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Updates for local agencies, community-based organizations, and providers who provide assistance to members of Wisconsin's health and nutrition public assistance programs.
Change to Disability Determination Verification Requirement for Medicaid Applicants and Members Who Start Receiving Social Security Retirement Benefits
To be eligible for Medicaid, people must be age 65 or older or, if they are younger than 65, be determined blind or disabled by the Disability Determination Bureau. To be eligible for the Medicaid Purchase Plan (also known as MAPP), a person must have a disability determination regardless of age.
Many Medicaid applicants and members receive Social Security Disability (SSDI) or other disability-related payments that require a disability determination by the Social Security Administration (SSA). Receipt of SSDI or other disability-related payments is used as verification of the applicant’s or member’s disability determination for Medicaid, which means that an applicant or member does not have to independently verify their disability.
However, when a person who has a disability determination reaches retirement age, which could be before age 65, he or she will no longer receive SSDI or other disability-related payments and will instead start receiving Social Security Retirement (SSRE) benefits.
Previously, applicants or members who started receiving SSRE benefits instead of SSDI and whose disability determination could not be verified through SSA needed to complete a Medicaid Disability application and go through the disability redetermination process to verify their disability determination for Medicaid. This was particularly an issue for members enrolled in MAPP, whose disability needed to be verified even though they had turned 65.
Starting immediately, existing members who start receiving SSRE benefits instead of SSDI or other disability-related payments will continue to be considered disabled for Medicaid (including MAPP). They will not need to complete a Medicaid Disability application and go through the disability redetermination process.
In addition, new applicants who have already changed from SSDI to SSRE benefits may verify their disability determination by providing a copy of a letter from SSA or another similar document from their online my Social Security account stating that their SSDI or other disability-related benefits are changing to retirement benefits. Applicants who provide this verification will not be required to complete a Medicaid Disability application or go through the disability redetermination process.
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