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Title 8: Medicaid Page 71 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 SSA final decision denies disability based on substantial gainful activity but the applicant could be eligible for MEPD coverage Check for SDX payment status code N44. Proceed with Department disability determination. See When the Department Determines Disability. SSA decision is final. The original condition has not worsened and client does not claim a new 12- month period of disability 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 is final. Client claims a new disabling condition that will last at least 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 a disability determination by the Department unless the client reapplies at SSA. SSA decision has been final for at least 12 months. Client claims a change or deterioration in the disability that is expected to last 12 months. Proceed with a Department disability determination unless the client reapplies with SSA. See When the Department Determines Disability.