Non-grant Medical Assistance

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Non-grant Medical Assistance

Revised January 18, 2008

Purpose: This category describes the social services procedures to obtain a determination of disability or blindness that enables adults not receiving other assistance to be eligible for Categorically Needy medical coverage (Medicaid).

DEFINITIONS

Division of Disability Determination Services (DDDS): The state entity that uses federal criteria to determine disability or blindness under an agreement with the Social Security Administration.

WORKER RESPONSIBILITIES

On receipt of request for a Medicaid decision, the Social Worker:

Reviews the referral information and arranges an interview with the client or their representative (assess for necessary supplemental accommodation (NSA) and provide these services to eligible persons).

During the interview or contact, confirms that the client is claiming blindness or disability. If the claim does not appear to meet SSI criteria, explains this to the client or representative and suggest the application be withdrawn. Get the withdrawal request in writing if the client or representative agrees and route it to the financial worker. If the client or representative insists on pursuing the application, explain the following points about the determination process:

DDDS makes the determination of blindness or disability;

There is an expectation that this decision is made within 60 days but it may take more or less time;

The Social Worker’s role is to put together and send a decision packet to DDS; and

The client has a right to request a fair hearing if they disagree with the decision and it will be the responsibility of DDDS to defend the decision.

Creates a decision packet containing the following:

Transmittal Summary, DSHS 14-144

Write “NGMA” at the top in red and complete the TO: and FROM: sections.

Medical Disability Decision, DSHS 14-144A

Write “NGMA” at the top of the first page in red and complete the client identification section. Have the client or representative complete the remainder of the form, giving as much detail as possible. The Social Worker helps NSA clients complete the form.

Medical Information Release Forms

Use the Authorization for Source to Release Information to the Social Security Administration, SSA 827. To be able to process the case, DDDS needs the client (not the representative) to sign but not date at least five release forms. The space for entering the source releasing the information should also be left blank.

Medical Records

Send copies of medical records whenever possible. Include a copy of the death certificate if client is deceased.

Previous NGMA Packet

If the client is reapplying or requesting continued NGMA benefits, include the previous packet.

Sends the completed decision packet to the DDDS office serving your CSO (fax urgent cases or those with available medical records).

Opens a Disability Medical screen and enters case notes in the Inclusive Case Management System (ICMS) to document actions taken.

The DDDS Disability Adjudicator makes the determination, completes the DSHS 14-144, attaches an explanation of denial if necessary, and returns the decision packet to the Social Worker.

On receipt of the DDDS decision, The Social Worker routes a copy of the DSHS 14-144 and explanation of denial, if necessary, to the Financial Worker (when working with a call center, use secure e-mail to send this information). The Social Worker files the decision packet and documents the NGMA decision results in ICMS, including closing the Disability Medical screen or setting a reminder for review as appropriate.

Non-grant Medical Assistance
Revised January 18, 2008

Purpose: This category describes the social services procedures to obtain a determination of disability or blindness that enables adults not receiving other assistance to be eligible for Categorically Needy medical coverage (Medicaid).
DEFINITIONS Division of Disability Determination Services (DDDS): The state entity that uses federal criteria to determine disability or blindness under an agreement with the Social Security Administration.
WORKER RESPONSIBILITIES On receipt of request for a Medicaid decision, the Social Worker: Reviews the referral information and arranges an interview with the client or their representative (assess for necessary supplemental accommodation (NSA) and provide these services to eligible persons). During the interview or contact, confirms that the client is claiming blindness or disability. If the claim does not appear to meet SSI criteria, explains this to the client or representative and suggest the application be withdrawn. Get the withdrawal request in writing if the client or representative agrees and route it to the financial worker. If the client or representative insists on pursuing the application, explain the following points about the determination process: DDDS makes the determination of blindness or disability; There is an expectation that this decision is made within 60 days but it may take more or less time; The Social Worker’s role is to put together and send a decision packet to DDS; and The client has a right to request a fair hearing if they disagree with the decision and it will be the responsibility of DDDS to defend the decision. Creates a decision packet containing the following: Transmittal Summary, DSHS 14-144 Write “NGMA” at the top in red and complete the TO: and FROM: sections. Medical Disability Decision, DSHS 14-144A Write “NGMA” at the top of the first page in red and complete the client identification section. Have the client or representative complete the remainder of the form, giving as much detail as possible. The Social Worker helps NSA clients complete the form. Medical Information Release Forms Use the Authorization for Source to Release Information to the Social Security Administration, SSA 827. To be able to process the case, DDDS needs the client (not the representative) to sign but not date at least five release forms. The space for entering the source releasing the information should also be left blank. Medical Records Send copies of medical records whenever possible. Include a copy of the death certificate if client is deceased. Previous NGMA Packet If the client is reapplying or requesting continued NGMA benefits, include the previous packet. Sends the completed decision packet to the DDDS office serving your CSO (fax urgent cases or those with available medical records). Opens a Disability Medical screen and enters case notes in the Inclusive Case Management System (ICMS) to document actions taken. The DDDS Disability Adjudicator makes the determination, completes the DSHS 14-144, attaches an explanation of denial if necessary, and returns the decision packet to the Social Worker. On receipt of the DDDS decision, The Social Worker routes a copy of the DSHS 14-144 and explanation of denial, if necessary, to the Financial Worker (when working with a call center, use secure e-mail to send this information). The Social Worker files the decision packet and documents the NGMA decision results in ICMS, including closing the Disability Medical screen or setting a reminder for review as appropriate.

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