2663 Presumptive Medicaid Disability (PMD)

Medical assistance under the Medicaid program is available to individuals who meet Social Security disability criteria as determined by the Presumptive Medical Disability Team (PMDT) and Disability Review Team (DRT) (see 2662 ). Eligibility is determined under existing program rules for the applicable medical coverage group for individuals with a qualifying disability determination.

A Presumptive Medical Disability case differs from a regular medical assistance case only by the entity making the disability determination. Except for coverage under SSI-related Presumptive Medical Disability, Social Security does not make disability determinations for PMD; disability determinations are made by the PMDT and DRT. Medical assistance cannot be authorized until the PMDT issues a disability determination.

Age - A PMD determination is available only to individuals under age 65. Because Medicaid for the aged is available at age 65, a PMD determination is not necessary for individuals in this age group.

A PMD determination is not required for individuals who are eligible under another Medicaid category , such as Caretaker Medical. However, a PMD determination may be completed for an individual who is currently eligible under another coverage group when that coverage is ending, or when the individual seeks services that require a disability determination. PMD is also applicable for children seeking coverage under a disability-related group. Because MediKan eligibility is limited to adults, only Tier 1 determinations apply to children. The PMDT and DRT apply SSA childhood disability criteria when making disability determinations for children.

A PMD determination is necessary only when another Medicaid or CHIP coverage group is not available, or when the child seeks services that require a disability determination.

Example : A 16-year-old child receives CHIP (Title 21) coverage. The child’s parent seeks Home and Community-Based Services (HCBS) for Physical Disability (PD) waiver services, which are not available under CHIP and require a disability determination. Because access to services is limited without a disability determination, the child is appropriate for PMD consideration.