Wash. Admin. Code § 388-449-0001 - What are the disability requirements for the aged, blind, or disabled (ABD) program?
(1) For the
purposes of this chapter, the following definitions apply:
(a) "We" and "us" mean the department of
social and health services.
(b)
"You" means the applicant or recipient.
(c) "Disabled" means the inability to engage
in any substantial gainful activity (SGA) by reason of any medically
determinable physical or mental impairment(s) which has lasted or can be
expected to last for a continuous period of not less than 12 months with
available treatment or result in death.
(d) "Physical impairment" means a diagnosable
physical illness.
(e) "Mental
impairment" means a diagnosable mental disorder. We exclude any diagnosis of or
related to a substance use disorder.
(2) We review if you meet disability
requirements when:
(a) You apply for ABD cash
benefits;
(b) You become employed;
or
(c) A disability review is
required under WAC 388-449-0150.
(3) You are likely to meet disability
requirements if:
(a) You are determined to
meet SSA disability criteria by the Social Security Administration
(SSA);
(b) You are determined to
meet SSA disability criteria by disability determination services (DDDS) based
on the most recent DDDS determination;
(c) SSA stops your supplemental security
income (SSI) payments solely because you are not a citizen;
(d) You are eligible for services through the
developmental disabilities administration (DDA) for a medical condition that is
expected to last 12 months or more or result in death;
(e) You are eligible for long-term care
services from the aging and long-term support administration (ALTSA) for a
medical condition that is expected to last 12 months or more or result in
death;
(f) You have been civilly
committed to eastern or western state hospital;
(g) You have been placed in eastern or
western state hospital for an offense you have been found not guilty by reason
of insanity;
(h) You have been
diagnosed as having an intellectual disability based on a full scale score of
70 or lower on the Wechsler adult intelligence scale (WAIS); or
(i) You are approved through the sequential
evaluation process (SEP) defined in WAC 388-449-0005 through 388-449-0100. The
SEP is the sequence of five steps. Step 1 considers whether you are currently
working. Steps 2 and 3 consider medical evidence and whether you are likely to
meet or equal a listed impairment under Social Security's rules. Steps 4 and 5
consider your residual functional capacity and vocational factors such as age,
education, and work experience in order to determine your ability to do your
past work or other work.
(4) If you have a physical or mental
impairment and you are impaired by a substance use disorder and do not meet the
other disability criteria in subsections (2)(a)- (c) of this section, we decide
if you are eligible for ABD cash by applying the sequential evaluation process
described in WAC 388-449-0005 through 388-449-0100. You are not eligible for
ABD cash benefits if you are disabled primarily because of a substance use
disorder.
(5) In determining
disability, we consider only your ability to perform basic work-related
activities. "Basic work-related activities" are activities that anyone would be
required to perform in a work setting. They consist of: Sitting, standing,
walking, lifting, carrying, handling, and other physical functions (including
manipulative or postural functions such as pushing, pulling, reaching,
handling, stooping, or crouching), seeing, hearing, communicating, remembering,
understanding and following instructions, responding appropriately to
supervisors, co-workers, and usual work situations, maintaining appropriate
behavior, and adapting to changes in a routine work setting.
(6) We determine you are not likely to meet
disability criteria if SSA denied your application for SSI or Social Security
Disability Insurance (SSDI) based on disability in the last 12 months unless:
(a) You file a timely appeal with
SSA;
(b) SSA decides you have good
cause for a late appeal; or
(c) You
give us medical evidence of a potentially disabling condition that SSA did not
consider or medical evidence confirming your condition has
deteriorated.
Notes
Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, 74.08A.100, 74.04.770, 74.04.0052, 74.04.655, 74.08.043, 74.08.335, and 2011 1st sp.s. c 36. 12-10-042, § 388-449-0001, filed 4/27/12, effective 6/1/12.
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