Eligibility Under the Pickle Amendment

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Congress passed the Pickle Amendment in 1977. It protects low-income Social Security recipients from losing their Medicaid eligibility when Social Security cost-of-living adjustments increase their income. You are eligible for relief under the Pickle Amendment if you were eligible for both Social Security and need-based Supplemental Security Income with Medicaid in any month since April 1977.

Social Security, SSI and Medicaid

Social Security is the federal program that pays monthly stipends to retired people age 62 and older, to people with disabilities who are unable to work, and to some recipients’ spouses and dependents. The amount people receive is based mainly on their work earnings. Supplemental Security Income (SSI) is a federal program that pays a stipend to low-income people with limited resources who either are age 65 or older, have a disability, or are blind. The law sets out strict limits on the income and resources for SSI eligibility.

Medicaid is a government-run health insurance program for low-income people. Each state establishes and administers its Medicaid program, subject to federal guidelines. In most states, people who qualify for federal SSI automatically qualify for state Medicaid. You should check your state laws and regulations to see if SSI eligibility is tied to your state's Medicaid eligibility.

The SSI and Medicaid Eligibility Issue

Many people who receive SSI also receive Social Security. In 1972 Congress passed a law giving Social Security recipients cost-of-living increases (COLAs) to offset inflation. The COLA increase sometimes raises a low-income person’s Social Security payment above the limit for SSI. If the person is in a state where SSI eligibility also makes him eligible for Medicaid, he loses both SSI and Medicaid due to the increase.

The Pickle Amendment

The Pickle Amendment, named for its congressional sponsor, protects people who had been eligible for both Social Security and SSI/Medicaid, but lost their SSI/Medicaid eligibility because of the COLA increase. The amendment says that those people (those who would have been eligible for SSI/Medicaid if not for the COLA raises) don't have to include the COLA for Medicaid eligibility. As long as the original Social Security payment amount, along with any other income and resources, is within the income and resource limits for SSI, the person can get SSI for Medicaid purposes only.

Pickle Amendment Example

You retired at age 65 in March 2007 and began collecting Social Security payments. You had very limited resources and almost no other income, so you were also eligible for SSI with Medicaid. In January 2009 there was a 5.8% COLA increase to your Social Security payment. This increase made your income too high for SSI eligibility, and consequently Medicaid.

By using the Pickle Amendment, you can use your original Social Security payment amount (identified in March 2007) without any subsequent COLA increases, for your income. Provided your other income and resources do not disqualify you, you will be able to re-qualify for SSI for Medicaid purposes only. You can do this any time after you lost coverage in January 2009.