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5.9 Presumptive Disability 5.9.1 Presumptive Disability Introduction Federal SSI law and regulations state that the SSI program can find a person to be presumptively disabled, and the person will be treated as a person with a disability until a final disability determination can be completed. To be treated as presumptively disabled by SSI means that the applicant’s benefits can begin before SSA, or its contracted agency, has formally determined the person to be disabled. Wisconsin's Medicaid program also allows a determination of presumptive disability. Presumptive disability is a method for temporarily determining a disability for a person while a formal disability determination is being done by Disability Determination Bureau (DDB). Presumptive disability is determined either by DDB, or in some circumstances, the IM agency. The regular disability application process (see SECTION 5.3 DISABILITY APPLICATION PROCESS) must still be completed for persons with a presumptive disability. A presumptive disability decision stands until DDB makes its final disability determination. When the regular disability determination is denied by DDB, a new presumptive disability determination cannot be made for that person unless there has been a change in the person’s condition. 5.9.2 Presumptive Disability Determined by the IM Agency When an applicant or member has an urgent need for medical services attested to in writing by a medical professional and is likely to be found disabled by DDB because of an apparent impairment, the applicant or member may be certified as presumptively disabled by the IM agency. When the IM agency is making the presumptive disability decision, they should do so as quickly as possible. However, the normal 30-day application processing period applies (see SECTION 2.7 APPLICATION PROCESSING PERIOD). In determining that the applicant is presumptively disabled, the IM agency will need a medical professional to attest in writing that: 1. The person has an urgent need for medical services (see SECTION 5.9.2.1 DEFINITION OF URGENT NEED). 2. The person has one of a certain set of impairments (see SECTION 5.9.2.2 IMPAIRMENTS). Note If the attending physician attests under “Urgent Need for Medical Services” that the applicant has one or more medically determinable physical or mental impairments that cause severe functional limitations and/or inability to work, and that have lasted or can be expected to last for at least 12 months or are expected to result in death, and the applicant is otherwise eligible for Medicaid, the IM worker must certify presumptive disability even if the applicant does not have one of the specific listed impairments (see SECTION 5.9.2.1 DEFINITION OF URGENT NEED). For purposes of presumptive disability determinations, a "medical professional” is defined as any health care provider or health care worker who is familiar with the applicant and is qualified to confirm the presence of an urgent need and the presence of one of the impairments. A medical professional may be a licensed physician, physician’s assistant, nurse practitioner, licensed or registered nurse, psychologist, osteopath, podiatrist, optometrist, hospice coordinator, medical records custodian, or social worker. Some urgent need criteria specifically require a physician to make the attestation, which is noted where applicable.