Effective Date: January 1, 2024

Previous Policy

1. Open BM or DM when:

a. BM or DM was denied because SSA or the State Medicaid Disability Office denied blindness or disability, and

b. The member appealed the decision, and

c. The blindness or disability was approved.

2. Eligibility may begin as early as three months before the date of the application that was denied but no earlier than the date of the disability onset.

3. A person who is not receiving medical assistance would have to contact the Medicaid office to request eligibility back to the original application date when the appeal is through SSA.

4. Recalculate any spenddown using DM rules. If the member owes less spenddown under DM the member may ask for a refund. To get a refund, other family members would have to qualify for Medicaid without a spenddown.

5. Contact Medicaid Claims if you open DM for a member who was on Refugee Medicaid so the medical bills are paid from the right funding source.