*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: May 1, 2013 |
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Archived: June 1, 2016 (Previous Versions) |
People with a disability or blindness may have a basis of eligibility for Medical Assistance (MA). In order to have a disabled or blind basis of eligibility, the disability or blindness must be certified by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). The certification process may also be referred to as a disability determination.
When Is A Disability Determination Required?
When Is A Disability Determination Not Required?
What Is A Certifiable Disability?
When Is A Disability Determination Required?
People under age 65 with a disability or blindness must be certified to use a disabled or blind basis of eligibility for MA.
For some people, this certification may be part of their eligibility determination for the Community Alternative Care (CAC) , Community Alternatives for Disabled Individuals (CADI) , and Brain Injury (BI) waiver programs.
Note: A disability certification from SSA or SMRT is not needed for DD waiver services; the case manager may make that determination. See Waiver Programs for more information.
When Is A Disability Determination Not Required?
A disability determination is not needed for MA eligibility for:
l People age 65 or older who are blind or disabled. These people already have a basis of eligibility for MA based on their age.
Note: People age 65 or older who apply for MA-EPD must have been certified disabled prior to age 65 to qualify.
l People who have already been certified disabled by SSA. This may include people who:
n Receive RSDI or SSI cash benefits, or
n Have 1619(a) or 1619(b) status under the SSI program, or
l Are eligible for Medicare, and lose their RSDI or SSI benefits because they earn more than the SGA level. These people are eligible for the Medicare extension . (Because SSA considers these people to remain disabled during the Medicare extension, they continue to meet a disabled basis for MA.)
What Is A Certifiable Disability?
For general reference, disability may be broadly defined as the existence of a severe medical impairments that prevents the person from participating in SGA.
Exception: The SGA criterion does not pertain for people who are eligible for MA-EPD.
However, workers should not attempt to determine which clients may or may not meet the criteria for a disability certification. Clients who are not yet certified should be referred to SSA or SMRT if they indicate that their disability:
l Has lasted or is anticipated to last more than one year, or
l Is a terminal condition or illness.
For examples of conditions that may be considered disabling by SSA and SMRT, see www.ssa.gov/disability/professionals/bluebook/.
People under age 65 may have their disability or blindness certified by SSA or SMRT. If they have not had an SSA disability determination and their disability or blindness is expected to last at least one year (or result in death), they should generally be referred to both of the following:
l The SSA to apply for disability benefits. SSA makes determinations of blindness and disability as part of the eligibility determination for RSDI or SSI benefits.
l The SMRT for a disability determination. SMRT generally uses the same criteria as SSA to make blindness and disability determinations.
People with a disability or blindness should be referred only to SMRT and not to SSA if they:
l Have an application for RSDI or SSI already pending, or
l Have had their eligibility for RSDI or SSI benefits denied or terminated by SSA for reasons other than lack of blindness or disability (e.g., lack of work quarters).
The Veterans' Administration and the Railroad Retirement Board do not certify disability for purposes of an MA basis of eligibility. People who are receiving VA or railroad retirement disability income who are not otherwise certified disabled should, like other disabled clients, be referred to SMRT and SSA.
Exception: Some people may receive railroad retirement income in place of RSDI, and should not be referred to SSA.
For more information, see:
SSA Disability Determinations.
SMRT Disability Determinations.
TEFRA Level of Care Determination.