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Chapter: 1400 Technical Requirements Program: MSSI, SFP 45 1440.1204 Blindness/Disability Determinations (MSSI, SFP) If the individual has not received a disability decision from SSA, a blindness/disability application must be submitted to the Division of Disability Determinations (DDD) for individuals under age 65 who are requesting Community Medicaid under community MEDS-AD, Medically Needy, and Emergency Medicaid for Alien Programs.

State disability determinations for disability-related Medicaid applications must be done for all applicants with pending Title II or Title XVI claims unless SSA has denied their disability within the past year. If SSA has denied disability within the past year and the decision is under appeal with SSA, do not consider the case as pending. Use the decision SSA has already rendered. The SSA denial stands while the case is pending appeal.

When the individual files an application within 12 months after the last unfavorable disability determination by SSA and provides evidence of a new condition not previously considered by SSA, the state must conduct an independent disability determination. Request a copy of the SSA denial letter. The SSA denial letter contains an explanation of all the conditions considered and the reason for denial.

In some regions or circuits, Children's Medical Services (CMS) and the Multi-Handicapped Assessment Team (CMAT) handle disability determinations for children under age 21.

The disability determination for the Home Care for Disabled Adults (HCDA) Program is determined by the Adult Services Counselor.

A medical prognosis with a life expectancy of six months or less satisfies the disability requirement for an individual who elects Hospice.

A level of care from the Agency for Persons with Disabilities giving an appropriate level for the iBudget Florida satisfies the disability requirement.

For individuals applying for dual programs such as OSS and MEDS-AD, the (DMRT) may be used to determine disability for both. When determining eligibility for ongoing ICP or HCBS and the individual is requesting MEDS-AD or Medically Needy for the prior months, use DMRT for both.

Note: If Social Security determines an individual is not disabled, the decision generally replaces that which was made by the state. Refer to passages 1440.1205 and 1440.1206 for guidance. 1440.1205 Exceptions to State Determination of Disability (MSSI, SFP) The state does not make a disability determination under the following conditions:

1. When an individual only applies to SSA (no application is filed with DCF and no SSI denial or ex parte is involved). 2. When an individual receives Title II disability or SSI benefits based on their own disability (not dependent or early retirement benefits). 3. When an earlier favorable federal or state determination of blindness/disability is still in effect and no unfavorable decision has been rendered by SSA. 4. When an individual is no longer eligible for SSI solely due to institutionalization. 5. When the applicant is appealing an earlier decision from SSA and claims no new disabling condition (condition not previously considered by SSA). 6. When the individual files an application within 12 months after the last unfavorable disability determination by SSA, and the individual alleges no new disabling condition or claims a deterioration of an existing condition previously considered by SSA. Refer the individual to SSA for disability reconsideration or appeal. Only request a disability decision from DDD if: