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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.
Return to: Social Security Disability Resource Center, or read answers to Questions
If your disability claim is approved or denied
Social Security Award letter for SSD, SSI
Tips for veterans filing for Social Security Disability
How many SSD or SSI denials will you get before being approved?
How long will it take to get a decision on SSD or SSI after a medical examination?
Do you get SSI back benefits from the time you were disabled?
Does SSI disability come with automatic medical care?
Disabled with obesity, muscle spasms, bone spurs, advanced arthritis in spine?
How Much Income Can you Earn If you draw Social Security Disability?
What does Social Security need from your medical records?
Does a person with severe keratoconus qualify to receive disability?
When do you need a Disability Lawyer for a Case?
How to file for disability in North Carolina NC
Can You File For Disability While Receiving Unemployment?
Are Social Security Disability Claims Based On Back Pain Usually Turned Down?
Information on the following topics can be found here: Social Security Disability Questions and in these subsections:
Frequently asked questions about getting Denied for Disability Benefits | FAQ on Disability Claim Representation | Info about Social Security Disability Approvals and Being Approved | FAQ on Social Security Disability SSI decisions | The SSD SSI Decision Process and what gets taken into consideration | Disability hearings before Judges | Medical exams for disability claims | Applying for Disability in various states | Selecting and hiring Disability Lawyers | Applying for Disability in North Carolina | Recent articles and answers to questions about SSD and SSI
These pages provide answers to basic questions about pursuing disability benefits
How to check the status of my Social Security disability claim
To qualify for disability, what to prove
Preparation to win a disability hearing
Social Security Disability lawyers FAQ
How Much Income Can you Earn If you draw Social Security Disability?
What does Social Security Disability SSI pay, how much?
Social Security Disability Maximum back pay
Social Security Disability Claims and Medical Exams
What is qualifying for disability benefits based on?
Partial Social Security Disability SSI benefits
Filing for disability and financial help
Getting approved after a Social Security Disability Psychological exam
How long does it take to receive disability benefits after you are approved?
Does Social Security Disability Come With Medicaid Benefits?
Applying for Disability or SSI - How long does it take
Can you work if you get Social Security Disability?
Am I eligible to receive disability benefits?
What medical disabilities, conditions qualify for Disability Benefits?
How to get disability for degenerative disc disease
What mental problems qualify for disability?
Conditions that get approved for disability