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LONG-TERM CARE INTRODUCTION and CHAPTER 37 HOME AND COMMUNITY-BASED SERVICES: THE CHILDREN'S LONG-TERM SUPPORT WAIVER PROGRAM. 5.2.2 Disabled Medicaid Applicants and Members Who Convert from Social Security Disability to Social Security Retirement Benefits An EBD Medicaid applicant or member whose SSDI or any other disability-related Old Age, Survivors and Disability Insurance (OASDI or Title II) benefits stopped because he or she began receiving SSRE is considered to have met the disability requirement for all types of EBD Medicaid, including MAPP. A disability re-determination is not required. The member is not required to provide verification of the disability unless the worker is not able to use data exchanges or other information from SSA to confirm that the individual received disability payments immediately prior to receiving SSRE. Example 1 Ed is an EBD Medicaid member who was determined disabled ten years ago and has been receiving SSDI since that time. Upon turning 63, his SSDI payments change to SSRE payments. The IM worker can see this change by querying SOLQ-I. By policy, Ed is considered disabled and will not be required to provide any further verification or go through a re-determination.

Example 2 Nancy was determined disabled fifteen years ago and began receiving SSDI. Two years ago, her SSDI payments converted to SSRE payments. Nancy came into the agency this year to apply for MAPP. Although she was previously unknown to CARES, the IM worker was able to research her payments through SOLQ-I and see that prior to receiving her SSRE payment, she was receiving SSDI. Nancy is considered disabled and is not required to provide any further disability verification.

Example 3 Fred was determined disabled twenty years ago. His SSDI payments recently converted to SSRE. Fred moved to Wisconsin and applied for MAPP. The worker was unable to find evidence of this conversion through SOLQ-I. Fred provided a statement from his “My Social Security” account that shows his SSDI payment stopped and SSRE payments began. This verification is sufficient to consider Fred disabled. He does not need to provide any further verification or go through a re-determination. 5.2.3 Katie Beckett Medicaid Members Moving to Other EBD Medicaid Programs Katie Beckett Medicaid (KBM) is a full-benefit Medicaid program for children with disabilities who have complex health care needs and live at home (see CHAPTER 29.1 KATIE BECKETT MEDICAID). KBM workers determine eligibility for KBM. Eligibility for KBM requires a disability determination that is completed by the Bureau of Clinical Policy and Pharmacy (BCPP) rather than the Disability Determination Bureau (DDB). BCPP uses the same criteria as the Social Security Administration (SSA) and the DDB. When a member loses eligibility for KBM for any reason other than a medical cessation of disability, the member’s KBM disability determination meets the disability requirement for all categories of EBD Medicaid as long as the member submits requested information timely. The member’s submission of information is timely if a health care application is submitted to IM within three months of when their KBM coverage ended. When an application is received, if the former KBM member otherwise meets all financial and non-financial requirements, they will be enrolled in an EBD Medicaid program first and then asked to submit the Medicaid-Disability Application, F-10112 (MADA), and an Authorization to Disclose Information to Disability Determination Bureau (DDB), F-14014 (ADDD). As long as all required information is provided timely and they are otherwise eligible, the former KBM member will continue to