MEDICAID DISABILITY MANUAL
TABLE OF CONTENTS
PAGE
I. INTRODUCTION
II. OFFICIAL POLICY
1
Basic Definitions
1
1. Disability
2. Blindness
3. Medically Determinable Physical or Mental Impairment
4. Substantial Gainful Activity
5. Disability Review Team
6. Disability Case Record
7. Group I
8. Group II
1
1
1
1
1
2
2
2
Disability Eligibility
2
1. Categorical
2. Derivative
2-3
3
Local District Responsibilities
4
1. Identifying Disabled Persons
2. Informing the Applicant/Recipient
3. Securing Medical Documentation
4. Completion of Forms
5. Referral to Disability Review Team
6. Pending of Disability Cases
7. Submitting Cases for Continuing Disability Review
8. Responding to Disability Review Team Decisions
4
6
7
10
11
11
11
12
A.
B.
C.
Updated: May 2017
Table of Contents 1
MEDICAID DISABILITY MANUAL
PAGE
D.
Evaluation of Disability
12
1. General
2. Sequential Evaluation Process for Adults
3. Medical Considerations
4. Vocational Considerations
5. Responsibilities of Disability Review Team
6. Effective Date of Disability
7. Expiration Dates
12
12-16
17
22
31
33
35
Vocational/Financial Considerations
35
1. Substantial Gainful Activity
2. Trial Work Period
3. Plans for Achieving Self-Support
35
39
40
F.
Disability Determinations for Individuals Under 21 Years Old
44
G.
Continuing Disability Review (CDR) Process for Adults
44
1. General
2. Medical Improvement
3. Evaluation Steps
44
45
51
H.
Reapplication for Medicaid by Certified Disabled Individuals
54
I.
SSI Applicants and Recipients
54
1. Determination of Eligibility of SSI Applicants/Recipients
2. Local District Responsibilities
3. Department Responsibilities
4. Individuals Denied SSI
5. Loss of SSI Eligibility
6. SSI Recipients with Medical Bills for Three Months
Prior to SSI Eligibility
54
54
55
55
56
E.
Updated: May 2017
56
Table of Contents 2
MEDICAID DISABILITY MANUAL
PAGE
J.
Substance Addiction Disorders
57
K.
Blindness
58
1. Determination of Blindness Status
2. Pending Cases
3. Examinations
4. Medicaid Disability Reviews
58
59
59
59
Evaluation of Symptoms and Pain
59
1. Presence of a Medically Determinable Impairment
2. Symptoms and Pain and the Sequential Evaluation Process
3. Pain and Medical Improvement
59
60
62
Evaluation of Children from Birth to Attainment of Age 18
62
1. General
2. Sequential Evaluation Process
3. Considerations in Determining Disability for Children
4. Age as a Factor in the Sequential Evaluation Process for Children
5. Medical Equivalence
6. Functional Equivalence for Children
7. Continuing Disability Review for Children
62
63
64
71
73
74
96
L.
M.
100
APPENDICES
I. Listing of Impairments
A. Individuals Age 18 and over
B. Children under Age 18
II. Medical Vocational Guidelines
Updated: May 2017
APPENDIX I
Page 1
Page 174
APPENDIX II
Table of Contents 3
MEDICAID DISABILITY MANUAL
EXHIBITS
Updated: May 2017 Table of Contents 4