Effective Date: October 1, 2022

Previous Policy

Members who are going through the disability determination process may be eligible on a different medical program while awaiting a disability determination. If Social Security or the State Medicaid Disability Office later decides the person is disabled, the member may be eligible for Disabled Medicaid for all or some of the past months.

The available benefits may be different under Disabled Medicaid than it was under the Adult Expansion program. If the member will have a spenddown on Disabled Medicaid, the member has the choice of whether to pay the spenddown for the past months. If the member does not want to pay the spenddown, do not change their eligibility from the previous medical program for those months.

1. Adults who have received coverage under the Adult Expansion program may be eligible for Disabled Medicaid coverage back to the date the disability began.

2. Eligibility may begin as early as three months before the month the application was received, but no earlier than the date of the disability onset. See 705 to determine the retroactive period.

3. An individual who meets the criteria for Disabled Medicaid without being on SSI and the Adult Expansion program can choose to remain on the Adult Expansion program.

4. If the Social Security Administration determines the individual eligible for SSI, they cannot choose to stay on Adult Expansion program.

5. If individuals qualify for Adult Expansion and a Medically Needy program, or a Disabled Medicaid program based on criteria other than SSI or SSI Protected Group status, they can choose which of the two programs is most beneficial for them. See 348 .