B-7300, MEPD Eligibility Pending a Decision of SSI Application

Revision 25-4; Effective Dec. 1, 2025

People who applied for SSI , but had their SSI application delayed more than 90 days, may be certified under the appropriate MEPD program pending the SSI eligibility decision.

The person must meet all applicable non-financial and financial MEPD criteria to be eligible including:

disability; and

institutionalization for 30 consecutive days.

Consider the age of the person when deciding if a disability determination is necessary.

The state office Disability Determination Unit (DDU) needs a disability determination if the person is younger than 65. DDU cannot make a disability determination decision unless 90 days have passed since the SSI date of application, and SSA 's disability decision is still pending. If SSA finds the person is not disabled after DDU has established a disability, DDU must follow SSA’s decision. The staff must deny eligibility. Set a special review for the fifth month to monitor the final SSA decision on disability.

When a MEPD recipient becomes eligible for SSI, SSA reports the SSI eligibility to HHSC by the State Data Exchange (SDX). Upon receipt of the SDX information, the eligibility determination system automatically denies the MEPD benefit and activates the SSI coverage. This is not an adverse action because the person does not lose benefits.

The above policy only applies to situations where the processing of an SSI application was delayed. Verify and document that an SSI application was filed.

Note: If the person is 65 or older, a disability determination is not necessary. Verify that the person has filed an application for SSI.