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Title 8: Medicaid Page 66 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 not applied for disability benefits but agrees to file an SSDI application within ten days. Notify both SSA and DDS about the concurrent application with form 470-2631, Notice of Pending Medicaid Application within 15 working days.  Have SSA claim and are processing. If so, hold the Medicaid application until the determination has been made.  Have recently completed a disability determination. If so, check for an SDX.  Do not have a claim. If so, check for an SSDI denial for reasons other than disability. If SSA denies the client for reasons other than disability, proceed with a disability determination by the Department. Contact the client to explain that HHS will determine disability. Client has never applied for disability benefits and is not choosing to do so. Proceed with disability determination by the Department if the client meets all other eligibility requirements. Comment:

1. Ms. R applies for Medicaid on August 1. She was denied SSI benefits on June 15 because the SSA determined she was not disabled based on her reported disabilities of arthritis and shortness of breath. Ms. R is not claiming any new disabilities. She says the arthritis has gotten worse. This is a change in an existing condition that was considered by SSA. It does not represent a different condition or an addition to the conditions considered by SSA, so the SSI Medicaid application is denied based on the SSA decision. (This is assuming no other conditions apply, such as an SSA refusal to consider the worsening of her condition.) The IM worker refers Ms. R back to SSA to determine eligibility for SSI, because Ms. R claims a change in her arthritis (the original condition). If Ms. R were ineligible for SSI because of income or resources, a HHS disability determination would be done instead of referring Mrs. R. back to SSA.