Page 1154

West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 1 Chapter 13 Determining Disability, Incapacity, and Blindness

INTRODUCTION Several of the Division of Family Assistance (DFA) programs require that a medically determined physical and/or mental impairment exist for the client and/or family to receive benefits. This chapter deals with how disability is established for these programs. The nature, degree, and duration of the impairment required for eligibility purposes vary from program to program. Some decisions are made by the Medical Review in the Bureau for Medical Services (BMS). 13.1.1 MRT DECISIONS The following incapacity/disability decisions are made by MRT: • Supplemental Security Income (SSI)-Related Medicaid – when eligibility of the individual is based on disability or blindness and neither has been determined by Social Security. • WV WORKS – when a temporary exemption from the work requirement, based on incapacity or temporary incapacity, is alleged and the Worker and Supervisor are unable to make the determination. • WV WORKS – when an assistance group (AG) is being considered for an extension of the 60-month lifetime limit based on disability, and disability was not established prior to the 55th month, a referral to MRT is mandatory. See Section 18.2. • Medicaid Work Incentive (M-WIN) – when eligibility of the individual is based on disability or blindness and neither has been determined by Social Security. 13.1.2 OTHER DISABILITY DECISIONS Other Medicaid coverage groups require a medical determination of disability or blindness, but the responsibility for the determination rests elsewhere. The Worker, therefore, is not usually involved in the process, but must be notified of the disability decision prior to case approval and recertification. These coverage groups are: • SSI Recipients: The disability decision is made by the Social Security Administration (SSA). • Deemed SSI Recipients, except essential spouses of SSI Recipients: The disability decision is made by the SSA.