5.2 Determination of Disability

Definition of Disability

The law defines disabilityThe law defines disability for Medicaid as "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." for Medicaid as: "The inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." See Section 39.4.1 Elderly, Blind, or Disabled Assets and Income Table for the current SGA limits. See Section 26.1 Medicaid Purchase Plan Introduction for the MAPPMedicaid Purchase Plan disability definition.

An individual who is blind or disabled is non-financially eligible (see Section 4.1 Who is Nonfinancially Eligible for Medicaid?). Disability and blindness determinations are made by the DDBDisability Determination Bureau in the Department of Health and Family Services. The IMincome maintenance agency should submit an application for a disability determination even if the memberA recipient of Medicaid; formerly referred to as a "client." has already applied for SSISupplemental Security Income. A program based on financial need operated by the Social Security Administration that provides monthly income to low income people who are age 65 or older, blind, or disabled. or SSDISocial Security Disability Insurance. A benefit to disabled or blind individuals who have contributed to the Federal Insurance Contribution Act (FICA). (see Section 5.3 Disability Application Process).

This page last updated in Release Number: 09-03

Release Date: 06/05/09

Effective Date: 06/05/09

The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030