Pickle People: Medicaid Benefits for Certain Medicare Recipients

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Pickle People Medicaid Benefits for Certain
Medicare Recipients

• James Dean
• Colorado Legal Services

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What We Will Learn About Pickle People

• What is a Pickle Person?
• Why is it important to find Pickle People?
• How do you know a Pickle Person when you see one?
• Some commonly unidentified Pickle Persons

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What Is a Pickle Person?

• A Social Security recipient eligible for Medicaid
  benefits because some of her/his Social Security
  COLAs are not counted because of the Pickle
  Amendment

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The Pickle Amendment

• A 1977 amendment to the Social Security Act named
  after its House sponsor, Claude Pickle
• Restores Medicaid to former SSI recipients who
  would still be eligible for SSI (or OAP) if not
  for Social Security COLA increases

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Why Is It Important to Find Pickle Persons?

• Medicaid benefits for the person
• Prescription costs
• More extensive mental health benefits
• Medicare premiums, co-pays, deductibles
• Medicaid payments to the health care provider
• No one is looking
• Referral sources and many social service techs do
  not recognize Pickle persons

The Pickle person pool increases every year!!
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How Do You Know a Potential Pickle Person When
You See One?

• Current Social Security recipient
• Was both
• entitled to Social Security and
• received SSI (or OAP) in the
  same month sometime since
  1977 (We call this dual
  eligibility)

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How Do You Know an Actual Pickle Person When You
See One . . . ?

• A Potential Pickle person
• who would now be eligible for SSI or OAP
• if you did not count their Social Security COLAs
  from the date dual eligibility ended

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Example of a Pickle Person

• Claudia applied for SSDI and SSI in 1991 while
  hospitalized. Social Security found her
  disabled and she started receiving 407 in SSI
  and Medicaid, in August, 1991. That October she
  received a 2 month retroactive SSDI check and an
  October SSDI check for 523. She then lost SSI
  and Medicaid because her income was over the SSI
  standard.
• Claudia is now 42. Her monthly income is 730 in
  SSDI. Her Medicare wont pay for mental health
  treatment or Zyprexa.

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How Do You Know a Pickle Person When You See One?
Example

• Claudia remembers attending the MH Advocates
  training and thinks What about Pickle?
• Is she a current Social Security recipient? Yes.
• Was she both entitled to Social Security and
  receiving SSI sometime since 1977 (dual
  eligibility)? Yes.
• Would she now be eligible for SSI or OAP if
  Social Security COLAs from the date dual
  eligibility ended were disregarded? How do we
  determine this?

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Determining SSI Eligibility

• Disabled (same standard as for SSDI)-yes
• Countable resources (bank accounts, cash, etc.)
  below 2000-yes
• Countable income below SSI standard of need (564
  in 2004)-??

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Determining Countable Income

• Social Security income
• Current Social Security benefit minus COLAs since
  SSI last ended.
• Approximation from Pickle Eligibility Screen,
  730 x .716523 or
• Actual SSDI benefit when SSI ended, obtained from
  SSA 523
• Minus 20 general disregard 523-20 503

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Claudia is a Pickle!

• Her countable SSDI is 503, which is below this
  years SSI standard of 564.
• She has no countable resources over 2000
• She has no other income

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If Claudia had other income

• If Claudia had earned income, she could disregard
  65 and one half of the remainder for each month,
  plus impairment related work expenses (IRWEs).
• Example A person earning 265 per month without
  any IRWEs would have 100 in countable income
  265-65200 200/2100
• Other unearned income generally is counted in
  full.

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Some Commonly Unidentified Potential Pickle
Persons

• SSDI recipients who received SSI for a few months
  while awaiting their first SSDI check
• SSDI recipients who end a Plan to Achieve Self
  Support (PASS)
• Persons who are getting QMB or SLMB benefits and
  had SSI in the past

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What if you cant be Pickled?

• Medicare cost sharing programs allow for higher
  income and resources, and dont require past SSI.
• But they only help with Medicare costs.

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Qualified Medicare Beneficiary (QMB)

• Income 789 (1050 for two) in 2003, including
  20 disregard. SSI earned income disregards
  apply.
• Resources 4000 (6000 for two)
• QMB pays Medicare part B premium plus co-pays and
  deductibles.

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Special Low Income Medicare Beneficiary (SLMB)  

•  Income 938/1252 in 2003, including 20
  disregard. SSI earned income disregards apply.
• Resources same as for QMB.
• State pays the part B premium only.

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Qualified Individuals (QI 1)

• Income 1051/1404 in 2003, including 20
  disregard. SSI earned income disregards apply.
• Resources same as QMB.
• Pays Medicare premium, but funding is limited.
• (First come first served.)

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Problem One

• 1. Current Social Security Disability benefits of
  850 after 59 Part B premium withheld, with no
  other income. Client is 50 years old, was
  approved for SSDI in March 1987, and lost SSI the
  following month. She has 2300 in her savings
  account. Is she eligible for Medicaid as a
  Pickle?

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Problem Two

• 2. Same facts as above (current Social Security
  Disability benefits of 850 after 59 Part B
  premium, with no other income. Client is 50
  years old, was approved for SSDI in March 1987,
  and lost SSI the following month) except that
  client has 1500 in her bank account and no other
  countable resources. Is she eligible for
  Medicaid as a Pickle?

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Problem Three

• 3. Same facts as 2 (current gross Social
  Security Disability Insurance of 909 client is
  50 years old, was approved for SSDI in March
  1987, and lost SSI the following month client
  has 1500 in her bank account and no other
  countable resources) except that client also has
  earned income of 125 per month. Is she
  eligible for Medicaid as a Pickle?

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Problem Four

• 4. Same facts as 2 (current Social Security
  Disability Insurance of 851 with no other
  income client is 50 years old, was approved for
  SSDI in March 1987, and lost SSI the following
  month client has 1500 in her bank account and
  no other countable resources) except that client
  has earned income of 85. Is she eligible for
  Medicaid as a Pickle?

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Problem Five

• 5. Client is a 66-year-old man receiving 950 in
  SSR with no other income and no resources. He
  first received SSDI in 1984, and lost SSI as a
  result. He started a PASS and received
  SSI/Medicaid in 1985 until 1986. Is he eligible
  for Medicaid as a Pickle?

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Problem Six

• 6. Client is a 63-year-old widower receiving 802
  in SSDI with no other income and no resources.
  He first received SSDI with a small amount of SSI
  in 1976. He stopped receiving SSI in 1991 when
  he married. Is he eligible for Medicaid as a
  Pickle?

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Problem Seven

• 7. How much could the gentleman in 6 earn per
  month and still remain eligible for Medicaid?
  (63-year-old widower receiving 802 in SSDI with
  no other income and no resources. He first
  received SSDI with a small amount of SSI in 1976.
  He stopped receiving SSI in 1991 when he
  married.)

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Questions?
Ooh, Peter Pipers Coming!
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• James Dean
• Colorado Legal Services
• 303-866-9323
• jdean_at_colegalserv.org