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COMAR 10.09.24.05

542

State of Maryland Medical Assistance Manual Revised July 2012

(1) Procedure for Determination of Disability Applicant with pending SSA Determination The State Review Team (SRT) of the Department of Human Resources determines disability of MA applicants who are requesting eligibility in an ABD coverage group if SSA has not already determined the applicant is currently disabled. The case manage manager must determine if the applicant meets or does not meet Substantial Gainful Activity by calculating the applicants countable earnings and compare earnings to MA- Schedule for SGA guidelines. If the individual doesn’t meet SGA, they have met then initial criteria for being determined “Disabled, the case is then referred to the State Review Team with an SRT Referral Packet.

The Referral Packet consists of:

DHR/FIA 707 State Review Disability or Blindness Determination Transmittal Form Verification of SSA status: o Verification from SSA; OR o Original printout of the appropriate SDX, SVES, and/or SOLQ screen. Original DHR/FIA 827 Authorization to Disclose Information Form; Original DHR/FIA 3368 Disability Report form is completed only when: o The applicant is applying for MA under the X02 category; or o The applicant and/or spouse applying are receiving any type of income Verification of any earned income, if the applicant is employed; OES 06 SGA Worksheet when required, including the Impairment-Related Work Expenses descriptions. The applicant is expected to complete the top portion of the SGA Worksheet; Any original medical documentation that the applicant provides to the LDSS; and DHR/FIA 700 Customer Declaration of Disability Form

(3)Applicant with current SSA Determination (Disabled or not Disabled) If SSA has determined the applicant is currently disabled, the LDSS or other entity determining MA eligibility does not need to submit the disability determination package to SRT for an applicant requesting eligibility in an ABD category. A SSA determination is binding on the State. If SSA changes their decision, their new decision is also binding on the State. The LDSS must use the State Data Exchange (SDX), State Verification Eligibility System (SVES), or State Online Query (SOLQ) to determine the applicant’s Social Security benefits status before sending a disability referral to the SRT as specified below. If the above referenced systems indicate a different status than the applicant states to the LDSS, then verification from SSA is required. A receipt from SSA will serve as proof that the applicant