Screening for Medicaid Eligibility Under the Pickle Amendment

A Quick and Easy Method of Screening for
Medicaid Eligibility Under the Pickle Amendment

by Gordon Bonnyman Jr., Executive Director, Tennessee Justice Center

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. Is simultaneously entitled to receive both social security (Old Age, Survivors, or Disability Insurance (OASDI)) and 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 the individual for SSI after deducting all OASDI cost-of-living adjustments (COLA) received since the last month in which the individual 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 individual 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 individual, “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 individual must still satisfy separate Medicaid resource and nonfinancial 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 $1,079 per month, which happens to be the average monthly benefit for retired workers. Her private pension is $275 a month, for a combined total of $1,354 monthly.

In 2008, the income limit for SSI (taking into account a $20 general income disregard) is $657 for an individual. Thus, Mrs. Gherkin’s income is over twice the SSI income limit, which her state has adopted as the Medicaid limit for persons who are 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 (.299). You multiply Mrs. Gherkin’s current Social Security benefit of $1,079 by that factor, to determine her current countable “Pickle” income.

$1,079 multiplied by .299 = $322 (“Pickled” social security income, rounded downward)

$322 countable social security income + $275 private pension = $597 total countable “Pickle” income.

Since $597 is less than the current SSI income limit (including the standard $20 disregard) of $657, Mrs. Gherkin is eligible for Medicaid, even though she is ineligible for SSI.

Reduction Factors for Calculating Medicaid Eligibility Under the Pickle Amendment During 2008

If the last month in which an individual received SSI while, or immediately prior to, receiving social security was in any of the periods below, multiply the present amount of her social security by the corresponding index:/2/

1. The individual need not literally receive both Supplemental Security Insurance (SSI) and social security checks in the same month but need only be entitled to both for the same month. There is a one-month lag in OASDI payments, which are not disbursed until the month after entitlement, while SSI payments are paid in the month of entitlement. It is common for a person to receive SSI while awaiting receipt of OASDI payments. Once her monthly OASDI begins, if it exceeds the SSI rate, she receives just OASDI thereafter. In such circumstances, even though the person never actually received simultaneously payments from both programs in a single month, she meets the first Pickle requirement. This is true even if income from a retroactive OASDI payment exceeds the SSI benefit level for all months in which SSI was received. For this reason, you should ask not only whether the individual received both SSI and social security in the same month but also whether the individual received SSI immediately before the individual’s social security payments began. See 42 C.F.R. § 435.135; 51 Fed. Reg. 12326 (Apr. 10, 1986). For more information, see my Medicaid Eligibility in a Time Warp, 22 Clearinghouse Review 120 (June 1988).

2. Due to social security’s rounding rules, the adjustment factors in the table result in an approximate, rather than exact, figure. Because a discrepancy of one cent may mean the difference between Medicaid eligibility as a Pickle case and no meaningful access to health care, advocates should obtain exact information from the Social Security Administration if the figure resulting from the screening method determines that the client is over the eligibility limit by a small amount (i.e., $20 or less).