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5.5.2 Reversed or Delayed Disability Decision When a disability denial decision is reversed (approved) as a result of a reconsideration/hearing request or SSI or SSDI appeal, or when a delayed approval is granted, the individual’s Medicaid eligibility must be redetermined. The original Medicaid application filing date associated with the Medicaid Disability Application (MADA) decision (see SECTION 5.3 DISABILITY APPLICATION PROCESS) or the SSI or SSDI disability determination must be honored. A new application or signature is not required. The individual’s Medicaid eligibility must be re-evaluated for all months between the filing date (and backdated period, if backdating was requested) and the date of the DDB, SSI, or SSDI approval. For this retroactive period, the individual is only eligible for Medicaid in the months in which they met all Medicaid eligibility requirements. Example: Kate (47) originally applied for health care in January with a three month backdate request and was determined over income for BadgerCare Plus. She submitted a MADA, and her disability was initially denied. In May, her disability denial decision was reversed. Her disability onset date is December 15. The worker redetermines her health care eligibility as of October. Kate is ineligible for health care in October and November but eligible for EBD Medicaid for December and ongoing. This page last updated in Release Number: 22-01 Release Date: 04/04/2022 Effective Date: 04/04/2022 5.6 Medical Exam Cost If the person's Medicaid application is approved, Medicaid will pay the cost of any medical examination necessary for the completion of a current medical report. If it is denied, you may claim the cost of the examination as an administrative expense. Reimbursement is from the Medicaid administrative account. This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008 5.7 Redetermination 5.7.1 Redetermination Introduction Review a DDB disability determination when any of the following are true: 1. The Disability Determination and Transmittal (SSA-831) indicates medical re-examination in item 17 of that form and the person is not currently receiving SSDI or SSI Disability Benefits. 2. The person is younger than 65 years old and no longer receives OASDI (Social Security) disability benefits. This does not include members who have converted from OASDI benefits to Social Security Retirement benefits (see SECTION 5.10.2 MEDICAID APPLICANTS AND MEMBERS WHO CONVERT FROM SOCIAL SECURITY DISABILITY TO SOCIAL SECURITY RETIREMENT). 3. The medical circumstances have significantly improved (see SECTION 5.7.2 MEMBERS EXCEEDING THE SUBSTANTIAL GAINFUL ACTIVITY LEVEL). 4. The person has returned to work. When a disability redetermination is required, the following information is required and is sent electronically to DDB: