B-7300, MEPD Eligibility Pending a Decision of SSI Application

Revision 19-4; Effective December 1, 2019

Persons who have applied for SSI, whose SSI application has been delayed longer than 90 days, may be certified under the appropriate MEPD program pending the SSI eligibility decision.  

Person(s) must meet all non-financial and financial MEPD criteria to be eligible including:

  • establishing disability, if applicable;
  • pursuing all other benefits; and
  • meeting the 30 consecutive days of institutionalization, if applicable.

Consider the age of the person to determine if a disability determination is needed.

The state office Disability Determination Unit (DDU) needs a disability determination if the person is younger than 65. DDU cannot make a disability determination decision unless 90 days have passed since the SSI date of application and SSA's disability decision is still pending. If SSA finds the person is not disabled after DDU has established a disability, DDU is required to follow SSA’s decision and eligibility must be denied. Staff must set a special review for the fifth month to monitor the final SSA decision on disability.

Once an MEPD eligibility recipient becomes eligible for SSI, SSA will report the SSI eligibility to HHSC via the SDX system. Once the SDX information is received, TIERS will automatically deny MEPD coverage and activate the SSI coverage. This is not an adverse action because the person does not lose benefits.

The above should be used only in situations where the processing of a SSI application has been delayed. Staff must verify and document that an SSI application has been filed.

Note: If the person is age 65 or older, no disability determination is needed. Verify that the person has filed an application for SSI.

Related Policy

SSI Applications, B-7100
Special Reviews, B-8430
Supplemental Security Income (SSI) Applicants and Retroactive Coverage, D-2500
Application for Other Benefits Requirement, D-6300
Other Benefits Subject to Application Requirement, D-6310
Other Benefits Exempt from Application Requirement, D-6320
Supplemental Security Income (SSI), D-6340