Special Assistance SA-3110 APPLICATION PROCESS

To be eligible for SAD, an individual must be age 64 and under, and must be determined disabled according to Social Security disability standards or meet criteria for legal blindness.

A. Already Receiving SSI/SSDI

An applicant who is receiving SSI/SSDI based on disability meets the disability requirement.

B. Not Receiving SSI/SSDI, No Pending Application

1. If the SA applicant is not receiving SSI/SSDI based on disability or legal blindness has not been established, and does not have a disability application pending, advise the applicant that he/she must apply for Social Security benefits within 60 days of the date of the SA application.

2. Discuss the applicant’s current and retroactive medical needs and advise the applicant that he/she may make a separate application for Medicaid. Refer to instructions in MA-2525, Disability for establishing disability for Medicaid. A Disability Determination Services (DDS) decision of disability for Medicaid does not apply to SA, except for situations described in D.

3. If the applicant applies for SSI/SSDI within the 60 day processing time standard, hold the SA application pending up to 12 months awaiting the SSA decision.

4. If SSA denies the application due to not meeting criteria for disability or legal blindness, deny the SA application. Advise the applicant that if he appeals the SSA decision and the denial is overturned, the SA application may be reopened.

C. SSI/SSDI Application Pending

1. If the applicant has an application for SSI/SSDI pending with SSA, hold the SA application pending for up to 12 months awaiting the Social Security decision. Check the SDX monthly to determine if a decision has been made.

2. If the disability application is denied due to not meeting criteria for disability or legal blindness, deny the SA application. Advise the applicant that the SA application may be reopened if he appeals the SSA decision and the denial is overturned in appeal.

D. SSA Makes No Disability Determination

1. In some cases, SSA may approve or deny benefits without determining disability. For example, the applicant may be financially ineligible for both SSDI and SSI and the application is denied without a disability determination, or an applicant may be approved for a benefit that does not require a disability determination such as early retirement.

2. When SSA approves or denies benefits, determine the reason for the decision and whether a disability decision was rendered. Refer to the SDX, SOLQ, award or denial letter or contact with SSA.

3. In those situations where SSA will not make a disability determination, disability must be established by Disability Determination Services. Follow instructions in MA-2525, Disability to submit a request for a disability determination for an SAD applicant.

4. The only time DDS makes a disability determination for SAD is when SSA will not make a disability determination.

5. In those situations where SSA will not make a legal blindness determination, blindness must be must be established by the Division of Services for the Blind. Proof of an individual’s visual acuity will be based on a completed eye examination report which reflects his/her current visual condition. The eye examination report must be dated and signed by a medical or eye care professional. Acceptable report forms are:

a.  DSB-2202: Report of Eye Examination, which is completed, dated, and signed by a medical or eye care professional; or

b. A written statement on official letterhead signed and dated by a medical or eye care professional which states, at minimum, the individual’s visual acuity in both eyes with best correction, date of examination, and primary diagnosis.

c. Mail to: Division of Services for the Blind, 2601 Mail Service Center, Raleigh, NC, 27999-2601