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so his coverage is reduced to QMB-only. In December, John notifies the DFR that his resources have been depleted and he wants reconsideration for full coverage Medicaid. Because his MA D was closed for a non-disability reason less than 48 months ago, new medical information is not required unless the SSA no longer considers John to be disabled and he is not claiming a change in condition since that SSA determination.

2412.45.00 DECISION OF MEDICAL REVIEW TEAM (MED 1) The policy stated in this section applies to the MA D, MADW, and MA R categories of assistance. The Medicaid Medical Review Team, which is comprised of physicians, nurses and consultants, will review the medical evidence and the social information and make one of the following decisions:

• The applicant meets the disability requirement; a progress report is not required. • The applicant meets the disability requirement; a progress report is required by a date specified by the MMRT. • The applicant does not meet the disability requirement. Whenever necessary, the MRT will request Additional Information from medical providers and the applicant to decide as to whether the applicant meets the disability requirement. The MMRT decision and reason for a denial when applicable, is transmitted to the eligibility system. The MMRT will issue a detailed explanation for a denial to the applicant and a copy will transmit to the applicant’s electronic eligibility file. This letter along with the eligibility decision notice that contains appeal rights should be used in the appeals process.

As of June 1, 2014, a positive determination of disability made by MRT is no longer considered effective when the SSA has determined disability for an individual. If MRT determines a person to be disabled and a later determination is made by SSA that agrees with the MRT decision, there is no change regarding the determination of disability for that individual. If MRT determines a person to be disabled and the SSA later determines the person is not disabled, then the SSA determination supersedes the MRT approval. If a SSA denial is received, and the denial is not appealed within 65 days (see IHCPPM 2412.50.00), then the MED 1 category should be closed, and the Medicaid hierarchy must be explored (see IHCPPM 2412.50.00).

2412.50.00 PROGRESS REPORTS AND ONGOING ELIGIBILITY (MED 1) The policy stated in this section only applies to the MA D, MADW, MADI, and MA R categories of assistance.