Because of financial struggles that occur when an individual is disabled and unable to perform work, it is common for an individual to qualify for Medicaid coverage (poverty based medical insurance program) in Delaware prior to applying for or being found disabled under the Social Security Disability Insurance (SSDI) program of the Social Security Administration. Prior to March 1, 2001, many individuals who were on Medicaid before they were approved for SSDI, lost their eligibility for Medicaid as a result of being approved for SSDI. Once an approval was issued, the Delaware Division of Social Services would send an individual a notice indicating that their Medicaid was terminated because of their income from SSDI.
Effective March 1, 2001, Delaware extended Medicaid eligibility to certain individuals that were approved for SSDI. The program was named “Medical Assistance During Transition to Medicare” or “MAT” and was codified as part of the Delaware Administrative Code. (See Title 16 Sec. 17800 of Delaware Administrative Regulations).
Beginning March 1, 2001, individuals in Delaware who were already receiving Medicaid and were approved for at least one month of Supplemental Security Income payments (SSI is the Social Security Administration’s poverty based disability program) no longer lost their eligibility for Medicaid because of the receipt of SSDI. The only requirements were that 1) the individual lost Medicaid because of receipt of SSDI, and 2) they were not yet eligible for Medicare. This was an important change, because previously these same individuals would lose eligibility for Medicaid if their SSDI payments were above the State income limits. Since Medicare does not begin until 24 months after eligibility for the first SSDI payment, before MAT, it was common for individuals to lose Medicaid and have to go months or even as long as 2 years without government provided medical coverage, despite being found disabled by the Social Security Administration.
Unfortunately, MAT did not extend Medicaid coverage in every situation. Only individuals that were approved for SSDI and had at least one month of SSI eligibility qualified for this program. The result was that anyone in Delaware that was receiving Medicaid and approved for SSDI, but was not approved for SSI (or never applied for SSI), still lost their Medicaid eligibility and had no government provided medical insurance coverage until Medicare began.
Effective September 1, 2008, Delaware extended MAT to any individual that was 1) not yet eligible for Medicare and 2) lost eligibility for Medicaid on or after January 1, 2008 due to the receipt of SSDI. As a result, even if an individual never met the requirements for SSI, they became eligible to retain Medicaid as long as they were receiving Medicaid before their SSDI claim was approved. This change in the Administrative Regulations closed a loophole that was causing many individuals in Delaware to lose all government provided medical coverage once they were approved for SSDI until they were finally eligible for Medicare.
In effect, this now means that no Delaware resident who is receiving Medicaid should lose government provided medical insurance just because of being found disabled by the Social Security Administration. Unfortunately, the regulations are not being applied consistently by the Delaware Division of Social Services. Many of my clients have had Medicaid benefits terminated after being approved for SSDI benefits, even though they should still qualify under MAT. I have found that several employees of the Delaware Division of Social Services are still not aware of these changes, and need reminders on how to properly apply the MAT Regulations.
I recommend that individuals that receive a notice that their Medicaid coverage has been terminated because of receipt of SSDI (who are not yet eligible for Medicare), print out copies of the applicable regulations and provide them to their Social Worker. Additionally, the individual should provide the Social Worker with the Notice of Approval from the Social Security Administration to prove that the source of their new income is SSDI benefits.
In order to implement this Medicaid gap coverage, individuals that fall within these limited categories are made eligible for $5.00 in an optional Delaware SSI State Supplement program regardless of the amount of their earned or unearned income. A Medicaid redetermination may be necessary after qualifying for SSDI, but the Administrative Regulations provide that eligibility for Medicaid continue until Medicare eligibility begins.
Remember, both of these extensions of Medicaid only apply if you were already receiving Medicaid before you were approved for SSDI. If you did not qualify for Medicaid before being found disabled under the SSDI program, you will still need to wait 24 months from the date of your first SSDI payment until you are eligible for Medicare Coverage. If you have not yet been approved for SSDI, and do not have medical insurance, you can use the Delaware Division of Social Services online Application for Social Services and Internet Screening Tool to determine if you qualify for State Assistance while waiting for your disability determination.
If you were represented by an attorney for your Social Security disability claim, and your Medicaid is terminated before you are eligible for Medicare, I would recommend that you ask your attorney to write a letter to your Social Worker describing the applicable regulations and explaining why you should retain your eligibility. If you live outside of Delaware, it is important that you determine if your State has a similar MAT program.
Relevant Links
Applicable Medical Assistance during Transition to Medicare Regulations
- Delaware Administrative Code Title 16, Section 17800 Medical Assistance during Transition to Medicare
- Delaware Administrative Code Title 16, Section 17801 Status Eligibility
- Delaware Administrative Code Title 16, Section 17802 Financial Eligibility
- Delaware Administrative Code Title 16, Section 17803 Eligibility Determination
- Delaware Administrative Code Title 16, Section 13434 Recipients of Optional State Supplement Payments
Delaware Medicaid
- Delaware Division of Medicaid & Medical Assistance
- Work World/Delaware Benefit Information System
- Work World Section on Delaware Medicaid MAT Program
- Delaware Application for Social Services and Internet Screening Tool
Medicare
Sample Letter
This article was written by Steven Butler. Steven is a partner at Linarducci & Butler, PA and his practice is limited to Social Security Disability/SSI claims. Steven offers free initial consultations for Social Security Disability/SSI claims to residents of Delaware, Maryland, New Jersey and Pennsylvania. To schedule a consultation with Steven, please use the Linarducci & Butler Contact Form or call 302-613-0707 to schedule an appointment.