D-2100, When a Medical Determination Is Not Required

Revision 12-4; Effective December 1, 2012

Receipt of Medicare is an indication that the person is either:

age 65 or older; or

has been determined blind or disabled based on the Social Security Administration (SSA) criteria for RSDI Title II or SSI Title XVI disability.

A medical determination is not required to establish blindness or disability if the person has Medicare. The receipt of the Medicare is satisfactory verification that the person has been determined to meet the SSA's criteria for aged, blind or disabled. This includes a person determined blind or disabled by SSA in the 24-month period before receiving Medicare. Upon verification of the receipt of a disability benefit, a medical determination is not required to establish blindness or disability if a person is currently receiving disability benefits from:

SSI;

RSDI; or

Railroad Retirement.

For an eligibility determination during the retroactive coverage months, a medical determination is not required to establish blindness or disability during that retroactive coverage period if a person:

has unpaid or reimbursable covered Medicaid expenses during the retroactive coverage months prior to the application;

has a date of onset for RSDI Title II blindness or disability based on SSA query records; and

the date of onset for the RSDI Title II blindness or disability covers the retroactive coverage months prior to the application.

Note: Do not use the Title XVI "Dsblty Onset Date" on the SSI Entitlement screen as the basis to establish blindness or disability for:

retroactive coverage;

current coverage; or

future coverage.

A medical determination is not required to establish blindness or disability if a person:

applies with HHSC for SSI-related medical assistance only (MAO);

is under age 65; and

lost SSI for reasons other than a decision that the disability or blindness has stopped.