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5.9.6 Disability Application Denials 5.9.6.1 DDB Returns a Negative Presumptive Disability Decision If DDB returns a negative Presumptive Disability decision, the IM worker must send a manual notice of decision to the applicant. The notice must state: "Your request for Medicaid is based upon your statement that you are disabled. The final decision on your disability has not yet been made, however we have determined that you cannot be considered presumptively disabled. This means that you cannot be certified as eligible for Medicaid as a person with a disability until a final disability decision has been made. You will be informed when the Disability Determination Bureau makes the final disability decision. (Wis. Stats. ss. 49.46 and 49.47)” 5.9.6.2 Ineligible for Non-Medical Reasons If a member is determined ineligible for non-medical reasons, eligibility based on a presumptive disability may be terminated with timely notice without waiting for DDB's final disability decision. In such a case, the IM agency will notify DDB immediately that a medical determination is no longer needed. 5.9.6.3 DDB Reverses Presumptive Disability Decision Made by DDB or by the IM Agency If DDB denies a disability application, their decision reverses a presumptive disability decision made by the IM agency or by DDB. Medicaid eligibility is terminated following timely notice requirements. Medicaid eligibility based on a presumptive disability decision does not continue during the period a person is appealing DDB's decision that they are not disabled. Benefits received while the disability decision was pending are not subject to recovery unless the person made misstatements or omissions of fact at the time of the presumptive disability determination. This page last updated in Release Number: 23-04 Release Date: 12/18/2023 Effective Date: 12/18/2023 5.10 Medicaid Purchase Plan Disability 5.10.1 MAPP Introduction When a disability determination for the MAPP is required, complete the application process in SECTION 5.3 DISABILITY APPLICATION PROCESS. Section V – Work History of the Medicaid – Disability Application (F-10112) must be completed in full detail in all MAPP disability determination requests. The Disability page in CWW should be coded to indicate whether the request is for a MAPP disability determination or both a regular Medicaid disability determination and a MAPP disability. It is advisable to have both determinations completed if an applicant may move from regular Medicaid disability to MAPP disability. A determination of disability for MAPP excludes consideration of Substantial Gainful Activity (SGA), while a regular Medicaid disability determination does not.