Kansas Economic and Employment Services Manual
2000 General Eligibility
10-17
2660 Medical Only Coverage
Related to the SSI Program (MS/CI) - Medical assistance is available
for persons who are aged or disabled and who are not financially eligible
for SSI cash benefits. In addition, assistance is also available to children
in a state institution.
2661 Related to Age -
The individual must have attained the age of 65 prior to or within any
month for which eligibility is being determined.
2662 Related to Disability,
Including Blindness - To receive Medicaid coverage based on disability,
the individual must be determined blind or disabled according to the Social
Security Administration's standards within any month for which eligibility
is being determined. To receive MediKan coverage, the individual must
meet the MediKan definition of disability.
- SSA Definition of Disability
(Medicaid) - The inability to do any substantial gainful
activity by reason of any medically determinable physical or mental
impairment which can be expected to last for a continuous period of
not less than 12 months or result in death.
- SSA Definition of Blindness
(Medicaid) - Central visual acuity of 20/200 or less in the
better eye with the use of correcting lens which has lasted, or is
expected to last, for a continuous period of not less than 12 months
or result in death.
- MediKan Definition of Disability
- A severe impairment which significantly limits physical
or mental ability to do basic work activity that is expected to last
12 months or result in death. Basic work activities are those abilities
and aptitudes necessary to do most jobs. Examples include:
- Physical functions such as walking, standing, sitting, lifting,
pushing, pulling, carrying;
- Capacities for seeing, hearing and speaking;
- Understanding, carrying out and remembering simple instructions;
Use of judgement;
- Responding appropriately to supervision, co-workers and usual
work situations;
- Dealing with changes in a routine work setting.
However, the existence of the severe impairment does not prevent the
individual from performing past relevant work or adjusting to other work.
The Social Security Administration will make a determination of disability
or blindness as part of the eligibility determination for SSI or SSDI
benefits. Individuals receiving either Social Security Disability benefits
or SSI based on disability have met the necessary disability standard.
Verification of the Social Security decision is required. This can generally
be obtained through the EATSS system, but can also be obtained through
a notice of entitlement, an SSA-1610 or other SSA document. Receipt of
Social Security benefits in general does not automatically indicate the
individual meets disability criteria, as some types of SSA benefits are
not dependent upon a disability determination (e.g., early retirement
or survivor's benefits). Contact with the local SSA office may be needed
to determine if a disability decision has been made.
2662.1 Disability
Levels for Presumptive Disability and MediKan - The state's Presumptive
Medical Determination Team (PMDT) along with the Disability Review Team
(DRT) will determine if the individual meets the definition of disability
or blindness (see above) for purposes of determining eligibility for MediKan
and Presumptive Medicaid Disability:
Tier 1 Disability: The individual
is determined to meet the SSA definition of disability or blindness. For
PMD, those who meet the SSA level of disability are considered Tier 1.
The Tier 1 determination will evaluate if the impairment(s) meet or equal
a listing described in Appendix 1 of CFR 404, Subpart P and will also
consider the Medical-Vocational guidelines outlined in Appendix 2 of C.F.R.
404, Subpart P.
Tier 2 Disability: The individual
is determined to meet the MediKan definition of disability. For MediKan,
the disability determination will use the same procedures as the Medicaid
determination. This process involves an evaluation of the individual’s
impairments related to their ability to work. To receive MediKan, the
individual must be determined to have a severe impairment but, because
of the person’s ability to work, the individual does not meet SSA criteria.
Persons meeting these criteria are considered Tier 2.
The Tier 2 determination considers the individual’s ability to perform
past relevant work or adjust to other work. If a severe impairment does
not exist, the individual does not meet Tier 2 criteria.
Persons must meet Tier 1 disability criteria in order to qualify for
Medicaid under Presumptive disability. For MediKan the individual must
meet Tier 2 disability criteria. The PMDT will initially consider disability
under Tier 1 and, if not met, will then consider disability under Tier
2.
2662.2 Authorization
to Determine Disability - A disability determination may only
be made by an entity authorized by KDHE-DHCF. A disability determination
or certification by another agency is not sufficient to document disability
for Medicaid or MediKan. Where a disability determination has been made
by another entity, such as the Veterans Administration or Railroad Retirement
Board, a SSA determination must be obtained in order to qualify for Medicaid.
- Social Security - If
a final determination of disability or blindness has not been made,
the applicant is initially referred to Social Security for a determination.
If the individual is potentially eligible for benefits through the
Social Security disability insurance program or Supplemental Security
Income, SSA will take an application and complete the disability determination.
