Department of Human Services: Chapter9

AR: N/A

AX: N/A

SR: The disability standard used in Medicaid for individuals applying for Medicaid based on disability is the same as that used by the SSA when administering SSI and SSDI. Recipients of SSI are categorically eligible for Medicaid, and no further verification of disability is required.

Recipients of SSDI benefits based on an individual’s own disability are considered to meet the disability standard applied in Medicaid. This includes a person whose entire SSDI benefit is being withheld for recoupment. Applicants receiving SSDI must provide verification that they receive SSDI benefits (that is, a document from the SSA verifying receipt of SSDI based on disability or blindness) and those benefits are based on their own disability. No further medical information must be verified.

Individuals applying for Medicaid based on disability who do not receive either SSI or SSDI must submit the results of a medical examination within 45 days of filing an application. The MRT reviews this form and issues a disability determination within 90 days from the date of application.

If an individual applies for Medicaid based on disability but the individual would be eligible based on a non-disability eligibility category, the SSR should determine eligibility based on the non-disability-related standard since this will reduce burden on the applicant (s/he will not be required to submit a medical evaluation form) and will speed the eligibility determination process. The individual should be strongly encouraged 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.

QM: N/A

The following table shows what verification is required for an individual claiming to be disabled for FS purposes by category of disability:

Category of Disability (from Section 9.3: Definition)	Verification Required
An individual who: Receives SSI benefits based on disability 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.	The household must provide proof that the disabled individual is receiving benefits under Titles I, II, X, XIV, or XVI of the Social Security Act (that is, a statement from the SSA).
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.	The household must present a statement from the VA which clearly indicates that the disabled individual is receiving VA disability benefits for a service connected or non-service connected disability and that the disability is rated total or paid at that total rate by VA.
An individual who: 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 and considered by VA to be permanently incapable of self-support under Title 38 of the U.S. Code.	The household must prove that the disabled individual is receiving VA disability benefits (that is, a statement from the VA).
An individual who: 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 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.	If it is obvious to the SSR that the individual has one of the disabilities listed on SSA’s most current list of disabilities considered permanent under the Social Security Act, the household is considered to have a verified disability. If the disability is not obvious to the SSR, the household must provide a statement from a physician or licensed or certified psychologist certifying that the individual either has one of the disabilities listed or is unable to purchase meals because s/he suffers from some other severe permanent physical or mental disease or non-disease-related disability. This medical statement is reviewed by the MRT which decides whether the individual meets the required disability standard.
An individual who 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.	The household must provide proof that the individual receives a Railroad Retirement Disability annuity from the Railroad Retirement Board and has been determined to qualify for Medicare.

The following is a partial list of disabilities considered permanent under the SSA:

Permanent loss of the use of both hands, both feet, or one hand and one foot.
Amputation of a leg at a hip.
Amputation of a leg or foot because of diabetes mellitus or a peripheral vascular disease.
Total deafness not correctable by surgery or a hearing aid.
Statutory (that is, legal) blindness, except if due to cataracts or a detached retina.
IQ of 59 or less established after age 16.
Paraplegia or quadriplegia.
Multiple sclerosis that is severe and recurring and includes muscle weakness, paralysis, or interference of vision or speech .
Muscular dystrophy with a significant effect on the use of the arms or legs.
Chronic renal disease (documented by persistent, adverse objective findings) resulting in severely reduced kidney function.

As discussed in Section 1.3: Mandatory Group Members in this Part, a person at least 60 years old, his/her spouse, and their children under 18 may choose to be a separate group from those they live with even if they purchase and prepare food together if:

The person age 60 or over cannot purchase and prepare meals due to a permanent disability as determined by SSA or a non disease related permanent disability, and
The countable income of all the other people with whom the senior impaired group lives does not exceed 165 percent of the FPL.

For disability determinations which must be made relevant to this provision, the individual must be unable to purchase and prepare meals because s/he suffers from a severe physical or mental disability, even if the individual’s disability is not specifically mentioned on the SSA list.

The elderly and disabled individual (or his/her authorized representative) is responsible for obtaining the cooperation of the individuals with whom s/he resides in providing the necessary income information about the others to the SSR for purposes of this provision.