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AGED, BLIND, AND DISABLED MEDICAID 105-1 Disability Determination Supersedes: ABD 105-1 (07/01/06) Reference: 42 CFR 435.540, 541, .911; ARM 37.82.101, .204, ARM 46.12.3002 Overview: An individual applying for Medicaid based on disability must meet the Social Security Administration's (SSA) disability criteria, unless disability is based on death. Disability may be established through SSA and/or MEDS (Medicaid Eligibility Disability Services), using SSA criteria. A disability determination is not required prior to the client being evaluated for disability- related Medicaid. If the client is otherwise eligible, their disability determination is pursued through SSA and/or MEDS as outlined below. NOTE: Eligibility for (VA) Veterans Administration disability benefits does not automatically meet SSA disability criteria. Therefore, veterans must complete the SSA or MEDS disability determination process. DISABILITY DETERMINATION FOR DECEASED APPLICANT: A Medicaid application may be filed on behalf of a deceased person. Benefits are provided if the individual would have been eligible had an application been made prior to his/her death. An individual is considered to meet disability criteria in the month of their death. If the cause of death was a factor during any of the previous three retro months, the deceased is assumed to have been disabled for those months. A doctor’s statement is required to establish if the cause of death was a factor during the retro months. MEDS DISABILITY DETERMINATION: DPHHS is required to make a disability determination through MEDS when a Medicaid applicant: 1. Has not applied for SSI cash benefits; NOTE: Medicaid clients are not required to apply for SSI. 2. Has applied for SSI benefits and is found ineligible for benefits for a reason other than disability (e.g., excess income or resources); NOTE: When SSI benefits are denied because the client's income exceeds the SSI limits, the client may meet Medicaid eligibility criteria for other programs (e.g., medically needy). 3. Has applied for SSDI benefits and is found ineligible for a reason other than disability (e.g., insufficient creditable quarters of work);