3.6.6 Redetermination

Review a disability determination when:

1. The Disability Determination and Transmittal ( SSA-831 ) indicates medical re-examination in item 17 of that form, or

2. The person is younger than 65 years of age and no longer receives OASDI ( Social Security ) disability benefits,  
   
   Note:  Disability determinations should not be done for recipients over age 65, except in some circumstances for MAPP (See  3.6.9.1 for MAPP)
   
   or

3. The medical circumstances have significantly improved (see 3.6.6.1 for recipients who exceed the substantial gainful activity level),
   
   or
    

4. The person has returned to work.

Complete and/or forward the following to DDB:

1. 1. MA Disability Redetermination Report. (HCF 10114)

   2. Signed Confidential Information Release forms.  See 3.6.2.2.

   3. The original Disability Determination form ( SSA-831 ) and any subsequent disability determinations and all prior medical evidence and forms.

DDB will make a decision, which will be indicated on a Cessation or Continuance of Disability form ( SSA-833 ).

Item 9 ( SSA-833 ) indicates the decision of (A) continuing, or (B) ceased.

Item 23B ( SSA-833 ) indicates a medical re-examination date when necessary.  

3.6.6.1 Recipients Exceeding the Substantial Gainful Activity level

A Medicaid recipient who loses SSDI because s/he exceeds the Substantial Gainful Activity level does not lose Medicaid coverage if:
 

• S/he is a recipient with a disability, who was receiving non-MAPP full benefit Medicaid, and is currently working,
  
  or
   

• S/he is a current MAPP recipient.

In these cases, a MAPP disability determination must be done and MAPP continued until the determination is made.

 

This page last updated in Release Number : 06/02

Release Date: 07/14/06

Effective Date: 07/14/06