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 physician or psychiatrist.  A proper medical provider for a blindness decision is a physician skilled in diseases of the eye or an optometrist.  A temporary blindness or disability decision does not allow the authorization of full APA and Medicaid benefits.  Instead, it serves as an indication that the individual is blind or disabled for the purposes of qualifying for Interim Assistance (IA Interim 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 #3 Review Report on Aid to the Blind, "Report of Eye Examination" for blindness, or on an AD #2 Preliminary 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 SSI Supplemental Security Income program may make presumptive disability payments to SSI Supplemental 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.

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

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

425-2 C.   SSA BLINDNESS OR DISABILITY DECISIONS

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

Applicants may appeal the SSA decision.  

• If the appeal results in a finding of blindness or disability, reevaluate eligibility for regular APA and Medicaid benefits back to the month of APA application.  To determine the benefit start dates for APA and Medicaid, refer to manual section 410-11.

• If the appeal results in a finding of no blindness or disability, eligibility for APA and Medicaid does not exist.    

If, after a finding of no blindness or disability, an Interim Assistance recipient enters or reenters the SSI 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 APA and Medicaid benefits will be reevaluated.  To determine the benefit start dates for APA and Medicaid, refer to manual section 410-11.

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 SSI Supplemental Security Income or SSA benefits because of other reasons not related to the individual's blindness or disability.  In such situations, the State must make the blindness or disability decision; the Disability Determination Service (DDS Disability Determination Service) 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 APA and Medicaid benefits if the individual meets all other factors of eligibility for the APA program.  A finding of no blindness or disability results in a denial of APA and Medicaid benefits.  An individual may appeal a state-only DDS Disability Determination Service decision through the state's fair hearing process.

Substantial Gainful Activity.  The DDS Disability 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 (SGA Substantial Gainful Activity).  If an individual (who is subject to a state-only disability determination) appears to be engaging in SGA Substantial Gainful Activity, the case worker will need to make an SGA Substantial Gainful Activity determination based on the criteria described in MS Manual Section 425-1(2).  If the case worker determines that the individual is engaged in substantial gainful activity, APA eligibility must be denied or terminated.

Note:  SGA Substantial Gainful Activity determinations by DPA case workers are only necessary for state-only disability determinations.  The Social Security Administration is responsible for all other SGA Substantial Gainful Activity decisions.