Sec. 405 IAC 2-1.1-3 - Applying for benefits

ยง 405 IAC 2-1.1-3. Applying for benefits

Authority: IC 12-13-7-3; IC 12-15

Affected: IC 12-15-2; IC 12-15-3

Sec. 3.

(a) For purposes of this rule, any determination of eligibility on the basis of blindness or disability made by SSA is binding upon the state. A determination of eligibility by SSA for SSI automatically confers Medicaid eligibility upon that individual. This subsection governs when:

(1) an eligibility determination is to be made by SSA; and

(2) a determination is to be made by the state.

(b) SSA determinations.

(1) SSA determination of eligibility. When an individual has been determined eligible for SSI by SSA, the state shall:

(A) receive notification of such eligibility;

(B) adopt SSA's determination; and

(C) automatically enroll that individual in Medicaid.

(2) SSA determination of ineligibility. SSA's determination of ineligibility for SSI or SSDI on the basis of disability or blindness is binding on the state as it relates to disability or blindness, regardless of any prior determination the state may have made.

(3) Changed determination. SSA's determination of eligibility on the basis of disability or blindness is binding on the state until changed by SSA. If such SSA determination is changed, the new SSA determination on the basis of disability or blindness is also binding on the state.

(c) State determinations.

(1) The state must make a determination of eligibility for Medicaid under the following circumstances:

(A) Applications for benefits are filed with both SSA and the state;

(B) SSA has determined the individual to be blind or disabled, and the individual:

(i) is not receiving SSI; and

(ii) submitted an application to the state as described in 405 IAC 2-1-2(d); or

(C) The individual alleges a change in circumstances as provided in section 1(c) of this rule.

(2) Pending application with SSA. Where an individual has applied to both SSA for benefits and the state for Medicaid, the state must make a determination within ninety (90) days of its receipt of the individual's application for Medicaid when no determination has been made by SSA, as set forth in 42 CFR 435.541(c)(2).

(3) Where an individual has not applied to SSA for benefits but applies to the state for Medicaid, the state must make a determination of eligibility. In accordance with 42 CFR 435.608, the state shall require such individual to apply for all other benefits he or she may be eligible to receive, including SSI or SSDI benefits, as a condition of Medicaid eligibility.

(4) Change in circumstances. The state must make a determination if:

(A) SSA has previously determined the individual to be ineligible for SSI on the basis of blindness or disability; and

(B) the individual alleges a change in circumstances.

(Office of the Secretary of Family and Social Services; 405 IAC 2-1.1-3; filed Apr 8, 2014, 12:37 p.m.: 20140507-IR-405130533FRA Readopted filed 11/13/2019, 11:54 a.m.: 20191211-IR-405190487RFA)

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