23 Miss. Code. R. 102-7.7 - Situations Not Requiring a Separate DDS Decision

A. In the following situations a separate blindness/disability determination for Medicaid is not needed. The applicant/beneficiary is considered to be blind/disabled:

1. Applicant Receives Title II Disability;

a) The Medicaid applicant receives Title II disability benefits on an ongoing basis based on his own disability and the disability onset date is verified to include all months to be covered by the Medicaid application, i.e. the month of application and any retroactive months. Receipt of Title II disability must be re-verified at each redetermination.

2. Disability Decision Overturned by Administrative Law Judge (ALJ) Order;

a) An Administrative Law Judge (ALJ) reverse a disability denial and establishes disability with a disability onset date which covers all months of the Medicaid application. If the Medicaid applicant is otherwise eligible, eligibility can be established as of the date of the onset of disability as established by the ALJ order, but no earlier than:

1) The Medicaid application date; or

2) Three months before the Medicaid application date if retroactive benefits are an issue.

(a) Example: An ALJ order reversed a disability decision and established disability effective February 2008. The application for Medicaid is filed on July If the Medicaid applicant met all other requirements retroactive benefits, eligibility could be established effective April 1, 2008.

3. Deceased Applicants;

a) A verified death date establishes disability if a disability, due to any illness or accident which resulted in death, existed in all months for which Medicaid eligibility was requested.

1) Example: A traumatic onset of disability occurred on September 14, 2008, due to an accident. On October 12, 2008, individual dies as a result of injuries sustained in the accident. The application for Medicaid is filed on November 3, 2008. Under this exception, Medicaid eligibility can only be established starting September, the month of the accident, forward.

4. Disabled Adult Children.

a) Disability has been established by SSA for an applicant who is over 18, entitled to Medicare and receiving Title II benefits as a child (C1-C9 beneficiary). The disability onset date must be determined.

Notes

23 Miss. Code. R. 102-7.7

42 CFR §435.601(a); 42 CFR §435.601(b) (Rev. 1993).