Adult Medicaid Manual MA-2525 DISABILITY

III. POLICY principles

A. When A Disability Determination by DDS Is Required

A disability determination by DDS is required in the following situations:

1. The person requesting Medicaid is ineligible in any other aid program category, and he:

a. States that he is disabled, and

b. His disability has not already been established.

2. The person requesting Medicaid may be eligible in another category but policies in MAD are more favorable to him, and he

a. States that he is disabled, and

b. His disability has not already been established.

3. The person is working and states that he is disabled but:

a. Has not had a disability determination; or

b. Has not received disability in the twelve months prior to the date of application; or

c. Exceeds regular Medicaid income and resource limits.

NOTE: If an HCWD applicant has been found disabled within the twelve months prior to the month of application he is considered disabled for HCWD purposes.

REISSUED 06/01/11 - CHANGE NO. 10-11

(III.A.)

4. The person requesting Medicaid has been determined disabled, but an earlier onset date must be established to cover dates prior to the established onset date.

5. Ongoing Cases: Some MAD recipients require a periodic continuing disability review (CDR). The date when a CDR is due is called a "Diary/Re-Exam Date" which is established by DDS or by the Hearing Officer in the hearing decision. If a Diary/Re-exam date is established, enter the date in the Special Review Code to flag the case for a disability review at the scheduled time.

B. Applicants who are Working

When an applicant alleges he is disabled and is working request a disability determination from DDS using the DMA-4037, Disability Determination Transmittal.

C. Application Time Standards

For all applications involving disability, the time standard for processing the application is 90 days. Register the MAD application on the 8124. Enter in the DIS/DET field a “Y” for “Yes”, when disability must be determined, or “N” for “No”, when the disability determination is not needed.

D. Verification of Disability Status

Verify whether an individual has applied for or been determined disabled for RSDI/SSI through SOLQ, TPQY, BENDEX, or SDX inquiry. For individuals receiving RSDI who are under age 65, the county must verify with SSA whether the individual has been determined disabled in order to be eligible under MAD.

E. Continue Eligibility Determination

For applications, continue to determine eligibility while disability is being determined by DDS. If prior to receiving a disability determination from DDS the county determines that the applicant is ineligible for regular MAD and HCWD, immediately contact DDS and tell them that a disability determination is no longer necessary. Denying the application which updates the DDS Data Screen is not sufficient. Call or fax DDS. (See DDS contact information at IV.B.10. below.)