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West Virginia Income Maintenance Manual Chapter 13

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

• If it is verified that the SSI payment was terminated for some reason other than the lack of disability or blindness, medical eligibility is presumed prior to obtaining medical reports. • The Worker then follows the usual procedures to obtain medical reports, complete the DFA-RT-1, Social Summary Outline and submits the case to the MRT for a final decision, etc. See Section 13.3 for instructions regarding completion of the DFA-RT-1. 13.6.3 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF BLINDNESS To meet the definition of blindness, the client must have central visual acuity of 20/200 or less in the better eye with correcting glasses. 13.6.4 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF DISABILITY FOR SSI- RELATED MEDICAID AND M-WIN, AGE 18 OR OVER 13.6.4.A Definition of Disability An individual, who is age 18 or over, is considered disabled if he is unable to engage in substantial gainful employment by reason of any medically determined physical or mental impairment that can be expected to result in death, or that has lasted or can be expected to last for a continuous period of not less than 12 months. 13.6.4.B Role of the Worker in the Presumptive Medical Approval Process Prior to referral to the MRT, the Worker must review the medical information to determine if the client's conditions meet any of the criteria for presumptive approval listed in Appendix A. If a client’s medical information does not meet the criteria for presumptive approval, but the Worker or Supervisor feels the client’s condition(s) is severe enough to warrant an immediate evaluation, he should submit the case to the MRT as soon as possible.