Individuals Covered (Children with Disabilities) 510-05-58-10

(Revised 7/1/14 ML #3206)

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An individual may be enrolled under the Children with Disabilities coverage if he or she:

Is under age 19 (including month individual turns age 19);

Is disabled; and

Except for Qualified Medicare Beneficiary or Special Low-income Medicare Beneficiary coverage, is not in receipt of any other Medicaid benefits under Service Chapter 510-03 or 510-05.

The Social Security Administration may refuse to determine disability for a new applicant when the family has excess assets or income. In these situations, the State Review Team will make a medical determination of disability. This disability determination is valid for all Medicaid coverages; however, these individuals will likely remain eligible for Medicaid under the Children with Disabilities coverage.

Applicants or recipients who are eligible under this coverage, but who may also be eligible as medically needy, may choose which coverage they want, and will likely be based on which is more cost-effective for them. Once a recipient has been authorized as eligible for a current or past benefit month under one coverage, and the eligibility cannot be unauthorized, the recipient cannot switch coverages for that benefit month. A recipient can switch between coverages prospectively.

A SSI recipient, or an individual who is eligible as a 1619a or 1619b, is not eligible under this coverage if categorically eligible for Medicaid.