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2412.30.00 VERIFICATION OF THE DISABILITY REQUIREMENT (MED 1) The policy stated in this section only applies to the MA D, MADW and MA R categories of assistance. The Disability requirement is verified by any one of the following categories: • The applicant is receiving Supplemental Security Income (SSI) benefits as a "disabled individual", "disabled child", or "disabled spouse." This is verifiable by the State Data Exchange (SDX) • The applicant is receiving Social Security Disability (SSDI) as verified by the SSA BENDEX data exchange and the “onset of disability” date is documented • If the applicant alleges to be receiving Social Security benefits based on disability, but it is not verifiable through the SDX or BENDEX, the applicant can obtain proof of Disability status from the Social Security Administration. This verification must be directly issued by the SSA, must be current within 30 days of receipt by the DFR, and must specify receipt of benefits based on the individual’s disability • The Medicaid Medical Review Team reviews medical evidence and social history information submitted by the eligibility worker and determines that the person meets the definition of disability. Additionally, in the above circumstance of proof of disability status from the SSA, the MMRT will record the disability approval in the system upon receipt of documentation from the eligibility worker.

When disability cannot be verified by the SSA data exchanges or statement from the SSA, the MMRT will decide of disability. The policy and procedures outlined below are to be followed by eligibility workers. In no situation can the individual be considered as “not cooperating” due to failure to obtain documentation from the SSA regarding disability status. This is an available option for the individual and if this verification is not obtained, the eligibility worker must pursue medical information collection as explained in the following sections. An individual who has been determined by the SSA to not be disabled, will not meet the Medicaid definition of disability unless the condition has worsened since the SSA denial, or the individual has had onset of a new condition not considered by the SSA. In this situation, medical information must be submitted to the MMRT for decision.65

2412.30.05 Exceptions when MRT will determine disability SSA will determine disability for Medicaid except in the following circumstances where MRT will determine disability: a. An individual has never applied to the SSA for disability benefits