MDHS HEALTH CARE PROGRAMS MANUAL ML 42 JANUARY 2005 PICKLE DISREGARD MinnesotaCare: No provisions. MA: METHOD A: No provisions.
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1 MinnesotaCare: MA: METHOD A: METHOD B: Clients who meet certain conditions are deemed to be receiving SSI benefits for purposes of determining MA eligibility. These clients may apply the Pickle disregard to their income. To be eligible for the Pickle disregard, clients must meet ALL of the following conditions: > Currently receive or be entitled to receive RSDI benefits. > Were eligible for 1619(b) or were eligible for and received SSI, MSA, or 1619(a) benefits while concurrently entitled to or receiving RSDI in any month since April > Lost eligibility for SSI, MSA, 1619(a) or 1619(b) for any reason. 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. 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 open 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 income is over the SSI income standard and he loses SSI benefits beginning July 1. John is eligible for the Pickle disregard because he was entitled to RSDI benefits in June while receiving SSI. When clients eligible for the Pickle disregard have a spouse or parent receiving RSDI, consider the parent or spouse's RSDI income available to the client. Allow the
2 Pickle disregard from the spouse s or parent s RSDI when determining the client s eligibility. Do not allow the Pickle disregard when determining the parent s or spouse s eligibility unless they also meet the Pickle eligibility conditions. Subtract previous cost of living adjustments (COLAs) to determine the RSDI benefit of the client and responsible relative on the more recent of the following dates: > The last month the applicant or enrollee was eligible for 1619(b) or was eligible for and received MSA, 1619(a) or SSI benefits concurrently with RSDI. OR > This is known as the Pickle threshold date. Use the COLA chart below. Divide the client's current gross RSDI benefit by the percentage of the previous year's COLA. (This yields the RSDI level before the last COLA.) Repeat the computation for each RSDI COLA received since the client became ineligible for SSI or MSA (1-05 RSDI increase) = Benefit Before 1-05 COLA (1-04 RSDI increase) = Benefit Before 1-04 COLA (1-03 RSDI increase) = Benefit Before 1-03 COLA (1-02 RSDI increase) = Benefit Before 1-02 COLA (1-01 RSDI increase) = Benefit Before 1-01 COLA (1-00 RSDI increase) = Benefit Before 1-00 COLA Benefit before 1-00 COLA = Benefit Before 1-99 COLA (1-99 RSDI increase) Benefit before 1-99 COLA = Benefit Before 1-98 COLA
3 1.021 (1-98 RSDI increase) Benefit before 1-98 COLA = Benefit before 1-97 COLA (1-97 RSDI increase) Benefit before 1-97 COLA = Benefit before 1-96 COLA (1-96 RSDI increase) Benefit before 1-96 COLA = Benefit before 1-95 COLA (1-95 RSDI increase) Benefit before 1-95 COLA = Benefit before 1-94 COLA (1-94 RSDI increase) Benefit before 1-94 COLA = Benefit before 1-93 COLA (1-93 RSDI increase) Benefit before 1-93 COLA = Benefit before 1-92 COLA (1-92 RSDI increase) Benefit before 1-92 COLA = Benefit before 1-91 COLA (1-91 RSDI increase) Benefit before 1-91 COLA = Benefit before 1-90 COLA (1-90 RSDI increase) Benefit before1-90 COLA = Benefit before 1-89 COLA 1.04 (1-89 RSDI increase) Benefit before 1-89 COLA = Benefit before 1-88 COLA (1-88 RSDI increase) Benefit before 1-88 COLA = Benefit before 1-87 COLA (1-87 RSDI increase) Benefit before 1-87 COLA = Benefit before 1-86 COLA (1-86 RSDI increase) Benefit before 1-86 COLA = Benefit before 1-85 COLA (1-85 RSDI increase)
4 Benefit before 1-85 COLA = Benefit before 1-84 COLA (1-84 RSDI increase) Benefit before 1-84 COLA = Benefit before 7-82 COLA (7-82 RSDI increase) The difference between the current RSDI benefit and the RSDI computed from the COLA chart is the Pickle disregard. Compare the client s net countable income after subtracting all earned and unearned disregards, including the Pickle disregard, to the current year s SSI federal benefit rate (FBR). If income is below the SSI FBR, the client meets the income requirement to be deemed an SSI recipient and is eligible for MA with no spenddown. If net income is over the SSI FBR, determine the current MSA rate that would apply if the client applied for MSA. See the DHS Combined Manual for MSA standards. If the income after subtracting all earned and unearned income disregards including the Pickle disregard is less than the MSA rate, the client meets the income requirement to be deemed an SSI recipient and is eligible for MA with no spenddown. Use the SSI or MSA standard for a couple when married clients live together, and 1 or both of them meet the disability and resource criteria for SSI eligibility. The MSA standard for a client in group residential housing is the group residential housing rate plus the personal needs allowance. Use the MSA standard for a person living with others for an unmarried client who has minor children. In addition to meeting the income requirement, the client must meet an MA basis of eligibility and must be within MA asset limits. If a client is determined eligible for the Pickle disregard in the threshold month, disregard all RSDI COLAs beginning with the 1st COLA received after the threshold month. EXAMPLE: Bart received RSDI and SSI concurrently through July He lost SSI beginning in August July 1997 is the Pickle threshold month. The worker disregards RSDI COLA increases for January 1998 and each year thereafter to determine the amount of the Pickle disregard. After applying the Pickle disregard and all other earned and unearned income disregards, Bart s income is greater than the SSI FBR but less than the MSA benefit rate. Bart
5 is eligible for the Pickle disregard if he continues to meet an MA basis of eligibility and has assets within MA limits. If the client's countable income after applying all earned and unearned income disregards including the Pickle disregard is greater than both SSI or MSA standards, do not apply the Pickle disregard to income when determining eligibility. Determine whether clients potentially eligible for the Pickle disregard become eligible when MSA, SSI, or RSDI standards increase, or when their circumstances change. For MAXIS system instructions, see TEMP manual TE (Entering Pickle Cases). GAMC:
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