Medicaid Use Report

During a personal or telephone interview with the SSI recipient, an SSA employee asks the following questions: • Have you used any medical care or services in the past 12 months that were paid for by Medicaid (or Medi-Cal, etc.)? • Do you expect to receive any medical care or services in the next 12 months that will be paid for by Medicaid (or Medi-Cal, etc.)? • Without Medicaid (Medi-Cal, etc.), would you be unable to pay your medical bills if you become ill or injured in the next 12 months? We use this information to determine if an SSI recipient whose payments have stopped based on earnings, is entitled to special SSI payments and, consequently, to Medicaid benefits under section 1619 (b) of the Act. The respondents are SSI recipients for whom SSA has stopped payments based on earnings.

The latest form for Medicaid Use Report expires 2024-01-31 and can be found here.