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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 6 Chapter 13 Determining Disability, Incapacity, and Blindness

PROCESS FOR DETERMINING DISABILITY, INCAPACITY AND BLINDNESS 13.4.1 GENERAL REQUIREMENTS The following steps are necessary in the process of determining incapacity, disability, and blindness. These steps do not apply to the determination of disability for Supplemental Nutrition Assistance Program (SNAP); see Section 13.15. • Accept the application • Prepare the Social Summary Outline • Obtain initial medical reports • Evaluate for presumptive approval and/or referral to the Medical Review Team (MRT) • Obtain additional medical reports when indicated • Reevaluate for presumptive approval • Re-refer to the MRT • Receive MRT decision • Notify the client of disposition • Notify the Federally Facilitated Marketplace (FFM) electronically when appropriate NOTE: Determining whether the client will meet the spenddown should not delay the determination of disability, incapacity, or blindness for Supplemental Security Income (SSI)-Related Medicaid applicants. The establishment of disability, incapacity or blindness and meeting a spenddown requirement are both eligibility factors and both must be pursued simultaneously. If the application is denied in the eligibility system for a reason other than failure to meet a spenddown prior to a MRT decision, the Worker must notify MRT of the denial. MRT will stop consideration of the case and return all information to the Worker. If the Worker determines that the client is ineligible for any other reason prior to the MRT decision, the application is denied, and the Worker must notify MRT to stop consideration of the application. This does not apply when the only reason for denial is failure to meet a spenddown.