If SSA will not complete the determination because of a reason not
related to the disability, the case may be referred to DDS.
- Presumptive Medicaid Disability
Team (PMDT) and The Disability Review Team (DRT) with the KDHE (for
months on or after 09-2006 only) - The DRT, along with the
PMDT will make disability decisions for Presumptive Medicaid (see
2666) and MediKan (see 2640)
determinations only. These are limited to persons potentially eligible
for Social Security benefits. The DDS referral process is used where
there is no potential eligibility for SSI or SSDI benefits.;
No verification of the duration of the disability is needed prior to
sending a referral to the PMDT. A referral is sent based on the client's
statement of disability duration.
- Disability Determination Services
- DDS makes determinations of blindness or disability only
when a disability determination has not, or will not, be made by SSA
for reasons unrelated to disability. SSA will not make a disability
determination if the individual is not eligible for a cash payment
from SSI or SSDI. Reasons for cash ineligibility which would require
a DDS referral include: Insufficient work history, excess income or
resources, transfer of property penalty. SSA will also not make a
disability determination on a deceased individual with no active application
on file. Documentation of the SSI/SSDI denial for a reason other than
disability is required prior to referring to DDS. See 2662.3
for referral process.
- Initial Disability Determinations
- DDS will determine disability beginning with the first
month required for the Medicaid determination. A disability onset
date will be established for persons with favorable determinations.
- Disability Onset Date for Medicaid
- DDS will determine an onset date for Medicaid determinations
prior to the onset of SSI.
Example: Mary T applies for Medicaid on May 10 and requests
prior medical. She was approved for SSI with payments beginning May
and SI eligibility beginning in April. Disability criteria is met
for both May and April. However, because there is no potential for
cash benefits in February and March, Social Security will not determine
Mary T's disability in those months. A referral is sent to DDS to
determine if she meets disability criteria in February and March.
2662.3 Referral
to Disability Determination Services (DDS) -
- When a referral to DDS is necessary because SSA will not make the
determination of disability as described above, the procedure outlined
in this section shall be followed. Eligibility
staff are responsible for securing initial information related
to the disability determination and providing the information to DDS.
DDS will request additional information prior to rendering a decision.
Refer to the Miscellaneous Forms
section for copies of the forms referenced.
- Complete sections I and II of the DD-1104,
Disability Determination Request, obtaining general information
about the individual. If the client does not have an SSN (e.g.,
undocumented alien applying for SOBRA coverage only), this should
be indicated in the space allotted.
The onset date requested must be noted on the form in Section
II. This would normally be the month of application or the 3 months
prior to the application month.
If available, attach a copy of the Social Security denial
letter to the referral.
- Complete section I, II and III of DD-1105,
Disability Determination Date/Report, obtaining social information
as well as employment and medical history. The individual, medical
representative or other party(such as a case manager) may complete
the form. If someone other than the individual completed the form,
the name and relationship of the person should be included on
the form. All doctors the applicant has seen since the alleged
onset date are to be listed on the form. The applicant may provide
a complete list in Section IV or attach additional pages. The
completed form must be signed and dated by the Eligibility
Specialist and Supervisor.
- The DD-1103 is used to secure necessary signatures for release of medical
information. The client must sign the form unless unable to do
so because of the persons medical condition. In these instances,
a person authorized to act in his or her behalf may sign the form.
Indicate the reason the client is unable to sign. If the form
is signed by a mark, a witness must attest to the signature. The form should also be dated at this time. The Eligibility Specialist must complete the appropriate
section of the form.
The original DD-1104,
1 original DD-1105,
and the appropriate number of original DD-1103 forms shall be submitted to: Disability Determination Services, Attn:
Case Control, 2820 S.W. Fairlawn, Suite 100, Topeka, Kansas 66614,
for decision and completion of Form DD-1104, Section III. The Eligibility Specialist shall retain a copy of each form for the case record.
DDS will assume responsibility for securing whatever medical
information is necessary to make a disability decision, assuming
the applicant and local agency have provided the necessary information
on medical providers who have served the applicant. DDS will enter
on Form DD-1104
the decision (approval or disapproval), date of decision, onset
date, review date (diary date) pertinent diagnosis, and any recommended
medical procedures that might aid the social service worker in
working effectively with the applicant toward maximum health and
activity. DDS will return the completed original Form
DD-1104, and Form DD-1105,
with copies of any pertinent medical information to the local
office. For the case still pending a decision at the end of 45
days, updated information can be requested directly from Disability
Determination Referral Services at (785) 267-4440.
