What is the DAC – Disabled Adult Child Program?

This program provides full-scope, no cost Medi-Cal to qualifying adults who receive “Social Security Disabled Adult Child (DAC) benefits.”14 An adult is entitled to receive Title II Disabled Adult Child benefits if that adult is unmarried; has a disability that began before the age of 22; and was dependent on his or her parent at the time of application, the time of the parent’s death, or at the time the parent’s own period of disability began.15 The standard for determining disability is the same as for the Title II Social Security Disability Insurance (SSDI) program. To qualify as a Medi-Cal Disabled Adult Child an individual must be entitled to receive Title II Disabled Adult Child benefits and must have had and lost SSI because of eligibility for these Title II benefits.

Individuals first receive Social Security DAC payments at the time of the retirement, disability or death of a parent. When this occurs, an individual who is receiving SSI can begin receiving a DAC payment that is higher than the SSI payment rate. This makes the individual ineligible for SSI and for SSI-linked Medi-Cal. The DAC MediCal program maintains the status quo with respect to Medi-Cal by continuing to provide categorical Medi-Cal so long as the individual would be eligible for SSI if the individual were not receiving the DAC Social Security payments. The DAC Medi-Cal program, like the Pickle program, also provides protection from loss of SSI-linked Medi-Cal caused by Social Security COLAs. This second part of the DAC Medi-Cal program is sometimes called the “Pickle DAC” or “pseudo Pickle DAC” program.

DAC Program Eligibility Requirements

Individuals who receive “Social Security DAC” benefits can qualify for full-scope, no cost Medi-Cal if they:

• Received SSI in July 1987 or later;
• Initially qualified for Title II DAC benefits, or qualified for an increase in Title II DAC benefits, on or after June 1, 1987; and
• Would be eligible for SSI now but for either:

° the current receipt of Title II DAC benefits which they first became eligible for while they were receiving SSI, or
° the increase in Title II benefits because of COLAs since they last received both Title II benefits and SSI.16

In order for an individual with Title II DAC benefits to continue to receive MediCal with no Share of Cost, the Social Security Title II income is disregarded when calculating Medi-Cal eligibility.17 Under federal law, the individual is treated for Medicaid purposes as if they were still an SSI beneficiary.18 To determine if an individual who received both Title II Social Security DAC and SSI at
some time in the past qualifies for the Medi-Cal DAC Program, compare their Title II grant level in 1987 with the current SSI grant level. If they would qualify for SSI now, i.e., if their Title II DAC benefits were at the same level as when they last qualified for both benefits, then the individual is eligible for no-cost Medi-Cal through the MediCal DAC program.19 The individual would also qualify for no-cost Medi-Cal if they became eligible for Title II DAC benefits after July 1987.20 Note: When determining an individual’s eligibility for no-cost Pickle or DAC Medi-Cal based on COLA’s, you cannot deduct Medicare premiums from the person’s Title II benefits. In others words, count the Title II benefits before any Medicare premium deductions are taken.

Getting and Keeping DAC Medi-Cal

Any individual described above who qualifies should be able to get Medi-Cal either as a continuing benefit when she loses SSI or, if later, as a new applicant under the Medi-Cal DAC Program. The state periodically sends counties lists of Title II DAC recipients whose SSI/SSP has been or is being terminated.21 The counties are required to contact the recipients to see if they need assistance in completing the forms required for the application process.22 Eligible individuals should remain eligible as long as they meet all the other SSI eligibility rules. Copied from Western Poverty Law Center – Coverage for Low Income California’s DAC Program Page 84 – Non Magi Medi-Cal 3.71

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Eligibility Group Requirements*: An individual who was receiving Supplemental Security Income (SSI) benefits and who meets the following:

• Is at least 18 years of age;
• Has blindness or a disability which began before the age of 22;
• Has been receiving Supplemental Security Income (SSI) based on blindness or disability; and
• Has lost Supplemental Security Income (SSI) due to the receipt of Social Security benefits on a parent’s record due to the retirement, death or disability of a parent.

*If the person meets all of the above criteria, they may qualify as a Disabled Adult Child under Section 1634 of the Social Security Act (regarding DAC). This designation comes from the Social Security Administration. Eligibility for Medicaid may continue as long as the person is determined blind or disabled. However, if the person receives income from another source or exceeds the resource limits, they may become ineligible for Medicaid coverage

See the rest of the New Jersey 2 page explanation

 

Bibliography

New Jersey 2 page explanation

ssa.gov Section 1634

Social Security Disability Planner: Benefits for A Disabled Child

Publications

Understanding Supplemental Security Income SSI For Children– 2017 Edition

Western Poverty Law Center – Coverage for Low Income California’s DAC Program Page 84 – Non Magi Medi-Cal 3.71

 

 

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