Disability Determination
Applicants or participants must meet and maintain all eligibility criteria during the period of time the participant is determined eligible for Medicaid and receives services. Eligibility determinations are made on an annual basis by the combined efforts of the Division of Welfare and Supportive Services (DWSS) and the Division of Health Care Financing and Policy (DHCFP).
DWSS processes applications to
determine Medicaid eligibility and submits disability determination requests to
Medicaid.
DHCFP staff in the District
Offices is responsible to:
- Facilitate
the evaluation of disability determinations for:
- State Plan Medicaid disability program (must be under 65 years of age);
- Home
and Community-Based Waiver (HCBW) for Persons with Physical Disabilities (must meet eligibility criteria in the most current Medial Service Manual (MSM) Chapter 2300)
- Katie
Beckett Option (must meet the eligibility criteria in the most current Medical Operations Manual (MOM) Chapter 600 and
- Emergency
medical services.
- Request and receive necessary medical evidence from the applicant’s acceptable medical sources. A completed packet containing sufficient evidentiary information (medical, psychological and applicable vocational and/or social information) to determine disability must be submitted from the DHCFP District Office to the DHCFP Central Office.
- Assist the applicant in obtaining his or her medical records when given permission to do so. Medical records generally come from sources that have treated or evaluated the individual for his or her impairment(s).
Although the agency will assist the applicant in obtaining medical records, each individual who files a disability application is responsible for providing medical evidence showing that he or she has impairment and the severity of the impairment.
The medical records and, if indicated, the death certificate, must be received by the DHCFP Central Office within 45 days of request. If the appropriate records are not received within this time period, the application will be denied at the Central Office level.
Disability
Determination Medicaid Operations Manual (MOM): Refer to Regulatory section
Recipient
Contact your local District Office.
DHCFP District Offices