Disability Evaluation Determinations
Who is eligible?
You may be eligible to receive Medi-Cal benefits if you meet one of the following requirements:
- Aged: Persons 65-years old and older
- Blind: Persons who have been declared legally blind by the Social Security Administration or the State Programs - Disability and Adult Programs Division (SP-DDSD).
- Disabled: Persons who have been declared disabled by the Social Security Administration or the State Programs - Disability and Adult Programs Division (SP-DDSD).
If you are 65-years old or older, and/or a person with a disability, you may qualify for free or low-cost health care coverage through the Medi-Cal Program. Examples of services that might be covered through Medi-Cal include: comprehensive preventative care services; primary and/or specialty care medical office visits; vision and dental care; mental health services; hospitalization: and, prescription medications.
For the purpose of receiving Medi-Cal benefits, there are two types of disability:
- Federal disability, as determined by the Social Security Administration.
- State disability, as determined under Medi-Cal.
If you have been determined to be disabled by the Social Security Administration, you are also considered disabled under Medi-Cal regulations.
A person with disabilities who has not been determined to be disabled by the Social Security Administration may still apply to receive Medi-Cal benefits as a disabled individual by simply completing the required disability paperwork and submitting it to the State Programs – Disability Determination Services Division (SP-DDSD). The SP-DDSD determines disability for Medi-Cal using the Social Security Administration’s criteria for disability. Once the paperwork is received, the SP-DDSD will conduct a disability evaluation and send the results to the County.
In the event that the SP-DDSD determines that you are not disabled, you have a right to appeal their decision.
Special Medi-Cal Programs for Seniors and Persons with Disabilities
It is possible for a person to be working and considered disabled at the same time, provided his or her income does not exceed the Substantial Gainful Activity ("SGA") amount that is based on the federal average wage index.
This is one of many special programs designed to assist Seniors and persons with disabilities with their health care needs. To see if you qualify for the 250% Working Disabled Program or other special programs, please contact your local Social Services Agency and initiate an application.