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Title 8: Medicaid Page 73 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… When SSA Denies Disability After Disability Approval By DDS or SSA Legal reference: 441 IAC 75 (Rules in Process) Policy: A member may have been approved for Medicaid or State Supplementary Assistance based on the Department’s or the Social Security Administration’s (SSA’s) determination of disability but at a later date the Social Security Administration (SSA) makes a determination the person is not disabled. The Department is required to follow the final SSA decision. Comment: Since the SSA allows 65 calendar days to file an appeal, an SSA decision cannot be considered final until the 65 day appeal period has expired. It is important to understand the difference between an SSA decision that is final and one that is not final, because they affect Medicaid eligibility differently. Procedure: Use the procedures in the following chart for the correct action at each step in the decision process when the SSA denies disability for a Medicaid member who has been determined to be disabled by DDS or SSA:

Status Action HHS receives notification that SSA has denied disability for a person who was approved based on a DDS or SSA disability decision. 1. Continue Medicaid or State Supplementary Assistance for 65 days from the date of the SSA denial. 2. Set a reminder to track the 65 days. 3. On the 66th day, check to see if an SSA appeal has been filed. If the member has not filed an appeal with SSA by the end of the 65 days, the SSA decision is a final decision. Cancel benefits with timely notice using a manual Notice of Action with the language listed below. If the member appeals the denial within 65 days, the SSA decision is not a final decision. Continue benefits until there is a final decision from SSA. This could be either:  A decision issued at the Social Security Appeals Council level; or  The most recent decision that the member does not pursue to the next appeal level by the end of 65 days.