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MAGI MC and DDSD
Individuals eligible for MAGI Medi-Cal (MC) must still be referred to DDSD when appropriate. When the disability determination is returned, indicate the outcome of the referral on the DDSD window. The client will remain on MAGI unless their circumstances change (i.e, start receiving Medicare, request Non-MAGI evaluation, etc.). All references to Non-MAGI eligibility below assume that a MAGI evaluation was already completed and the client was not eligible, or the client requested a Non-MAGI evaluation.
Federally Disabled Individuals
Medi-Cal eligibility for disabled individuals is determined by County Welfare Departments and the Disability Determination Service Division (DDSD). Counties are responsible for the non-medical part of the eligibility determination; DDSD is responsible for the collection of medical data and the disability determination.
Disability benefits established through State Disability Insurance (SDI), Veterans' Benefits, and Workers' Compensation Fund, do not establish disability for MC. These benefits establish incapacity deprivation only, not disability.
Definition of Disabled
Federal law defines an individual 18 years of age or older as disabled if that person meets the Social Security Administration's disability criteria for RSDI or SSI/SSP. State law requires that Medi-Cal (MC) clients 21 through 64 years of age who allege disability must have their eligibility evaluated under the Aged, Blind and Disabled-Medically Needy (ABD-MN) Program.
The condition of disability must be expected to result in death or has lasted or can be expected to last for a continuous period of at least 12 months in order for a person to be considered federally disabled. Also, it must prevent a person from working. The 12-month disability period is determined from the first day the client is unable to work due to that disability.
Note: A disabled working individual may be considered for the 250% Working Disabled Program.
A DDSD referral must be made on MC applicants or recipients who are eligible under another program (i.e., MAGI, AFDC-MN/MI), and who allege disability and choose to apply or be redetermined as disabled MN.
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