10:71-3.11 Determination of disability and blindness eligibility; a State function
(a) The determination of disability and blindness eligibility for the Medicaid Only program is
a direct responsibility of the medical review team in the Division of Medical Assistance and
Health Services. Determination of all other factors of eligibility is the responsibility of the
CBOSSs. The medical review team is composed of a medical consultant; and a medical
social work consultant; it reviews Medicaid Only applications submitted by the CBOSSs.
(b) In situations where an applicant's disability or blindness appears to meet the definition in
section 12 of this subchapter, presumptive eligibility for either of these factors can be
granted with the approval of the Medical Review Team (MRT).
(c) If an individual has been determined disabled for Social Security purposes (that is, he or
she is currently receiving Disability Insurance Benefits), the CBOSS shall not refer the
individual to the Medical Review Team (MRT) for a determination of medical eligibility. The
individual shall be considered automatically eligible, in this respect, for Medicaid Only
benefits.
1. In the event the Social Security Administration determined within the 12 months prior to the application for Medicaid Only that the individual was not disabled, the MRT will not make
an independent determination of the applicant's disability but will be bound by the
determination of the Social Security Administration. If an individual whose Social Security or
SSI disability claim was denied within the last 12 months presents new or additional
evidence to support that claim, the CBOSS should refer the applicant to the Social Security
Administration for a reevaluation of its determination.
2. When the denial by the Social Security Administration occurred more than 12 months
prior to the application for Medicaid Only, the (MRT) will make an independent
determination of disability.