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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 3 Chapter 13 Determining Disability, Incapacity, and Blindness

CLIENT HAS BEEN FOUND NOT DISABLED BY SSA The blind or disabled individual who is determined not disabled by the SSA must not, normally be found disabled for Medicaid purposes. However, in the following situations, the client who has been found not disabled by the SSA may be eligible for Medicaid when: • There has been a deterioration in the client's condition subsequent to the SSA's determination of ineligibility; or • The client has appealed the SSA decision and DOHS’s determination of disability or blindness is made prior to completion of the SSA appeal process. If the SSA's decision is upheld, Medicaid must be stopped. • An individual may be eligible for Medicaid while his claim for RSDI and/or SSI is being processed, providing that an MRT determination of disability or blindness is made prior to SSA's determination that the client is not disabled.

NOTE: When a Medicaid application is denied or the benefit is stopped because the SSA found the client not disabled, consideration must be given to his eligibility for all other coverage groups.