Page 3

SSA DECISION ON APPLICANT: When SSA determines a Medicaid applicant is not disabled, but MEDS has determined the applicant is disabled, the SSA decision supersedes the MEDS determination, and the Medicaid request for coverage based on disability must be denied. Re-evaluate the client’s Medicaid request when the Medicaid denial is based solely on an SSA disability denial, when: 1. SSA reverses the disability denial; and 2. The client is later approved for SSDI or SSI Medicaid eligibility is re-evaluated as follows: 1. Approved for SSDI – back to original Medicaid application date; 2. Approved for SSI – back to the earlier of the SSI application date or the original Medicaid application date. SSA DECISION ON CLIENT: If SSA finds a Medicaid client is not disabled (whether favorable MEDS determination or when SSA finds that an individual who they previously considered disabled no longer meets that criteria), Medicaid is continued during the 60-day period within which an SSA appeal may be filed. The eligibility staff member sets a system alert for the first of the month of the 60th day after the SSA notice of decision date, if they are aware of the findings in advance. NOTE: Repayment of benefits is not required during the 60-day period the client has to file an appeal. This process does not apply to a termination of presumptive SSI eligibility. PRESUMPTIVE DISABILITY ENDS: If SSA determines that an individual who receives Medicaid due to receipt of presumptive SSI benefits is not disabled; SSI Medicaid is terminated as soon as possible, allowing for timely notice, rather than being continued for 60 days. Non-SSI Medicaid may be provided during the 60-day period within which an SSA appeal may be filed. In the month in which the 60-day appeal period expires, send timely notice of Medicaid closure to the client using the appropriate system notice. The notice informs the client that Medicaid benefits will be terminated at the end of the month unless they provide verification (within 15 days of the notice) that the disability decision has been appealed to the Social Security Administration. The notice also informs the client that if their appeal is unsuccessful they may have to repay the continued Medicaid benefits they requested. If the client brings in verification of the SSA appeal, and requests continued Medicaid benefits, those benefits continue through the appeal process until a decision is reached by the Appeals Council.