North Carolina Administrative Code › Title 10A - HEALTH AND HUMAN SERVICES › Chapter 23 - MEDICAL ASSISTANCE ADMINISTRATION › Subchapter E - MEDICAID ELIGIBILITY REQUIREMENTS › Section .0100 - NON-FINANCIAL REQUIREMENTS › Section 23E .0105 - DISABILITY

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As set out in
				  the Medicaid State Plan, individuals eligible for Medicaid in December 1973 as
				  disabled individuals and who meet conditions required by
				  42 CFR
				  435.133 shall be permanently and totally
				  disabled based on a physical or mental impairment that precludes him or her
				  from engaging in substantial gainful activity, as defined at
				  20 CFR
				  416.910, which is incorporated by reference
				  with subsequent amendments and editions and available free of charge at
https://www.ecfr.gov/
, and such
				  impairment can be expected to result in death, or has lasted or can be expected
				  to last 12 months or longer.
(b)
				  Any client who has applied for Medicaid since January 1, 1974 on the basis of
				  disability shall be found disabled under the definition of disability and
				  procedures established for evaluation of vocational and medical factors under
				  the supplemental security income program.
(c) A social history shall be completed by
				  the caseworker and submitted to the Division of Vocational Rehabilitation
				  Services, Disability Determination Services Section with the request for
				  disability determination. The social history shall provide information to
				  identify and contact the claimant; contact information of anyone assisting the
				  claimant in providing the social history; nature and onset of the impairment
				  with the date it became disabling; date claimant stopped work or if still
				  working, provide name of employer with contact information, how many hours
				  worked and earnings; claimant's description of impairment; work history and
				  educational background; contact information for all medical sources during the
				  last 12 months with condition treated, dates seen, and whether treatment is
				  still ongoing; Vocational Rehabilitation office, counselor's contact
				  information, and last seen date; in cases where mental impairment is alleged or
				  there is evidence of drug or alcohol abuse or homelessness, provide name,
				  address, and phone number of a third party contact; signature, title, and phone
				  number of caseworker.
(d) The
				  Disability Determination Services Section shall determine disability for all
				  individuals, except for those receiving social security or supplemental
				  security income on the basis of a disability.
(e) Social Security Administration (SSA)
				  decisions made for social security disability or supplemental security income
				  shall be binding for persons applying for Medicaid.
(f) Disability determination shall be
				  verified from the client's award letter, SDX, BENDEX, Disability Determination
				  Services Section approval, Administrative Law Judge decision, or other
				  documentary evidence. SDX and BENDEX are defined in
				  10A NCAC
				  23A .0102.
(g) Disability for purposes of Medicaid
				  eligibility shall cease when the client is determined by the Social Security
				  Administration or the Disability Determination Services Section to be capable
				  of engaging in substantial gainful activity. The client may appeal the
				  termination of Medicaid, pursuant to
				  G.S.
				  108A-70.9A.
Authority
					 G.S.
					 108A-54;
					 108A-54.1B;
					 20 C.F.R.
					 404.1505;
					 42 C.F.R. 435.540;
					 42 C.F.R.
					 435.541; Alexander v. Flaherty Consent Order
					 filed February 14, 1992;
Eff. September 1, 1984;
Amended Eff. April 1, 1993; August 1, 1990;
Transferred from
					 10A NCAC
					 21B .0305 Eff. May 1, 2012;
Readopted Eff. August 1, 2019.