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Section 1634 of the
Social Security Act allows states to contract, for a very low administrative
fee,
to have the Social Security Administration determine Medicaid eligibility
automatically, and
simultaneously, while determining SSI eligibility (and, under Section 1616,
they can also contract
to have SSA determine eligibility for, and pay, any state supplements to
SSI). The majority of states
took the 1634 option and they simply mail out Medicaid cards to those SSI
recipients on an
electronically-transmitted list sent to them several times a month by SSA.
States process eligibility
cancellations using the same system when electronically alerted to a loss of
SSI eligibility by SSA.
In these states, only a tiny handful of welfare workers need be assigned to
handle the few Medicaid
problem cases of SSI recipients that may come up because of systems glitches
or other administrative
lapses.
But CT, HI, IL, IN, MN,
MO, ND, NH, OH, OK and VA, in long-forgotten policy decisions made in the
early
1970s, chose to retain some minor Medicaid eligibility rules for the aged,
blind and disabled that are only
very slightly more strict than those of SSI. Therefore, they became
“209(b)” states---where aged, blind and
disabled persons must apply separately (and duplicatively) to state welfare
offices for Medicaid even if they
qualify for SSI ! And AK, ID, KS, NE, NV, OR and UT, while they
accept SSI rules and give Medicaid to
all SSI recipients who separately apply for it at their welfare
offices---again, because of long-forgotten policy
decisions made in the early 1970s--- at last report had still
not signed Section 1634 contracts with SSA for
automatic Medicaid eligibility determinations of SSI recipients. This
means that, as in “209(b)” states, untold
thousands of aged, blind and disabled persons on SSI in these “Title XVI
states” also must apply separately
(and duplicatively) for Medicaid at state welfare offices.
Every month, in both
“209(b)” and “Title XVI” states, thousands of aged, blind and disabled SSI
applicants
and
recipients must be unnecessarily and duplicatively processed for Medicaid
eligibility in welfare offices
at a cost
of untold millions of dollars in wasted personnel and administrative
costs that could be
easily avoided by signing Section 1634 contracts with SSA. States made these
now-outdated eligibility
policy decisions (for which present state eligibility policymakers don’t know the original
rationale) to not
rely on SSA determinations of
Medicaid eligibility for SSI recipients because, in the early 1970s, they
feared losing control of Medicaid eligibility
and costs to the then-new, unfamiliar and untested SSI program.
But in the
over 30 years since then, SSI has
proved reliable and well-administered and state eligibility staff
have
become familiar with it and its rules.
While “209(b)” states
do have some minor eligibility rules for the aged, blind and
disabled that are very
slightly
more strict than those of SSI, the potential, added Medicaid costs of the
few SSI eligibles that
the slightly
stricter “209(b)’ rules currently exclude from Medicaid are surely far,
far less than the multi-
million dollar costs
of maintaining a large, expensive and unnecessarily duplicative Medicaid
eligibility
determination bureaucracy. The rationales for states’ “209(b)” and “Title XVI” status have long
vanished,
along with the state policymakers
who made those now-ineffective and unnecessarily–costly decisions.
Note: Many
states---not only “209(b)” states and “Title XVI” states ,but even some
“1634” states---have
unaccountably failed to use the very inexpensive option offered by Section
1616 of the Act to have SSA
also
determine eligibility for ,and pay out, their state supplements on top of
the basic federal SSI amount
that more liberal states offer to aged, blind and disabled living independently in the
community. (This, too,
probably reflects
no-longer-justified policy decisions from the early 1970s.) Almost all
states do have
specialized state
supplements designed to pay higher-than-normal rents in group homes or
residential
facilities for the disabled or
frail elderly, but--- since these particular supplements necessarily also
require
special placement, care-planning
and social work attention by the adult social services staffs of states’
welfare offices anyway—these kinds of
supplements probably should continue to be paid by states
themselves
(as they largely are now) and not by
SSA. However, this is not true for general,
living-
independently-in-the-community supplements----for these, states
can and should contract to have SSA
do the work, and thereby save themselves
considerable administrative and
eligibility-determination costs.
Data on each state’s
“209(b)”, “1634”, “Title XVI” and “1616” status and contracts regarding
Medicaid and
state
SSI supplements is available in the latest available edition of State
Assistance Programs for SSI
Recipients,
searchable (albeit with some difficulty) on the Office of Policy and
Research pages at
www.ssa.gov .
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