CMS Eliminates Mandatory Filing for Social Security to Maintain Medicaid Eligibility

Historically, Medicaid applicants and beneficiaries were required to apply for Social Security benefits or other potential income sources as a condition of eligibility. This policy was based on Medicaid's role as a "payer of last resort", ensuring individuals accessed all available benefits before relying on Medicaid. However, the Centers for Medicare & Medicaid Services (CMS) has recently finalized a rule that eliminates this requirement.

What Changed?

In its Final Rule on Medicaid and CHIP Eligibility, CMS has removed the requirement for individuals to apply for certain benefits, including Social Security retirement and survivor benefits, to maintain Medicaid eligibility. This update simplifies Medicaid enrollment and renewal, especially for older adults and individuals with disabilities, who may face burdensome processes when forced to apply for benefits they don’t yet want or need.

Previous Policy: 42 CFR § 435.608

Under the prior policy, Medicaid required individuals to apply for:

  • Social Security Retirement Benefits (age 62+)
  • Social Security Disability Insurance (SSDI)
  • Supplemental Security Income (SSI)
  • Other benefits such as pensions or veteran compensation

Failure to apply for these benefits could jeopardize an individual’s Medicaid coverage.

What Does the New Rule Mean?

The updated rule changes the definition of “available income” for Medicaid eligibility. Individuals are no longer required to apply for Social Security or other similar benefits if they have not yet done so. Specifically:

  • Medicaid applicants and beneficiaries cannot be forced to file for Social Security retirement or survivor benefits.
  • The focus will now be on income and resources within the individual’s control, rather than requiring individuals to pursue benefits they have not yet claimed.

This change reduces administrative burdens and aligns Medicaid policies with equity goals, particularly for older adults or individuals managing disability or complex financial situations.

Who Benefits?

  • Older Adults: Individuals who are eligible for Social Security retirement benefits at age 62 but wish to delay filing to maximize their monthly benefit at age 70.
  • People with Disabilities: Those who may be eligible for SSDI but need additional time to navigate the application process.
  • Survivors: Widows, widowers, and dependents eligible for survivor benefits no longer face mandatory filing requirements.

Why This Matters

The change removes unnecessary barriers to Medicaid eligibility. It allows individuals to make independent decisions about when to claim Social Security benefits without risking their healthcare coverage.

https://www.medicaid.gov/medicaid/eligibility-policy/index.html?utm

https://ccf.georgetown.edu/2024/04/11/medicaid-eligibility-and-enrollment-rule-explainer/?utm

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-435/subpart-G

https://ecfr.io/Title-42/Section-435.608?utm


Created by Norm Haug

12172024

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