Effective Date: February 1, 2017

Previous Policy

This section is applicable to Blind or Disabled Medicaid recipients who appeal an SSA decision that the recipient is not blind or disabled.

Reopen Blind or Disabled Medicaid back to the date of the Medicaid closure when:

The individual appeals the SSI or SSDI denial or closure; and

You receive proof of the appeal no later than 10 days after the appeal was filed.

Keep Blind or Disabled Medicaid open until one of the following occurs:

The member fails to file an appeal to the next step in the SSA review process.

The SSA administrative review process is exhausted.

The member requests the case be closed.

Something else changes that makes the member ineligible.

Do not request a disability review from the State Medicaid Disability Office while the SSA appeal is pending unless the member has a new disabling condition that SSA did not consider.

Close the Blind or Disabled Medicaid if the final SSA decision is still a denial. See section 825 .

The member may appeal in federal court. The member cannot continue to get Medicaid during an appeal in federal court unless the most recent SSA denial occurred over 12 months ago .

Continue Medicaid if SSA approves the blindness or disability as a result of the appeal. No overpayment has occurred.