When the Forms DD-1104 and DD-1105 (including any attachments)
have been returned, the local Eligibility Specialist will:
- Complete the proper case
action indicated; and
- File the original copy
of Form DD-1104
in the case file for documentation
purposes.
- Specific Referrals – The following types of referrals require the inclusion of additional information.
- . SOBRA – A non-qualifying alien may be eligible for emergency medical services under the SOBRA program (see 2691). If eligibility will be determined under a disability program, a referral to DDS via the DD-1104 is required. The form should clearly indicate that this is a SOBRA referral. In addition, the referral should include any medical records obtained through the MS-2156 process.
-
Deceased Applicant – Assistance may be applied on behalf of a deceased individual [see 1411.3(1)]. If eligibility will be determined under a disability program, a referral to DDS via the DD-1104 is required. The form should clearly indicate that the individual is deceased, including the date of death. In addition, the referral should include a copy of the death certificate (if available) and any medical records.
-
Child – There may be instances where a child claiming a disability is not eligible under either the poverty level or MA/CM programs. To consider eligibility under the Medically Needy (MN) program for the child, referral to DDS via the DD-1104 for a disability determination would be appropriate. The form should clearly indicate that this is a child referral.
In addition, there are instances where the disability status of a non- applicant/recipient child is relevant to the eligibility of another individual. Even though the child is not seeking assistance, a referral to DDS would be appropriate in order to determine eligibility for the other individual.
For example, an elderly applicant for long term care coverage has funded a special needs trust for a minor grandchild. In order for this not to be considered an inappropriate transfer subject to penalty (see 5720), the grandchild must meet disability criteria. If the child has not already been determined disabled through the Social Security Administration (SSA), a disability determination is required.
-
Reconsideration/Appeal – If the DDS decision is negative, the client has the right to request a reconsideration/appeal of that decision. Eligibility staff shall complete a new DD-1104 and forward to DDS, clearly indicating this is a Reconsideration. DDS will review the record, including any additional medical evidence presented to reconsider the original disability determination. The outcome of the reconsideration by DDS will determine the next steps in the process.
- If disability is approved through the reconsideration process, the agency will be notified and action should be taken to reprocess eligibility based on the disability finding. b. If the DDS decision upon reconsideration is still negative, the agency shall complete an appeal form and agency summary. These forms, along with the reconsideration file returned by DDS, shall be submitted to the Administrative Hearing Office (AHO). The forms should be clearly identified as a DDS appeal case. A fair hearing will then be scheduled and conducted. DDS will represent their decision at the hearing.
-
If the DDS decision is upheld, no further action on the case is required by the agency.
-
If the DDS decision is overturned, the original application shall be reinstated and processed based on the applicant meeting disability criteria.
See also 1614.1(4) and (5), and 1614.3(9) for additional guidance.
-
Continuation Review – If DDS has made a favorable decision, the DD-1104 returned by DDS to the agency will include the date the disability determination needs to be reviewed in the future. This is called the diary date. The Eligibility Specialist shall make a re-referral to DDS on the diary date using the DD-1104. The re-referral shall include all the previous information used to make the original decision, including the returned DD-1104 and DD-1105 forms. DDS will then review the client’s disability status to determine if he/she continues to meet disability criteria.
DDS will complete and return the DD-1104 to the Eligibility Specialist. If the decision is favorable, eligibility continues. DDS will include a new diary date indicating when the next disability review will be required. If the decision is unfavorable, the client no longer meets disability criteria. Adverse case action may be required.
2662.4 Presumptive
Medical Disability Team (PMDT) - A referral to the PMDT is necessary
in order to complete a disability determination for Presumptive Disability/Medicaid
or MediKan. The eligibility worker is responsible for initiating the PMDT
determination and, unless specifically approved
by KDHE Policy, the PMDT shall only accept referrals from eligibility
staff. The eligibility worker makes
a referral to the PMDT by completing steps 1-4 below. Once the referral
is received from the ES, the PMDT will obtain additional information by
requesting additional information from the applicant and completing steps
5-12. The eligibility worker then completes Step 13.
- Determine if Individual is Eligible
for Referral to PMDT - To determine if a referral is necessary,
the eligibility worker must evaluate all requests for or Medical Assistance.
A referral may be sent for both MediKan and Medicaid, or
for Medicaid only. A referral for MediKan only is not appropriate. Individuals who do not meet financial or other criteria for
MediKan may be referred for Medicaid only. For MediKan/Medicaid referrals,
the PMDT will automatically consider disability under both MediKan
and Medicaid.
