Adult Medicaid Manual N MA-2180 HEALTH COVERAGE FOR WORKERS WITH DISABILITIES

III. COVERAGE GROUPS

A. Basic Coverage Group

The Basic Coverage Group consists of individuals aged 16 through 64 who, except for engaging in substantial gainful activity, would meet the Social Security/SSI disability criteria, or who do not engage in substantial gainful activity but are over income and/or reserve for regular MAD. See MA-2525, Disability.

REISSUED 11/01/09 – CHANGE NO. 17-09

(III.)

B. Medically Improved Coverage Group

1. The Medically Improved Group consists of individuals age 16 through 64 who previously received HCWD in the Basic Coverage Group but lost eligibility in this group because their medical conditions improved to the point where they no longer meet the Social Security/SSI definition of disability.

2. Although no longer considered disabled by Social Security due to medical improvement, the individual must continue to have a severe medically determinable impairment. The individual continues to have a severe medically determinable impairment if he:

62Ba. Still has the underlying condition or conditions which made him disabled;

b. Is under treatment for the condition or conditions; and

c. Has a strong likelihood of again meeting the Social Security definition of disabled if he were to cease treatment.

3. If the answer to any of the questions in 2. is no, refer to IV.C. below.

4. Eligibility in the Basic Group for any period of time qualifies an individual for eligibility in the Medically Improved Group if he meets all other eligibility requirements.

5. Eligibility in the Medically Improved Group can begin no earlier than the month after coverage ends in the Basic Group.