Page 74

Title 8: Medicaid Page 70 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…

Appeal Level Process 4. Review by the Appeals Council The Appeals Council hears cases sent in by the ALJ or upon the request of a claimant. The Appeals Council decides if a request for hearing before the Council will be granted. The Appeals Council can, on its own, take a case from an ALJ before a hearing is conducted. If the Appeals Council denies the request for review, the decision of the ALJ becomes final. A decision on disability by the Appeals Council is the final decision for SSA. Disability may be denied or approved at any level. The claimant may stop the appeal at any level if the claimant does not want benefits from SSA. A “final” decision is reached when either:  The person has gone through the full SSA appeal process, been denied at all levels, and cannot go further in the SSA system.  A denial was made at any level of the SSA appeal process and the person did not appeal to the next level within 65 calendar days. Procedure: Use the following procedures when the SSA has made a disability denial:

Status Action SSA decision is not final. Deny the Medicaid application issuing a manual Notice of Action using the language listed in the following chart. Determine if Medicaid eligibility exists under another coverage group. SSA decision on SSDI is final but the applicant could be eligible for Medically Needy coverage Proceed with Department disability determination. See When the Department Determines Disability.