ACT 261 (Interim Process for Disability Determinations in the Disability Financial Assistance Program)
Action Change Transmittal Letter No. 261
July 19, 2016
TO: All Cash Assistance Manual Holders
FROM: Cynthia C. Dungey, Director
SUBJECT: Interim Process for Disability Determinations in the Disability Financial Assistance Program

Background

Currently the Ohio Department of Medicaid's Disability Determination Area (DDA) determines an individual's disability for both Medicaid for the Disabled and Disability Financial Assistance. Beginning on August 1, 2016, the Ohio Department of Medicaid will no longer require disability determinations for every individual alleging a disability. While the Ohio Department of Job and Family Services is finalizing changes to the DFA rules, the disability determination requirements for DFA remain unchanged at this time. This letter is intended to provide county agencies with guidance on how to process applications for DFA until the proposed changes to the rules in Chapter 5101:1-5 of the Administrative Code become effective.

Interim Policy

In accordance with rule 5101:1-5-20, a county agency is responsible for providing applicants with certain forms and collecting and submitting medical documentation to DDA. The Ohio Employees Health Plans (OEHP) assists the county agency with collecting medical documentation and then submitting it to DDA for a disability determination. This process is unchanged during the interim period: OEHP will continue to collect medical records for individuals applying for DFA and the disability determination process for DFA applicants will still take place through the Ohio Department of Medicaid. Also unchanged during this period is the use of eQuil for making referrals and storing medical records.

As Medicaid will no longer require every individual alleging a disability to be referred to OEHP, the county agency must ensure that applicants that are potentially-eligible for DFA are referred for a disability determination. Under the current rules, potential eligibility for DFA exists when the applicant:

  • Meets the DFA financial and non-financial eligibility criteria; and
  • Claims to be unable to do any substantial or gainful activity by reason of a medically determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for not less than nine months.

If both criteria are met, then the county agency must refer the case to OEHP and adhere to all of the requirements described in rule 5101:1-5-20. Once referred to OEHP, the disability determination process will proceed just as it did prior to August 1.

If an applicant is otherwise ineligible for DFA due to financial or non-financial eligibility criteria, then a disability determination is unnecessary and the application should be denied.

Implementation

County agencies shall follow the interim process in this letter beginning on August 1, 2016. On or before September 30, 2016, the Ohio Department of Job and Family Services will issue revised rules in Chapter 5101:1-5 of the Administrative Code or will issue additional guidance for conducting disability determinations until new rules are made effective.