405 IAC 2-9-7 Medically improved disability

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.