Page 69

Title 8: Medicaid Page 65 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial Non-MAGI-Related Eligibility Revised October 10, 2025 When the Department Follows an SSA Disability…

Status Action Client has applied for disability benefits. SSA denied disability within the last 12 months and decision is “final.” Client states the disabling condition has worsened and claims a new 12- month disability period. Ask the following questions:  Has the SSA refused to reconsider the claim on the worsening of the condition?  Has the client lost eligibility for SSI due to other factors (income, resources, etc.)? If the answer to both questions is “no,” deny the Medicaid application based on the SSA decision and refer the client back to SSA. Manually issue a Notice of Action using the language listed below this chart. Determine if Medicaid eligibility exists under another coverage group. If the answer to either question is “yes,” proceed with a disability determination by the Department if the client is otherwise eligible. Client has applied for disability benefits. SSA denied disability within the last 12 months and decision is “final.” Client states there is a new condition that is expected to last 12 months. Determine whether the client has a different condition than those considered by SSA.  Request a copy of the denial explanation from the applicant.  Compare the information on the denial explanation to the disability information on the Medicaid application. If there is a new disabling condition, proceed with disability determination by the Department unless the client reapplies at SSA. If the client has reapplied at SSA, notify both SSA and DDS about the concurrent application with form 470-2631, Notice of Pending Medicaid Application, within 15 working days.