C.M.R. 10, 144, ch. 332, app 144-332-C
In order to be considered under this amendment all of the following criteria must be met:
I. There must have been concurrent entitlement to both SSI or State Supplement and Social Security benefits no earlier than 4/1/77. Concurrent entitlement can occur without concurrent receipt. Usually entitlement to Social Security benefits occurs the month prior to receipt of the first Social Security check.
II. The individual or couple must be current recipients of Social Security benefits.
III. The reason for closure of SSI benefits can be for any reason.
IV. If there is a spouse, with Social Security benefits used in the deeming process, the COLA of the spouse may also be disregarded even if the spouse does not qualify for PICKLE status. This disregard applies only when using the SSI income standard as the criteria.
When these conditions are present, all COLA's since the last loss of SSI or the State Supplement (but not prior to 7/77) will be disregarded from monthly countable income as the last step in that process.
Individuals or couples, who are categorically eligible, without using this disregard, are not eligible under the Pickle Amendment.
As an additional benefit, the State of Maine will pay the Medicare Part B premium of Pickle individuals or couples. (see Appendix A)
Once an individual or couple is covered under this group, each additional COLA is disregarded along with the initial increase to determine continued eligibility.
Individuals or couples remain in this group until ineligible due to other SSI criteria, such as no longer living in Maine, increase in assets, increase in income from another source, or change in living arrangements.
Individuals and couples may lose coverage under this group and later regain it. Continuous eligibility is not necessary.
Example:
Mr. Tom Keys' SSI was closed when he became entitled to Social Security benefits in 6/97. A review was completed to determine Medicaid coverage.
$ 600.00 Gross income |
- $ 20.00 Federal disregard ___________________ |
$ 580.00 |
- $ 55.00 State disregard _________________ |
$ 525.00 >State Supplement standard ($494.00 eff. (1/97) |
This determination placed Tom in a deductible for 6/97 - 11/97. In 2/05, Mr. Keys reapplies.
$ 718.20 |
- $ 20.00 Federal disregard |
$ 698.20 |
- $ 55.00 State disregard |
$ 643.20> State Supplement standard ($589.00) |
- $ 118.20 Pickle disregard of COLAs 1/98 - 2005 |
$ 525.00< Categorical standard ($589.00) |
This results in eligibility effective 2/2005.
One of the problems that may arise during calculation of this disregard results when all the prior Social Security benefits needed are not available through old records of SVES. However, using the following formula, the COLA's can be determined when only one benefit amount is confirmed.
Current Gross Benefit |
÷ 1 + COLA increase % |
previous gross benefit |
Example:
Check received 10/82 shows a benefit amount of $182. The gross would be $12.20 more to account for a deduction for payment of the Medicare Part B premium.
$194.20 Gross amount of check ($182 + $12.20) |
÷ 1.074 COLA Percentage Increase for 1982 _________________________________________ |
$180.819 or $181 In 1981 Medicare Part B premium was an even $11.00. |
This method is not fault free because the Social Security Administration has changed the rounding off rule several times in recent years. The method will be off if the individual receives benefits based on a spouse or parent's earnings record. Also, if a change in benefit type took place, such as the individual is receiving benefits from a living spouse who dies, changing the claim type to widow benefits.
C.M.R. 10, 144, ch. 332, app 144-332-C