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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 38 Chapter 13 Determining Disability, Incapacity, and Blindness

13.12 PROCEDURES WHEN SSA FINAL DISABILITY DECISION IS MADE AFTER MEDICAID APPROVAL When the SSA's disability decision becomes known after the Medicaid application is approved, the procedure is as follows. 13.12.1 CLAIM DISALLOWED If Medicaid eligibility cannot be based on disability, the Worker needs to reevaluate the client for other Medicaid coverage groups. 13.12.2 CLAIM APPROVED When the client's claim for Supplemental Security Income (SSI) and/or Retirement, Survivors, and Disability Insurance (RSDI) based on his disability is approved after the Medicaid application is approved, the procedure is as follows: • If the Medicaid recipient becomes eligible for SSI, an SSI Medicaid case is opened for him. • If the Medicaid application was approved on a presumptive basis and the medical reports and social summary are with the Medical Review Team (MRT), the MRT must be informed that the client has been approved for SSI. • If the Medicaid recipient becomes eligible for RSDI, but not for SSI, the application was approved presumptively, and a final decision of the MRT has not been received, the MRT must be notified.

NOTE: If the client appeals the SSA decision, the reevaluation on the Medicaid case is delayed until the results of the appeal are known.