MEDICAID DISABILITY MANUAL
- Introduction also available in Portable Document Format (PDF)
I. INTRODUCTION
Department Regulation Section 360-5
The purpose of this Manual is to consolidate the procedures and regulatory reference materials which are used in the determination of disability status for Medicaid applicants and recipients (A/R). The guidelines in this Manual serve as the basis for the determination of an A/R’s disability by the Department’s Disability Review Team or by the Disability Review Team of those local agencies that perform this function.
Agency personnel who are responsible for processing Medicaid disability cases should familiarize themselves with the contents of this Manual and utilize it on an ongoing basis. Particular attention should be given to the section on local agency responsibilities.
Certified blind or disabled individuals aged 19-64, not eligible under MAGI, may qualify for Medicaid under different eligibility criteria. Children and pregnant women may also be eligible for more favorable financial eligibility criteria if they are certified disabled.
New York State is currently providing Medicaid with federal participation to most recipients, regardless of category of assistance. This time limited waiver was granted pursuant to Section 1115 of the Social Security Act. The waiver agreement specifies that budget neutrality must be demonstrated to the federal government for the waiver period. Thus, identifying disabled recipients from the S/CC category is important for the purpose of the cost neutrality calculation.
The criteria for determining whether an individual is disabled for Medicaid purposes are contained in this Manual and are the same as those used by the federal government for determining whether a person is disabled under the Social Security Act Title XVI (Supplemental Security Income) and/or Social Security Act Title II (Disability Benefits). Consequently, individuals who are eligible under these programs are considered disabled for Medicaid upon appropriate verification.
Updated: January 2018 Introduction 1
MEDICAID DISABILITY MANUAL
In accordance with Title XIX of the Social Security Act, disability and blindness are two categories under which Medicaid may be provided. Title XIX, Section 1902, provides that the Medicaid program use the same definition of disability used in the Supplemental Security Income (SSI) program, except for certain cases originating prior to January 1, 1974.
The federal requirements for the evaluation of disability or blindness for the SSI program are contained in the Code of Federal Regulations, 20 CFR Part 416. The statutory basis for the State’s Medicaid program is found in Title II of Article 5 of the New York State Social Services Law.
Updated: January 2018 Introduction 2
