The individual has the choice of when benefits begin:
On the first day of the month in which the application is received by the CAO.
On the first day of the following month.
If the individual does not say which month to start benefits in, the CAO must contact him or her to find out the preferred begin date. If the MAWD individual does not understand CAO individuals, translation services will be used.
Reminder: Because a full monthly premium payment is required for each month of eligibility, it is important that the CIS/e-CIS case record have the correct eligibility begin date.
When a Medical Review Team (MRT) disability determination is required, the individual has the choice of when benefits begin:
On the first day of the calendar month in which the application is received by the CAO.
On the first day of the calendar month in which the disability determination is made.
Important: If the MAWD applicant chooses to begin coverage starting with the month in which the application was received, he or she must pay premiums starting with that month.
If the application is held for longer than 30 days, the CAO will contact the individual by letter. The CAO will also follow up with a phone call to verify a possible change in the eligibility begin date.
NOTE: If an individual lists a disability but does not have the needed proof; the CAO will authorize the individual as presumed disabled. The individual must provide some type of disability documentation.
Examples:
An application is received on May 25, requesting benefits to begin the first day of the month in which it is received. The MRT review is completed on August 14. The CAO contacts the applicant and explains that premiums are required for May, June, July, and August. Unless the individual has medical expenses that haven’t been paid, it may be better for the individual to have coverage begin in August.
An application is received on June 25. The applicant is receiving SSDI, and he or she is asking for benefits to begin on June 1. The CAO does not receive proof of income until July 30. The CAO contacts the applicant to find out whether they would prefer benefits to begin in June or July.
MAWD eligibility ends on the last day of the calendar month that eligibility conditions are no longer met or when the individual requests that benefits be stopped. (Chapter 377, Notices, for information about notification.)
NOTE: When the budget must remain open for extra months to allow for the expiration of the appeal period (which gives the individual an extra month of MAWD eligibility), the CAO must enter code 05 (administrative processing) in CIS/e-CIS. This lets the Central Office know that a premium is not required for that time period because of good cause.
The CAO determines whether an individual is eligible every 12 months, using these guidelines:
An office visit is not required, unless the individual requests the visit.
The renewal can be completed by telephone, by mail or on-line on Compass in a language that the individual understands.
Review theindividual’s disability as described in Section 316.211.
For more information on renewals, Chapter 376, Renewal.
Updated February 14, 2012, Replacing October 17, 2008