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MassHealth Disability Definition

The definition of "Permanent and Total Disability" used by MassHealth is contained in 130 CMR 505.001 (see below). It is:

(1) For Adults and 18-Year-Olds.

(a) The condition of an individual, aged 19 or older, who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that:

(i) can be expected to result in death; or

(ii) has lasted or can be expected to last for a continuous period of not less than 12 months.

(b) For purposes of this definition, an individual age 18 or older is determined to be disabled only if his or her physical or mental impairments are of such severity that the individual is not only unable to do his or her previous work, but cannot, considering age, education, and work experience, engage in any other kind of substantial gainful work that exists in the national economy, regardless of whether such work exists in the immediate area in which the individual lives, whether a specific job vacancy exists, or whether the individual would be hired if he or she applied for work. "Work that exists in the national economy" means work that exists in significant numbers, either in the region where such an individual lives or in several regions of the county.

(2) For Children Under Age 18.

The condition of an individual under the age of 18 who has any medically determinable physical or mental impairment, or combination of impairments, of comparable severity to an impairment or combination of impairments that disables adult, or are of such severity that the child is unable to engage in age-appropriate activities, as defined in Title XVI as in effect on July 1, 1996.

Additional Information

The Code of Massachusetts Regulations is available at: http://www.lawlib.state.ma.us/cmr.html.

Also see:

MassHealth Basic Eligibility Standards

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