Section 120.313 Blind

Section 120

Section 120.313  Blind

MANG(B)

a)         To be eligible for medical assistance as a blind person an

individual must be determined blind as currently defined by the Social Security

Administration (SSA).  (See 20 CFR 416, Subpart I, April 1, 1984).

b)         If an individual is receiving Supplemental Security Income

(SSI) or primary Social Security (OASDI) benefits, the Department shall accept

the Social Security Administration determination of blindness.  The Department

will make the determination when the client has been denied SSI on the basis of

too much income or when the client is applying for medical assistance only and

not receiving SSI or OASDI.  The Department uses the same criteria for

blindness as is used under SSI.  (See 20 CFR 416, Subpart I, April 1, 1984).

c)

1)         If an individual applying for or receiving medical assistance

is determined currently "not blind" by SSA under the SSI or primary

OASDI programs, the Department shall accept SSA's determination of blindness

and deny or cancel the case, no matter which agency made the original determination

of eligibility.

2)         If the individual appeals the SSA determination of blindness

to SSA, medical assistance shall be continued for recipients through the level

of a determination by an Administrative Law Judge (ALJ) subject to the time

limits of c)3) below.  If medical assistance has been cancelled but the client

later appeals to SSA, the case shall be reinstated through the ALJ level

subject to the time limits of c)3) below.

3)         If the client notifies the Department of his appeal to SSA

within 10 days of the date of the Department notice, medical assistance will be

continued with no break.  If the client notifies the Department of his appeal

to SSA within 11 through 65 days of the date of the Department notice, medical

assistance will be reinstated back to the original date of cancellation

ts of c)3) below.

3)         If the client notifies the Department of his appeal to SSA

within 10 days of the date of the Department notice, medical assistance will be

continued with no break.  If the client notifies the Department of his appeal

to SSA within 11 through 65 days of the date of the Department notice, medical

assistance will be reinstated back to the original date of cancellation.  If

the client notifies the Department of his appeal to SSA more than 65 days after

the date of the Department notice, medical assistance will be provided

prospectively only, unless the client actually appealed to SSA within 65 days

of the date of the Department notice, in which case medical assistance will be

reinstated back to the original date of cancellation.

4)         Medical assistance shall not be provided to applicants for

medical assistance through the SSA appeals process.

5)         If an Administrative Law Judge finds the individual "not

blind", the Department shall accept that finding as final. The individual

shall not have the right to appeal the determination of blindness to the

Department at any time during this process.

d)         Redetermination of blindness is a condition of continuing

eligibility for individuals who are not applying for or receiving SSI or OASDI

benefits.

e)         When appropriate, the Department shall pay for a medical

examination to determine blindness.