DATE: JULY 29, 2008
Manual: Aged, Blind, and Disabled Medicaid
Change No: 18-08
To: County Directors of Social Services
Effective: August 1, 2008
Disability Determination Services (DDS) has been receiving numerous incomplete and unnecessary requests for disability determinations. Definitions have been added and updates have been made to MA-2525, Disability, to provide more information on when a disability review is required and clarification on forms that are needed to complete a disability review. The updates are also the result of concerns from a workgroup on MA-2525, Disability, held November, 2007.
MA-2525-I. Introduction -The definition of Disability has been defined as the Social Security definition of disability.
MA-2525-II. Definitions -This section has been revised to include the Diary /Re-Exam definition.
MA-2525-III.C. Verification of Disability Status includes a statement to emphasize that individuals under age 65 who receive RSDI benefits may not be disabled and therefore, verification with SSA of the disability must be documented.
MA-2525-IV. Applications/Reapplications-Disability Not Established provides information that not all Medicaid disability allowances are required to have a Diary/Re-exam date and clarifies when and why one is established. It also states that DDS will not make a decision on disability if all forms needed for a disability referral are not complete. The list of possible treating sources that was under the instructions for completing the DMA-5009 have been removed and incorporated into section IV.of the DMA-5009. (See figure 8).
MA-2525-V. Applications/Reapplications-Disability Already Established has been reformatted and the content of the information unchanged.
MA-2525-VII. Appeal Reversal of MAD Disability Denial has been reformatted and the content of the information unchanged.
MA-2525-X. Protected Medicaid Status for Non-SSI Children has been reformatted for clarity and deletes the need for a disability review to be conducted every three years.
MA-2525-XI. B. Non-SSI MAD Children without Protected Status has been updated to delete the need for a review to be conducted every three years. The request for a continued disability review will be submitted to DDS according to the Diary/Re-Exam date found on the most current DMA-4037 or in the body of the attachment.
MA-2525-XII. Recipients Receiving RSDI Benefits Based on Disability clarifies that Social Security is responsible for the review of disability if the recipient receives RSDI disability.
MA-2525,Figure 8, DMA-5009. Section IV. is updated to include examples of medical services that were in policy. Section VI. requests that third party information also be included if there is evidence of drug or alcohol abuse by the a/r or if the a/r is homeless, in a shelter or in a halfway house.
MA-2525,Figure 9,DMA-5028. There have been no changes made to this document. It has just been identified as MA-2525 Figure 9.
This policy is effective August 1, 2008. Apply this change to applications taken and redeterminations started on or after August 1, 2008 as well as those presently in process.
A. Remove: MA-2525, Disability, pages 1-29, the Table of Contents, and Figures 8 and 9.
If you have any questions regarding this information, please contact your Medicaid Program Representative. For any issues that are not able to be handled through that venue, Mrs. Angela Floyd, Assistant Director for Recipient and Provider Services, will be your point of contact and can be reached at (919) 855-4000.
(This material was researched and written by Susan Castle, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.