Page 1167

West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 14 Chapter 13 Determining Disability, Incapacity, and Blindness

13.6.5 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF DISABILITY FOR SSI- RELATED MEDICAID AND M-WIN, UNDER AGE 18 13.6.5.A Definition of Disability A child who is under age 18 is considered disabled if he has a physical or mental impairment that can be expected to last or has lasted for at least 12 months and is of comparable severity to that which qualifies an individual age 18 or over. Comparable severity exists, provided the child is not engaged in substantial gainful activity, when the child's physical or mental impairment(s) so limits his ability to function independently, appropriately and effectively in an age-appropriate manner that the impairment(s) and the limitation(s) resulting from it are comparable to those that would disable an adult. 13.6.5.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 condition meets any of the criteria for presumptive approval listed in Appendix B. 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.

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Page 1167

Official source

West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 14 Chapter 13 Determining Disability, Incapacity, and Blindness

13.6.5 GUIDELINES FOR PRESUMPTIVE MEDICAL DECISION OF DISABILITY FOR SSI- RELATED MEDICAID AND M-WIN, UNDER AGE 18 13.6.5.A Definition of Disability A child who is under age 18 is considered disabled if he has a physical or mental impairment that can be expected to last or has lasted for at least 12 months and is of comparable severity to that which qualifies an individual age 18 or over. Comparable severity exists, provided the child is not engaged in substantial gainful activity, when the child's physical or mental impairment(s) so limits his ability to function independently, appropriately and effectively in an age-appropriate manner that the impairment(s) and the limitation(s) resulting from it are comparable to those that would disable an adult. 13.6.5.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 condition meets any of the criteria for presumptive approval listed in Appendix B. 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.