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Title 8: Medicaid Page 72 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…

____ is not blind or disabled. The Social Security Administration denied benefits as you are not disabled at this time. We are required to follow Social Security’s decision. If you are approved for disability benefits at a later date, please tell us within 10 days of the date on your notice from Social Security. EM 8-C Denial Based on Disability; 441 Iowa Admin. Code 75 (Rules in Process)

Status Action SSA decision is final within the last 12 months. Client claims a change or deterioration in the disability that is expected to last 12 months. 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. Determine is 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. Comment: The only payment status code on the SDX that means disability was denied due to substantial gainful activity is N44. Payment status codes of N31, N32, N42, or N43, indicate denials of disability based on “capacity for substantial gainful activity.” This means that, despite a medical impairment, the person has the ability to perform sedentary, light, or medium work that would allow the person to return to customary past work or other work.