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Chapter: 1400 Technical Requirements Program: MSSI, SFP 46 a. SSA refuses (or has already refused) to reconsider the unfavorable disability decision, or b. the applicant no longer meets SSI non-disability criteria such as income or assets.

The eligibility specialist must explore eligibility for Medicaid for the individual based on other coverage criteria, e.g., family-related coverage prior to exploring eligibility for disability-related Medicaid. 1440.1206 Change in Disability Determination by SSA (MSSI, SFP) When the Social Security Administration (SSA) renders a disability decision that is different than that made by DCF, the SSA decision must be adopted unless the SSA decision was based on a condition different than that which the state reviewed.

If SSA determines the individual is not disabled or that the disability has ceased, action must be taken to close the SSI-Related Medicaid benefits on FLORIDA that are based upon disability, allowing for ten days advance notice of adverse action. Should the individual file a timely appeal with SSA, Medicaid benefits must be continued, pending a final decision by SSA.

If SSA renders a favorable disability decision on a case previously determined not disabled by the Department, the Department must adopt the SSA decision. Standard application processing policy applies. 1440.1207 Blindness and/or Disability Redetermination (MSSI, SFP) Blindness and/or disability must be redetermined under the following conditions:

1. when the DMRT, hearing officer, or DDD requests a review; or 2. three years following the date of a hearing officer’s final order (in absence of a request for an alternative review date from DMRT, DDD, or the hearing officer); or 3. for a regularly scheduled review as indicated on the Transmittal for Incapacity (DCF Form 82), or the Disability Determination and Transmittal (DCF Form 2909); or 4. when the eligibility specialist becomes aware of a notable improvement in the individual's condition; or 5. when a child receiving MTA coverage is approaching his/her 18th birthday. 1440.1208 Presumptive Disability (MSSI, SFP) The eligibility specialist must refer potential expedited disability decisions for MEDS-AD and Medically Needy individuals to the Division of Disability Determinations for a presumptive disability decision. Presumptive disability is defined as a preliminary finding of disability when available evidence and/or readily observable severe categories of impairments (without obtaining medical evidence) reflect a high degree of probability that the individual is disabled. 1440.1209 Confidential Information Regarding Disability (MSSI, SFP) Any information received from DDD is treated as confidential information. If a request for this information is received, the eligibility specialist must have a release (Authorization to Release Medical Information) signed by the individual allowing the release of information to a third party.

The Financial/Medical Release form is not a release for a third party. This form only allows information to be obtained from others. It does not allow information to be released to a third party. (Also see Chapter 400 on Use of Confidential Information.) 1440.1210 How to Request a Disability Redetermination (MSSI, SFP) When requesting a disability redetermination, the eligibility specialist must submit the original Medical evidence along with updated forms to indicate the applicant’s current condition.