*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: April 1, 2009 |
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21.50.15 - Pickle Disregard |
Archived: June 1, 2016 (Previous Versions) |
The Pickle Disregard is a disregard of the RSDI COLA amounts. This disregard is only available for MA Method B and the Medicare Savings Programs. Clients who qualify for the Pickle Disregard are treated like SSI recipients for purposes of determining MA eligibility. They will not have a spenddown.
Follow the steps to determine if the client qualifies to use the Pickle Disregard.
Step 2 - Pickle Threshold Date.
Step 3 - Determining Threshold Date RSDI Amount.
Step 4 - Determine the Pickle Disregard Amount.
Step 5 - Qualification for Pickle Disregard.
Applying the Pickle Disregard.
Clients must meet all of the following conditions to determine if the Pickle Disregard can be used:
l Currently receive or be entitled to receive benefits.
Remember: Clients may be entitled to but not actually receive RSDI benefits for the month for which RSDI eligibility is approved. RSDI benefits are paid in the month following the month they cover.
l Were eligible for 1619(b) or were eligible for and received , or 1619(a) benefits while concurrently entitled to or receiving RSDI in any month since April 1977.
Remember: Entitlement to RSDI in a month in which the enrollee received SSI, MSA or 1619(a) or was eligible for 1619(b) qualifies the individual for the Pickle disregard.
Example:
John is active on MA and received SSI in June. Effective June 1, John became entitled to RSDI benefits. He received his first RSDI check in July for June. Because John was entitled to RSDI on June 1, SSA determines that John's RSDI income is over the SSI income standard and he loses SSI benefits beginning July 1.
Action:
John has met the conditions for the Pickle Disregard because he was entitled to RSDI benefits in June while receiving SSI.
l Lost eligibility for SSI, MSA, 1619(a) or 1619(b) for any reason.
People who meet the conditions are often referred to as ”potential pickles.” It is important to note in case notes if a client meets the conditions and is a ”potential pickle.”
Step 2 - Pickle Threshold Date
The second step to determine if a client qualifies to use the Pickle Disregard is to determine the Pickle threshold date.
The Pickle threshold date is the more recent of the following two dates:
l April 1, 1977.
l The last month the client was eligible for and received at least one of the following benefits concurrently with receipt of RSDI benefits or entitlement to RSDI benefits:
n 1619(b).
n MSA.
n 1619(a).
n SSI benefits.
Step 3 - Determining Threshold Date RSDI Amount
The next step, after determining the Pickle threshold date, is to determine the amount of the RSDI benefit the client received on the threshold date.
Note: Determine the threshold RSDI amount based on the client’s threshold date for RSDI that is deemed from another household member (spouse or parent) to the Pickle eligible client. Do not allow the Pickle disregard when determining the parent's or spouse's eligibility unless they also meet the Pickle eligibility conditions.
To determine the threshold RSDI amount, subtract the previous cost of living adjustments (COLA) the client received back to the threshold date.
MAXIS can do this calculation. Find the COLA amounts on the Pickle Disregard COLA Chart.
Exception: MAXIS cannot do the calculation if the Pickle Threshold Date is prior to July 1, 1982; a work-around must be used. MAXIS will calculate the threshold RSDI amount back to July 1, 1982. Use the Pickle Disregard COLA Chart to calculate the threshold RSDI amount for any years prior to July 1, 1982 and add that to the amount calculated by MAXIS. If the client is Pickle eligible (coded ’1’ on PDED) FIAT the correct disregard amount on BBUD.
Step 4 - Determine the Pickle Disregard Amount
To determine the amount of the Pickle Disregard, subtract the threshold RSDI amount calculated in Step 3 from the client’s current RSDI amount.
Note: If the client’s spouse or parent has RSDI and a threshold RSDI amount was determined for their RSDI in Step 3, be sure to determine the difference between their current RSDI and their threshold RSDI amount. Add the difference to the client’s Pickle Disregard to have a total Pickle Disregard.
Step 5 - Qualification for Pickle Disregard
The fifth step in the Pickle process is to determine if the client meets the income requirement to qualify to be considered as if they are an SSI recipient and be eligible for MA without a spenddown.
To qualify as an SSI recipient, for Pickle Disregard purposes, complete the following steps:
a. Determine the client’s current net income. Be sure to deem income as appropriate and subtract all earned and unearned disregards, including the Pickle Disregard amount.
b. Compare the net income to the SSI payment amount (SSI federal benefit rate (FBR)).
i. If the income is less than the SSI FBR the client is qualified to use the Pickle Disregard and will not have a spenddown.
ii. If the income is higher than the SSI FBR, continue to Step c.
c. Compare the net income to the current MSA standard that would apply if the client applied for MSA. See the DHS Combined Manual for MSA standards.
i. If the income is less than the MSA standard the client is qualified to use the Pickle Disregard and will not have a spenddown.
ii. If the income is greater than that MSA standard the client is not eligible for the Pickle Disregard, but does remain a ”potential pickle.”
Apply the Pickle Disregard amount calculated in Step 4 to the client’s income calculation. The client will always be a ”potential pickle” as long as he or she continues to receive RSDI. At each renewal, repeat Steps 4 and 5 to determine the amount of the Pickle Disregard and whether or not it applies (the Pickle Threshold Date and the Threshold Date RSDI Amount will not change).
Remember: Use current RSDI amounts in the income calculation for eligibility.