ELIGIBILITY FOR INDEPENDENT LIVING SERVICES
Persons who meet criteria in items I, II, and III below are eligible to receive independent living services funded by Social Services Block Grant through the Division of Services for the Blind. These eligibility criteria are based on:
Vision: either legal blindness or visual impairment, and
Need for the service: as defined in target population under service definitions, and
Income if receiving In-Home Aide Services: Level I-Home Management.
A. LEGAL BLINDNESS
1. Visual acuity of 20/200 or less, best corrected, or a field of vision in the better eye to such a degree that its widest diameter subtends an angle no greater than 20 degrees. [Reference: N.C. General Statutes: 105-249.]
B. VISUAL IMPAIRMENT
1. Visual acuity of 20/100 or less with best correction with a progressive eye condition or a 30 degree field limitation. A progressive eye condition, which is also called progressive eye pathology, is defined as any pathology of the eye diagnosed by an ophthalmologist or optometrist, which indicates vision deterioration or loss over a period of time. Examples: macular degeneration, diabetic retinopathy, and retinitis pigmentosa; or
2. Best corrected central vision acuity of 20/70 or less in the better eye; or
3. One or both of the following conditions:
a. The presence of chronic, progressive eye pathology; and/or
b. Visual acuity better than 20/70 without progressive eye pathology that nevertheless results in a functional handicap.
A functional handicap is defined as any physical or mental condition that impairs, interferes with or otherwise impedes a person’s ability to perform one or more major life activities such as self-care, mobility, and communication, self-direction, or homemaking skills.
Special Note: All persons with more than 20/70 visual acuity in the better eye without progressive eye pathology must have prior approval from the Chief of Independent Living Services before services can be provided. To request approval, the Social Worker for the Blind will prepare an assessment demonstrating that the vision loss presents a functional handicap to the applicant. This assessment, along with the applicant's eye report from a physician or optometrist is to be sent to the Chief of Independent Living Services who will approve or disapprove the provision of services for this person, as appropriate.
C. Additional Vision Requirement for In-Home Aide Services: Level I-Home Management
Vision eligibility for In-Home Aide Services: Level I - Home Management is based on the definition of legal blindness. See page 5 of this manual for definition. If there are uncertainties or questions regarding the consumer’s eligibility based on vision for In-Home Aide Services: Level I, the Social Worker for the Blind will send a copy of the eye report to the Chief of Independent Living Services in the State Office. This information will be forwarded to the State Consulting Ophthalmologist who will determine the consumer's vision eligibility for In-Home Aide Services: Level I.
D. Verification of Vision Status
When a person applies for independent living services, the Social Worker for the Blind must explain that documentation is needed to verify his/her current visual acuity. Proof of an applicant's current visual acuity will be based on a completed eye examination report.
The eye examination report must be dated and signed by a medical or eye care professional. After ILS eligibility has been determined, a copy of the eye report or written statement must remain in the consumer’s case record as proof of ILS eligibility based on vision. If the current eye report obtained to determine eligibility for In-Home Aide Services: Level I-Home Management indicates that the applicant has just had eye surgery that is expected to improve the vision, the provision of In-Home Level I would be authorized only for a few months to allow the vision to improve. It would be necessary for the SWB to have a system to remind himself/herself that a new eye report must be obtained to determine on-going eligibility for the service. It must not be assumed by the SWB that if the applicant/recipient was once eligible based on vision that he/she will continue to be eligible based on vision indefinitely. If the eye condition is one that is expected only to worsen and the eye doctor does not recommend annual exams, then the SWB should not require annual updates on the eye condition. However, a report on the A/R’s vision should be obtained at least every five years for recipients of In-Home Aide Services even if his/her eye condition is one that is not expected to improve. The receipt of up-dated reports on the recipient’s vision will not only determine continued eligibility based on vision but will also assist the SWB in counseling regarding vision loss and planning additional services that might assist the recipient.
1. Acceptable Forms of Documentation
a. DSB-2202 Report of Eye Examination: completed, dated and signed by a medical or eye care professional; or,
b. A written statement presented on official letterhead signed and dated by a medical or eye care professional which states, at minimum, the person's visual acuity in both eyes with best correction, date of examination, and primary diagnosis.
2. Special Procedures for Applicants Unable to Obtain Eye Reports
Applicants for independent
living services unable to obtain a copy of
the required eye examination report may qualify for an eye examination
purchased at Medicaid or Medicare rates. This purchase
is used only for situations in which the eye report is not otherwise
obtainable or when the consumer is unable to pay for an eye exam or
when there are no other resources to pay for the eye examination.
The Social Worker for the Blind will open the case using DSB-7001, entering appropriate data electronically, and submitting an Authorization to pay for the eye exam. If the applicant is found to be ineligible for ILS services based on findings shown on the exam report, the SWB will close the case in Status 08: Rejected.
E. Mandate to Inform Applicants of General Statutes
It is mandatory that the Social Worker for the Blind inform all applicants of the following General Statutes:
1. General Statute 111-4
This statute requires the Division of Services for the Blind to maintain a register of people who are legally blind, and
2. General Statute 111-2
This statute requires the Division of Services for the Blind to release to the North Carolina Department of Motor Vehicles and North Carolina Department of Revenue the name and medical records of any person listed on the Register of the Blind.
ELIGIBILITY BASED ON NEED FOR SERVICE
Those persons who meet the vision criteria for ILS eligibility are eligible for certain services solely on the basis of their need for the service and without regard to their income. The basis of need for a service is defined in the target population under service definition in the ILS Manual section for each respective service. These services are:
Adjustment Services for the Blind and Visually Impaired
Health Support Services
Individual and Family Adjustment Services
Information and Referral
Income is an eligibility criterion for only one ILS service, that of In-Home Aide Services: Level I-Home Management. The consumer must have family income of less than 150% of the state's Established Income. Refer to Appendix D for Established Income Levels by family size. Refer to page 64 for the definition of family and the detailed instructions in the computation and verification methods that are necessary to determine eligibility for this service.
Interpreter services may be purchased for deaf and hard-of-hearing persons who are making application for independent living services and who are unable to provide their own interpreter at the time of application. To locate an appropriate interpreter, refer to the Interpreting Services Vendor List (ISVL) which is updated at least monthly. Also, refer to the ILS Manual, Appendix C
A. Interpreter Services.
Interpreter services may also be purchased for applicants of independent living services whose language preference is one other than English. Sign language interpreting services may be purchased when it is determined that the SWB and/ or the Resource Specialist cannot communicate effectively with the applicant/ consumer during the application process and/ or service delivery. Such services are not subject to an individual's financial eligibility; however, comparable benefits from other agencies or organizations must be used first when available. Refer to ILS Manual, Appendix C: Interpreter Services, Foreign Language Interpreting Services.
The Social Worker for the Blind will open the case using DSB-7001 and enter appropriate data electronically. To authorize payment to interpreters for this service, refer to Appendix C: Interpreter Services. If the applicant is found to be ineligible for independent living services, the SWB will close the case in Status 08: Rejected.
For questions or clarification on any of the policy contained in these
manuals, please contact the local district office.