SSI facilitation
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SSI facilitation

Revised June 3, 2009

B. SOCIAL SECURITY DISABILITY CRITERIA
Purpose: Document all actions in ICMS (GA) or eJAS (TANF)


Disability

  1. SSA defines disability as:

    1. Inability to engage in any substantial gainful activity,

    2. One or more severe physical and/or mental impairments are present, and

    3. The impairment is expected to result in death or has lasted or is expected to last for a continuous period of not less than 12 months.

  2. A person who is 65 years old or older may be eligible for SSI based on age and should be referred immediately to the local SSA District Office (SSADO). Non-U.S. citizens over age 65 may also have to meet disability criteria.

 


Presumptive Disability

  1. SSA may find that persons who meet certain severe disability criteria are presumptively disabled. SSA Presumptive disability criteria include allegations of:

    • Amputation of a leg at the hip

    • Total deafness

    • Total blindness

    • Bed confinement or immobility without a wheelchair, walker, or crutches due to a longstanding condition, excluding recent accident and recent surgery

    • Stroke (cerebral vascular accident) more than three months in the past and continued marked difficulty walking or using a hand or arm

    • Cerebral palsy, muscular dystrophy, or muscle atrophy and marked difficulty walking, speaking, or coordination of hands or arms

    • Down Syndrome

    • Severe mental deficiency requiring care and supervision of routine daily activities

    • A child who has not reached his or her first birthday and the birth certificate or other evidence shows a weight below 1200 grams (2 pounds, 10 ounces) at birth, or who meets gestational age and weight as listed in the Presumptive Disability Gestational Weight Table

    • Human Immunodeficiency Virus (HIV) infection, where the medical provider indicates that disease manifestations are of listing-level severity (even if the person has not been diagnosed as having Acquired Immunodeficiency Syndrome, AIDS).

    • A person receiving hospice services because of terminal cancer

    • Spinal cord injury with inability to ambulate without the use of a walker or bilateral hand-held assistive devices for more than two weeks following the injury

    • End stage renal disease with ongoing dialysis

    • Amyotrophic lateral sclerosis (ALS, Lou Gehrig's Disease)

Presumptive Disability Gestational Weight Table

Gestational Age (in weeks)

Weight at Birth

37-40

Less than 2000 grams

4 pounds, 6 ounces

36

1875 grams or less

4 pounds, 2 ounces

35

1700 grams or less

3 pounds, 12 ounces

34

1500 grams or less

3 pounds, 5 ounces

33

1325 grams or less

2 pounds, 15 ounces
Note: Gestational age is the age at birth based on the date of conception, may be shown as "GA" in medical records. If more than one "GA" is noted in the available medical evidence, the case may go to DDDS for consideration of Presumptive Disability.

  1.  When a client appears to meet SSA presumptive disability criteria:

    1. Expedite facilitation services, and

    2. Refer the client directly to SSA for presumptive disability determination.

  2. A client who meets SSA presumptive disability criteria may receive SSI benefits for up to six months.

    1. Division of Disability Determination Services (DDS) continues to process the case to make a disability determination during the six months.

    2. Presumptive payments may end if DDS is unable to make a determination.

    3. DDS continues to process the case until a final determination is made after presumptive payments end.

  3. The person needs to claim financial hardship. SSA considers presumptive disability to be emergency and not interim assistance, so it is critical to track the person's payment status.

  4. Notify financial services to terminate GAU benefits when a client begins receiving presumptive SSI benefits.

 


Disability Listings

  • SSA refers to their disability criteria as the "Listings" and publishes them in Disability Evaluation Under Social Security.

  • SSA considers the person disabled when the medical disorder meets or equals the listed disability criteria.


Disability Decision

The Division of Disability Determination Services (DDS):

  1. Decides if a person applying for SSI, SSDI, or Non-Grant Medical Assistance (NGMA) meets disability criteria,

  2. Uses a sequential evaluation process similar to the Progressive Evaluation Process (PEP) to consider the effect of the physical and/or mental impairment and the combined effect of multiple impairments, and

  3. Considers the effect of the following on the person’s ability to work:

    1. Current and past work activity;

    2. Severity of impairment;

    3. Residual functional capacity;

    4. Age, and

    5. Education.


Links

Social Security:

DSHS: (Note: you may receive a "page not found" error if you do not work for DSHS)

DASA and Treatment Expansion:

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Modification Date: June 3, 2009
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