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DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 15

SSI MEDICAID – AUTOMATED PROCESS

(VII.D.4.) A continuing SSA appeal is not a requirement if the hearing officer determines that 3. a., b., or c. applies and that the a/r is disabled.

E. Evaluate All Coverage Groups

Evaluate the recipient's eligibility in all coverage groups. This may involve contacting the recipient to obtain additional information, ONLY if necessary information is unavailable to the agency from another source or is not current. See F.

If the recipient is eligible in more than one coverage group, the recipient has a right to choose the coverage group. Explain the advantages of each coverage group and document the recipient's choice.

1. MAD - Refer to D. for continuation of MAD when SSI disability termination is in appeal status.

If the recipient’s SSI was terminated for a non-disability related reason, such as income, evaluate for MAD. If the recipient remains eligible, as MAD, continue MAD. At the next regular eligibility redetermination, submit forms to DDS to establish a regular “Diary/Re-Exam Date” for ongoing reviews of disability.

2. Children Terminated from SSI With Protected Status - Refer to MA-2525, Disability, for instructions for evaluating children with protected status.

3. MAA - If the individual is aged 65 or older, evaluate for MAA.

4. MAB - If the individual has been determined to be blind by Social Security, evaluate for MAB.

5. MAF - Evaluate for MAF-C. If it appears the recipient is eligible for MAF-C, then, advise a/r to apply for Work First. However, approve him for MAF-C if eligible. If the SSI recipient’s family is authorized for Work First, the former SSI recipient must be added to the Work First assistance unit.

6. Other Family and Children's Medicaid

a. Evaluate the recipient's eligibility in all Family & Children's categories, including MAF, MIC, NCHC, HSF, MPW, Breast and Cervical Cancer Medicaid and Family Planning Waiver.

b. If it is known to the agency that the recipient is pregnant, contact the recipient to request verification of pregnancy to evaluate for MPW. If there is no information to indicate pregnancy, continue to evaluate in other coverage groups. It may be necessary to contact the recipient to inquire whether she is pregnant if there is no other basis for eligibility. See instructions in F.