Persons who have met the lifetime limit
for MediKan are only referred for Medicaid. A referral for MediKan
is not appropriate.
The referral should indicate if the consumer is requesting prior medical.
If so, include the first prior medical month in the referral.
- The referral must indicate which programs are applicable.
Example 1: Application is received for an individual
who has already received 12 months of MediKan coverage. The applicant
may not receive MediKan, so the only program considered is Medicaid.
Example 2: Application received for an individual with countable
monthly income of $500.00. This is over the income
limit for MediKan, so the only program considered is Medicaid.
- The eligibility worker must ensure
the individual has made a declaration of disability that meets the
minimal standards. Use
the following guidelines and processes for determining if a referral
is sent.
- Statement of Disability
- The disability may be claimed on the application or
through contact with the individual. The worker must gather additional
information regarding the duration of the disability, status of
past or current Social Security applications and other medical
information. This is communicated to the PMDT as part
of the initial referral.
Note: Disability is a requirement for both Medicaid
and MediKan. Do not refer if the individual does not claim a disability
or does not respond to the questions.
For couples, if only one spouse is reporting a disability, there
is no eligibility for MediKan and the referral would be for Medicaid
only.
- Duration - Determine if the individual
meets the durational requirements - the disability will last at
least 12 months or result in death.
Note: The durational requirements are necessary for both
Medicaid and MediKan. Do not refer if this condition is not met.
Example: Client reports on application for medical assistance
that he is disabled. He then reports his disability,
an arm injury, will only last about 6 months. The durational requirements
are not met and therefore, no referral is sent.
- Status of SSA Disability
Application - (see 2662 ) Determine
if a final determination of disability has been made. A determination
is not considered final if the application is still pending with
Social Security or is in appeal status.
Note: If a final determination has not been made, referral
is made for Medicaid
and possibly MediKan.
Example: Applicant was denied Social Security last year.
Decision was appealed and is currently awaiting a hearing. A final
determination has not been made and case is referred to PMDT.
- Date of Final SSA Determination
- Determine if a final determination of disability has
been made in the past 12 months (see 2666).
If the individual reports more than 12 months have passed since
a Social Security denial, the worker shall attempt to verify date
of final determination using the EATSS system. However, the referral
is not to be delayed while awaiting the verification.
Note: Refer for both Medicaid and possibly
MediKan.
Example: Client reports his application for Social Security
was denied in 2003 because he wasn't disabled. A
TPQY confirms the 2003 denial. Because more than 12 months
have passed, the case may be referred to the PMDT. However,
the individual must reapply for Social Security in order to be
eligible.
- Final SSA Determination
within Past 12 Months - For final determinations made
within the past 12 months, determine if the condition has changed
or deteriorated since the decision. Client statement regarding
the change is adequate.
Note: If a change in condition is reported, refer for
both Medicaid and possibly
MediKan .
Example: Applicant was denied Social Security 6 months
ago due to severity level of disability. Client reports on application
that there has been a change in his disability because he was
recently diagnosed with hepatitis. Case may be referred to PMDT
for both Medicaid and MediKan due to the reported change.
- Refer To Social Security -
Unless verification of a current pending application with
Social Security is available, refer the individual to Social Security
to make application for SSI or SSDI benefits. Verification of a pending
application is required prior to approval, but a referral to PMDT
is still appropriate.
- Presumptive Medical Disability
Determination Questionnaire - This form,
ES-3903, will capture medical information associated with the individual
applicant and takes the place of the Telephone Consultation. This
form, the ES-3904 and the ES-3909 Instructional Cover Letter will
be provided to the applicant by the PMDT
upon receipt of the referral. A self-addressed stamped envelope is included along with instruction to
return the information to the PMDT within 15 days. Failure
to provide complete information may result in needless delay and/or
an unfavorable determination. Applicants
needing assistance should be directed to friends, family, and other
community resources for assistance. In addition, the form includes
language directing the applicant to contact the PMDT at their toll
free number (1-888-547-2763) if they have questions about the form.
Questionnaire forms received directly by the
Clearinghouse staff, even if only partially complete, should
still be forwarded to the PMDT as part of the referral process. Upon
receipt of the questionnaire, the PMDT will review the form and determine
if additional information is needed, and contact the applicant if
necessary.
