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(2) If the termination of RSDI or SSI benefits occurred more than 12 months prior to the date of application or the termination was for medical reasons, a DDS determination of disability is required.

3. A determination of blindness by Division of Services for the Blind (DSB).

A HCWD applicant who alleges blindness and does not receive RSDI due to blindness must have their blindness determined by DSB unless a previous determination of blindness has been made. Follow procedures in MA-2531, Blindness M-AB policy for submitting materials to DSB if a determination is needed.

D. Medically Improved Cases

1. MAD Cases

a. If DDS determines during a Continuing Disability Review that an HCWD beneficiary in the Basic Group is no longer disabled, and still working, assume that the beneficiary is Medically Improved until the next recertification. b. At recertification do not refer a beneficiary in the Medically Improved Group to DDS for a determination of whether they still meet Medically Improved Criteria. To determine if the beneficiary continues to meet the Medically Improved eligibility criteria, contact the beneficiary’s treating physician using the DHB-5151, Health Coverage for Workers with Disabilities (HCWD) Medical Release Authorization and a DHB-5028, Authorization to Disclose Information forms asking the following three questions:

(1) Does the patient still has the underlying condition or conditions which made them disabled?

(2) Is the patient still under treatment for the condition or conditions which made them disabled?

(3) Is there a strong likelihood that the patient would again be disabled if they were to cease this treatment?

If the answers to all three questions are yes, the beneficiary continues to meet the Medically Improved criteria. Be sure to upload the document into NC FAST system.

If the answer to one or more of the questions is no, the beneficiary no longer meets the Medically Improved criteria. Evaluate eligibility in all other programs including the HCWD Basic Coverage Group. Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4

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Official source

(2) If the termination of RSDI or SSI benefits occurred more than 12 months prior to the date of application or the termination was for medical reasons, a DDS determination of disability is required.

3. A determination of blindness by Division of Services for the Blind (DSB).

D. Medically Improved Cases

1. MAD Cases

(1) Does the patient still has the underlying condition or conditions which made them disabled?

(2) Is the patient still under treatment for the condition or conditions which made them disabled?

(3) Is there a strong likelihood that the patient would again be disabled if they were to cease this treatment?

If the answers to all three questions are yes, the beneficiary continues to meet the Medically Improved criteria. Be sure to upload the document into NC FAST system.