2662.6 Changes During the Disability Determination

When either the Clearinghouse or the Presumptive Medical Disability Team (PMDT) becomes aware of a change that may affect a pending disability determination, the change must be shared to ensure the determination is based on current and accurate information. Changes include, but are not limited to, updates in contact information, living arrangements, legal representation, eligibility, or other circumstances that may affect eligibility or the disability determination. Changes that may affect the need for a continuing disability review must be shared in accordance with 2662.7 .

If an eligibility determination is made on the case for reasons unrelated to disability while the disability determination is pending, the PMDT must be notified.

NOTE : A PMDT referral remains valid for up to 12 months. When coverage under PMDT is maintained without a break, staff must not initiate a new PMDT referral at review if the individual remains otherwise eligible and the disability determination is still pending with SSA. If SSA issues a final determination that the individual does not meet disability criteria, the individual is denied or discontinued due to no longer meeting program requirements. (See 2663.4 and 2663.6 )

If the individual later reapplies for SSA disability benefits after a final denial, this does not automatically continue prior PMDT eligibility. A new Medicaid application is required, and a new referral to PMDT must be completed in accordance with 2662.5 .