Special Medical is a group of categories that allow clients to continue receiving medical assistance despite their income when specified increases in income are received.  All the categories require client to have received the State Supplemental Payment (SSP) at a specified point but are no longer receiving it because their income has increased.  Keep in mind that only the income from the categories below is disregarded.  The individual must meet the individual resource standard of $2,000.  If the individual starts receiving any other income, it must be counted in re-determining eligibility.

There are several categories in which individuals considered Special Medical can be placed in. This article is specific to the Widows/Widowers and Disabled Widows/Widowers.

• Widows / Widowers– individuals in blind or disabled cases who lose SSP due to receipt of or increase in widow’s / widower’s benefits due to age and work quarters but is not disabled widow’s benefits. The individual must also: be between the ages of 60 and 65, not yet eligible for Medicare, have received SSI prior to age 60, and meets all other factors of eligibility. Medicaid terminates at age 65, or upon entitlement to Medicare.
  • IMS Indicator: B70=D

Scenario:

Kristen Twain is 54 years old. Her husband was receiving $785 in RSDI while she received $290 in RSDI and $100 in SSI. They have each received $41 in SSP for the last 6 years. Her husband died so she is now receiving $785 as a widow’s RSDI benefit, which ended her SSI benefit. She is not on Medicare, is under age 60 and received the SSP benefit for at least the month before the survivor benefit started. She is now eligible for Special Medical under Widow/Widower.

• Disabled Widows / Widowers– individuals in blind or disabled cases who lose eligibility for SSP due to receipt of Disabled Widow’s / Widower’s benefits, received SSA before age 60 to be a Disabled Widow, received SSP month prior to month they began receiving RSDI, and meets all other factors of eligibility. Medicaid terminates at age 65, or upon entitlement to Medicare Part A.
  • IMS Indicator: B70=W
  • BENDEX Screen: SSA number with suffix of W, will change to D upon reaching age 60.

Scenario:

Conway Wagoner is 58 years old and received $300 in SSI. His wife Tammy was 65 and received $875 in RSDI. They both received the SSP for the last three months. She died so now he receives $875 as a survivor benefit, which ended his SSI benefit. He is not on Medicare Part A and received the SSP the month before the survivor benefit started. He is now eligible for Special Medical under Disabled Widow / Widower.

Special medical stays open or closes depending on the category. Pickle Amendment and Disabled Adult Child (DAC) stays open indefinitely. 1619b ends when SDX no longer shows an A, B, or F in Block 40 Medicaid Test Indicator. Widow/Widower and Disabled Widow/Widower end when the client turns 65 or becomes entitled to Medicare, whichever happens first. Policy states Medicare for Widow/Widower but specifies Medicare Part A for Disabled Widow/Widower.