WAC 182-512-0050 SSI related medical -- General information

1. The department provides medical benefits under the categorically needy (CN) and medically needy (MN) SSI related programs for SSI related people, meaning those who meet at least one of the federal SSI program criteria as being: 

   1. Age sixty five or older;

   2. Blind with:

      1. Central visual acuity of 20/200 or less in the better eye with the use of a correcting lens; or

      2. A field of vision limitation so the widest diameter of the visual field subtends an angle no greater than twenty degrees; or

   3. Disabled:

      1. "Disabled" means unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment, which:

         1. Can be expected to result in death; or

         2. Has lasted or can be expected to last for a continuous period of not less than twelve months; or

         3. In the case of a child seventeen years of age or younger, if the child suffers from any medically determinable physical or mental impairment of comparable severity.

      2. Decisions on SSI related disability are subject to the authority of:

         1. Federal statutes and regulations codified at 42 USC Sec 1382c and 20 CFR, parts 404 and 416, as amended; and

         2. Controlling federal court decisions, which define the OASDI and SSI disability standard and determination process.

2. A denial of Title II or Title XVI federal benefits by SSA solely due to failure to meet the blindness or disability criteria is binding on the department unless the applicant's:

   1. Denial is under appeal in the reconsideration stage in SSA's administrative hearing process, or SSA's appeals council; or

   2. Medical condition has changed since the SSA denial was issued.

3. The department considers a client who meets the special requirements for SSI status under Sections 1619(a) or 1619(b) of the Social Security Act as an SSI recipient. Such a client is eligible for CN medical coverage under WAC 388-474-0005.

4. Individuals referred to in subsection (1) must also meet appropriate eligibility criteria found in the following WAC and EA Z Manual sections:

   1. For all programs:

      1. WAC 388-408-0055, Medical assistance units;

      2. WAC 388-416-0015, Categorically needy and WAC 388-416-0020, Medically needy certification periods;

      3. Program specific requirements in chapter 388-475 WAC;

      4. WAC 388-490-0005, Verification;

      5. WAC 388-503-0505, General eligibility requirements for medical programs;

      6. WAC 388-505-0540, Assignment of rights and cooperation;

      7. Chapter 388-561 WAC, Trusts, annuities and life estates.

   2. (b) For LTC programs:

      1. Chapter 388-513 WAC, Long term care services

      2. Chapter 388-515 WAC, Waiver services.

   3. For MN, chapter 388-519 WAC, Spenddown;

   4. For HWD, program specific requirements in chapter 388-475 WAC.

5. Aliens who qualify for Medicaid benefits, but are determined ineligible because of alien status may be eligible for programs as specified in WAC 388-438-0110.

6. The department pays for a client's medical care outside of Washington according to WAC 388-501-0180.

7. The department follows income and resource methodologies of the Supplemental Security Income (SSI) program defined in federal law when determining eligibility for SSI related medical or Medicare Cost Savings programs unless the department adopts rules that are less restrictive than those of the SSI program.

8. Refer to WAC 388-418-0025 for effects of changes on medical assistance for re-determination of eligibility.