413.00Supplemental Security Income Medical  Assistance Only (SSI MAO)

 

A. General  Description

 

The  SSI Medical Assistance Only (SSI MAO) program is for customers who are  age 65 or older, blind, or disabled and do not receive SSI cash.

 

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B. Who Determines  Eligibility?

 

The  AHCCCS SSI MAO Office determines eligibility for:

• SSI Non-cash;
• Disabled Child (DC);
• Disabled Adult Child (DAC);
• Disabled Widow Widower (DWW); and
• Pickle.

 

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C. General  Conditions of Eligibility

 

The  general conditions of eligibility applicable to SSI Non-cash, Disabled  Adult Child (DAC), Disabled Child (DC), Disabled Widow Widower (DWW),  and Pickle are:

• Valid application (MS 533.00);
• Categorical element (age 65 years or older (MS 503.00), blind (MS 505.00), or disabled (MS 511.00));
• Does not receive SSI cash payment;
• Cooperate in providing information needed for eligibility determination (MS510.00);
• Resident of Arizona (MS 529.00);
• Social Security Number (MS 531.00);
• U.S.citizenship (MS 508.00) or appropriate non-citizen status (MS 522.00)
• Not in a Penal Institution (MS 523.00);
• Apply for potential benefits (MS 524.00); and
• Assignment of rights to medical benefits and cooperation (MS 504.00).

 

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D. Special  Conditions of Eligibility

 

In addition to meeting the general conditions  of eligibility listed above, the special conditions of eligibility for  SSI Non-cash, Disabled Adult Child (DAC), Disabled Child (DC), Disabled  Widow Widower (DWW), and Pickle are listed below:

 

IF the customer…	THEN the customer qualifies under…
Has countable income less than or equal to 100% of the FPL.	SSI Non-cash
Is under age 18 (MS 502.00); Received SSI Cash as a child before 8/22/96 (MS527.00); Continues to meet disability requirements established as of 8/22/96 (MS 511.00); and Has countable income less than or equal to 100% of the Federal Benefit Rate (FBR) (MS 621.00).	Disabled Child (DC)
Is over age 18 (MS 502.00); Received SSI Cash in the past; Became ineligible for SSI-Cash on or after July 1, 1987, due to entitlement to or an increase in Title II (SSA) payments as a disabled adult child (MS 527.00); The WTPY shows a “C” claim number that is either credited or not credited; and Has countable income less than or equal to 100% of the Federal Benefit Rate (FBR) (MS 621.00).	Disabled Adult Child (DAC)
Is age 50 or older, but not yet 65 (MS 502.00); Not entitled to Part A Medicare (MS 521.00); Not currently married; Received prior SSI Cash disability payment (MS 527.00); The WTPY shows a “D” or “W” claim number that is either credited or not credited; and Has countable income less than or equal to 100% FBR (MS 621.00).	Disabled Widow Widower (DWW)
Is receiving Social Security Title II (MS528.00); Received prior SSI Cash payment (MS 527.00); Received both SSI Cash and Title II payments in the same month for at least one month; and Has countable income less than or equal to 100% FBR (MS 621.00).	Pickle Amendment

 

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E. Service  Package

 

Customers eligible for  SSI MAO receive AHCCCS Medical Services (MS 302.01).

 

If  the customer meets all eligibility requirements except U.S. citizenship  or appropriate non-citizen status, the customer is eligible to receive  emergency services only (MS 302.03).

 

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F. Customer  Cost

 

The  customer does not pay a premium for AHCCCS Medical Services. However,  the customer may be responsible for co-payments for certain services (MS1205.00).

 

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G. Enrollment

 

Customers  approved for coverage under SSI MAO are enrolled in an AHCCCS Health Plan.  Use the following tables to determine where to refer customers with questions  about enrollment.

 

BEFORE ENROLLMENT
IF the customer has questions about…	THEN the customer can…
Choosing a Health Plan	Call the eligibility SSI MAO where; Review the AHCCCS Application for Health Insurance (Page D); or Call the AHCCCS CommunicationsCenter
Doctors, other providers, or available services	Call the Health Plans

 

AFTER ENROLLMENT…
IF the customer has questions about…	THEN the customer can…
Changing a Health Plan	Call the AHCCCS CommunicationsCenter
Choosing a doctor	Call the Health Plan
Other providers, or available services	Call the Health Plan

 

TheAHCCCS CommunicationsCenter telephone  numbers:

• If calling from area codes 602, 623, or 480 dial (602) 417-7100
• If calling from area codes 520 or 928 dial (800) 334-5283

 

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H. Legal Authorities

 

The table below shows the legal authorities  and the references applied to SSI MAO eligibility.

 

Category	Legal Authority	Reference
SSI Non-Cash	United States Code	Title 42, Chapter 7, Subchapter XIX
	Code of Federal Regulations (CFR)	Title 42, Chapter IV, Part 435
	ArizonaRevised Statutes (ARS)	Title 36, Chapter 29, Article 1
	Arizona Administrative Code (AAC)	Title 9, Chapter 22, Article 15
DAC DWW	United StatesCode	Title 42, Section 1383c
	Code of Federal Regulations (CFR)	Title 42, Chapter IV, Part 435.210
	Arizona Revised Statutes (ARS)	Title 36, Chapter 29, Article 1
	Arizona Administrative Code (AAC)	Title 9, Chapter 22, Article 1505
Pickle	United StatesCode	Title 42, Section 1383c
	Code of Federal Regulations (CFR)	Title 42, Chapter IV, Part 435.135
	Arizona Revised Statutes (ARS)	Title 36, Chapter 29, Article 1
	Arizona Administrative Code (AAC)	Title 9, Chapter 22, Article 1505

 

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I. PMMIS Key Codes