Scenarios
Note: Non-filer rules are used in all MAGI scenarios below.
Disability Verified by SSA or MRT
Scenario 1
The applicant is a single 25-year old, permanently disabled, the disability is MRT certified. Earned income is $1000 a month, and there are no resources reported on the application.
The CAO Action: The CAO authorizes PH 00 M since the applicant meets the requirements of the SSI-related Healthy Horizons program and completes a DAP referral as an application for Social Security benefits is still required.
Scenario 2
The applicant is a single 55-year old, permanently disabled, the disability is MRT certified, income is worker’s compensation $900 a month, and verified resources are over the Healthy Horizons resource limit.
The CAO Action: The CAO authorizes MG 90 D since the applicant is not eligible in Healthy Horizons due to excess resources. The CAO completes a DAP referral as an application for Social Security benefits is still required.
Scenario 3
The applicant is a single 60-year old, permanently disabled, receiving RSDI due to disability, RSDI is $950 a month, not receiving Medicare, and the verification of reported resources was not provided with the application.
The CAO Action: The CAO authorizes MG 90 D and pends for verification of resources.
Scenario 3.1
The individual provides the verification of resources. Resources are under the Healthy Horizons limit.
The CAO Action: The CAO enters verified resources information in eCIS and runs eligibility. The CAO authorizes PH 00 M.
Scenario 3.2
The individual provides the verification of resources. Resources are over the Healthy Horizons limit.
The CAO Action: The CAO enters verified resources information in eCIS and runs eligibility. The person remains eligible for MG 90 D.
Scenario 3.3
The individual does not provide verification of resources by the due date.
The CAO Action: The CAO enters a narrative in the Case Comments. The CAO does not take any further action on the case. The person remains eligible in MG 90 D. The CAO will not ask for verification of resources in the future.
Scenario 4
The applicant is a 50-year old single adult, permanently disabled, receiving RSDI due to disability, no Medicare. Income: RSDI is $900 a month and pension is $400 a month. The applicant submitted verification of pension with the application. RSDI was verified electronically. The applicant reports resources and resources are not verified.
The CAO Action: The CAO authorizes MG91. The CAO does not request verification of resources as the individual is over income for PH 00 M.
Scenario 5
The applicant is a 45-year old single adult, permanently disabled, receiving RSDI due to disability, no Medicare. Income: RSDI is $900 a month and earned income is $200 month. Reported resources are under $2000. The CAO verifies RSDI electronically. Earned income and resources are not verified.
The CAO Action: The CAO requests verification of earned income and resources.
Scenario 5.1
The individual returns verification of earned income and resources.
The CAO Action: The CAO authorizes PH 00 M since net income is below the Healthy Horizons income limit.
Scenario 5.2
The individual returns verification of earned income but fails to return verification of resources.
The CAO Action: The CAO authorizes MG 91 as income is over 102% FPL.
Scenario 6
The applicant is a 45-year old single adult, MRT certified, income – unemployment compensation is $700 a month and earned income is $600 month. Reported resources are $1700. Income and resources are not verified.
The CAO Action: The CAO requests verification of income and resources.
Scenario 6.1
The individual returns verification of income and resources.
The CAO Action: The CAO authorizes PH 00 M. The CAO completes a DAP referral.
Scenario 6.2
The individual returns verification of earned income but fails to return verification of resources.
The CAO Action: The CAO authorizes MG 91. The CAO completes a DAP referral.
Disability NOT Verified by SSA or MRT at Application
Scenario 7
The applicant is a 55-year old parent of a 15-year old child, who lives in the same household. The applicant indicates a disability on the application for himself. The disability is not verified by the SSA or MRT. Income: wages is $530 a month and Worker’s Compensation of $800 a month. Verification of income is not available at application.
The CAO Action: The CAO requests verification of income and a PA1663 to verify disability.
Scenario 7.1
The individual returns income verification but does not return the PA 1663.
The CAO action: The CAO authorizes MG 91.
Scenario 7.2
The individual returns income verification and the PA1663 which shows that the individual is disabled for 12 months or more.
The CAO Action: The CAO completes the disability screen and initiates the DAP referral process. The individual stays in MG 91 after eligibility is rerun.
Scenario 7.2.1
The individual cooperates with the DAP process. The SSA determines the individual to be permanently disabled. The individual begins receiving RSDI of $900 a month and the child begins receiving RSDI of the parent’s claim of $100 a month.
