Department of Human Services: Chapter9

AR: N/A

AX: N/A

SR: Disability/blindness determinations are made by the SSA, the Department's eye specialist, or MRT. Individuals receiving SSI are categorically eligible for Medicaid, and no further disability determination is required (see Chapter 12: Categorical Eligibility in this Part). Individuals receiving SSDI based on their own disability have met the disability requirement for disability-related Medicaid. The MRT does not make a separate disability determination in this case. If the SSDI recipient meets the other non-financial and financial eligibility requirements (see Part VI: Financial Eligibility), s/he will qualify for Medicaid.

The disability determination for those individuals who do not receive SSI or SSDI (based on their own disability) who are applying for Medicaid based on disability will be made by the MRT unless the SSA has already made a disability determination and found that the individual does not meet the SSA disability standard (and no changes in the individual’s medical condition have occurred).

Individuals for whom a final SSA disability/blindness determination has not been made are entitled to a disability/blindness determination by the MRT. An SSI/SSA determination that disability or blindness does not exist for SSI purposes is considered final for MA purposes if:

No further appeals may be made at SSA (see Exhibit IV-6: General Information About the SSA Appeals Process) or the applicant/recipient failed to file an appeal at any step within SSA's 60-day limit, and
The applicant/recipient is not claiming:
- A totally different disabling condition than the condition SSA based its determination on, or
- An additional impairment(s) or change of deterioration in his/her condition on which SSI has not made a determination.

Once SSA's determination of ineligibility is final, eligibility for Medicaid based on disability or blindness does not exist, even if the MRT had determined the individual to be disabled or blind.
Individuals denied SSI eligibility because of a refusal to meet an SSI program requirement not applicable under Medicaid should be granted Medicaid coverage if they meet non-financial and financial eligibility requirements (see Part VI: Financial Eligibility). These individuals include:

Disabled or blind individuals over age 15 and under 65 who refuse to meet the SSI program requirement for vocational rehabilitation, and
Individuals who refuse to meet the SSI program requirements for:
- Alcoholism treatment,
- Drug treatment, or
- Corrective surgery.

QM: N/A

N/A

AR: N/A

AX: N/A

SR: Applicants who qualify for Medicaid based on non-disability-related eligibility criteria, such as applicants age 65 or over, children, or parents/caretaker relatives caring for minor children, do not have to rely on a disability/blindness determination and their eligibility should be determined under the appropriate non-disability-related category. Disabled parents should be strongly encouraged, however, to complete the medical evaluation form because if the MRT determines the individual disabled and the case is converted to an SR case, the individual will not be placed in the same managed care system that serves non-disabled Medicaid participants. This system may not be as appropriate for individuals with disabilities as for those without disabilities. If however, the individual would not meet the SR financial eligibility criteria, the individual should not be given a medical evaluation form.

QM: N/A

N/A