Social Security Disability and Medicaid for Disabled Adults

"I have a question I cant find the answer to and hope you can help. I applied for SSI and was denied,I filed a appeal and hired an attorney. I also filed for medicaid and recieved notice recently that I am going to be recieving medicaid .I read SS and Medicaid have the same guidelines on determination and wondered why would I be denied SSI and awarded medicaid for a disability. Im also wondering if winning the medical portion will help my SSI case?"

I used to be a disability examiner for disability determination services, the state-level agency that renders determinations on disability claims for SSA. However, I am also a former caseworker. I worked in nearly every program, including taking MAD applications at a Department of Social services. MAD basically means medicaid for adults who are disabled. As you yourself stated, an individual can apply for medicaid for disabled adults separately from an SSI or Social Security Disability claim that is filed with the social security administration.

This is how it works with MAD. The application is taken at social services. However, just as with a Social Security Disability or SSI disability claim that is taken at a social security office, the medicaid claim is not processed at social services. Instead, it is sent to the state agency that is responsible for rendering disability determinations. In most states, this agency is called DDS, disability determination services.

Social Security Disability and SSI disability claims that are taken at social security field offices are sent to processing units at DDS and are assigned to disability examiners to be evaluated and decided.

Medicaid claims for disabled adults, that are taken at social services, are also sent to the state disability agency (DDS, or a name very similar to this, depending on the particular state).

However, medicaid claims are sent to different kinds of units. They are sent to medicaid units that, at the risk of being repetitive, only process medicaid claims for disabled adults.

So, if you filed for SSI disability and also filed for medicaid for disabled adults, those two claims were sent to the same agency, but were sent to two separate processing units and were worked on by two different kinds of disability examiners. Which is why you received two separate decisions.

Sometimes, if an SSD (or SSI) claim has been decided, the medicaid application can simply "adopt" the decision that was made on that case.

But---if there is no SSD or SSI decision to adopt, then the medicaid claim will be subject to the processing deadline that the county caseworker has to adhere to----meaning that the medicaid case has to be returned to the county caseworker who actually took the medicaid application by the disability examiner (this can be confusing) before the deadline expires...even if it means halting ongoing work on the medicaid claim.

Of course, this is an example of government gone wrong. The processing deadline for disability-medicaid claims was instituted to "help" medicaid claimants get a "speedy decision". But, in actuality, it has often meant that many applicants for disability-medicaid have had their claims denied simply because processing a case can take longer than a silly artificial 90 day deadline.

Yes, if they--the DDS medicaid unit--can't get the case done by the 90th day deadline, they are forced to send ti back to the county department of social services which will summarily deny it. Absolutely idiotic government at work.

There is, however, a different wrinkle here. If a disability medicaid claim has been denied by a department of social services (because the DDS disability examiner did not have an SSD or SSI decision to adopt), then the person who has been denied for MAD can actually pursue a separate medicaid appeal...that has nothing to do with the social security system. Instead, this appeal moves through the state government apparatus (in North Carolina, health and human services).

Is this worth pursuing? It can be. I've seen medicaid appeals filed in this manner get approved independently of an SSD or SSI disability claim.

Why bother? To get access to doctor visits and needed prescription medication.

To answer one of your questions, though, medicaid claims can adopt Social Security Disability or SSI disability decisions; however, it does not work the other way around.

About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.

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