2662.7 Continuing Disability Reviews

Disability determinations are subject to periodic review to determine whether the individual continues to meet disability criteria for purposes of Medicaid eligibility.

Continuing disability reviews may be conducted by the Social Security Administration (SSA), Disability Determination Services (DDS), or the Presumptive Medical Disability Team (PMDT), consistent with the source of the most recent disability determination and applicable review requirements.

A continuing disability review may be initiated based on, but not limited to:

A scheduled review or diary date by SSA or DDS;

Information received by the agency indicates a possible change in the individual’s medical condition;

Program requirements for ongoing eligibility under a disability-based coverage group.

When a continuing disability review is required, the agency must ensure that a current disability determination is available to support ongoing eligibility. Individuals are required to cooperate with a continuing disability review in the same manner as an initial disability determination.

If a continuing disability review results in a determination that the individual no longer meets disability criteria, eligibility under all coverage groups must be determined before taking adverse action in accordance with applicable notice and appeal requirements. (See also 2652 , 2662.3 , 2662.8 , PM2018-10-01 , and PM2024-08-01 .)

Note: Continuing disability reviews are not applicable to MediKan Tier 2 disability determinations.