1. (1) Aged, blind or disabled individuals or couples receiving SSI, mandatory state supplements, or only a state supplementary payment under the optional state supplementary program are presumed to have met the financial requirements for medicaid eligibility.

2. (2) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving SSI, the SSI financial requirements which are set forth in 20 CFR Part 416, Subparts J, K and L, will be used to determine whether an individual or couple is eligible with respect to resources and with respect to income. 20 CFR Part 416, Subpart J, contains the SSI criteria for evaluating family relationships; 20 CFR Part 416, Subpart K, for evaluating income, including the income of financially responsible relatives; and 20 CFR Part 416, Subpart L, for evaluating resources, including the resources of financially responsible relatives. The department hereby adopts and incorporates by reference 20 CFR Part 416, Subparts J, K and L. A copy of these federal regulations may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

   1. (a) Notwithstanding the above and in accordance with ARM 37.82.901(2) (b) , (c) , (d) and (e) for purposes of this coverage group:

      1. (i) the increase in OASDI benefits on July 1, 1972, will be excluded from unearned income;
      2. (ii) any cost-of-living increases in OASDI paid under section 215(i) of the Social Security Act after April 1977 will be excluded from unearned income; and
      3. (iii) the January 1, 1984, increase in social security disabled widow's and widower's benefits caused by an elimination factor for individuals who became entitled to said benefits before age 60 will be excluded from unearned income; and
      4. (iv) Title II early widow(er) 's benefits for individuals who meet eligibility criteria at ARM 37.82.901(2) (e) will be excluded from unearned income.

   2. (b) In addition, aged, blind or disabled individuals who would be institutionalized solely because of the income and resources requirements relating to financially responsible relatives will be exempt from those requirements and such individuals will have their eligibility determined on the basis of their own income and resources if the department approves such an exemption. The administrative mechanism for approval of this exemption shall consist of:

      1. (i) The department shall review individual cases.
      2. (ii) The department will accept applications for exemption only from department long term care specialists, and developmental disabilities division area office staff, who must recommend that the income and resources requirements relating to financially responsible relatives not be applied in the particular case.

      3. (iii) The application must justify the exemption by showing that:

         1. (A) The economic burden on the financially responsible relative for the care of the individual is the sole reason that institutionalization of the individual is being pursued. The burden on the financially responsible relative of personally providing care to the individual is not a factor.
         2. (B) Enabling the applicant to be eligible for medicaid on the basis of his own income and resources will result in an individual plan of care for home and community-based services which is feasible and cost-effective as provided in ARM 37.40.1421.
   3. (c) For a disabled widow, disabled widower or disabled surviving divorced spouse receiving social security benefits who is eligible for medicaid as provided in ARM 37.82.901 the social security benefits are excluded from countable income.

3. (3) For individuals and couples under the heading aged, blind or disabled individuals or couples who are not receiving a state supplementary payment under the optional state supplementary program, the optional state supplementary program financial requirements set forth in ARM 37.43.101 through 37.43.104 will be used to determine whether an individual or couple is eligible with respect to resources and with respect to income.

   1. (a) Notwithstanding the above and in accordance with ARM 37.82.901(3) (a) and (b) , for purposes of this coverage group:

      1. (i) the increase in OASDI benefits on July 1, 1972 will be excluded from unearned income; and
      2. (ii) any cost-of-living increases in OASDI paid under section 215(i) of the Social Security Act after April 1977 will be excluded from unearned income.

4. (4) For individuals under the heading individuals who were eligible for medicaid in December 1973, the December 1973 OAA, AB, APTD, or AABD financial requirements will be used to determine whether the individual continues to be eligible with respect to December 1973 medicaid financial criteria. A copy of the December 1973 OAA, AB, APTD, and AABD financial requirements may be obtained from the Department of Public Health and Human Services, Human and Community Services Division, Public Assistance Bureau, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952.

   1. (a) When individuals under this heading must also meet current medicaid financial requirements, as provided in ARM 37.82.901(4) (b) , the SSI financial requirements identified in (2) above apply.

Authorizing statute(s): Sec. 53-2-201, 53-6-113 and 53-6-402, MCA

Implementing statute(s): Sec. 53-2-201, 53-6-101, 53-6-131 and 53-6-402, MCA

History: NEW, 1982 MAR p. 729, Eff. 4/16/82; AMD, 1983 MAR p. 863, Eff. 7/15/83; AMD, 1983 MAR p. 1079, Eff. 8/15/83; AMD, 1987 MAR p. 208, Eff. 2/27/87; AMD, 1988 MAR p. 2231, Eff. 10/14/88; AMD, 1991 MAR p. 1049, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.