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Title 8: Medicaid Page 94 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Nonfinancial Non-MAGI-Related Eligibility Revised October 10, 2025 Denial of Medicaid Based on Disability Denial The Department of Inspections, Appeals, and Licensing (DIAL) notifies the HHS worker, the appellant, the appellant’s representative, and DDS (if appropriate) of the hearing date. The worker is the representative for the Department (HHS) and must attend the hearing to explain HHS procedures leading to the denial of Medicaid. If DDS made the disability determination on behalf of HHS, the DDS representative attends the hearing to:  Explain DDS procedures,  Explain the disability determination decision, and to  Answer questions from the administrative law judge, the appellant, or the appellant’s representative. On rare occasions, the administrative law judge (ALJ) may determine that additional medical examinations are required to make a decision. DDS is responsible for obtaining these services. After the ALJ issues a written order to DDS describing the required tests or examinations, DDS requests the disability file from the local office. DDS may ask the worker to obtain signed releases from the appellant as needed. DDS will then schedule the tests, provide the results to the ALJ, and return the disability file to the local office. If the Final Decision states that the appellant is disabled, and all other eligibility requirements are met, approve Medicaid. Under this circumstance, if a date is not given for a Continuing Disability Review (CDR), contact the HHS, SPIRS help desk for guidance. When SSA Denial Is Reversed in an SSA Appeal Legal reference: 441 IAC 50.2(1) and 75 (Rules in Process) Policy: When an applicant reports that the Social Security Administration (SSA) appeal process has reversed the denial of disability and the person is now determined to be disabled, the Department must determine if this change affects Medicaid eligibility. Procedure: If Medicaid was denied based on the Department’s disability determination and not based on an SSI or Title II denial, the SSA reversal has no effect on the Medicaid denial. Advise the client to file a new Medicaid application.