210.01 Non-Financial Eligibility Requirements SR 02-04, 02/02 (AAM-A)

MEAD-eligible individuals must meet non-financial criteria in addition to MEAD-specific eligibility requirements.

General and Technical Requirements

The individual must meet all the general and technical requirements for other adult categories of medical assistance. See AAM Chapter 300, NONFINANCIAL CRITERIA, for additional information.

Age Requirement

The individual must be age 18 through age 64 inclusive. MEAD eligibility ends when the individual turns age 65. Evaluate the case for OAA/MA prior to the individual’s 65th birthday.

Medical Criteria

The individual must meet the medical criteria for APTD, ANB, or MEAD as determined by the Medicaid Administration Bureau (MAB). Refer to Medical Assistance Manual Chapter 900 for further information. To meet MEAD medical criteria, the individual must have a documented medical impairment that:

• meets or exceeds the SSI criteria for disability; and

• has persisted or is expected to persist for a minimum of 48 months.

The Substantial Gainful Activity (SGA) test does not apply to MEAD-eligible individuals,. Individuals medically eligible for MEAD can earn more than the substantial gainful employment income limit. See AAM PART 209, AID TO THE PERMANENTLY AND TOTALLY DISABLED.

MEAD eligibility determinations are not required for:

• blind individuals;

• currently open ANB and APTD individuals whose earnings do not exceed SGA limits; and

• individuals previously approved for ANB or APTD with a "no review" reason and who were not closed due to medical improvement.

MEAD eligibility determinations are required for ANB and APTD individuals whose earnings:

• exceed SGA limits; or

• are less than SGA limits and whose resources exceed medically needy limits.

For MEAD medical determinations, send the following forms when forwarding the request to MAB:

• Form 177, Non-Medical Evaluation of Disability;

• Form 900, Authorization to Release Information (2 copies); and

• Form 940M, Cover Memo to Accompany Medical Eligibility Information for Medicaid for Employed Adults with Disabilities (MEAD).

If the individual does not meet MEAD medical eligibility criteria and wants to apply for ANB or APTD, a separate ANB or APTD medical eligibility determination is required.

Enrollment in Cost-Free Health Insurance Through the Employer

Individuals who are eligible for private health insurance through employment or membership in an organization, at no cost to them, must be enrolled in those insurance plans in order to be eligible for MEAD.

Payment of Premiums

See Section 210.09, Payment of Premiums, regarding this requirement.