A Quick and Easy Method of Screening for Medicaid Eligibility

A Quick and Easy Method of Screening for Medicaid Eligibility under the Pickle Amendment
The Pickle Amendment requires that an individual is to be deemed an SSI recipient (which in many states means automatic Medicaid eligibility) if he or she:
  1. Simultaneously entitled to receive both Social Security [Old Age, Survivors or Disability Insurance (OASDI)] and Supplemental Security Income (SSI) in some month after April 1977;1
  2. Is currently eligible for and receiving OASDI;
  3. Is currently ineligible for SSI; and
  4. Receives income that would qualify him for SSI after deducting all OASDI cost-of-living adjustments (COLA) received since the last month in which he was eligible for both OASDI and SSI.
Screening for Medicaid eligibility under the Pickle Amendment is quick and simple. The screening process will eliminate the great majority of those who are not eligible without the necessity of performing any mathematical calculations. For those who survive the initial screening and for whom mathematical calculations are required, the table below provides a simple formula for performing the necessary calculations.
The screening process is as follows:
Step 1: Ask the person, ?Are you now receiving a Social Security check?? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go on to the next step.
Step 2: Ask the person, ?After April 1977, did you ever get an SSI check at the same time that you got Social Security, or did you get SSI in the month just before your Social Security started?? If the answer is no, the person cannot be Pickle eligible. If the answer is yes, go on to step 3.
Step 3: Ask the person, ?What is the last month in which you received SSI??
Step 4: Look up the month in which the person last received SSI in the following table. Find the percentage that applies to that month. Multiply the present amount of the person?s (and/or spouse?s) Social Security benefits by the applicable percentage.
Step 5: You have just calculated the person?s countable Social Security income under the Pickle Amendment. Add the figure that you have just calculated to any other countable income the person may have. If the resulting total is less than the current SSI income criteria in your state, the person is Pickle eligible, from the standpoint of income, for Medicaid benefits. (The person must still satisfy separate Medicaid resource and non-financial requirements.)
Example
Mrs. Ima Gherkin received both Social Security and SSI checks in 1976-78. However, her SSI was terminated in March 1978 because she started receiving a private pension that, added to her Social Security benefits, raised her income to an amount above the 1978 SSI income limits. There have been gradual increases in her income since 1978. She now receives a Social Security benefit of $1,175 per month, which happens to be the average monthly benefit for retired workers. Her private pension is $253 a month, giving her a total of $1,428 monthly.
In 2011, the income limit for SSI (taking into account a $20 general income disregard) is $694 for an individual ($1,011 for a couple). Thus, Mrs. Gherkin?s income is over twice the applicable SSI income limit of $694, which her state has made the Medicaid limit for the aged, blind or disabled.
You screen Mrs. Gherkin for Pickle eligibility as outlined above. Determining that the last month in which she received both Social Security and SSI was March 1978, you look up that time period in the following table and find the corresponding reduction factor (.282). You multiply Mrs. Gherkin?s current Social Security benefit of $1,175 by that factor, to determine her current countable ?Pickle? income. $1,175 multiplied by .282 = $331 (?Pickled? Social Security income, rounded downward) $331 countable Social Security income + $253 private pension = $584 total countable ?Pickle? income.
Since $584 is less than the current individual SSI income limit (including the standard $20 disregard) of $694, Mrs. Gherkin is eligible for Medicaid, even though she is ineligible for SSI.

Text has been truncated. For full publication text, download document.

Related Content

For almost 50 years, the National Health Law Program has fought to expand access to quality health care to low-income individuals and underserved communities. Today we are pleased to launch a newly designed website for our future work to make health care a reality for all people. Please take time to peruse our new site, and sign up for our email updates to learn about us, watch the work we do, and become engaged.

Continue to site