Named after its Congressional sponsor and enacted in 1977, the Pickle Amendment created a separate category of Medicaid eligibility. Under the Pickle Amendment, an individual who received both Social Security benefits (SSA) and Supplemental Security Income (SSI) benefits but became ineligible for SSI due to cost-of-living adjustments (COLA) in the SSA benefit will remain eligible for Medicaid if the individual would continue to be eligible for SSI benefits if the COLA increases in the SSA benefits were disregarded. In other words, the Pickle Amendment requires that an individual is to be deemed an SSI recipient (which in many states means automatic Medicaid eligibility) if he or she:

1. Simultaneously entitled to receive both SSA and SSI benefits in some month after April 1977. The person need not literally receive both SSI and SSA checks in the same month, but need only be entitled to both for the same month;
2. Is currently eligible for and receiving SSA benefits;
3. Is currently ineligible for SSI; and,
4. Receives income that would qualify him for SSI after deducting all SSA COLA received since the last month in which he was eligible for both SSA and SSI benefits.

Screening for Medicaid eligibility under the Pickle Amendment can be done easily by using this chart – Pickle Chart

Source: Tennessee Justice Center