IM-05 February 03, 2025; IM-77 May 16, 2019, IM-66 March 29, 2019, IM-70 December 6, 2016, IM-44 September 4, 2014
The Medical Review Team (MRT) determines medical eligibility per 13 CSR 40-2.200(1). Before a Non-MAGI application can be rejected or a case closed on the factor of disability, staff must send a referral packet to the MRT for a medical determination.
EXCEPTIONS: Medical eligibility is established and a medical determination by the MRT is not required for Non-MAGI programs if the participant:
- Is eligible based on age.
- Meets the definition of disability as established by the Social Security Administration (SSA).
- Is eligible for Medicare received from disability-based Railroad Retirement.
- Does not receive SSDI or SSI, but is eligible for Medicare because they have End Stage Renal Disease (ESRD) if not earning more than the Substantial Gainful Activity (SGA) maximum; or
- It has been less than 12 months since the individual received a kidney transplant.
The SSI or SSDI approval decision is made by SSA and may be verified per the award letter or other notification received from SSA documenting the disability decision date.
- A Favorable Decision (FD) letter from SSA stating that they have determined the person disabled but SSA is unable to approve a payment due to non-disability related factors is valid proof of disability for 12 months after the date of the letter.
- Do not use the date displayed on the IIVE as an acceptable form of verification of the disability start date, unless they are receiving disability income in that section or FSD confirms with SSA that the disability date is accurate.
NOTE: MRT must determine eligibility for months prior to the SSA disability start date.
Presumptive SSI Eligibility is not a guarantee the participant is disabled, and an MRT decision is required.
An MRT decision is required if:
- The individual’s earned income exceeds the SGA, or
- It has been more than 12 months since the individual received a kidney transplant, or
- The individual is no longer receiving Medicare, unless approved for SSI, SSDI, or is age eligible.
MRT Decision Has Not Expired On a Closed Non-MAGI Case:
If Non-MAGI is closed for reasons other than the MRT decision and the participant re-applies, a new MRT decision is not needed as long as:
1. The MRT decision has not yet expired.
and
2. The application is received within 90 days from the closing action date.
If the MRT decision has not expired and the application for benefits is received within 90 days of the initial closing date, do not request a new MRT decision.
MRT Waiver:
If the MRT decision was previously waived and a new application is made:
- Within 90 days of the closing, the prior waiver is considered valid. However, if the participant is now earning more than SGA or has indicated medical improvement, and a new MRT determination is required.
- Outside of 90 days of the closing, the prior waiver is considered invalid and a new MRT determination is required.
Do not refer any cases that are obviously ineligible on any eligibility factor other than disability or resources to the MRT. If a case, already referred to MRT and pending a determination of disability, is later rejected or closed on a factor other than disability notify MRT immediately when rejecting the application or closing the case by emailing MRT.ProcessingCenter@dss.mo.gov.
Do NOT hold the MRT packet to determine eligibility on other factors. The MRT must receive the packet in a timely manner to allow sufficient time for processing.