The Medical Review Team (MRT) determines medical eligibility per 13 CSR 40-2.200(1). Before a MO HealthNet for Aged, Blind, and Disabled (MHABD) 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 MHABD if the applicant/participant:
- Is eligible based on age;
- Meets the definition of disability as established by the Social Security Administration;
- Is eligible for Medicare received from disability-based Railroad Retirement;
- Does not receive SSDI or SSI, but is eligible for Medicare because s/he has 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 decision date.
- IIVE may be used to verify payment amounts; however, do not use the date displayed on the IIVE as an acceptable form of verification of the disability start date.
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 MHABD Case:
If MHABD is closed for reasons other than the MRT decision and the participant re-applies, a new MRT decision is not needed as long as;
- The MRT decision has not yet expired,
- The MHABD application is received within 90 days from the closing action date.
If the MRT decision has not expired and the request for benefits is received within 90 days of the initial closing date, do not request a new MRT decision.
If the MRT decision was previously waived with a future re-determination date listed within twelve months from the re-application date, request a new MRT decision.
MRT determined a participant previously qualified for a waiver:
- If a waiver was previously granted by MRT, review the decision to determine whether or not there is a waiver period with a future review date listed.
- If a waiver had been granted with a future review date and the waiver review date listed is within one year of the re-application date, a new MRT decision is needed.
- If there is no future review date set by MRT, and the participant has not obtained employment or indicated there has been improvement to the extent a re-determination of medical eligibility is warranted, do not request a new MRT decision.
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 upon rejection/closing by emailing MRT.Personnel@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.