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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M03 October 2019 Subchapter Subject Page ending with Page M0310 GENERAL RULES & PROCEDURES M0310.112 24

1. Individual Under Age 19 and Not Receiving Long-term Care A child under age 19 who is not receiving LTC services and who is claiming to have a disabling condition must have his disability determined by DDS if: • he is not eligible for FAMIS Plus or FAMIS, or • it is 90 calendar days prior to his 19th birthday.

Do NOT refer a disabled child under age 19 to DDS for the sole purpose of participation in the Health Insurance Premium Payment (HIPP) program 2. Individual Under 21 in LTC a. Facility-based Care

An individual under age 21 in a nursing facility or intermediate care facility for the intellectually disabled (ICF-ID) must have his disability determined if • he is not eligible in the Individuals Under 21 covered group, or • it is 90 calendar days prior to his 21st birthday. b. Home and Community-based Services (HCBS)

A child who is receiving HCBS waiver services and has not previously had a disability determination must have his disability determined prior to his 18th birthday because he will no longer be eligible in the F&C 300% SSI covered group (under which parental income is not counted), once he turns 18. The child must be evaluated for coverage as a blind or disabled individual using the income and resource rules applicable to blind/disabled institutionalized individuals. For a child under 19 who is not disabled, MAGI income counting rules require that parental income be included in the eligibility determination.

Ninety days (90) prior to the child turning age 18, the eligibility worker must contact the parent or responsible party and send a verification checklist to request the required documents to start the DDS referral process. Follow the procedure in M0310.112 G below to make a referral to DDS.

Note: The local DSS is not responsible for initiating a DDS referral for a child turning 18 who receives SSI. The child will have a review of continuing disability and SSI eligibility completed by the SSA. The child remains disabled for Medicaid purposes unless and until his disability status is discontinued by SSA. E. When an LDSS Referral to DDS is Required 1. Disability Determination Has Not Been Made The DDS must make a determination of disability when the applicant alleges a disability and a disability determination has not been made by SSA or the RRB. The DDS must make a disability determination within a time frame that will allow the LDSS to process the application within 90 days, provided all medical information has been submitted.