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4.1 Who is Nonfinancially Eligible for Medicaid? To be eligible for Medicaid, an individual must meet the following criteria: • Be elderly, blind, or disabled (SECTION 5.2 DETERMINATION OF DISABILITY, or SECTION 37.1.2 CHILDREN'S LONG-TERM SUPPORT (CLTS) WAIVER PROGRAM INTRODUCTION) • Be a resident of the state of Wisconsin (see SECTION 6.1 RESIDENCY ELIGIBILITY) • Be a U.S. citizen or Qualifying Immigrant (see SECTION 7.1 US CITIZENS AND NATIONALS) • Cooperate with medical support liability (see SECTION 8.1 MEDICAL SUPPORT) • Cooperate with TPL (see SECTION 9.1 THIRD PARTY LIABILITY) • Provide SSN or apply (see SECTION 10.1 SSN REQUIREMENTS) • Pay a premium if required (see SECTION 11.1 PREMIUM OR COST SHARE) • Pay a community waiver/FamilyCare cost share if required (see SECTION 11.1 PREMIUM OR COST SHARE) This page last updated in Release Number: 20-03 Release Date: 08/03/2020 Effective Date: 08/03/2020 5.1 Elderly Elderly is defined as an individual 65 years of age or older. See SECTION 4.1 WHO IS NONFINANCIALLY ELIGIBLE FOR MEDICAID?. This page last updated in Release Number: 18-02 Release Date: 8/10/2018 Effective Date: 8/10/2018 5.2 Determination of Disability 5.2.1 Definition of Disability The law defines disability for Medicaid as: "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." See SECTION 39.4.7 SSI REFERENCE VALUES for the current SGA limits. One exception to this is that a MAPP disability determination does not involve the SGA test. See SECTION 26.1 MAPP INTRODUCTION for the MAPP disability definition. Disability and blindness determinations for most EBD Medicaid programs are made by the DDB. The IM agency should submit an application for a disability determination even if the applicant/member has already applied for SSI or SSDI (see SECTION 5.3 DISABILITY APPLICATION PROCESS), except for children applying for home and community-based waivers. An application for a disability determination should only be submitted for these children at the parent's request. Note that for some long-term care programs, eligibility is based on level of care determinations rather than on a disability determination. For example, there is no disability determination required for children to be eligible for home and community-based waivers. The appropriate level-of-care determination as established by the functional screen is used as an indicator of the child’s need for services. This is also true for some adults. See SECTION 28.1 ADULT HOME AND COMMUNITY-BASED WAIVERS