All Medicaid Programs |
Obsolete Policy |
Who Meets Disability
Clients meet the definition of blindness or disability when they have:
Been approved for or receive SSI because of blindness or disability.
Been approved for or receive Social Security Disability insurance (SSDI).
Individuals age 62-65 may receive Early Retirement while applying for disability benefits. If the person has applied for disability benefits, the SSA match record may show an estimated date of disability onset. This does not mean the client has been determined disabled. Request verification that disability has been approved before authorizing Disability Medicaid for these individuals.
1619(a) or 1619(b) status. See Section 329-1
Been approved for or receives survivor’s benefits such as Childhood Disability Benefits (for adults) (331), or Disabled Widow/Widower Benefits (337).
Been determined blind or disabled by the State Medicaid Disability Office. Receipt of unemployment benefits does not preclude someone from being determined disabled.
Died. People are disabled for this reason only in the month of death.
Clients continue to meet the definition of blindness or disability when:
SSDI benefits have stopped because the disabled individual is working above the Substantial Gainful Activity level. SSA refers to these individuals as the Working Disabled. If the individual was eligible for Medicare, he may continue to be eligible for Medicare.
The client was determined disabled before or after entering an IMD or a public institution, has not left the IMD or public institution for 30 continuous days or more, and has not received a disability denial from Social Security after such approval date. (See Sec. 303-10 to decide when to request a new disability determination.)
A client reapplies or completes the eligibility review process within 12 months of when the SMDO redetermination should have occurred. Open Medicaid during the SMDO process if the client is otherwise eligible. Allow the client a minimum of 30 days to submit SMDO related documents. See section 303-3.
If Medicaid has been closed for more than 12 months from the month in which the SMDO review should have occurred, a new disability decision is required before the Medicaid may be opened.
SSI or SSDI Benefits Stop
Clients continue to meet the definition of blindness or disability without requiring a new disability determination for 12 months after SSI or SSDI benefits stop for a reason other than no longer being blind or disabled. Complete an SMDO disability review at the end of the 12 months if SSI or SSDI benefits have not restarted. See Section 303.
Some examples of when SSI or SSDI benefits may stop are:
The client had too much income.
The client made false or misleading statements to SSA.
The client’s SSI payment stopped only due to a transfer of assets for less than fair market value.
The client entered a nursing home.
The client entered a public institution.
The client is a qualified alien, has exhausted the time-limited SSI benefit period and does not meet at least one of the additional SSI eligibility criteria for aliens required by various public laws.
The client refused to accept vocational rehabilitation.
The client’s whereabouts are unknown to SSA.
The client’s SSI status is "eligible but not paid".