Page 79

required notices. The member then has another opportunity to appeal the termination of his or her Medicaid eligibility. The fact that this second potential fair hearing essentially involves the same issue (disability) that was the subject of the first appeal is irrelevant. As stated earlier, this process is required by federal law. 5.7.1.1 Example of Medicaid Disability Cessation Case Notice Text To: ____________________ Medicaid Disability Cessation Case The Disability Determination Bureau has determined that ______________________ SSN:____________ is no longer disabled. (See the SSA-832 decision in file.) The member has not appealed this decision within the 45-day appeal period that expired on ____________. Unless this individual qualifies for Medicaid on some basis other than disability, please initiate action to terminate MA coverage. See MA Eligibility Determination Handbook instructions in section 5.7.1. 5.7.2 Members Exceeding the Substantial Gainful Activity Level A Medicaid member who loses SSDI because he or she exceeds the Substantial Gainful Activity level does not lose Medicaid coverage if one of the following is true: 1. He or she is a member with a disability who was receiving non-MAPP full-benefit Medicaid and is currently working. 2. He or she is a current MAPP member. In these cases, a MAPP disability determination must be done and MAPP continued until the determination is made. This page last updated in Release Number: 25-04 Release Date: 12/10/2025 Effective Date: 10/21/2023 5.8 Conflicting Claims Disability determinations for Social Security, SSI, and Medicaid are completed under the same regulations. DDB’s decisions will be consistent if the person files for any of these programs. If a decision on one program is later changed by appeal or because of new evidence, etc., DDB will notify the other program’s to change their determinations to match. DDB may request return of Medicaid disability files when reviews of conflicting or updated decisions are needed. This page last updated in Release Number: 08-01 Release Date: 02/01/2008 Effective Date: 02/01/2008