Current through September 17, 2024
The eligibility requirements and definitions for blindness
and disability follow:
007.01
ELIGIBILITY REQUIREMENTS APPLICABLE ONLY TO BLIND OR
DISABLED. All applicants for Assistance to the Aged, Blind, or
Disabled payment or State Disability Program after January 1, 1974, must meet
the medical definitions of blindness or disability of the Retirement,
Survivors, Disability Insurance or Supplemental Security Income Programs as
administered by the Social Security Administration. The determination by Social
Security Administration that an individual is disabled or blind must be
accepted for eligibility for Assistance to the Aged, Blind, or Disabled. In
some cases, the State Review Team may make the determination of blindness or
disability.
007.02
DEFINITIONS OF DISABILITY AND BLINDNESS. The following
definitions are used by the Social Security Administration and the Department's
designated Medical Consultant Review process in making a determination for the
Assistance to the Aged, Blind, or Disabled payment program and the State
Disability Program:
(A) An individual is
considered disabled for the Assistance to the Aged, Blind, or Disabled payment
program when it is not possible for the individual to engage in any substantial
gainful activity due to any medically determined physical or mental impairment
which can be expected to result in death or which has lasted, or can be
expected to last, for a continuous period of not less than 12 months. A child
through age 17 is considered disabled if the individual suffers from any
medically determined physical or mental impairment of comparable
severity.
(B) An individual is
considered blind for the Assistance to the Aged, Blind, or Disabled payment
program if that individual has central visual acuity of 20 over 200, or less,
in the better eye with correcting lens, or a field defect in which the
peripheral field has contracted to such an extent that the widest diameter of
visual field subtends an angular distance of no greater than 20
degrees.
(C) An individual is
considered disabled for the State Disability Program if it is not possible for
the individual to engage in any substantial gainful activity by reason of a
medically determined physical or mental impairment which can be expected to
result in death or which has lasted, or can be expected to last, for a
continuous period of not less than 6 months from onset and not more than 12
months. The Department's designated medical reviewer always makes the
determination for State Disability Program. The individual cannot be ineligible
for other Medicaid programs.
007.03
DETERMINATION OF
ELIGIBILITY FOR THE BLIND OR DISABLED
(A) When the Social Security Administration
has made the disability determination, all eligibility requirements for the
Assistance to the Aged, Blind, or Disabled payment program, except for the
disability determination, are the responsibility of the Department.
(B) To have the State's Medical Consultant
make the disability determination for the State Disability Program the
individual must be denied by Social Security for a 'lack of
duration'.
(C) To be eligible for
Assistance to the Aged, Blind, or Disabled payment program, the individual must
have been determined disabled by the Social Security Administration, and be
currently eligible to receive Supplemental Security Income or Retirement,
Survivors, Disability Insurance, or be determined disabled by the State Review
Team.
(D) To be eligible for a
State Disability Program payment, the individual must have been denied
Supplemental Security Income due to a 'lack of duration' of their disability,
and was determined disabled by the Department's Medical Consultant.
(E) The cost of medical examinations to
determine initial or continuing State Disability eligibility may not exceed the
established Medicaid allowable fee. The cost of a medical examination to
determine eligibility is an allowable Title XIX expenditure if the individual
is eligible for medical benefits on the date of the examination. If the initial
application is rejected, the cost of the examination must be paid from
administrative funds
