5160:1-3-02.3 Medicaid: grandfathering provisions resulting from the implementation of the supplemental security income (SSI) program.  

  • Text Box: ACTION: Final Text Box: DATE: 07/12/2016 1:15 PM

     

     

     

    TO BE RESCINDED

     

    5160:1-3-02.3              Medicaid: grandfathering provisions resulting from the implementation of the supplemental security income (SSI) program.

     

     

     

    (A)   With the implementation of the SSI program in January 1974, various grandfathering provisions were enacted to assure that aged, blind, and disabled persons previously eligible for cash assistance and medicaid under the former programs of aid would not be disadvantaged by the new eligibility conditions under the SSI program.

     

    (B)   "Cash assistance," for the purpose of this rule, means the receipt of at least one of the following: Ohio works first (OWF), supplemental security income (SSI) or residential state supplement (RSS), or the former programs of aid known as aid for dependent children (ADC), aid for the aged (AFA), aid for the blind (AFB), and aid for the disabled (AFD).

     

    (C)   Under the grandfathering provisions, certain persons who were eligible for medicaid in December 1973 are entitled to continued medicaid eligibility coverage even though they may not meet the medicaid eligibility requirements imposed beginning in January 1974 for the coverage of the aged, blind, and disabled.

     

    (1)  The grandfathered groups are the following:

     

    (a)    An individual who is the recipient of mandatory supplement payments administered by the social security administration is automatically eligible for medicaid.

     

    (b)   Any individual who was eligible in December 1973 as a dependent spouse remains eligible as long as the dependent spouse continues to be the spouse of and lives with the former cash assistance recipient of AFA, AFB, or AFD, and if the dependent spouse's needs were considered in determining the amount of assistance payable to the recipient in December 1973. The dependent spouse must meet all other requirements for medicaid except limiting physical factor.

     

    (c)    An individual who was eligible for medicaid in December 1973 because the individual met the definition of blindness or disability in effect under the former programs of AFB or AFD remains eligible for medicaid under the following criteria:

     

    (i)   The individual meets all current requirements for medicaid eligibility except for blindness or disability; and

     

     

     

    (ii)   The individual was eligible for medicaid in December 1973 as blind or disabled, whether or not the individual received cash assistance in December 1973; and

    (iii)    For each consecutive month after December 1973, the individual has continued to meet the December 1973 criteria for blindness or disability; and

    (iv)    For each consecutive month after December 1973, the individual has continued to meet all other eligibility requirements which were in effect December 1973.

    (d)    Individuals eligible despite the October 1972 twenty per cent general increase in RSDI:

    (i)     An individual who would currently be eligible for SSI or cash assistance except for the amount of increased income resulting from the October 1972 twenty per cent general increase in RSDI is eligible for medicaid if, for the month of August 1972, the individual met the following criteria:

    (a)   The individual was eligible for and receiving cash assistance under the ADC, AFA, AFB, or AFD programs, and

    (b)       The individual received and was entitled to monthly retirement, survivors and disability insurance (RSDI) benefits.

    (ii)       Only the October 1972 RSDI increase is disregarded. Any subsequent increases in RSDI are not disregarded.

    (iii)      Although the amount of the October 1972 RSDI increase is disregarded in determining financial eligibility, the individual must meet all of the current eligibility requirements for medicaid or the ADC eligibility requirements which were in effect on July 16, 1996.

    (e)   An individual who was eligible for medicaid in December 1973 because the individual was an inpatient or resident of a Title XIX institution, and who would have been eligible for cash assistance if not in the institution, is entitled to continued medicaid as long as the individual

    continues  to meet the medicaid eligibility requirements in effect in December 1973 and continues to require institutional care.

    (2)   Failure to meet any one of the conditions listed in paragraph (C)(1) of this rule renders the individual ineligible under the blind or disabled grandfathering provisions.

    (3)    A blind or disabled grandfathered individual permanently loses grandfathered status when the individual fails to meet any December 1973 eligibility requirement for any one month.

    (4)    Any change in circumstances requires a redetermination of eligibility based upon all the conditions set forth in paragraph (C)(1) of this rule.

    Effective:                                                             08/01/2016

    Five Year Review (FYR) Dates:                         04/15/2016

    CERTIFIED ELECTRONICALLY

    Certification

    07/12/2016

    Date

    Promulgated Under:                           111.15

    Statutory Authority:                           5160.02, 5163.02

    Rule Amplifies:                                  5160.02, 5163.02

    Prior Effective Dates:                         9/3/77, 10/26/78. 5/1/79, 9/21/79, 2/7/80, 10/15/98,

    10/1/02

Document Information

Effective Date:
8/1/2016
File Date:
2016-07-12
Last Day in Effect:
2016-08-01
Five Year Review:
Yes
Rule File:
5160$1-3-02$3_FF_R_RU_20160712_1315.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 5160:1-3-02.3. Medicaid: grandfathering provisions resulting from the implementation of the supplemental security income (SSI) program