Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 2 - MEDICAID MEMBERS; ELIGIBILITY
Rule 9 - Medicaid for Employees with Disabilities
Section 9-7 - Medically improved disability

Universal Citation: 405 IN Admin Code 9-7

Current through March 20, 2024

Authority: IC 12-15

Affected: IC 12-14-15-1; IC 12-15-2-6.5; IC 12-15-41

Sec. 7.

(a) In order to qualify for the Medicaid for employees with disabilities program after improvement of a medical condition, a member must meet the requirements in this section.

(b) The person must be a member of Medicaid under the Medicaid for employees with disabilities group described in section 6 of this rule who no longer qualifies for coverage under that category due to a medical improvement in his or her condition. The improvement of the condition must be verifiable by acceptable clinical standards; however, the disease, illness, or process must be of a type that, due to the nature and course of the illness, will continue to be a disabling impairment. A condition that has been resolved or a person who is completely recovered does not medically qualify for this program.

(c) The determination of whether a member meets the medical eligibility requirements for this category will be made either:

(1) when the Social Security Administration determines the member is no longer disabled according to 20 CFR 416.905 or 20 CFR 416.906; or

(2) at the time of the member's next medical review as determined by the Medicaid medical review team (MMRT). Determination of medical eligibility under this section is made by the MMRT.

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