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MIR offers financial planning services designed to help elderly clients preserve their assets in safe investments so they may qualify for government financial assistance programs. MIR charges fees to assist elderly clients in submitting Medicaid applications, and we may receive commissions for annuities structured in the planning process. In 11 years filing Medicaid applications, we have never had an application denied.
We are not attorneys and do not offer legal advice or draft any legal documents. The decision to hire MIR is in no way equivalent to or a substitution for an attorney.
DCF Process for Evaluating a Disability Claim for a Person Under Age 65
Sometimes an individual under the age of 65 requires care in a skilled nursing facility. While this doesn’t come up all that often, when it does, this information can be invaluable. The only way an individual under age 65 can qualify for Medicaid ICP is to be deemed blind or disabled. Here is an overview explaining how an individual may be deemed disabled by DCF.
What is the definition of the term disability?
DCF uses the Social Security Administration’s definition of disability: Unable to work for 12 months or longer or will die within 6 months if a terminal condition runs its normal course.
Who can determine if an individual is disabled?
The Social Security Administration (SSA)
The Department of Disability Determinations (DDD) or
The District Medical Review Team (DMRT)
Are there any situations in which disability can
be established by another means? Who must be determined to be disabled for ICP? What information does DMRT need to determine if an
individual is disabled? Must the applicant also file for other benefits? What happens if SSA and DMRT disagree?
Yes. Terminal Prognosis can substitute for a disability determination for individuals applying for Hospice.
Anyone under age 65 who has not already been determined to be disabled as noted above.
DMRT must have medical records showing prognosis and diagnosis that support the allegation that the individual meets the Social Security Administration’s criteria for disability.
SSI-Related Medicaid policy requires that all applicants file for and diligently pursue to conclusion all other benefits they may be eligible for except SSI. This includes individuals already receiving SSA retirement benefits that could receive SSA disability benefits. [SSI is Supplemental Security Income]
The Social Security Administration’s decision is a Federal decision and takes precedence over State decision made by DDD, DMRT, and Hospice terminal diagnosis. If Medicaid eligibility was established before a SSA denial of disability, the Medicaid will remain open as long as the individual verifies that they are pursuing all levels of appeal and continues to meet all other factors of eligibility.
Who must be determined to be disabled for ICP?
What information does DMRT need to determine if an
individual is disabled?
Must the applicant also file for other benefits?
What happens if SSA and DMRT disagree?