B Disability Determination

Revised 03/22/2022

Policy

A referral to the Disability Determination Services Administration (DDSA) is required when the customer:

• Is under age 65;

• Is applying for Medical Assistance and is not eligible for any other category; and

• Does not have proof of disability (MA509) or blindness (MA504).

 

1) Customers with Serious Mental Illness (SMI)

Depending on the functional criteria reported on the following forms, the customer may be considered disabled or presumed disabled:

• A SMI Determination Report Summary; or

• SMI Eligibility Outcome supplemental form completed and signed by a physician or psychiatrist; and

• Medical evidence supporting the SMI diagnosis.

If the customer is...	Then...
Considered disabled (SMI A)	Medical Assistance benefits may be approved if the customer is otherwise eligible. However, a DDSA referral is required for a random sample of these customers to confirm the disability.
Presumed disabled (SMI B)	Medical Assistance benefits may be approved if the customer is otherwise eligible. However, a DDSA referral is required to confirm disability.

See Processing Applications for SMI A and SMI B Customers for details

 

2) Presumptive Eligibility for SSI-Cash

Under certain circumstances, Social Security will approve SSI-Cash for a six-month presumptive eligibility period while determining whether a person meets the criteria of disability. When a person has been approved for presumptive SSI disability benefits, a DDSA referral is not required because the customer is considered to have met the definition of disabled during the presumptive eligibility period.

 

Definitions

Term	Definition
Serious Mental Illness (SMI)	A diagnosable mental, behavioralm or emotional disorder that results in functional impairment which substantially interferes with or limits one or more major life activities.

 

Legal Authority

Program	Legal Authorities
SSI-MAO	42 CFR 435.540; 42 CFR 435.541 AAC R9-22-1501