Senior & Disabled Questions & Answers

General Questions

1. My parent is currently living in an out-of-state nursing home and is on Medicaid. Can I file the application for Medicaid for an arbitrary start date - i.e. get my parent qualified for Medicaid here in Colorado for a time when my parent's care there is no longer possible
   No. The individual applying for Medicaid services must be a resident of the State of Colorado. We can send you an application; you can fill it out and have it ready to turn in the day your parent arrives.
2. What are the rules about moving to Colorado?
   First, you would want to make sure there is a nursing home here locally that has an opening for a Medicaid pending individual and make arrangements with that nursing home to move your parent there.
3. What is the approval process - specifically, when does my parent's eligibility begin?
   If your parent comes directly from the out-of-state nursing home to the nursing home in Colorado, the 30 day institutionalization would have been met. BUT, if not, your parent would have to be institutionalized for 30 days prior to Medicaid being approved. However, Medicaid can be retroactive if your parent is found to be Medicaid eligible on the day they enter the nursing home here.

AND (Aid for the Needy Disabled)

1. When I apply for AND does it mean I have been approved for SSI?
   As part of the application for AND, you must apply for SSI at the Social Security office. You can receive AND without receiving SSI.

OAP (Old Age Pension)

1. Do I need to provide proof of the social security income when I apply for OAP?
   Yes. All sources of income must be verified when you apply for OAP.

QI-1 (Qualified Individual 1)

1. Does QI-1 include prescription assistance?
   No, only premiums.

QMB (Qualified Medicare Beneficiary)

1. What does QMB pay for?
   If you qualify, QMB pays for all of the following:

   • Your monthly Medicare Part B premium which is currently $50.00 per month. To receive benefits from the QMB program you must be receiving Part A (Hospital insurance benefits) coverage of Medicare.
   • Your Medicare yearly deductible for Part B Medicare services such as office visits, lab, x-ray services.
   • The Part A deductible if you are hospitalized.
   • The 20% co-pay for most medical services.

   QMB does not pay for prescriptions or for your prescription deductibles.
2. What is income?
   Income is anything that can be used to purchase food, clothing, or shelter. Some examples include wages, social security, pensions, child support and unemployment benefits and spouse's income.
3. What if my income changes?
   You will be asked to complete a redetermination, similar to the application, to re-evaluate your income each year or when your Senior and Disabled Office expects a change in your circumstances, such as a cost of living increase from Social Security.
4. Can I qualify if I am an Alien?
   You must be a U.S. citizen and a resident of Colorado (or be eligible under Requirements for Aliens) to qualify for QMB.
5. If I am eligible for QMB when will assistance begin?
   You will not see a difference in your Social Security check for up to 3 months. Social Security will issue a separate check to reimburse your Medicare Part B premium from the time you were approved.

SLIMB (Special Low Income Beneficiaries)

1. When does buy-in start?
   It can take up to six months before the state starts paying the premium.

SSI (Social Security Income)

1. What is Supplemental Security Income (SSI)?
   The SSI program provides monthly income to people who are age 65 or older, or are blind or disabled, and have limited income and financial resources. Effective January 2005 the SSI payment for an eligible individual is $579 per month and $869 per month for an eligible couple. If you are married, and only one person is eligible, a portion of your spouse's income may be counted. In addition, your financial resources (savings and assets you own) cannot exceed $2,000 ($3,000 if married). You can be eligible for SSI even if you have never worked in employment covered under Social Security.

   Generally, to be eligible for SSI, an individual also must be a resident of the United States and must be a citizen or a noncitizen lawfully admitted for permanent residence. Also, some noncitizen's granted a special status by the Department of Homeland Security (DHS) may be eligible.

2. What is the difference between Social Security disability and SSI disability?
   The Social Security Administration is responsible for two major programs that provide benefits based on disability: Social Security Disability Insurance (SSDI), which is based on prior work under Social Security, and Supplemental Security Income (SSI). Under SSI, payments are made on the basis of financial need.

   Social Security Disability Insurance (SSDI) is financed with Social Security taxes paid by workers, employers, and self-employed persons. To be eligible for a Social Security benefit, the worker must earn sufficient credits based on taxable work to be "insured" for Social Security purposes. Disability benefits are payable to blind or disabled workers, widow(er)s, or adults disabled since childhood, who are otherwise eligible. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker.

   Supplemental Security Income (SSI) is a program financed through general revenues. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by countable income and resources. See www.socialsecurity.gov for an explanation of SSI benefit payment rates.

3. Can I receive Social Security benefits and SSI?
   You may be able to receive SSI in addition to monthly Social Security benefits, if your Social Security benefit is low.

   The amount of your SSI benefit depends on where you live. The basic SSI check is the same nationwide. Effective January 2005, the SSI payment for an eligible individual is $579 per month and $869 per month for an eligible couple.

   If you get SSI, you also may be able to get other help from your state or county. For example, you may be able to get Medicaid, food stamps, or some other social services.

4. How is "earned income" defined for Supplemental Security Income (SSI) purposes?
   Earned income is:

   • Wages from a job, whether in cash or another form.
   • Net earnings from a business, if a person is self-employed.
   • Payments for services performed in a sheltered workshop or work activities center.
   • Royalties earned in connection with publication of the individual's work or honoraria received for services rendered.
5. How is "unearned income" defined for Supplemental Security Income (SSI) purposes?
   Income that does not meet the definition of earned income is unearned income. Some examples of unearned income include:

   • the value of food, shelter or clothing that someone gives you, or the amount of money they give you to help pay for them;
   • Department of Veterans Affairs (VA) benefits;
   • railroad retirement and railroad unemployment benefits; annuities, pensions from any government or private source, workers' compensation, unemployment insurance benefits, black lung benefits and Social Security benefits;
   • prizes, settlements and awards, including court-ordered awards;
   • proceeds of life insurance policies;
   • gifts and contributions;
   • support and alimony payments;
   • inheritances in cash or property;
   • interest earned, including interest on savings, checking and other accounts; rental income; and
   • strike pay and other benefits from unions.

   Someone may have "earned" the entitlement to these types of income, but we call it "unearned" because it is not connected to present employment.
6. Are Supplemental Security Income (SSI) payments only paid to disabled people?
   No. SSI payments are made also to people who are age 65 or older and have limited income and financial resources.
7. What is a "resource" in the SSI program?
   Resources are the things you own such as cash, real estate, personal belongings, bank accounts, stocks and bonds that you can use for your support.

   To be eligible for SSI a person must have $2,000 or less in countable resources. A married couple must have $3,000 or less in countable resources. If you own resources over the SSI limit, you may be able to get SSI benefits while trying to sell the resources.

   Not all of your resources count toward the SSI resource limit. For example:

   • the home you live in and the land it's on do not count.
   • your personal and household goods and life insurance policies may not count, depending on their value. your car usually does not count.
   • burial plots for you and members of your immediate family do not count.
   • up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse may not count.
   • if you are blind or have a disability, some items may not count if you plan to use them to work or earn extra income.