Clients Alleging Disability

Individuals being discontinued from CalWORKs or MC, who have no MC linkage and claim to be disabled, must continue to receive MC benefits while a disability determination is pending using the procedures below:

Complete the “Screening Form/SP-DDSD Applicants” (SCD 96) to determine if a disability referral is necessary.
Begin the process of making a referral to DDSD immediately, by having the client complete the “Applicant’s Supplemental Statement of Facts for Medi-Cal” (MC 223) and MC 220.
Complete the appropriate windows in CalSAWS.
Update the relevant income windows, if appropriate, to reflect the current income reported by the client. EDBC will automatically determine whether the client has a SOC or not and assign the appropriate pending disability Aid Code (6J, 6R, 5J, 5R).
1. Note: Aged, Blind and Disabled (ABD) income deductions are not allowed when determining net nonexempt income of individuals alleging disability. After DDSD determines that the client is disabled, allow the ABD income deductions retroactively back to the disability onset date.
Update the Medical Condition record when the disability decision is received. For detailed CalSAWS DDSD entries [Refer to Job Aid (JA): Medical Condition Detail-Disabled or SP-DDSD]

Methods for Alleging Disability

MC Application

When an applicant indicates a disability on an MC application, the EW must explain the DDSD referral process to the potentially disabled individual. In order for DDSD to approve the referral, the applicant's disability must:

Meet conditions of medical impairment. The disability must be severe, and have lasted or be expected to last for a continuous period of at least 12 months or is expected to result in death, and
Limit the person from physically or mentally performing past work or other work which would produce limited income.

The information notice “What You Should Know About Your Medi-Cal Disability Application” (MC 017) should be given to the applicant. It provides a summary of the disability evaluation process.

If the applicant...	Then...
Decides not to apply for Medi-Cal as a disabled person, for example, condition is not severe,	The applicant must cross out the “Yes” answer on Question 23, mark “No” and initial the change. The EW must thoroughly document the reason for the change.
Still wants to be referred to DDSD	The EW must process the referral.
Answers “Yes” but is already linked (for example, to AFDC-MN),	The applicant may choose whether or not to be referred. EWs must explain that there are greater income deductions for ABD-MN.

Blindness

If the client is aged (over 65), a DDSD referral must not be made unless blindness is claimed.

A blindness evaluation for a former SSI/SSP recipient for a determination under the Pickle Amendment to the Social Security Act may be necessary even if the applicant/recipient has reached age 65; or, has already been determined to be disabled. This is because a blind individual is entitled to a higher SSI/SSP payment level than a disabled or aged person. (The EW must check “Pickle-Blind” on Item #8 of the “Disability Determination and Transmittal” (MC 221), or DDSD may reject the referral as unnecessary.)
DDSD will also do a blindness evaluation for an employed person over age 65 due to possible entitlement for an additional income deduction.

Client's Statement

The applicant/recipient makes a written or oral statement to the EW which alleges disability.

RSDI/SSI Pending

The client states that he/she has an RSDI or SSI/SSP disability (including blindness) determination pending.

Presumptive Disability

The client has a letter from a physician verifying a condition of “presumptive disability.