2662.2 Authorization to Determine Disability

A disability determination for Medicaid or MediKan purposes may only be made by an entity authorized by KDHE-DHCF. Disability determinations made by other agencies are not sufficient. Where a disability determination has been made by another entity, such as the Veterans Administration or Railroad Retirement Board, a disability determination by SSA must be obtained in order to qualify for Medicaid.

Social Security - When a final SSA disability (or blindness) determination has not been made, the individual is initially referred to SSA for a disability determination for SSI or SSDI. If SSA will not complete the disability determination for reasons unrelated to disability, the case may be referred for a disability determination by DDS.

Presumptive Medicaid Disability Team (PMDT) and The Disability Review Team (DRT) with KDHE - The PMDT, with certification by the DRT, determines disability for Presumptive Medicaid and MediKan (see 2640) determinations only. These determinations apply to individuals potentially eligible for Social Security benefits or when otherwise authorized by the agency. The DDS referral process is used where there is no potential eligibility for SSI or SSDI benefits. Verification of the disability duration is not required prior to referral; the referral may be based on the individual’s statement regarding duration.

Disability Determination Services - DDS determines disability or blindness when SSA has not (or will not) make a determination for reasons unrelated to disability, including but not limited to the individual not pursuing benefits through the Social Security Administration (SSA) ( 2124.1 ), or being ineligible to receive a cash payment from SSI or SSDI. Reasons for cash ineligibility that would require a DDS referral may include, but are not limited to, insufficient work history, excess income or resources, or a transfer of property penalty. SSA will also not make a disability determination on a deceased individual with no active application on file. When an individual is referred to DDS due to SSA denying for reasons unrelated to disability, documentation of the SSI/SSDI denial is required prior to referring to DDS, except when authorized by KHDE-DHCF Eligibility Policy. (See 2662.3 )

Initial Disability Determinations - DDS will determine disability beginning with the first month required for the Medicaid determination. A disability onset date will be established for individuals with favorable disability determinations.

Disability Onset Date for Medicaid - DDS will determine an onset date for Medicaid determinations prior to the onset of SSI. Example : An individual applies for Medicaid on May 10 and requests prior medical. SSA approved their SSI benefit with payments beginning May, and SSI eligibility beginning in April. Disability criteria are met for both April and May. However, because there is no potential for cash benefits in February and March, SSA will not make a disability determination for the individual in those months. A referral is sent to DDS to determine whether the individual meets the disability criteria in February and March.