- Obtain One Original of the ES-3904,
HIPAA Compliant Authorization to Disclose information to Kansas Health
Policy Authority - This release is necessary in order to
obtain medical records. The release must be signed.
The PMDT shall request the form along
with the ES-3903 and ES-3909 as
instructed in item (4). The PMDT must receive the original
forms. If the eligibility worker obtains the forms from the client,
fax it to the PMDT. The original is sent to the PMDT. Providing a
signed release is a program requirement.
- Receipt by the PMDT -
All cases referred to the PMDT will be logged. Documentation and tracking
of cases pending with the PMDT will be recorded in the PMDT Central
Data Base. The data base is only accessible by designated KDHE-DHCF
staff. All policies and procedures used by the PMDT to determine disability
are located in the PMDT Procedures
Manual.
- Assign to Case Development Specialist
- Upon receipt of the ES-3901,
the case will be assigned to a CDS. The Specialist will be responsible
for requesting medical evidence, scheduling any consult examinations
and preparing the disability file for the Disability Examiner.
- Review by Disability Examiner
- Following development of the medical evidence, the disability
examiner will review the information and determine if there is sufficient
evidence to send the case on to the Disability Review Team for a final
determination. The disability examiner will prepare the file for review
by the DRT.
- Review by the Disability Review
Team - All persons determined disabled by the PMDT must be
certified through the Disability Review Team. The DRT consists of
a trained disability examiner and physician (or psychologist for evaluation
of mental disabilities). The team will evaluate the medical evidence,
including vocational and other non-medical information, and make a determination of the individual's
status. KDHE-DHCF currently contracts with Disability Determination
Services (DDS) for services provided by the Disability Review Team.
The PMDT's DE may also serve as the DE for the DRT.
- Notification to PMDT -
The DRT will notify the PMDT of the outcome of the disability determination.
The information will be recorded by the PMDT.
- Notification to the Eligibility
Worker - The PMDT will send final notification regarding
the disability determination to eligibility
staff.
- Final Determination and Notification
to the Applicant/Recipient - Using the disability information
from the PMDT, the eligibility worker is responsible for making the
final determination regarding the individual's eligibility. The eligibility
worker is also responsible for meeting the notice requirements (see
1430).
2662.5
Failure to Cooperate With the PMDT - Persons applying for Medical
Assistance must cooperate with the PMDT in determining disability. Failure
to cooperate with any of the following PMDT activities results in non-cooperation
and subsequent negative action. In each situation, the PMDT will notify
the case worker via the ES-3906,
Notification of Changes, of non-cooperation with the specific reason.
The eligibility worker shall take negative action based on failure to
cooperate with the PMDT.
- Presumptive Medical Disability
Determination Questionnaire (ES-3903) - This form must be
completed to the best of the client’s ability as part of the PMDT's
disability determination. The questionnaire along with the ES-3904
HIPPA Release must be received by PMDT.
- Medical Evaluation -
If sufficient evidence is not available to develop the disability
case, the PMDT may determine a medical evaluation is necessary. The
PMDT is responsible for scheduling the appointment with a contracted
medical provider. The PMDT will remind the applicant/recipient prior
to the appointment. If the applicant/recipient fails to keep the appointment,
it shall be considered non-cooperation. A second appointment will
not automatically be rescheduled.
- Medical Records - The
PMDT will request medical records as part of the disability determination.
Although the signed release of information will generally be sufficient
to obtain the records, the applicant/recipient may be asked to assist
with the process. Failure to follow through with a request to assist
with obtaining medical records is considered non-cooperation.
NOTE: If the individual
contacts the agency within 90 days
of the original application date to reschedule a missed appointment or
to cooperate, the application may be reactivated per 1414.2
(3). Requests for rescheduling may be made directly with the PMDT
or through the caseworker. Communication between the entities is necessary.
2662.6 Changes
During the Disability Determination - If either the PMDT or the
eligibility worker become aware of changes which could impact the determination,
the party receiving the information is responsible for notifying the other
entity of the change. This includes general changes, such as a change
in address, phone number, living arrangement, conservator, etc., as well
as changes in eligibility or process which could result in ineligibility.
The eligibility worker must notify the PMDT if a determination is made
on the case for reasons other than disability.
