NOTE: Effective April 1, 2014, qualified hospitals will be able to make presumpatientive disability determinations for certain MA and BadgerCare populations.
If MA is essential to have in place in order to discharge the patient, it is sometimes quicker to go through the County Income Maintenance Office, applying for MA Presumptive Disability.
County Human Service Depatients have the authority to approve a Request for a Presumptive Determination (PD) of Disability.
- The case requires the form HCF 10130
- On that form at least one box out of the first four in Section 1, and at least one box in Section II needs to be checked. Some Counties will approve a PD on that evidence alone. Other Counties have specific diagnoses they are allowed to approve. If the County itself does not approve the PD request, read further.
Medicaid mandates that the Disability Determination Bureau (DDB) make a finding (approval or denial) within 3 working days upon receiving a County MA Disability (MADA) application with a Presumptive Determination (PD) Request included.
- Unfortunately with the high caseloads that the County Caseworkers are dealing with, it may take weeks before the case is sent to the DDB, and it may take weeks before the patient is notified as the County has to officially approve the MA financial criteria
- Per Joan Corcoran, counties have 30 days to process all applications and submit to the DDB, regardless of the type of application
To speed up the process at the County, send in verification documents with the MADA application. Check with the county to see where the verifications should be submitted, as they may need to be sent to the CDP for scanning.
If caseworker asks for more verifications before or after the DDB medical finding, submit as quickly as possible.
When placement or numerous other high cost discharge needs are awaiting this PD decision, Social Worker can alert DDB Liaison.
Presumptive disability is approved as of the date all verification is received.
- Presumptive disability can not be backdated. If the disability determination comes back favorably, MA can be backdated up to 3 months prior to the month of application but no earlier than the disability onset date, provided all other eligibility requirements are met.
Request for Presumptive (DHFS)