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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2017 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.112 23

• individuals who received SSDI or SSI disability benefits or RR total disability benefits in one or more of the 12 months preceding the Medicaid application and whose benefits were terminated for a reason other than no longer meeting the disability or blindness requirements.

• individuals who have been determined disabled or blind by DDS for Medicaid or for SSA, without a subsequent decision by SSA reversing the disability determination, and

• individuals who have been determined “totally” disabled by the RRB. C. Procedures for Verifying Disability Status

1. Receives SSDI/SSI Disability Benefits Verify SSDI/SSI disability status through a SVES (State Verification Exchange System) or SOLQ (State Online Verification Query) request or through documentation provided to the applicant by the SSA.

2. Receives RRB Disability Benefits Verify RRB disability by contacting the RRB National Telephone Service at 1-877-772-5772 or through documentation provided to the applicant by the RRB. 3. Determined Disabled by DDS If disability status cannot be ascertained after reviewing SVES or SOLQ, contact your regional DDS office to verify disability status. Contact information for the regional DDS offices is contained in Appendix 2 of this subchapter.

4. Incarcerated Disabled Individual Although benefits administered by the Social Security Administration are suspended while an individual is incarcerated, a disabled individual continues to meet the definition of a disabled individual while incarcerated.

D. When a DDS Disability Determination is Required • The DDS makes a disability determination for Medicaid when the individual alleges a disabling condition and has never applied for disability benefits from SSA or has not been denied disability within the past 12 months; or

• the individual alleges a disabling condition and SSA has not yet made a determination on a pending SSDI/SSI claim; or

• the individual alleges a disabling condition which is different from that considered by SSA or is in addition to that considered by SSA.

An individual must have his disability determined by DDS if he: • is claiming to have a disabling condition but does not receive SS/SSI disability benefits or RR total disability benefits, and

• has not been denied SSDI or SSI disability benefits in the past 12 months.