The program is operated by States with Federal financial participation. States may limit the number of SSI recipients who are categorically eligible for Medicaid by applying more restrictive eligibility standards than those of the SSI program. However, these standards cannot be more restrictive than those programs that were effect before SSI began in 1972. Also, since SSI payments are not available in Puerto Rico, Guam, and the U.S. Virgin Islands, those who qualify for AFDC, as well as those who receive aid to the aged, blind, or disabled are eligible for Medicaid coverage.
States have options as to how they define categorically needy.
Their definition may include individuals receiving only a State supplementation of SSI, although their income would prohibit any SSI payment. In addition, there are many other services a State may choose to provide such as prescription drugs. For the medically needy, States have considerably more discretion in the services they provide. States may not impose an enrollment fee, premium, or similar charge on most categorically needy individuals. States may impose cost sharing in the form of nominal deductibles or co-payments on both the categorically needy and the medically needy.