

  SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

  SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

  When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county assistance office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

5. State of Virginia

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Virginia Department of Social Services

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Social Services office for determination of eligibility for Medicaid per local procedures.

6. State of West Virginia

The following describes the State’s Medicaid program:

• Name of Administering State Agency

West Virginia Department of Health and Human Resources, Bureau for Medical Services

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Health and Human Resources for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

D. Region IV Atlanta

1. State of Alabama

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Alabama Medicaid Agency

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application, and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Medicaid District Office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. State of Florida

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Florida Department of Children and Families

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Children and Families (DCF) for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

3. State of Georgia

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Georgia Department of Community Health, Medical Assistance Plans Division

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Family and Children Services (DFCS) county office for a determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

4. State of Kentucky

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Kentucky Cabinet for Health and Family Services, Department of Medicaid Services

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department for Community Based Services (DCBS) for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

5. State of Mississippi

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Mississippi Division of Medicaid

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement beginning July 1, 1981. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Medicaid office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

6. State of North Carolina

The following describes the State’s Medicaid program:

• Name of Administering State Agency

North Carolina Department of Health and Human Services

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department of Social Services (DSS) for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

• Field Office Instructions

  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

7. State of South Carolina

The following describes the State’s Medicaid program:

• Name of Administering State Agency

South Carolina Healthy Connections

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Healthy Connections County Offices for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

8. State of Tennessee

The following describes the State’s Medicaid program:

• Name of Administering State Agency

TennCare

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department of Human Services for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

E. Region V — Chicago

1. State of Illinois

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Illinois Department of Healthcare and Family Services (HFS)

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Human Services office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. State of Indiana

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Indiana Family & Social Services Administration (FSSA)

• Medicaid Determination

Effective June 1, 2014, SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

Effective June 1, 2014, SSA obtains answers to the question regarding third party coverage on the application and at all redeterminations. SSA does not obtain answers to the question regarding unpaid medical expenses.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Division of Family Resources (DFR) for a Medicaid eligibility determination. Refer to regional Supplements for any additional referral instructions.

3. State of Michigan

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Michigan Department of Community Health (MDCH)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Community Health office for determination of Medicaid eligibility. Refer to regional supplements for any additional referral instructions.

4. State of Minnesota

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Minnesota Department of Health

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local county Human Services Agency for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

5. State of Ohio

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Ohio Department of Medicaid (ODM)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department of Job and Family Services. Refer to regional supplements for any additional referral instructions.

6. State of Wisconsin

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Wisconsin Department of Health Services

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department of Health Services office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

F. Region VI Dallas

1. State of Arkansas

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Arkansas Medicaid, Department of Human Services (DHS)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the Department of Human Services, Arkansas Division of Medical Services for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

2. State of Louisiana

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Louisiana Department of Health and Hospitals (DHH)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to any Medicaid Application Center in the local parish for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

3. State of New Mexico

The following describes the State’s Medicaid program:

• Name of Administering State Agency

New Mexico Department of Human Services (HSD)

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Human Services office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

4. State of Oklahoma

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Oklahoma Department of Human Services (OKDHS), SoonerCare,

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local OKDHS Human Services Center for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

5. State of Texas

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Texas Health and Human Services Commission

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Texas Health and Human Services Commission office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

G. Region VII Kansas City

1. State of Iowa

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Iowa Department of Human Services, Iowa Medicaid Enterprise (IME)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Human Services Office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

2. State of Kansas

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Kansas Department of Health and Environment

• Medicaid Determinations

The State makes determinations for SSI recipients and recipients of the mandatory State supplement utilizing title XVI criteria.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local medical assistance office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

3. State of Missouri

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Missouri Department of Social Services, MO HealthNet Division

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referral

Refer SSI claimants to the local Department of Social Services office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

4. State of Nebraska

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Nebraska Department of Health and Human Services

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referral

Refer SSI claimants to the local Department of Health and Human Services office for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

H. Region VIII Denver

1. State of Colorado

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Colorado Department of Human Resources (CDHS)

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Department of Human Services.

2. State of Montana

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Montana Department of Public Health and Human Services (DPHHS)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the question regarding third party coverage and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local county Office of Public Assistance for a Medicaid eligibility determination. Refer to regional supplements for any additional referral instructions.

