Effective Date: July 1, 2016

Previous Policy

Who Meets Disability

Individuals meet the definition of blindness or disability when they have:

Been approved for or receive SSI because of blindness or disability.

Been approved for or receive Social Security Disability insurance (SSDI).

Individuals age 62-65 may receive Early Retirement while applying for disability benefits. If the person has applied for disability benefits, the SSA match record may show an estimated date of disability onset. This does not mean the individual has been determined disabled. Request verification that disability has been approved before authorizing Disability Medicaid for these individuals.

1619(a) or 1619(b) status. See Section 330-2

Been approved for or receives survivor’s benefits such as Childhood Disability Benefits (for adults) ( 330-1 ), or Disabled Widow/Widower Benefits ( 330-4 ).

Been determined blind or disabled by the State Medicaid Disability Office. Receipt of unemployment benefits does not preclude someone from being determined disabled.

Died. People are disabled for this reason only in the month of death.

SSI in suspense status due to assets in ABLE account.

Individuals continue to meet the definition of blindness or disability when:

SSDI benefits have stopped because the disabled individual is working above the Substantial Gainful Activity level. SSA refers to these individuals as the Working Disabled. If the individual was eligible for Medicare, he may continue to be eligible for Medicare.

The individual was determined disabled before or after entering an IMD or a public institution, has not left the IMD or public institution for 30 continuous days or more, and has not received a disability denial from Social Security after such approval date. (See Sec. 303-10 to decide when to request a new disability determination.)

A individual reapplies or completes the eligibility review process within 12 months of when the SMDO redetermination should have occurred. Open Medicaid during the SMDO process if the individual is otherwise eligible. Allow the individual a minimum of 30 days to submit SMDO related documents. See section 303-3 .

If Medicaid has been closed for more than 12 months from the month in which the SMDO review should have occurred, a new disability decision is required before the Medicaid may be opened.

SSI or SSDI Benefits Stop

Individuals continue to meet the definition of blindness or disability without requiring a new disability determination for 12 months after SSI or SSDI benefits stop for a reason other than no longer being blind or disabled. Complete an SMDO disability review at the end of the 12 months if SSI or SSDI benefits have not restarted. See Section 303 .

Some examples of when SSI or SSDI benefits may stop are:

The individual had too much income.

The individual made false or misleading statements to SSA.

The individual’s SSI payment stopped only due to a transfer of assets for less than fair market value.

The individual entered a nursing home.

The individual entered a public institution.

The individual is a qualified non-citizen, has exhausted the time-limited SSI benefit period and does not meet at least one of the additional SSI eligibility criteria for non-citizens required by various public laws.

The individual’s whereabouts are unknown to SSA.

The individual’s SSI status is "eligible but not paid".