Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 6 - SUPPLEMENTAL SECURITY INCOME(SSI) - RELATED MEDICAID COVERAGE › Section 144-332-6-4 - BASIC ELIGIBILITY REQUIREMENTS

Current through 2024-29, July 17, 2024
Individuals who are aged, blind or disabled and are not
					 receiving SSI or a State Supplement payment may be eligible for Medicaid as SSI
					 - Related if they meet the basic criteria of the SSI Program below.
Section 4.1
: Aged
The individual must be 65 years of age in or before the
					 month in which eligibility begins.
Section 4.2
: Blind
The individual must have, in terms of ophthalmic
					 measurement, central visual acuity of 20/200 (can see on the eye examination
					 chart at 20 feet what a normal vision can see at 200 feet) or less in the
					 better eye with best correcting glasses or must have a field defect in which
					 the peripheral field has contracted to such an extent that the widest diameter
					 of visual field subtends at an angular distance of no greater than 20 degrees
					 or must have a visual field efficiency reduced to 20% or less; or if in the
					 opinion of the consulting ophthalmologist the visual field limitation encroach
					 on the central visual axis sufficient to interfere with useful vision. Such a
					 person has what is known as economic blindness which prevents the performance
					 of ordinary activities for which eyesight is essential. For determining the
					 visual field efficiency, the amount of radial contraction in the eight
					 principal meridians shall be determined, and the sum of these eight, divided by
					 420 (the sum of the eight principal radii of the industrial visual field)
					 multiplied by 100 will give the visual field efficiency of one eye in
					 percentage.
Section 4.3
: Disabled
Current eligibility for Social Security, Railroad
					 Retirement, Medicare or SSI benefits based on disability or blindness is proof
					 of disability.
For individuals whose SSI Benefits are terminated, for
					 reasons other than disability, a contact to the local Social Security Office
					 should be made to determine the next disability review date. For Medicaid
					 purposes this review date will be adopted.
If the individual is not currently receiving benefits from
					 one of the sources above, then an independent disability decision must be made.
					 To determine if a person meets the SSI standard of disability, a referral will
					 be made to the Medical Review Team (MRT). This group consists of a physician
					 and a caseworker who specialize in medical eligibility determinations. This
					 group makes the decision as to whether or not the individual meets the SSI
					 standard of disability and establishes any additional reviews of medical
					 disability.
Section 4.3.1
:
				  Making the Decision
I. This decision
				  is based on a medical report which must include a substantive diagnosis based
				  either on existing medical evidence or upon current medical examination. To end
				  coverage based on disability, the Medical Review Team must determine that
				  medical improvement as set forth in
				  20
				  CFR 416.994 has occurred in relation to the
				  most recent decision that was favorable to the individual.
The medical evidence must be from an acceptable source.
					 Acceptable sources are:
A. licensed
				  physicians;
B. licensed
				  osteopaths;
C. licensed or
				  certified psychologists;
D.
				  licensed optometrists for the measurement of visual acuity and visual fields.
				  (A report from a physician may be required to determine other aspects of eye
				  diseases);
E. a hospital, clinic,
				  sanitarium, medical institution or health care facility; or
F. P.E.T. and other school medical records.
Reports from chiropractors are not acceptable.