9514.1 This section shall govern eligibility requirements for the following:

1. (a) The Supplemental Security Income (SSI) eligibility group pursuant to 42 CFR § 435.120; and
2. (b) The Optional State Supplemental Payment (OSP) eligibility group pursuant to § 1902(a)(10)(A)(ii)(IV) of the Social Security Act (the Act) and 42 CFR § 435.232.

9514.2 Consistent with the requirements of 42 CFR § 435.120, the SSI eligibility group shall include aged, blind, and disabled individuals or couples who are receiving or are deemed to be receiving SSI by the U.S. Social Security Administration (SSA), which includes individuals who are:

1. (a) Receiving SSI pending a final determination of blindness or disability;
2. (b) Receiving SSI under an agreement with SSA to dispose of resources that exceed the SSI dollar limits on resources; or
3. (c) Receiving benefits under § 1619(a) of the Act or in § 1619(b) status (blind individuals or those with disabling impairments whose income equals or exceeds a specific Supplemental Security Income limit), and those qualified severely impaired individuals defined in § 1905(q) of the Act.

9514.3 Aged, blind, and disabled shall have the same meanings as set forth under § 1614 of the Act.

9514.4 In order to be eligible for Medicaid under the OSP eligibility group, individuals and couples shall meet the following requirements:

1. (a) Be deemed eligible for SSI by SSA or meet SSI disability standards set forth by SSA, consistent with 20 CFR §§ 416.2101 through 416.2176; and
2. (b) Reside in an adult foster care setting, as described in 20 CFR § 416.1143(a)(1), that is located in the District of Columbia.

9514.5 SSA shall be responsible for conducting renewals and redeterminations in accordance with SSA's requirements for beneficiaries' continued receipt of SSI and OSP payments from SSA. The Department shall continue to deem beneficiaries with continued eligibility for SSI and OSP payments eligible for Medicaid.

9514.6 The Department shall make eligibility for Medicaid for SSI and OSP applicants effective no later than the third month before the month of application if the following requirements are met:

(a) The applicant received Medicaid services, at any time during that period, of a type covered under the District of Columbia's Medicaid State Plan; and

(b) The applicant would have been eligible for Medicaid at the time the applicant received the services if the applicant had applied (or someone had applied for the applicant), regardless of whether the individual is alive when application for Medicaid is made.

9514.7 The earliest possible date for retroactive eligibility shall be the first day of the third month preceding the month of application.

9514.8 Eligibility for Medicaid shall include meeting all financial, non-financial, and medical factors (as applicable).

SOURCE: Final Rulemaking published at 65 DCR 6841 (June 22, 2018).