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VA MEDICAID WORKS - Blindness and Disability

All individuals requesting enrollment in Virginia's MEDICAID WORKS program must meet the Medicaid definition of either blindness or disability.

Once enrolled, the MEDICAID WORKS participant continues to meet the disability criteria as long as SSA has not completed a Continuing Disability Review which determined that the individual no longer has a disabling condition. The fact that the MEDICAID WORKS enrollee is earning over the SSA Substantial Gainful Activity (SGA) amount has no bearing on whether he meets the disability criteria.

Determination of Disability

Disability Determination Services (DDS) is a division of the Virginia Department of Rehabilitative Services (DRS). Under federal regulations, DDS is charged with making the determinations of medical eligibility for disability or blindness benefits under the Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), and Medicaid programs. The same definitions of disability and blindness and the same evaluation criteria are used for all three programs.

The Railroad Retirement Board (RRB) makes disability determinations for railroad employees. Individuals who receive a "total" disability determination are disabled using the same criteria as the SSA.

The Medicaid disability definition is the same as the SSDI, SSI, and the Railroad Retirement (RR) total disability definition.

Blindness

Blindness is defined as having best corrected central visual acuity of 20/200 or less in the better eye.

The Medicaid blindness definition is the same as that of the Supplemental Security Income (SSI) blindness definition.

An SSI recipient who receives SSI as blind meets the blindness definition for Medicaid.

Individuals who meet the visual eligibility criteria are certified by the Department for the Blind and Vision Impaired (DBVI) and are listed in the Virginia Registry of the Blind.

Disability

Individuals who have been determined disabled or blind by DDS for Medicaid or for SSA, without a subsequent decision by SSA reversing the disability determination and individuals who have been determined disabled by the RRB meet the Medicaid covered group requirement of being "disabled."

An individual meets the Medicaid disability definition if he:

·               receives SSDI or SSI as a disabled individual, or RR total disability benefits; or

·               has been found to be disabled by the DDS without a subsequent decision by SSA reversing the disability decision.

An applicant who received SSDI or SSI disability benefits or RR total disability benefits in one or more of the 12 months preceding the Medicaid application and whose benefits were terminated for a reason other than no longer meeting the disability or blindness requirement continues to meet the disability or blindness definition.

An applicant who has not received SSDI or SSI disability benefits or RR total disability benefits in one or more of the 12 months preceding the Medicaid application must reapply for a disability determination.

Also See:

Virginia MEDICAID WORKS - Overview

Virginia MEDICAID WORKS - Agreement

Virginia MEDICAID WORKS - Cost Sharing and Premium Payment

Virginia MEDICAID WORKS - Employment Considerations

Virginia MEDICAID WORKS - Entitlement and Enrollment

Virginia MEDICAID WORKS - Financial Eligibility

Virginia MEDICAID WORKS - Good Cause Exceptions

Virginia MEDICAID WORKS - Non-Financial Eligibility

Virginia MEDICAID WORKS - Safety Net

VA MEDICAID WORKS - Work Incentive (WIN) Account

Source

Some information for this topic was drawn from the DMAS website at:
http://www.dmas.virginia.gov/downloads/pdfs/mb-FactSheet_Medicaid.pdf
http://www.dmas.virginia.gov/downloads/pdfs/rcp-medicaid_applicant_handbook.pdf

Additional information was drawn from Sections M0310.106, M0310.112, and M0320.211 of the Department of Social Services (DSS) Medicaid Manual.

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