2662.9 Impact of Social Security Determination

The outcome of the disability determination made by PMDT is binding until Social Security reaches a final determination.

If a Tier 1 disability is established, the consumer is considered disabled until SSA reaches a final determination. If Social Security affirms the disability, assistance may continue if all other eligibility factors continue to be met. If Social Security denies disability, categorical assistance is terminated under the disability category.

If a Tier 1 disability is not established, the application for disability-based Medicaid is denied. The application can be reconsidered if new information is presented during the 90-day application time frame (see 1413 ). If the consumer is approved for SSI based on the Social Security application associated with the PMDT, assistance may be provided effective with the Protected Filing Date if all other eligibility factors are met. Cooperation with Social Security disability is required.