3. State of North Dakota

The following describes the State’s Medicaid program:

• Name of Administering State Agency

North Dakota Department of Human Services

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local county Social Services Office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

4. State of South Dakota

The following describes the State’s Medicaid program:

• Name of Administering State Agency

South Dakota Department of Social Services, Division of Economic Assistance

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of the mandatory State supplement. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department of Social Services office for Medicaid eligibility determination.

5. State of Utah

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Utah Department of Health

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Workforce Services (DWS) for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

6. State of Wyoming

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Wyoming Department of Health

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the Wyoming Department of Health for determination of eligibility for Medicaid.

I. Region IX San Francisco

The following describes the State’s Medicaid program:

1. State of Arizona

• Name of Administering State Agency

Arizona Health Care Cost Containment System (AHCCCS )

• Medicaid Determinations

SSA makes determinations for SSI recipients. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding third party coverage on the SSI application and at all redeterminations. Effective February 1, 2014, we also obtain answers to the question regarding unpaid medical expenses.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the AHCCCS agency for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. State of California

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Department of Health Care Services, Medi-Cal

• Medicaid (Medi-Cal) Determinations

SSA makes determinations for SSI recipients and recipients of mandatory minimum and optional State supplementary payments. The State makes determinations for all other groups.

• Additional Medicaid (Medi-Cal) Questions

SSA obtains answers to the question regarding third party coverage on the SSI application and at all redeterminations.

SSA does not obtain answers to the question regarding unpaid medical expenses. (See “Medicaid (Medi-Cal) Referrals” below.)

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid (Medi-Cal) Referrals

While SSA is not required to ask the question regarding unpaid medical expenses on behalf of the State, SSA should tell claimants that the Medicaid (Medi-Cal) program may pay for unpaid medical expenses and refer them to the Medicaid (Medi-Cal) office.

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the Department of Health Care Services office for determination of eligibility for Medicaid (Medi-Cal). Refer to regional supplements for any additional referral instructions.

3. State of Hawaii

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Hawaii Department of Human Services, Med-Quest Division

• Medicaid Determinations

The State makes determinations for SSI recipients and recipients of mandatory minimum and optional State supplementary payments utilizing more restrictive criteria than title XVI.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Human Services for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

4. State of Nevada

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Nevada Department of Health and Human Services

• Medicaid Determinations

The State makes determinations for SSI recipients and recipients of mandatory and optional State supplementary payments utilizing title XVI criteria.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Health and Human Services office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

J. Region X Seattle

The following describes the State’s Medicaid program:

1. State of Alaska

• Name of Administering State Agency

Alaska Department of Health and Social Services

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing title XVI criteria.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medical Referrals

Refer all SSI claimants to the district office of the local District Public Assistance office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

2. State of Idaho

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Idaho Department of Health and Welfare

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing title XVI criteria.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Health and Welfare regional office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

3. State of Oregon

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Oregon Department of Human Services, Oregon Health Plan (OHP)

• Medicaid Determinations

The State makes determinations for SSI recipients utilizing title XVI criteria.

• Additional Medicaid Questions

SSA does not obtain answers to the questions regarding unpaid medical expenses and third party coverage.

• Medicaid Referrals

Refer SSI claimants to the local Department of Public Assistance office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

4. State of Washington

The following describes the State’s Medicaid program:

• Name of Administering State Agency

Washington Health Care Authority, Apple Health (Medicaid)

• Medicaid Determinations

SSA makes determinations for SSI recipients and recipients of mandatory and optional State supplements. The State makes determinations for all other groups.

• Additional Medicaid Questions

SSA obtains answers to the questions regarding unpaid medical expenses and third party coverage on the SSI application, and at all redeterminations.

• Field Office Instructions
  Provide the following information to the SSI claimants:

  1. Their SSI applications serve also as applications for Medicaid;

  2. They will receive notice regarding their Medicaid eligibility from the State; and

  3. A denial of their SSI claim does not necessarily preclude Medicaid eligibility if they can meet the requirements of any Medicaid coverage group.

• Medicaid Referrals

When SSA does not make determinations of eligibility for Medicaid, refer those SSI claimants to the local Department Health Care Authority office for determination of eligibility for Medicaid. Refer to regional supplements for any additional referral instructions.

K. References

• GN 03314.155 Automated Data Exchanges Between SSA and State Agencies

• SI 01730.045 Third Party Liability

• SI 01715.010 Medicaid and the SSI Program

• SI 01730.010 Determinations of Medicaid Eligibility

• MSOM MSSICS 019.012 Health Expenses (BHLT)