425-2        WHO DETERMINES DISABILITY/BLINDNESS

425-2 A.   TEMPORARY DISABILITY OR BLINDNESS DECISIONS

A proper medical provider can provide a temporary decision on an individual's blindness or disability.  

• A proper medical provider for a disability decision is a licensed physician, psychiatrist, advanced practice registered nurse, or physician assistant within their licensed scope of practice.
  
  
• A proper medical provider for a blindness decision is a licensed physician, advanced practice registered nurse, or physician assistant within their licensed scope of practice. 

A temporary blindness or disability decision does not allow the authorization of full APAAdult Public Assistance and Medicaid benefits.  Instead, it serves as an indication that the individual is blind or disabled for the purposes of qualifying for Interim Assistance (IAInterim Assistance) benefits until a final blindness or disability decision is made.

The medical provider must provide a temporary blindness or disability decision to the Division on the state form AB 3Review Report on Aid to the Blind , "Report of Eye Examination" for blindness, or on an AD 2Preliminary Examination for Interim Assistance form for disability.  The Division will not accept temporary blindness or disability decisions unless they are provided on one of these forms.

425-2 B.   PRESUMPTIVE DISABILITY DECISIONS

The SSISupplemental Security Income program may make presumptive disability payments to SSISupplemental Security Income applicants before they make a final blindness or disability decision.  To be eligible for presumptive disability payments, the individuals must have claimed impairments that are so severe that there is little doubt that Social Security Administration will finally decide they are blind or disabled.

SSISupplemental Security Income presumptive disability payments are made for no more than six calendar months.  Recipients of such payments are considered SSISupplemental Security Income recipients in all respects.  The APAAdult Public Assistance program considers these persons to be blind or disabled during the same period that the person is eligible for SSISupplemental Security Income payments.  The case worker shall authorize full APAAdult Public Assistance and Medicaid benefits during an SSISupplemental Security Income presumptive disability period if the individual meets all other factors of APAAdult Public Assistance eligibility.

The case worker must check the status of the SSISupplemental Security Income case before the end of the six-month period.  If the SSISupplemental Security Income presumptive disability payments will not continue, and eligibility for regular SSISupplemental Security Income payments has not yet been determined, the case worker must close the APAAdult Public Assistance and Medicaid case.  The case worker must open an Interim Assistance case if the individual is eligible for such assistance.  Regular APAAdult Public Assistance and Medicaid benefits are not available again until SSISupplemental Security Income determines eligibility for regular SSISupplemental Security Income benefits.  If the individual is finally determined eligible for regular SSISupplemental Security Income benefits, APAAdult Public Assistance and Medicaid benefits are authorized retroactive to the month that SSISupplemental Security Income benefits were resumed.

425-2 C.    SSA BLINDNESS OR DISABILITY DECISIONS

The Social Security Administration makes the disability decision for most APAAdult Public Assistance applicants and recipients.  A finding of blindness or disability allows the authorization of APAAdult Public Assistance and Medicaid benefits if the individual meets all other factors of eligibility for the APAAdult Public Assistance program.  A finding of no blindness or disability results in denial of APAAdult Public Assistance and Medicaid benefits, and if applicable, in termination of Interim Assistance benefits.  The case worker may pend an individual's application for APAAdult Public Assistance and Medicaid benefits only until SSASocial Security Administration's initial blindness or disability finding.

Applicants may appeal the SSASocial Security Administration decision.  

• If the appeal results in a finding of blindness or disability, reevaluate eligibility for regular APAAdult Public Assistance and Medicaid benefits back to the month of APAAdult Public Assistance application.  To determine the benefit start dates for APAAdult Public Assistance and Medicaid, refer to manual section 410-7.
  
  
• If the appeal results in a finding of no blindness or disability, eligibility for APAAdult Public Assistance and Medicaid does not exist.    
  
  

If, after a finding of no blindness or disability, an Interim Assistance recipient enters or reenters the SSISupplemental Security Income appeal process the individual may continue to receive Interim Assistance benefits until a final disability decision is made.  If the appeal process results in a final finding of blindness or disability, eligibility for regular APAAdult Public Assistance and Medicaid benefits will be reevaluated.  To determine the benefit start dates for APAAdult Public Assistance and Medicaid, refer to manual section 410-7.

Note:

If an initial applicant has already been denied by SSISupplemental Security Income and they haven't appealed the decision, there is no APAAdult Public Assistance or IAInterim Assistance eligibility and the application must be denied. The application is not pended for the applicant to appeal the SSISupplemental Security Income decision.

425-2 D.   STATE-ONLY BLINDNESS OR DISABILITY DECISIONS

Social Security will not decide an individual's blindness or disability if the individual is ineligible for SSISupplemental Security Income or SSASocial Security Administration benefits because of other reasons not related to the individual's blindness or disability such as more stringent citizenship requirements for Title XVI benefits..  In such situations, the State must make the blindness or disability decision; the Disability Determination Service (DDS) of the Division of Vocational Rehabilitation, Alaska Department of Labor and Workforce Development, is the agency that makes blindness or disability decisions for the State.  

A finding of blindness or disability allows the authorization of APAAdult Public Assistance and Medicaid benefits if the individual meets all other factors of eligibility for the APAAdult Public Assistance program.  A finding of no blindness or disability results in a denial of APAAdult Public Assistance and Medicaid benefits.  An individual may appeal a state-only DDSDisability Determination Service decision through the state's fair hearing process.

Substantial Gainful Activity.  The DDSDisability Determination Service is only responsible for making state-only disability determinations based on medical evidence; it does not determine disability based on whether or not an individual is engaging in substantial gainful activity (SGASubstantial Gainful Activity).  If an individual (who is subject to a state-only disability determination) appears to be engaging in SGASubstantial Gainful Activity , the case worker will need to make an SGASubstantial Gainful Activity determination based on the criteria described in MS 425-1(2).  If the case worker determines that the individual is engaged in substantial gainful activity, APAAdult Public Assistance eligibility must be denied or terminated.

If an applicant or recipient is still within the diary date of the Social Security disability determination, DDSDisability Determination Service should not be contacted for a disability decision.  The disability decision made by Social Security will be honored and APAAdult Public Assistance will continue until the end of the diary date.

Note:   

SGA determinations by DPADivision of Public Assistance case workers are only necessary for state-only disability determinations.  The Social Security Administration is responsible for all other SGASubstantial Gainful Activity decisions.

Note:

A disability decision made by the Social Security Administration (SSASocial Security Administration) always trumps a decision made by DDSDisability Determination Service.  Once SSASocial Security Administration determines that an individual does not meet the disability requirements, it supersedes any state only disability determination that found the individual disabled.  If we have an open APAAdult Public Assistance/ME case based on a determination of disability made by DDSDisability Determination Service and SSASocial Security Administration then determines that there is no disability, we would close down the APAAdult Public Assistance/ME case based on the SSASocial Security Administration denial.