Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Appendix 144-332-C - Pickle Amendment

Current through 2024-29, July 17, 2024
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.