Revision 14-4; Effective December 1, 2014

An applicant for Social Security disability benefits is evaluated for both SSI Title XVI and RSDI Title II disability eligibility. HHSC determines Medicaid eligibility for retroactive coverage for up to:

• three months before the date of SSI application for a person who has been denied SSI; or
• two months before the month in which an SSI recipient's Medicaid coverage automatically begins.

In these cases, the medical records; Form H3034, Disability Determination Socio-Economic Report; and Form H3035, Medical Information Release/Disability Determination, should be imaged in the Texas Integrated Eligibility Redesign System (TIERS). DDU uses this information to make the final decision (disability or blindness) for the retroactive coverage months. DDU enters the disability determination in case comments and in the Disability Determination — DDU page in TIERS, which indicates the decision, including the date of onset of the disability or blindness.

Federal regulations prevent a state's disability determination to conflict with the RSDI Title II date of onset, and DDU cannot establish an earlier date of onset for RSDI Title II blindness or disability. As a result, deny an application based on the person not meeting blind (Not Blind) or disabled (Not Disabled) criteria when a person applies for Medicaid and the person:

• has unpaid or reimbursable covered Medicaid expenses during the retroactive coverage months prior to the application;
• has a date of onset for RSDI Title II blindness or disability based on Social Security Administration (SSA) query records; and
• the date of onset for RSDI Title II blindness or disability does not cover any of the retroactive coverage months prior to the application.

Note: Do not use the SSI Title XVI "Dsblty Onset Date" on the SSI Entitlement screen as the basis to establish blindness or disability for retroactive coverage.

Federal regulations prohibit a state from making a disability decision that conflicts with an SSA decision. DDU cannot make an independent decision until all appeals to SSA regarding the date of disability onset for both RSDI Title II and SSI Title XVI are settled.

Request medical records covering the period for which eligibility is being tested when:

• there is no date of onset for RSDI Title II disability; or
• 90 days have elapsed since the SSI/RSDI file date and SSA has not completed a disability determination.

Submit the following items for imaging to the Texas Health and Human Services Commission, P.O. Box 149027, Austin, TX 78714-9971:

• Medical records
• Form H3034
• Form H3035

Occasionally, Form 4116, Authorization for Expenditures, is required to provide payment to medical providers for submitting medical records. If Form 4116 is required, submit this form for imaging with the medical records, Form H3034 and Form H3035.