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West Virginia Income Maintenance Manual Chapter 13

West Virginia Income Maintenance Manual Page 31 Chapter 13 Determining Disability, Incapacity, and Blindness

APPLICATION PROCESS WHEN SSA DETERMINATION OF DISABILITY IS INVOLVED At application, if the client is otherwise eligible, the Worker determines if the client has applied for Supplemental Security Income (SSI) and/or Retirement, Survivors, and Disability Insurance (RSDI) based on his disability. Procedures then depend on the status of a current application for SSI/RSDI or the results of a former application as follows. 13.9.1 APPLICANT IS CURRENTLY RECEIVING RSDI, BASED ON HIS OWN DISABILITY In this situation, it is not necessary to obtain medical reports or to refer the case to the Medical Review Team (MRT). Disability is established. 13.9.2 SSA DECISION PENDING When the applicant has applied for RSDI and/or SSI based on his disability and has not yet been notified of the result, or his application for RSDI and/or SSI has been denied due to lack of disability and he has appealed the decision, the Worker: • Follows up to determine the results of the application and/or appeal. • Processes the Medicaid application. • Approves the application if an MRT decision that the client is disabled or blind is made prior to the final SSA decision becoming known to DOHS. • If the SSA's decision on the individual's disability becomes known to the Worker before the Medicaid application is approved, the Worker takes one of the following actions: o If the individual is found eligible for SSI, an SSI Medicaid case is opened for him. o If the individual is found eligible for RSDI based on his disability and is not found eligible for SSI, the Worker approves the application based on disability or adds him to the assistance group (AG). • If the final SSA decision is that the client does not meet the definition of disability for SSI or RSDI, except for disabled widow's benefits, the application is denied, or the individual is excluded from the AG. The application continues to be processed only if the disabled widow's benefits have been denied by the SSA.