Independent Disability Determinations

Independent Disability Determinations. A. The Disability Determination Service (DDS) with the Department of Rehabilitation Services is the agency that determines disability for both Supplemental Security Income-related disability and blindness applications and Medicaid-only disability and blindness applications. A disability approval is required for all Aged, Blind and Disabled applicants under the age of sixty-five (65) applying for Medicaid on the basis of being disabled or blind. Throughout the remainder of Rule 7, the term “disability” also refers to blindness. B. An independent disability determination is required when an individual applies for both SSI benefits on the basis of disability or blindness and applies separately for Medicaid with the Division of Medicaid for the same period of time. An independent disability determination means that both the Social Security Administration (SSA) and the Division of Medicaid submit a request to DDS to determine disability for the same individual for the same period of time. The Medicaid application may also include a request for retroactive benefits. 1. If DDS has not ruled on the Supplemental Security Income (SSI) disability portion of an application filed with both SSA for SSI benefits and the Division of Medicaid for Medicaid-only benefits within ninety (90) days of the Medicaid-only request for a disability decision, DDS will issue a 90-day denial of disability for Medicaid purposes while the SSI disability decision remains pending. The Medicaid-only application must be denied because disability requirements are not met. The denial notice will inform the applicant to notify the Division of Medicaid if SSI benefits are approved by SSA. 2. If SSI is approved, the dates of SSI eligibility will be reviewed by the Division of Medicaid to determine if Medicaid-only eligibility is needed for the retroactive period and/or for any missing months of SSI eligibility. C. An independent disability decision utilizing DDS is required if an individual applies for Medicaid-only and has not applied for SSI or has applied for SSI and been denied for a reason other than disability. If SSI was denied due to disability, the Division of Medicaid will take a separate application and request a DDS decision, but the prior DDS denial will prevail unless there is new information, a new disabling condition exists or it has been more than twelve (12) months since the last SSI denial.