Special Considerations

When SSA makes a determination of not disabled for either RSDI or SSI, this ruling is in effect for 12 months. However, if the A/R alleges a worsening of his/her condition or if a different disabling condition has occurred, DFCS must accept a new Medicaid application upon expiration of the 12 months disability determination from SSA.

Follow SMEU procedures to verify disability.

It is important to submit medical evidence that substantiates the worsening and/or different condition alleged.

Document the applicant’s allegation of the change in his/her condition on the Form 184, SMEU Data Report, completed as part of the SMEU procedures.

If an A/R’s SSI has been terminated for a financial or non-financial reason other than failure to meet the disability requirement and s/he has applied for Medicaid through DFCS, the prior receipt of SSI is prima facie evidence of disability for twelve months following the last month of receipt of SSI. At the expiration of the twelve-month period, obtain a disability decision from SMEU.