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A referral to the Disability Determination Services Administration (DDSA) is required when the customer:
· Is under age 65;
· Is applying for Medical Assistance and is not eligible for any other category; and
· Does not have proof of disability (MA509) or blindness (MA504).
Depending on the functional criteria reported on the following forms, the customer may be considered disabled or presumed disabled:
· A SMI Determination Report Summary; or
· SMI Eligibility Outcome supplemental form completed and signed by a physician or psychiatrist; and
· Medical evidence supporting the SMI diagnosis.
If the customer is... |
Then... |
Considered disabled (SMI A) |
Medical Assistance benefits may be approved if the customer is otherwise eligible. However, a DDSA referral is required for a random sample of these customers to confirm the disability. |
Presumed disabled (SMI B) |
Medical Assistance benefits may be approved if the customer is otherwise eligible. However, a DDSA referral is required to confirm disability. |
Under certain circumstances, Social Security will approve SSI-Cash for a six-month presumptive eligibility period while determining whether a person meets the criteria of disability. When a person has been approved for presumptive SSI disability benefits, a DDSA referral is not required because the customer is considered to have met the definition of disabled during the presumptive eligibility period.
Term |
Definition |
Serious Mental Illness (SMI) |
A diagnosable mental, behavioralm or emotional disorder that results in functional impairment which substantially interferes with or limits one or more major life activities. |
Program |
Legal Authorities |
SSI-MAO |
42 CFR 435.540; 42 CFR 435.541 AAC R9-22-1501 |