Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits as a Disabled Adult Child (DAC).
Current Policy Effective Date: September 1, 2010
Date Last Reviewed: April 5, 2010
Previous Policy: January 1, 2007
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POL M1005A: Determining Disabled Adult Child Eligibility
1. Social Security Administration (SSA) Determines Eligibility
The SDX shows eligibility with a Medicaid eligibility code of “D.”
If the client does not appear on the SDX, a letter of verification from SSA will be accepted as proof of eligibility.
2. Applicants May be Eligible Under Another Medicaid Coverage Group
If the SDX shows a Medicaid test indicator code “R,” it must be determined whether the applicant is eligible under another Medicaid coverage group.
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Reference:
Defining Group: 42 CFR 435.120
Clarifying Information:
1. DAC is defined as a Disabled Adult Child age 18 or older who was receiving SSI due to a disability or
blindness prior to their 22nd birthday.
2. Verification of Eligibility Must be Obtained from SSA if Client Not Listed on SDX.
Training Link: Not available at this time
Worker Responsibilities:
Verifying Eligibility When Clients Do Not Appear on SDX
1. Seek verification from SSA.
2. Add client to EPICS manually, once eligibility has been verified.
Determining Eligibility When Clients on SDX With Test Indicator Code “R”
1. Require an EC-200 EqualityCare (Medicaid) Application.
2. Determine eligibility under another Medicaid coverage group.