Section 210-RICR-40-00-1.5 - IHCC Groups Subject to the SSI MethodologyA. On and after the effective date of this rule, the provisions of this chapter govern the following eligibility pathways that use the SSI methodology in whole or in part to determine eligibility for Medicaid benefits: 1. Elders and Adults with Disabilities (EAD) - Low-income elders who are sixty-five (65) and older and people living with disabilities who have income at or below one hundred percent (100%) of the Federal Poverty Limit (FPL) and resources at or under $4,000 for an individual or $6,000 for a couple.2. Medically Needy (MN) - Elders, persons with disabilities, children, parents and caretakers of Medicaid-eligible children, and pregnant women who do not qualify for eligibility on the basis of income but have high health expenses and must spend or contribute income and/or resources above the applicable income eligibility standards to obtain or retain Medicaid eligibility. Subchapter 5 Part 1 of this Chapter pertains to the MN eligibility pathway for Community Medicaid.3. Supplemental Security Income (SSI) Recipients - All persons receiving SSI cash assistance based on age or as an adult with a disability, as determined by the federal Social Security Administration (SSA). SSI recipients are automatically eligible for Medicaid on this basis and are not required to apply for Medicaid health coverage through the State. Program-specific provisions for SSI recipients twenty-one (21) and older are included in this chapter. The relevant provisions for Medicaid beneficiaries under 21 are located in the sections pertaining to coverage for children and families in Medicaid Code of Administrative Rules, Medicaid Coverage for Children and Families.4. State Supplement Payment (SSP) - Persons who qualify to receive the optional state- funded supplemental payment are automatically eligible for Medicaid health coverage under the Medicaid State Plan. This group includes beneficiaries eligible on the basis of SSI and EAD as well those with higher income who require Medicaid LTSS who meet the special living arrangement requirements for SSP set by the State.5. SSI Protected Status Beneficiaries - This group - sometimes referred to "SSI- lookalikes" - includes persons who meet the age or disability criteria for SSI, but are -- or become -- ineligible for full SSI cash benefits or qualify for special treatment. To protect Medicaid health coverage for members of these coverage groups, federal law requires the application of special rules that confer or preserve Medicaid eligibility. 6. Medicaid Premium Payment Program (MPPP) for Medicare beneficiaries with income at or below 135% of the FPL. The MPPP provides financial help through Medicaid to assist in paying Medicare costs including premiums, deductibles, and coinsurance in amounts that vary depending on income and resources.7. Sherlock Plan for Working Adults with Disabilities - The State's program for working adults with disabilities. The Sherlock Plan provides Medicaid health coverage and/or services and supports to persons with disabilities who are working, and who otherwise meet the SSI disability criteria for Community Medicaid or, based on a functional and health status review, have the level of need required for Medicaid LTSS. As is set forth in greater detail in Medicaid Code of Administrative Rules, Sherlock Program Regulations, beneficiaries in this group may have countable income at or below two-hundred and fifty percent (250%) of the FPL and resources less than or equal to $10,000 individual and $20,000 for a couple.8. IHCC Medicaid LTSS -- Consists of new applicants seeking Medicaid-funded LTSS and current IHCC group beneficiaries who develop a continuous need for the level of care typically provided in an institution (hospital, nursing facility, intermediate care facility for person with intellectual disabilities). Beneficiaries eligible in the MACC groups (see Medicaid Code of Administrative Rules, Overview of the Affordable Care Coverage Groups) who require LTSS are not subject to the SSI methodology; LTSS eligibility based on the SSI methodology and more generally is located in Medicaid Code of Administrative Rules, Evaluation of Resources and Resource Transfers.210 R.I. Code R. 210-RICR-40-00-1.5