Chesterfield, MI asked in Gov & Administrative Law, Health Care Law, Public Benefits and Social Security for Michigan

Q: Is this eligibility requirement compliant with the legislation in question?

MCL 400.106a authorizes a medicaid program for working disabled. To be eligible applicants must have been “found to be disabled under the federal supplemental security income program or the social security disability income program; or would be found to be disabled except for earnings in excess of the substantial gainful activity level as established by the United States social security administration.”

Referencing the fact that individuals do not necessarily need to be current or past recipients of SSI or SSDI to qualify, they must however meet the SSA's additional criteria for disability. The legislation also includes employment as a factor for eligibility.

MDHHS mandates that applicants must seek benefits through the SSA to establish their disability status for the program. However, individuals who are employed are not eligible for benefits they are not even permitted to apply.

Is this requirement compliant with the legislation in question?

1 Lawyer Answer
James L. Arrasmith
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A: The eligibility requirement set forth by the Michigan Department of Health and Human Services (MDHHS) appears to align with the legislation outlined in MCL 400.106a. This law permits a Medicaid program specifically designed for the working disabled, indicating that applicants must meet certain disability criteria similar to those used by federal programs like the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. Importantly, the legislation acknowledges that individuals who earn more than the substantial gainful activity (SGA) level, as determined by the Social Security Administration (SSA), can still be considered disabled for the purposes of this program.

The stipulation that applicants must have been found to be disabled under SSI or SSDI guidelines, or would have been if not for earnings above the SGA level, aims to ensure that those who are working and have a disability, but are not receiving SSI or SSDI due to their income, can still access Medicaid. This inclusion broadens the scope of eligibility to encompass a group of disabled individuals who are contributing to the workforce yet still require medical assistance through Medicaid.

However, the requirement that individuals must seek benefits through the SSA to establish their disability status, while concurrently stating that employed individuals are not eligible to apply, seems to present a contradiction with the intent of the legislation. If the legislation's purpose is to provide Medicaid to the working disabled, then excluding those who are employed from even applying does not align with the intent to support disabled individuals who are working. It's essential to clarify this point within the policy or seek a legislative or administrative clarification to ensure that the program is accessible to all who are intended to benefit from it, including those who are employed and meet the disability criteria set by the SSA.

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