*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: December 1, 2006 |
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03.30.15.05 - Medical Assistance (MA) for Special Category: Disabled Children |
Archived: June 1, 2016 |
Children who lost Supplemental Security Income (SSI) payments due to changes in childhood disability criteria under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) are eligible for Medical Assistance (MA) under a special category. Children are eligible under this category if they meet all of the following conditions:
l Are under age 18.
l Were receiving SSI payments on August 22, 1996.
l Were terminated from SSI solely due to an inability to meet the new, more restrictive SSI childhood disability criteria.
l Continue to meet the childhood disability criteria in effect before PRWORA.
The Social Security Administration (SSA) initially determined disability for these children. The State Medical Review Team (SMRT) must redetermine the disability, using the criteria above, at the time of renewal or application.
Note: Most of these children should have already been identified and determined eligible under this special category during the late 1990s.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Follow the disabled guidelines.
Follow standard MA guidelines.
Renewals (standard guidelines)
Follow standard MA guidelines.
SMRT will certify these children as eligible under this category for one to seven years depending on the disability determination. When a child's disability under this category must be recertified by SMRT:
l Submit a Determination of Disability form (DHS-1467A).
l Identify the child as eligible under the special category of MA children in the comments section of the Determination of Disability form.
See SMRT disability determinations for more information on this process.
Social Security Number (standard guidelines)
Follow MA guidelines for Children Under 21.
Follow standard MA guidelines.
Follow standard MA guidelines.
Follow standard MA guidelines.
Household Composition (standard guidelines)
Count only the income of the child and use a household size of one. Do not deem parental income.
Exception: If a disabled child eligible under this special category lives with a spouse, use a household size of two and deem the spouse's income. If the disabled child has children who live in the home, count them in the household size as well.
Use Method B for income.
There is no asset limit for children under 21, regardless of their basis of eligibility.
The income limit is 100% FPG.
Deductions/Disregards (standard guidelines)
Use the following Method B deductions in the order given:
1. Income used to fulfill an approved Plan to Achieve Self Support (PASS) for disabled or blind people.
2. Earned income disregard for blind or disabled student children.
3. The first $65 of earned income disregard.
4. Work expense deduction for disabled clients.
5. One-half the remaining earned income.
Spenddowns (standard guidelines)
Children with incomes over 100% FPG may be eligible by spending down to 75% FPG.
Follow MA guidelines for Children Under 21.
Service Delivery (Prepaid MHCP Manual)
People under age 65 who are eligible for MA due to blindness or disability are excluded from managed care enrollment.
Note: People under age 65 who are certified as disabled or blind but who choose another basis of eligibility may voluntarily enroll.
Not applicable.
If SMRT determines the child no longer meets the pre-PRWORA disability criteria, redetermine the child’s eligibility under another basis.
Not applicable.
Children who are certified disabled may also be eligible as children under 21. See Multiple Bases of Eligibility.
Example:
David’s SSI benefits ended because he was no longer considered disabled after the changes in disability criteria under PRWORA. David’s mother is now applying for MA for herself and David. Even though David may qualify for MA under the special category of disabled children, he chooses a children under 21 basis.
Action:
Approve MA for David under a children under 21 basis of eligibility. If he later becomes ineligible for MA without a spenddown, redetermine David’s MA eligibility under another basis. He may remain eligible for MA under the special category for disabled children if he meets all other eligibility factors.