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1144 Chapter 7:Worker guides • Section 7: OSIPM worker guides (07/2026) Presumptive Medicaid (PMDDT) procedures When an individual alleges a disability that would meet the SSA disability requirements for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits, Oregon is required to make a presumptive Medicaid disability determination within 90 days of the individual’s Date of Request (DOR). If an individual has already been determined to be disabled by the Social Security Administration (SSA) they already meet the Basis of Need requirements and to not need to be referred to PMDDT. If a non-SSI/non-SSDI applicant meets the financial and nonfinancial eligibility requirements for OSIPM, ODHS must make a disability determination using Social Security’s disability criteria. This is because State of Oregon elected to become a non-1634 state. This means ODHS|OHA retains responsibility for making Medicaid-related disability determinations. Presumptive Medicaid disability determinations are made, when needed, for all OSIPM programs, including Employed Persons with Disabilities (EPD) and Long-Term Care (LTC) services. Using administrative medical examinations When ODHS|OHA is responsible for making a decision of OSIPM disability or blindness, allow the individual to select a qualified medical provider to complete the medical evaluation. Authorize payment for an administrative medical examination as needed. See DMAP Worker Guide for information on these exams. A decision to deny or end benefits may be reconsidered when additional medical documentation relevant to the decision is received by ODHS|OHA within 30 days of the original effective date of denial or termination. Medical documentation Medical documentation must be written and contain: • A diagnosis in medical terminology • A prognosis • Clinical evidence Workers would not accept a brief note from a doctor saying the individual is disabled or blind. Determining eligibility is ODHS|OHA’s responsibility. To determine eligibility, ODHS|OHA will accept evaluations from the following sources: • Medical evaluations only from medical and osteopathic doctors. • Visual evaluations from optometrists. • Mental evaluations from licensed clinical psychologists. For casework planning (e.g., service planning, referrals to other agencies, or JOBS planning) and supplemental information, ODHS|OHA will accept: • Licensed Social Worker evaluations. • Physical capacity evaluations from licensed Physical Therapists and licensed Occupational Therapists.