IMA POLICY MANUAL PART IV: NON-FINANCIAL ELIGIBILITY REQUIREMENTS
CHAPTER 9: DISABILITY/BLINDNESS
INTRODUCTION 9.1
This chapter pertains to MA and FS only. Some applicants qualify for program benefits or special consideration when determining benefits on the basis of disability or blindness. This chapter discusses the definition of disability and blindness and how to establish disability or blindness for eligibility purposes. (See Section 1.6: Exemptions from Work Requirements in Part V for information on exemptions to TANF work requirements based on incapacity. See Section 3.10: POWER in Part VIII for information on the POWER program -- an alternative to TANF for incapacitated individuals.)
Disability or blindness affects eligibility for two programs, MA and FS. Individuals not otherwise eligible for Medicaid can qualify based on their disability or blindness if they also meet other non-financial and financial eligibility requirements (see Part VI: Financial Eligibility Requirements). FS households that include a disabled or blind household member are also entitled to special considerations. Such households are not required to meet the gross income test (see Chapter 8: Determining Income Eligibility in Part VI), can receive a larger shelter deduction under some circumstances, and can deduct certain medical expenses from their income (see Chapter 6: Income Disregards and Deductions in Part VI).
SR: A person is permanently and totally disabled when:
s/he has a medically determined physical or mental impairment,
his/her impairment prevents him/her from engaging in any substantial gainful activity, and
his/her impairment:
Can be expected to result in imminent death,
Has lasted at least 12 consecutive months, or
Is expected to last at least 12 consecutive months;
or s/he:
Meets the District of Columbia's October 1972 definition of disability , and
Received assistance under the Aid to the Permanently and Totally Disabled Program for December 1973.
The October, 1972 definition of disability is as follows:
An individual is "permanently and totally disabled" if that individual has some permanent physical or mental impairment, disease, or combination thereof that substantially precludes him or her from holding a job or engaging in a useful occupation within his or her competence.
A person is determined to be blind when:
The visual acuity in his better eye can only be corrected to 20/200 or less,
The widest diameter of the visual field in his/her better eye is limited to an angle 20 degrees or less,
Conditions that constitute severe visual handicaps exist, or
s/he:
Meets the District of Columbia's October 1972 definition of blindness, and
Received assistance under the Aid to the Blind Program for December 1973.
Under the 1972 definition of blindness, an individual is considered to be blind when he or she has
vision in the better eye of no more than 20/200 while wearing corrective glasses;
a loss of 80 percent or more of his or her peripheral vision; or
certain other conditions which constitute a severe visual handicap.
QM: N/A
FS
Disabled group member means a member of a household who meets any of the following requirements:
Receives SSI benefits under Title XVI of the Social Security Act or disability or blindness payments under Titles I, II, X, XIV, or XVI of the Social Security Act.
Receives federally or state administered supplemental benefits under Section 212(a) of Public Law 93-66.
Receives disability retirement benefits from a governmental agency because of a disability considered permanent under Section 221(I) of the Social Security Act.
Is a veteran with a service connected or non-service connected disability rated by VA as total or paid as total by VA under Title 38 of the U.S. Code.
Is a veteran considered by VA to be in need of regular aid and attendance or permanently housebound under Title 38 of the U.S. Code.
Is a surviving spouse of a veteran and considered by VA to be in need of regular aid and attendance or permanently housebound or a surviving child of a veteran considered by VA to be permanently incapable of self-support under Title 38 of the U.S. Code.
Is a surviving spouse or child of a veteran and considered by VA to be entitled to compensation for a service connected death or pension benefits of a non-service connected death under Title 38 of the U.S. Code and has a disability considered permanent under Section 221(I) of the Social Security Act ('entitled' as used in this definition refers to the veteran's surviving spouse and children who are receiving the compensation or pension benefits stated or have been approved for such payments but are not yet receiving them), or
Receives an annuity payment under Section 2(a)(I)(iv) of the Railroad Retirement Act of 1974, is determined to be eligible to receive Medicare by the Railroad Retirement Board or Section 2(a)(I)(iv) of the Railroad Retirement Act of 1974, and is determined to be disabled based upon the criteria used under Title XVI of the Social Security Act.