2662.7 Persons with Drug
Addiction or Alcoholism - Based on the drug addiction and alcoholism
provisions of the OASDI program, OASDI benefits are not available to individuals
whose drug addiction or alcoholism is a contributing factor to the determination
of disability (i.e., would not be found disabled if the drug abuse and/or
alcohol abuse were to stop). These provisions became effective as of March
29, 1996. Medical eligibility under the MS program shall not be provided
in such instances. However, OASDI beneficiaries whose benefits are terminated
due to these provisions and who are medical recipients shall continue
to be eligible for Medicaid if they timely appeal the SSA decision and
are otherwise eligible except for the disability determination. Such eligibility
continues throughout the appeal process. Verification from SSA that the
appeal was filed timely is required.
2662.8 Effect of Loss
of SSA/SSI Eligibility on Disability Determination - For medical
eligibility determination purposes, a prior determination of disability
by the SSA is not considered void if an SSA or SSI benefit is stopped
for reasons other than cessation of disability. See also 2662.2
above regarding cessation of benefits for persons with drug addiction
or alcoholism. However, persons whose benefits are terminated due to loss
of disability status and who timely appeal the SSA decision (defined as
within 90 days of notification of termination) shall continue to be eligible
for medical assistance if they are otherwise eligible except for the disability
decision. Such eligibility continues throughout the appeal process. Verification
from SSA that the appeal was timely filed is required.
For ongoing SI cases in which SSI benefits have been terminated due
to financial reasons (i.e., excess income or resources) and the client
is not otherwise eligible for OASDI disability benefits, continuing eligibility
under the MS program should be reviewed.
If an MS case is established, a referral to DDS (via the DD-1103,
1104,
and 1105)
is required primarily so that a continuing disability review period can
be initiated. The referral form should note the reason for the referral.
MS eligibility can be determined and medical benefits provided while the
DDS decision is pending. If disability status is denied, eligibility shall
be terminated based on timely and adequate notice requirements. If disability
status is approved, the case shall be re-referred to DDS on a periodic
basis (based on the review date specified in DDS) provided the client
does not attain eligibility for OASDI or SSI benefits in the interim.
This provision is not applicable to persons who meet one of the protected
group criteria of 2680, qualify for QWD
status per 2674, or who are eligible
under the 1619(b) provisions as referenced in 2634.
2662.9
Impact
of Social Security Determination -
The outcome of the disability determination made by PMDT is binding until
Social Security reaches a final determination.
If a Tier 1 disability is established, the consumer is considered disabled
until SSA reaches a final determination. If Social Security affirms the
disability, assistance may continue if all other eligibility factors continue
to be met. If Social Security denies disability, categorical assistance
is terminated under the disability category.
If a Tier 1 disability is not established, the application for disability
based Medicaid is denied. The application can be reconsidered if new information
is presented during the 90 day application time frame (see KEESM 1413).
If the consumer is approved for SSI based on the Social Security application
associated with the PMDT, assistance may be provided effective with the
Protected Filing Date if all other eligibility factors are met. Cooperation
with Social Security disability is required.
2662.10
Protected Filing Dates - The date an application for
medical assistance is made is considered the Protected Filing Date if
a determination of medical assistance cannot be made because a final determination for Supplemental Security Income
(SSI) has not been issued. The initial application date is active
as long as the individual cooperates with the medical assistance determination
and the SSI application is pending
an initial determination or is in appeal status. Verification of a timely
appeal is required. Failure to cooperate with MediKan criteria does not
impact the medical protected filing date.
If SSA finds the individual is disabled and
eligible for SSI payment, Medicaid coverage is potentially available
back to the protected filing date, or three prior months if prior medical
assistance was requested, as long as the onset date is on or before the
medical assistance start date. Medicaid coverage must also be established
back to the protected filing date for MediKan recipients. Persons who
are receiving Presumptive Medicaid Disability coverage are converted to
another type of Medicaid. In order to qualify
for coverage back to the Protected Filing Date, the consumer must report
the outcome to the agency within 10 days of receiving payment/notification
(whichever is later).
Note: The Protected Filing Date is only
applicable to SSI recipients. The Protected Filing Date is not applicable
to persons who qualify only for Social Security Disability benefits. In addition, when a referral has been made to Disability Determination Services (DDS) because SSA will not make a disability determination as indicated in 2662.2(3), a final decision for purposes of this section is the decision made by DDS. See also the Note in 2663.6.
If SSA finds the individual is not disabled, coverage
is denied unless the applicant qualifies under another Medicaid program.
However, the protected filing date is still alive for persons who file
a timely appeal of Social Security decision if
SSI coverage is ultimately approved. In addition, the protected
filing date is applicable to persons who are not eligible for PMD benefits,
but have been cooperative with the PMD. The protected filing date ends
if the individual fails to cooperate with the PMD process.