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Individuals denied SSI eligibility because of a refusal to meet an SSI program requirement not applicable under Medicaid should be granted Medicaid coverage if they meet non-financial and financial eligibility requirements (see Part VI: Financial Eligibility). These individuals include: • disabled or blind individuals over age 15 and under 65 who refuse to meet the SSI program requirement for vocational rehabilitation, and • individuals who refuse to meet the SSI program requirements for: o alcoholism treatment, o drug treatment, or o corrective surgery. QM: N/A FS N/A

PENDING DETERMINATIONS 9.5

VERIFICATION 9.6 MA AR: N/A AX: N/A SR: The disability standard used in Medicaid for individuals applying for Medicaid based on disability is the same as that used by the SSA when administering SSI and SSDI. Recipients of SSI are categorically eligible for Medicaid, and no further verification of disability is required. Recipients of SSDI benefits based on an individual’s own disability are considered to meet the disability standard applied in Medicaid. This includes a person whose entire SSDI benefit is being withheld for recoupment. Applicants receiving SSDI must provide verification that they receive SSDI benefits (that is, a document from the SSA verifying receipt of SSDI based on disability or blindness), and those benefits are based on their own disability. No further MA AR: N/A AX: N/A SR: Applicants who qualify for Medicaid based on non-disability-related eligibility criteria, such as applicants age 65 or over, children, or parents/caretaker relatives caring for minor children, do not have to rely on a disability/blindness determination and their eligibility should be determined under the appropriate non-disability-related category. Disabled parents should be strongly encouraged, however, to complete the medical evaluation form because if the MRT determines the individual disabled, and the case is converted to an SR case, the individual will not be placed in the same managed care system that serves non-disabled Medicaid participants. This system may not be as appropriate for individuals with disabilities as for those without disabilities. If however, the individual would not meet the SR financial eligibility criteria, the individual should not be given a medical evaluation form. QM: N/A FS N/A