*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: June 1, 2011 |
|
20.25.35 - RSDI and SSI |
Archived: June 1, 2016 (Previous Versions) |
The Social Security Administration (SSA) administers and funds two programs which provide income. Each program has its own purpose and eligibility requirements. The two types are:
l Retirement Survivors Disability Insurance (RSDI).
l Supplemental Security Insurance (SSI).
Whether to exclude or count income from these programs varies by health care program and the client’s living situation. This section explains program rules.
See Social Security Administration Benefits for more detailed information on these programs.
For information on RSDI and SSI for a person using a Long-Term Care (LTC) income calculation, see Long-Term Care (LTC) Income Calculation: Countable Gross Income Determination.
Gross RSDI Benefits - All Programs.
MA Method A, MA Method B, MA-EPD, and Medicare Savings Programs.
Gross RSDI Benefits - All Programs
For all programs, when determining whether to count or exclude an RSDI payment, the amount to consider is the gross amount of the RSDI benefit before any deductions for Medicare premiums.
Example:
Mildred is retired and receives an RSDI check for $683. The Medicare Part B premium amount is deducted prior to Mildred receiving her check.
Action:
Count the amount of the RSDI check and the amount of the Medicare Part B premium, which is the amount to which she is entitled before deductions, as her gross RSDI.
For more information on determining the gross amount of RSDI see Social Security Administration Benefits.
l RSDI.
Count the gross amount of RSDI payments as unearned income to the household.
Reminder: Count the gross amount prior to Medicare premium deductions.
l SSI.
Count the gross amount of SSI benefits as unearned income to the household.
Example:
Lavidia applies for MinnesotaCare. Her husband, Lester, is not eligible for coverage because he has Medicare. Lester receives SSI and Lavidia has earned income.
Action:
Count Lester’s SSI as unearned income and Lavidia’s earned income in the household income total.
MA Method A, MA Method B, MA-EPD, and Medicare Savings Programs
l RSDI.
Count the gross RSDI amount as unearned income except when all or a part is excluded or not counted.
Presume the payment is available to the client unless he or she can demonstrate it is not available. See Availability of Income. Count the gross RSDI when a representative payee receives the payment.
Note: If a representative payee is not making the RSDI available to the client, see Social Security Administration Benefits for steps on contacting SSA.
Specific exceptions to counting RSDI include:
n Exclude RSDI benefits received by or on behalf of children under age 18 who receive MA under the TEFRA option or receive services through the CAC, CADI, BI or DD waivers.
n Disregard all or part of the RSDI benefit when applicable under the following provisions:
m Disabled Adult Child Disregard.
m Disabled Widow and Widower's Disregard.
m Plan to Achieve Self-Support (PASS).
m RSDI Cost of Living (COLA) Disregard.
m Widow and Widower's Disregard.
l SSI.
Exclude the following for the SSI recipient:
Note: 1619(a) and 1619(b) recipients are considered SSI recipients who are automatically eligible without an income determination.
n The SSI benefit. Submit a query to the State Verification and Exchange System (SVES) in MAXIS to verify SSI benefit. Refer to Verification of SSI and RSDI Benefits and POLI/TEMP for more information.
Example:
Keisha applies for MA. Her only income is SSI.
Action:
Exclude Keisha’s SSI income.
n All other income that SSA considers when determining SSI eligibility and benefit amount. Do not require verification of other income that SSA considers when determining SSI eligibility and benefit amount.
Exception: Do not exclude VA Aid and Attendance benefits, and VA unusual medical expense payments.
Example:
Bob is disabled and receives $470 per month SSI. His wife Agnes works part time. SSA considered Agnes' income and assets in determining Bob's SSI benefit. Bob is not eligible for Medicare. Agnes is not elderly, disabled, or blind. They apply for health care coverage.
Action:
Exclude Bob's SSI benefit and Agnes' income to determine MA eligibility for Bob because her income was used to determine Bob’s SSI benefit amount.
n Income the SSI program excludes. Do not require verification of income the SSI program excludes.
Example:
Marcus receives SSI and is an MA enrollee. He reports receiving a one-time VA payment. SSA considers this VA payment to be excluded for SSI.
Action:
Exclude the VA payment for MA.
Exclude the SSI payment when deeming the income of an SSI recipient to a spouse or child. Count all other income of the SSI recipient unless it is excluded for MA.
Example:
Herman and Helen, a married couple, apply for MA. Herman is disabled and receives RSDI and SSI. Helen is employed part time and SSA considered her earnings in determining Herman's SSI eligibility.
Action:
Exclude Herman's SSI, RSDI, and Helen's earnings in determining his eligibility. Exclude Herman's SSI but count his RSDI and Helen's earnings in determining her eligibility.
Example:
Andrew applies for MA for himself and his seven-year old daughter Allana. Andrew is disabled and receives RSDI and SSI. His daughter receives dependent RSDI benefits.
Action:
For Andrew’s eligibility, exclude Andrew's SSI and RSDI. For Allana’s eligibility exclude Andrew's SSI, and count both RSDI payments.
If SSI benefits are suspended for reasons other than lack of disability:
l Consider the SSI recipient’s disability continued for MA.
l Do not exclude other income received during the month(s) of suspension even if it is normally considered in determining the SSI payment.
Note: A recoupment reducing SSI benefits to zero is not considered a suspension. Continue to exclude all other income considered by SSA in determining SSI eligibility and benefit amount before recoupment.
Example:
Gary applies for MA in February. Gary receives SSI and is employed part time. Gary receives $750 monthly earned income. His SSI benefits are suspended for three months beginning in February. His SSI benefits begin again in May but he receives $0 due to a recoupment.
Action:
Count his earned income in determining his eligibility for February, March, and April. Begin excluding the earnings again in May, the month SSI payments resume, even though he receives $0 due to the recoupment.
Garnishment and Other Income Withholdings.
MA Payment of Long-Term Care (LTC) Services.
Social Security Administration (SSA) Benefits.