This article is a section taken from MA for People Who Are Age 65 or Older or People Who Are Blind or Have a Disability (MA-ABD), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Table of Contents
Certification of Disability
Disability or blindness must be certified by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). The certification process is also called a disability determination.
People receiving the following benefits may or may not be certified disabled by SSA or SMRT.
- Short-term disability
- Long-term disability
- Long-term care insurance
- Veterans’ Administration (VA)
- Railroad Retirement Board (RRB)
- Worker’s Compensation
Only a SSA or SMRT certification of disability is valid for the purposes listed below.
Disability Certification for MA Eligibility
People must be certified disabled and use the disabled or blind basis of eligibility to:
- Enroll in MA for Employed Persons with Disabilities (MA-EPD)
- Use the TEFRA option. The TEFRA option for children with a disability is named after the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 that created the option. Children with a disability and household income above the MA income limit need a disability certification to use the TEFRA option.
- Receive home and community-based services through the:
- Brain Injury (BI) waiver
- Community Alternative Care (CAC) waiver
- Community Access for Disability Inclusion (CADI) waiver
A disability certification is not needed for services under the Developmentally Disabled (DD) waiver. The county case manager determines if the person meets the criteria for a developmental disability.
Children turning 18 need a new disability certification under the adult standards to continue using a blind or disabled basis of eligibility.
Disability Certification for Other Reasons
Some MA enrollees get a disability certification for managed care reasons including:
- To be excluded from managed care enrollment
- To enroll in Special Needs Basic Care (SNBC), a specialized managed care plan for people age 18-64 with a certified disability
Additional reasons for needing a disability certification include:
- Community Support Grant (CSG) eligibility
- Family Support Grant (FSG) eligibility
- Aged 65 and older and establishing a pooled trust
- Establish an asset transfer penalty exception
- Creating certain trusts
State Medical Review Team Certification of Disability
SMRT completes disability determinations for people not certified disabled by SSA. SMRT certifies disability using the same disability criteria as the SSA.
Since the SSA disability determination process can be long, the county, tribal or state servicing agency completes a SMRT Referral for a Disability Determination (DHS-6123). The person is also referred to SSA for a disability determination and benefits.
Expedited Case Criteria
SMRT expedites the disability determination process in three situations where the person is likely to meet disability criteria:
- The person has a condition that appears on the SSA Compassionate Allowance Listing (CAL)
- The person is awaiting discharge from a facility and can be discharged immediately if MA is approved
- The person has a potentially life-threatening situation and requires immediate treatment or medication
- The person has had a MnCHOICES assessment within the past 60 days and received services that can only be paid by a home and community-based services waiver.
Continuing Disability Review
People certified disabled by SMRT need a continuing disability review every one to seven years. Disability standards are different for children and adults, so at age 18, a child must be evaluated under the adult standards. Newborns certified disabled due to a low-birth weight must be reviewed prior to age one.
Code of Federal Regulations, title 20, sections 404.1501 to 404.1599
Code of Federal Regulations, title 20, sections 416.901 to 416.999d
Code of Federal Regulations, title 42, section 435.541
Minnesota Statutes, section 256.01
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.