425-2 WHO DETERMINES DISABILITY/BLINDNESS

425-2 WHO DETERMINES DISABILITY/BLINDNESS

425-2 A. TEMPORARY DISABILITY OR BLINDNESS DECISIONS

A proper medical provider can provide a temporary decision on an individual's blindness or disability.

A proper medical provider for a disability decision is a licensed physician, psychiatrist, advanced practice registered nurse, or physician assistant within their licensed scope of practice.

A proper medical provider for a blindness decision is a licensed physician, advanced practice registered nurse, or physician assistant within their licensed scope of practice.

A temporary blindness or disability decision does not allow the authorization of full APA and Medicaid benefits. Instead, it serves as an indication that the individual is blind or disabled for the purposes of qualifying for Interim Assistance ( IA ) benefits until a final blindness or disability decision is made.

The medical provider must provide a temporary blindness or disability decision to the Division on the state form AB 3 , "Report of Eye Examination" for blindness, or on an AD 2 form for disability. The Division will not accept temporary blindness or disability decisions unless they are provided on one of these forms.

425-2 B. PRESUMPTIVE DISABILITY DECISIONS

The SSI program may make presumptive disability payments to SSI applicants before they make a final blindness or disability decision. To be eligible for presumptive disability payments, the individuals must have claimed impairments that are so severe that there is little doubt that Social Security Administration will finally decide they are blind or disabled.

SSI presumptive disability payments are made for no more than six calendar months. Recipients of such payments are considered SSI recipients in all respects. The APA program considers these persons to be blind or disabled during the same period that the person is eligible for SSI payments. The case worker shall authorize full APA and Medicaid benefits during an SSI presumptive disability period if the individual meets all other factors of APA eligibility.

The case worker must check the status of the SSI case before the end of the six-month period. If the SSI presumptive disability payments will not continue, and eligibility for regular SSI payments has not yet been determined, the case worker must close the APA and Medicaid case. The case worker must open an Interim Assistance case if the individual is eligible for such assistance. Regular APA and Medicaid benefits are not available again until SSI determines eligibility for regular SSI benefits. If the individual is finally determined eligible for regular SSI benefits, APA and Medicaid benefits are authorized retroactive to the month that SSI benefits were resumed.

425-2 C. SSA BLINDNESS OR DISABILITY DECISIONS

The Social Security Administration makes the disability decision for most APA applicants and recipients. A finding of blindness or disability allows the authorization of APA and Medicaid benefits if the individual meets all other factors of eligibility for the APA and Medicaid program.

Note: Effective October 1, 2026, individuals must meet Medicaid qualified alien requirements for Medicaid. Refer to ADLTC MS 522 and MAGI MS 808 for policy on U.S. citizenship and eligible alien status.

A finding of no blindness or disability results in denial of APA and Medicaid benefits, and if applicable, in termination of Interim Assistance benefits. The case worker may pend an individual's application for APA and Medicaid benefits only until SSA 's initial blindness or disability finding.

Applicants may appeal the SSA decision.

If the appeal results in a finding of blindness or disability, reevaluate eligibility for regular APA and Medicaid benefits back to the month of APA application. To determine the benefit start dates for APA and Medicaid, refer to manual section 410-7 .

If the appeal results in a finding of no blindness or disability, eligibility for APA and Medicaid does not exist.

If, after a finding of no blindness or disability, an Interim Assistance recipient enters or reenters the SSI appeal process the individual may continue to receive Interim Assistance benefits until a final disability decision is made. If the appeal process results in a final finding of blindness or disability, eligibility for regular APA and Medicaid benefits will be reevaluated. To determine the benefit start dates for APA and Medicaid, refer to manual section 410-7 .

Note: If an initial applicant has already been denied by SSI and they haven't appealed the decision, there is no APA or IA eligibility and the application must be denied. The application is not pended for the applicant to appeal the SSI decision.

425-2 D. STATE-ONLY BLINDNESS OR DISABILITY DECISIONS

Social Security will not decide an individual's blindness or disability if the individual is ineligible for SSI or SSA benefits because of other reasons not related to the individual's blindness or disability such as more stringent citizenship requirements for Title XVI benefits. In such situations, the State must make the blindness or disability decision; the Disability Determination Service (DDS) of the Division of Vocational Rehabilitation, Alaska Department of Labor and Workforce Development, is the agency that makes blindness or disability decisions for the State.

A finding of blindness or disability allows the authorization of APA and Medicaid benefits if the individual meets all other factors of eligibility for the APA program. A finding of no blindness or disability results in a denial of APA and Medicaid benefits. An individual may appeal a state-only DDS decision through the state's fair hearing process.

Substantial Gainful Activity . The DDS is only responsible for making state-only disability determinations based on medical evidence; it does not determine disability based on whether or not an individual is engaging in substantial gainful activity ( SGA ). If an individual (who is subject to a state-only disability determination) appears to be engaging in SGA , the case worker will need to make an SGA determination based on the criteria described in MS 425-1(2) . If the case worker determines that the individual is engaged in substantial gainful activity, APA eligibility must be denied or terminated.

If an applicant or recipient is still within the diary date of the Social Security disability determination, DDS should not be contacted for a disability decision. The disability decision made by Social Security will be honored and APA will continue until the end of the diary date.

Note: SGA determinations by DPA case workers are only necessary for state-only disability determinations. The Social Security Administration is responsible for all other SGA decisions.

Note: A disability decision made by the Social Security Administration ( SSA ) always trumps a decision made by DDS . Once SSA determines that an individual does not meet the disability requirements, it supersedes any state only disability determination that found the individual disabled. If we have an open APA /ME case based on a determination of disability made by DDS and SSA then determines that there is no disability, we would close down the APA /ME case based on the SSA denial.