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considered disabled for Medicaid purposes and will be explored for other categories of Medicaid assistance. If an individual does not appeal the SSA determination within 65 days from the date the SSA denial, the determination of disability made by the SSA is binding, and the individual will not be considered disabled for purposes of Medicaid eligibility. Medicaid under a disability category is to be discontinued with timely notice when a final determination decision is made by the SSA. Prior to any such discontinuance, consideration of eligibility in one of the other Medicaid categories must be pursued.

2412.55.00 TREATMENT FOR RESTORATION OF PHYSICAL/MENTAL HEALTH (MED 1) The policy stated in this section applies to the MA D, MADW, MADI, and MA R categories of assistance.

A disabled recipient is required to cooperate in any treatment plan recommended by the examining physician and approved for payment by Medicaid, which may fully or partially restore his physical or mental health.67 A recipient cannot be required to undergo any treatment if good cause for refusing exists. "Good cause" includes, but is not necessarily limited to: • The treatment is contrary to his religious beliefs • Previous surgery of the same type recommended was unsuccessful • The recommended treatment is very risky because of its magnitude or unusual nature; or • Amputation of a major limb is involved.68

If the recipient refuses the recommended treatment without good cause, the caseworker is to report this fact and the reason(s) for his refusal to the Medical Review Team, Office of Medicaid Policy and Planning.

The decision to discontinue MA due to the refusal of recommended treatment will be made by the MRT.

2414.00.00 SSI STATUS