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J. A child has not attained their first birthday and had a gestational age (GA) at birth and corresponding birth weight within one of the ranges below: 1. GA of 37-40 weeks and birth weight under 2000 grams (4 pounds, 6 ounces) 2. GA of 36 weeks and birth weight of 1875 grams (4 pounds, 2 ounces) or less 3. GA of 35 weeks and birth weight of 1700 grams (3 pounds, 12 ounces) or less 4. GA of 34 weeks and birth weight of 1500 grams (3 pounds, 5 ounces) or less 5. GA of 33 weeks and birth weight of 1325 grams (2 pounds, 15 ounces) or less 6. GA of 32 weeks and birth weight of 1250 grams (2 pounds, 12 ounces) or less K. A physician confirms that the person has a terminal illness with a life expectancy of six months or less; or a physician or hospice official (hospice coordinator, staff nurse, social worker, or medical records custodian) confirms that the person is receiving hospice services because of a terminal illness L. Spinal cord injury producing an inability to ambulate without the use of a walker or bilateral hand-held devices for more than two weeks M. End stage renal disease (ESRD) requiring chronic dialysis N. Symptomatic human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) O. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease 5.9.2.3 Presumptive Disability Certification Process A medical professional must complete and sign the Medicaid Presumptive Disability (F-10130) form, attesting to both the urgent need and the impairment, before an IM worker may certify the applicant as presumptively disabled. The worker should not require any additional documentation from the medical professional beyond the Medicaid Presumptive Disability form. Once completed, a copy of this form will be saved in the case file to document the Medicaid Presumptive Disability decision. If the applicant is otherwise eligible for EBD Medicaid, Medicaid eligibility will be certified (see SECTION 5.9.5 ELIGIBILITY). Changes in Urgent Need Prior to Presumptive Disability Medicaid Certification Sometimes a person’s medical condition improves between the date of the presumptive disability Medicaid application and the date of the presumptive disability Medicaid certification. This improvement results in the person no longer meeting the urgent need criteria at the time of the presumptive disability Medicaid eligibility determination. The most common example of this situation is that of a person who is hospitalized on the date of the presumptive disability Medicaid application but then released from the hospital prior to being certified by the IM worker for presumptive disability Medicaid eligibility. Under these circumstances, if the presumptive disability applicant no longer has an urgent need as of the date that the IM agency is making the presumptive disability Medicaid eligibility determination/certification, the presumptive disability request must be denied, and the applicant must be notified that their request for a presumptive disability eligibility determination has been denied. Example 1 Bob is 55 years old and has been hospitalized since February 1, after suffering his second stroke in the last four months. Bob applies for Medicaid on February 7. His physician attests in writing that Bob has an urgent need (he is hospitalized) and that he has one of the impairments listed on the Medicaid Presumptive Disability (F-10130). The IM agency has requested verification of Bob’s non-exempt assets and completion of the Medicaid Disability Application (MADA) (F-10112). On February 14, Bob returns the completed MADA and asset verification information to his IM agency. He also indicates that he was released from the hospital on February 11 and is recuperating at home. On February 14, the IM agency has all the necessary information to make a presumptive disability Medicaid eligibility determination.