Disability Determinations for Medicaid

If an individual is receiving SSDI or SSI, medical information is not needed to establish disability for MO HealthNet. The rest of this page contains information which does not apply to applicants who have SSDI or SSI.

If not receiving SSDI or SSI, current medical information must be submitted to the Family Support Division’s Medical Review Team (MRT) for a disability determination.

The following forms are required to complete the MO HealthNet for Disabled application:

  • IM-61B - Disability Questionnaire
    • Fill in the client's answers to all the questions
    • Leave the pertinent information and observations of the Eligibility Specialist section blank.
  • IM-61C - Work History
    • The form asks for the past 10 years of work history.
    • Complete the form based on information readily available to the individual, do not delay submitting the form trying to get exact information.
    • If the individual doesn’t remember specific information such as phone numbers, addresses, monthly income, etc. just put an approximation based on what is remembered.
    • Reason for leaving and job duties are important if the reason for it or the inability to perform the job duties are related to the individual’s medical condition.
  • IM-61D - Doctor/Medical Facility List
    • The form asks the individual to list all hospitals, medical facilities, and physicians from whom he or she has received medical care in the past 12 months.
    • Mental health professionals, such as psychologists, advance practice nurses, and licensed clinical social workers should also be included.
  • MO 650-2616 - Authorization for Disclosure of Consumer Medical/Health Information
    • There are two signatures required on this form:
      • Page 2, the client should sign the line under question #2.
      • Page 2, where it says Signature of Consumer under the line "My signature below acknowledges that I have read, understand, and authorize the release of my PHI.

Additional information can be submitted with the application which will help speed up the determination process. This is optional, but the Medical Review Team will reach out to doctors/facilities for medical records if they do not have sufficient information to make a determination. In some cases an evaluation with a doctor will be scheduled.

  • Record of Treatment
    • If the psychosocial evaluation is not signed or co-signed by a psychiatrist or a licensed clinical psychologist, it will be accepted if someone with those credentials either:
      • signs a letter stating he or she has reviewed the evaluation and concurs with the findings; or
      • completes and signs the diagnosis / certification section of the IM-60A (Medical Report) form, available at https://dmh.mo.gov/medicaideligibility/mrtpacket.html, certifying that in his or her opinion the patient has a disability.
  • Psychosocial Evaluation by a psychiatrist or licensed clinical psychologist completed within the past 12 months.
  • IM-60A: Medical Report Including Physician's Certification/Disability Evaluation
    • The IM-60A, completed and signed by a psychiatrist or licensed clinical psychologist, can certify that the client has a disability if the psychosocial evaluation is over 6 months old or not signed by someone with those credentials. .
    • At the top of the first page put the client’s name, date of birth and if known the individual DCN.
    • Leave blank the eligibility specialist, FAMIS user ID, load, date of application, date submitted to MRT as the FSD worker will fill those in.
    • The most important parts of the form are Diagnosis section and the Determination of incapacity section.
    • To be determined disabled a client needs to have a mental or physical impairment that prevents him or her from engaging in substantial gainful activity that is expected to last for more than 12 months.

Disability Definition for MO HealthNet for the Disabled (MHD)

The definition of disability for MO HealthNet is the same definition used to determine disability for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.

The Social Security Act defines disability as:

  • the inability to engage in any substantial gainful activity (SGA) due to a physical or mental impairment(s) which:
  • can be expected to result in death or
  • has lasted or can be expected to last for a continuous period of at least 12 months.
  • SGA is the ability to be employed and earn over $1,180 per month (2018).

Disability Definition for Ticket to Work Health Assurance (TWHA)

The disability definition for the TWHA Medicaid program is slightly different:

  • A person earning above the SGA who otherwise meets the disability requirement may qualify for Medicaid through the TWHA program.
  • A person with a medically improved condition may qualify for TWHA.

Medicaid Disability Determination Process - training slides about the Disability Determination Process from 04/2018.