Disability Determination - Review of Disability

Revised on August 15, 2024

WAC 388-449-0150 When does my eligibility for the Aged, Blind, or Disabled (ABD) cash benefits end?

Review and Termination of ABD Cash

1. The Disability Specialist must review current medical evidence and determine whether the individual meets ABD disability criteria detailed in WAC 388-449-0001 (3) at least every 24 months.
   
   1. The Disability Specialist must initiate the Disability Review far enough in advance to request and consider available medical evidence from the individual's treating medical providers and request clarification and/or additional medical records when necessary to determine ongoing ABD eligibility.
   2. An ABD Disability Review is not required for recipients aged 65 or older.

2. The Disability Specialist may initiate an early Disability Review at any time if the Department receives information indicating that the individual is no longer likely to meet SSI disability criteria.
3. Eligibility for ABD cash ends when a final disability determination is made by the Social Security Administration (SSA) or when the individual no longer meets ABD disability criteria detailed in WAC 388-449-0001 (3).
4. A final disability determination includes an SSI or SSDI denial at the SSA Appeals Council level or an unfavorable determination at the initial, reconsideration, or hearing level for which the individual fails to file a timely appeal (and SSA has not granted good cause for a late appeal).
5. When SSA denies an application at the Initial, Reconsideration, or Hearing level, the SSI Facilitator reviews the SSA determination and performs a brief review of all available medical evidence to identify if the client's conditions have improved or deteriorated.
   
   1. If the client no longer appears to meet ABD disability criteria, the SSI Facilitator notifies the Disability Specialist that an early Disability Review is needed. The Disability Specialist reviews the medical evidence in detail and, if warranted, requests current medical evidence.
   2. If the client appears likely to meet ABD disability criteria, the SSI Facilitator determines an early ABD Disability Review is not necessary and continues with the SSI Facilitation process.
6. If SSA denied the application due to income or resources, the Disability Specialist or SSI Facilitator notifies financial regarding the denial. Financial reviews the case to determine if the client continues to meet ABD income and resource requirements.
   
   1. ABD recipients must follow through with the SSI application process which may include spending down or selling resources. Refer to the SSI Facilitation Participation in the SSI Process and Medical Treatment section for more information.
7. If SSI/SSDI was denied or terminated due to a failure to follow an SSA program rule or application requirement, we consider ABD eligibility once the client takes necessary steps (within their power) to resolve their non-cooperation.  Example: Client denied due to failure to follow through with Consultative Examination (CE).
   
   1. Failing to follow an SSA program rule or application requirement is not the same as failing to meet an SSA program rule or requirement. For example, if a client has failed to meet eligibility criteria (e.g., resources), we would still consider ABD eligibility.

NOTE: 

1. If the individual is coded as Equal Access (EA), the Disability Specialist and SSI Facilitator must follow all requirements of the EA plan when reviewing disability and document steps taken.

a. Screen for EA and implement any necessary accommodations when an individual frequently fails to follow through and/or expresses difficulty understanding program requirements.

Related Procedures (Staff Only):
Determining ABD Eligibility after a Final Disability Determination

Disability and Incapacity Reviews

Determining a New or Worsening Condition after an ABD Termination

ABD Early Disability Review