Resolving the Medicaid Issue

INARF has heard from many members about issues with individuals' eligibility recently and have received the following communications from DFR:

With the return to our normal operation for Medicaid, individuals are required to go through the Medicaid redetermination process and are now subject to the eligibility rules that were in place prior to the PHE.  From a DFR perspective, generally, what we have seen fall into two scenarios:

• Individuals turned 18 during the Public Health Emergency and did not have a disability determination from the Social Security Administration (SSA).  Once an individual turns 18 they must apply for Social Security Disability through the SSA; failure to apply will result in the Medicaid disability being discontinued. During the PHE we were not able to require this process be completed.  Now individuals must apply for disability with the SSA.  If the application to SSA is denied, then the denial must be appealed with SSA for DFR to keep the Medicaid open.
• Individuals’ claims for SSA disability are being denied or terminated and they are not appealing the denial or termination with SSA.  Failure to appeal the denial will result in the Medicaid being closed or the individual being placed on a category that is not compatible with the waiver (i.e., HIP)

We allow 65 days for individuals to appeal the SSA denial.

If the individual is unable to independently address their concerns regarding their Medicaid Eligibility; the Family, Provider, or the Case Manager assisting the individual must be designated as an Authorized Representative for Medicaid.

If you have specific case(s) that are in question, please let me know and I will have someone to review the case(s) in question.