8.04 Determination of blindness or disability

Disability and blindness determinations. Disability and blindness determinations are made by AHS in accordance with the applicable requirements of the Social Security Administration (SSA) based on information supplied by the individual and by reports obtained from the physicians and other health care professionals who have treated the individual. AHS will explain the disability determination process to individuals and help them complete the required forms. Bases for a determination of disability or blindness. AHS may determine an individual is disabled in any of the following circumstances: An individual who has not applied for SSI/AABD. An individual who has applied for SSI/AABD and was found ineligible for a reason other than disability. An individual who has applied for SSI/AABD and SSA has not made a disability determination within 90 days from the date of their application for Medicaid. An individual who has been found “not disabled” by SSA, has filed a timely appeal with SSA, and a final determination has not been made by SSA. See, also, §§ 82.00(e) and (f). An individual who claims that: (i) Their condition has changed or deteriorated since the most recent SSA determination of “not disabled;” (ii) A new period of disability meets the durational requirements of the Act; (iii) The SSA determination was more than 12 months ago; and (iv) They have not applied to SSA for a determination with respect to these allegations. An individual who claims that: (i) Their condition has changed or deteriorated since the most recent SSA determination of “not disabled,” (ii) The SSA determination was fewer than 12 months ago; (iii) A new period of disability meets the durational requirements of the Act; and (iv) They have applied to SSA for reconsideration or reopening of its disability decision and SSA refused to consider the new allegations, or they no longer meet the nondisability requirements for SSI but may meet AHS’s nondisability requirements for Medicaid. Additional examinations. AHS has responsibility for assuring that adequate information is obtained upon which to base the determination. If additional information is needed to determine whether individuals are disabled or blind according to the Act, consulting examinations may be required. AHS will pay the reasonable charge for any medical examinations required to render a decision on disability or blindness.