10A NCAC 23E .0105. DISABILITY

(a)  Individuals eligible for Medicaid in December 1973 as disabled individuals and who meet conditions required by 42 CFR 435.133 shall be permanently and totally disabled based on a physical or mental impairment which substantially precludes him from obtaining gainful employment, and such impairment appears reasonably certain to continue without substantial improvement throughout his life time.

(b)  Any client who has applied for Medicaid since January 1, 1974 on the basis of disability shall be found disabled under the definition of disability and procedures established for evaluation of vocational and medical factors under the supplemental security income program.

(c)  A social history on a form prescribed by the state shall be completed by the Income Maintenance Caseworker and submitted to the Disability Determination Section with the request for disability determination.

(d)  Except for client's receiving social security or supplemental security income on the basis of disability, the decision on disability is made by the Disability Determination Section of the Division of Social Services.

(e)  Social Security Administration (SSA) decisions made for social security disability or supplemental security income shall be adopted for persons applying for Medicaid.

(f)  Disability determination shall be verified from the client's award letter, SDX, BENDEX, Disability Determination Section approval, Administrative Law Judge decision or other documentary evidence.

(g)  Disability for purposes of Medicaid eligibility shall cease when the client is determined by the Social Security Administration or the Disability Determination Section to be capable of engaging in substantial gainful activity.  The client may appeal the termination of Medicaid based on his disability cessation.

 

History Note:        Authority G.S. 108A-54; 42 C.F.R. 435.540; 42 C.F.R. 435.541; Alexander v. Flaherty Consent Order filed February 14, 1992;

Eff. September 1, 1984;

Amended Eff. April 1, 1993; August 1, 1990;

Transferred from 10A NCAC 21B .0305 Eff. May 1, 2012.