Page 90

MISSISSIPPI DIVISION OF MEDICAID Eligibility Policy and Procedures Manual CHAPTER 102 – Non-Financial Requirements Page |90 Effective Month: September 2018 102.09.02 DISABILITY DETERMINATION PROCESS FOR SSI APPLICANTS In Mississippi, an application for SSI is also an application for Medicaid. In addition, an application for SSI is also an application for Title II benefits (Social Security benefits on the individual’s own record or someone else’s record). If the only application for Medicaid is filed with SSA for SSI benefits, the applicant is required to wait until SSA makes the SSI eligibility determination. Independent Disability Determinations If an individual applies for both SSI benefits with SSA on the basis of disability or blindness and applies separately for Medicaid through DOM, the regional office will make an independent disability determination, as outlined in this section. It is not permissible for the regional office to hold the application waiting for the SSI decision or to deny the application because the individual has an application pending with SSA. A DDS decision must be independently obtained from DDS when the applicant: • Has also applied for SSI (which may also involve an application for Social Security benefits on their own record or someone else’s record) with SSA and • The applications for Medicaid and SSI are for the same period of time (although the application dates may be different). The Medicaid application may also cover additional months due to a request for retroactive Medicaid benefits. 90-Day Disability Denial for SSI Applicants If DDS has not ruled on the SSI application disability decision within 90-days of the Medicaid-only request for a disability decision, DDS will issue a 90-day denial of Medicaid disability that will state that SSI (and Title II, if applicable) is still pending. When the 90-day denial is received by DOM, the Medicaid-only application must be denied because disability requirements are not met. The Specialist must enter remarks on the denial notice advising the individual to let the regional office know if disability benefits are approved by SSA. If the individual is later approved for disability through SSI or Title II, handle the denied application for Medicaid-only as follows: • If SSI is approved, review the SSI dates of eligibility to determine if additional months of Medicaid coverage are needed, such as the need for retroactive Medicaid (if the individual applied for retroactive coverage on the denied