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SSA/Medicaid/Pickle Amendment

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Unread 07-30-2007, 12:58 PM   #1
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Join Date: Jul 2007
Location: Key West, Florida
Posts: 20
Smile SSA/Medicaid/Pickle Amendment


I have been on SSDI back to 1996. I was receiving SSDI, Medicare and Medicaid until Medicare D became effective Jan. 2006. I live in Key west, FL and have many medical conditions requiring specialist care out of this county (no specialist's in this whole county) in Miami, 135 miles away. I had to use Medicaid transportation to get to these Dr's and I lost that with my full Medicaid and have been fighting them since and I recently came across a federal amendment, Pickle Amendment, that may give me it back. This may apply to many others. Here is some info.

"A Quick and Easy M ethod of Screening for Medicaid Eligibility under the
Pickle Amendment"

" The Pickle Amendment requires that an individual is to be deemed an SSI
recipient if he or she:

**1) Simultaneously entitled to receive both Social Security {Old Age,
Survivors or Disability (OASDI) and Supplemental Security Income (SSI) in some
month after April 1977; (A see below)

2) Is currently eligible for and receiving OASDI;

3) Is currently ineligible for SSI; and

4)Receives income that would qualify him for SSI after deducting all OASDI cost-
of-living adjustments (COLA) received since the last month in which he was
eligible for both OASDI and SSI."

**A) "The person need not literally receive both SSI and Social Security checks
in the same month, but need only be entitled to both for the same month. There
is a one-month lag in OASDI payments, which are not disbursed until the month
after entitlement, while SSI payments are paid in the month of entitlement. It
is common for a person to receive SSI while awaiting receipt of OASDI payments.
Once her monthlyOASDI begins, if it exceeds the SSI rate, she receives just
OASDI thereafter. In such circumstances, even though the person never actually
received simultaneous payments from both programs in a single month, she meets
the first Pickle requirement. This is true even if income from a retroactive
OASDI payment exceeds the SSI benefit for all months in which SSI was received.
For this reason, you should ask not just if the person received both SSI and
Social Security in the same month, but did he receive SSI immediatly before his
Social Security payments began. See 42 C. F. R. ~435.135 and 51 Fed. Reg. 12326
(April 10, 1996). For more information, see "Medicaid Eligibility in a Time
Warp", 22 Clearinghouse Review 120 (June 1988)."

Also, you can look up POMS SI 01715.05

If I can help anyone in any way, please feel free to ask.

capp3736 is offline   Reply With Quote
Unread 08-15-2007, 09:26 PM   #2
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Join Date: Aug 2007
Posts: 34

This is very interesting. Do you have a web site you could post for me? Thanks for the info.
dillypooh is offline   Reply With Quote
Unread 03-27-2011, 02:29 PM   #3
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Join Date: Mar 2011
Posts: 1
Default pickle amendment

do you know the dates effected for thw,"PICKLE AMENDMENT"? I received a check from both CO. :01/19/2001
I really don't want to wait so ling in the SSI office IF Im just wasting my time. Our nearest office is an hours drive! I assume since you must be disabled too yjay you know what a pai n in the +())* it all entails!
thanks for the "HEADS UP"!
ALLROWN is offline   Reply With Quote
Unread 03-28-2011, 12:09 AM   #4
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Join Date: Feb 2007
Posts: 1,804
My Mood:

Hi Margie,

KW is my favorite place to be.....I'm a little jealous that you get to live there I've taken that long drive back to Miami for the plane home a few times now.....What a pain in the butt that would be just to get reasonable medical care. I hope this works out for you.

My 75 yo dad is driving an hour to come get me to take me to doctor appointments another 1/2 to 1 hour away and I feel horrible about having to ask him, but have no alternatives at this time.


Gee, this looks like a great place to sit and have a picnic with my yummy bone !
finz is offline   Reply With Quote

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