The CAO Action: The CAO updates the disability and income screens and reruns eligibility. The individual becomes eligible for PH 00 M. Resources are excluded since a child under 21 is in the household.
Scenario 7.2.2
The individual does not cooperate with the DAP process.
The CAO Action: If the individual indicates he/she is no longer disabled, the CAO will accept that person’s statement and maintain the eligibility in a MAGI category (if they meet other eligibility requirements). If the individual fails to cooperate and still maintains they are disabled, the CAO will terminate MA for failure to pursue potential benefits.
Scenario 7.3
The individual returns income verification and the PA 1663 which shows that the individual is disabled for less than 12 months.
The CAO Action: The CAO authorizes MG 91 as the individual is considered to be a Parent/Caretaker age 21-64 with income at or between 33%-133% FPL. The individual will remain eligible for MG 91until circumstances change.
Scenario 8
The applicant is a 33-year old parent of a 3-year old child, who lives in the same household. The individual indicates a disability on the application. The disability is not verified by the SSA or MRT. Income: child support is $500 a month. CAO verifies child support through PASCES.
The CAO Action: The CAO authorizes MG 27 and pends a PA 1663 to verify disability.
Scenario 8.1
The individual returns the PA1663 which shows that the individual is disabled for 12 months or more.
The CAO Action: The CAO completes the disability screen and initiates the DAP referral process. The individual stays in MG 27 after eligibility is rerun.
See 7.2.1 and 7.2.2 for the DAP process cooperation scenarios.
Scenario 9
The applicant is a 45-year old single adult. The individual indicates a disability on the application. The disability is not verified by the SSA or MRT. Earned income is $2000 a month, not verified. No resources reported.
The CAO Action: The CAO requests verification of income and a PA 1663 to verify disability.
Scenario 9.1
The individual returns verification of income and the PA 1663 which states that the individual has a permanent disability.
The CAO Action: The CAO authorizes PH 00 D. The individual will be over the income limit for MG 91 and will pass PH 00 D due to the earned income deduction. The CAO will complete a DAP referral.
Scenario 9.2
The individual returns verification of income but fails to return the PA1663.
The CAO Action: The CAO will delete the Disability screen in eCIS. The individual is determined ineligible for MG 91.
Scenario 10
The applicant is a 30-year old single person. The individual indicates a disability on the application. The disability is not verified by the SSA or MRT. Earned income is $800 a month, not verified. Reported resources are $1000 and are not verified.
The CAO Action: The CAO requests verification of income, resources, a PA 1663 to verify disability.
Scenario 10.1
The individual returns verification of income, resources, and the PA 1663 which states that the individual has a permanent disability.
The CAO Action: The CAO authorizes MG 91and initiates the DAP referral process.
Refer to 7.2.1 and 7.2.2 for the DAP process cooperation scenarios.
Scenario10.2
The individual returns verification of income but fails to return the PA1663 and resource verification.
The CAO Action: The CAO deletes the Disability screen in eCIS, authorizes MG 91, and narrates the actions taken including that the PA 1663 was not returned. The individual remains eligible in a MAGI category until circumstances change.
Scenarios for 19 and 20-year olds
Scenario 11
The applicant is a 19-year old single person. The individual does not indicate a disability on the application. Earned income is $400 a month.
The CAO Action: The CAO authorizes MG 90 N since the individual is 19 and income is below 44% FPL.
Scenario 12
The applicant is a 20-year old single person. The individual does not indicate a disability on the application. Earned income is $800 a month.
The CAO Action: The CAO authorizes MG 91.
Scenario 13
The applicant is a 20-year old mother of a child who lives in the same household. The individual does not indicate a disability on the application. Earned income is $1000 a month.
The CAO Action: The CAO authorizes MG 91.
Scenario 14
The applicant is a 20-year old mother of a child who lives in the same household. The individual does not indicate a disability on the application. Child support is $400 month.
The CAO Action: The CAO authorizes MG 27.
Scenarios for Women Who Report a Pregnancy
Scenario 15
The recipient of MG 91calls the CAO to report a pregnancy.
The CAO Action: The CAO updates the pregnancy screen and authorizes MG 91 P. The individual stays eligible in MG 91 P until the end of the 12-month postpartum period.
Scenario 16
The recipient of MG 90 D calls the CAO to report a pregnancy.
The CAO Action: The CAO updates the pregnancy screen and authorizes MG 90 P. The individual stays eligible in MG 90 P until the end of the 12-month postpartum period.
Updated April 17, 2024, Replacing June 3, 2019