Elderly or Persons with a Disability - NA Requirements
(01/01/19 - 12/31/19)
An NA participant is considered an elderly participant or a participant with a disability when they meet at least one of the following:
Is 60 years of age or older. Consider a participant elderly for NA in the month they turn 60. AZTECS then displays the NA case Type as Special (SP or SPE) on CAP2, FSAD, and FSBH. (See Special NA Cases)
When a participant turns 60, AZTECS sends the Request for Medical Expenses (X003) notice. When the X003 is returned, see Effecting Changes. When there is no response to the X003, no action is required.
Receives SSI benefits under Title XVI or SSA disability or benefits for the blind under Title I, II, X, XIV, or XVI of the Social Security Act.
Persons certified for, but not actually receiving SSI or RSDI, are considered a participant with a disability when they present an SSA Disability Notice or when they have been approved for either of the following:
SSI presumptive disability payments
SSI emergency advanced payments
A participant may remain certified for disability benefits when their checks are entirely recouped to recover an overpayment. When this is the case, consider the participant to have a disability.
Receives long term disability payments from Arizona State Retirement System (ASRS).
Is a veteran with a service connected or nonservice connected disability. The VA must have rated the disability as total or paid as total under Title 38 of the U.S. Code. Veterans may be rated as having total disability, yet not be paid 100% of VA benefits. Do not confuse the percentage of payment with a rating of disability in determining a disability status for NA.
Is a veteran the VA considers to be in need of regular aid and attendance, or permanently housebound under Title 38 of the U.S. Code.
Is a veteran's surviving spouse(g) and considered in need of aid and attendance or permanently housebound under Title 38 of the U.S. Code. (There is no requirement that they receive payments from the VA.)
Is a veteran's surviving spouse or child who the VA considers to be entitled to benefits for a service-connected death or pension benefits for a nonservice connected death under Title 38 of the U.S. Code. In addition, the surviving spouse or child has a disability considered to be permanent under Section 221(i) of the Social Security Act. There is no requirement that the survivor actually receive entitled VA benefits.
Entitled to benefits means they are approved for the benefits, whether they are or are not receiving the benefits yet.
Receives disability retirement benefits from a federal, state or local government agency because of a disability considered permanent under Section 221(i) of the Social Security Act.
For participants to be considered disabled under Section 221(i), verification of the disability is required. The following can be used to verify disability:
Workers documented observation that the participant has one of the disabilities listed in Social Security Administration's (SSA) most current list of permanent disabilities.
Statement from a physician or licensed or certified psychologist certifying that the participant has one of the permanent disabilities listed by SSA.
NOTE The SSA list of permanent disabilities can be located by completing an online search for Listing of Impairments.
The worker’s documented observation must not include the medical condition of the participant.
Receives a disability annuity under Section 2(a)(1)(v) of the Railroad Retirement Act of 1974 and meets either of the following conditions:
Has been determined eligible for Medicare by the Railroad Retirement board.
Is considered a person with a disability based on the criteria used under Title XVI of the Social Security Act.
Receives Medicare under Title XIX, Part A of the Social Security Act.
Receives disability compensation through the Federal Employee Compensation Act (FECA).
Approved for AHCCCS Long Term Care System (ALTCS).
Special considerations do not apply to participants who are Elderly or have a disability and they are disqualified from participation for any reason.
A participant may be listed as having a disability for the following areas of policy and still not meet the disability requirements for NA:
Work registration exemption
Other disability benefits