Section 388-449-0001 - What are the disability requirements for the aged, blind, or disabled (ABD) program?(1) For the purposes of this chapter, the following definitions apply: (a) "We" and "us" mean the department of social and health services.(b) "You" means the applicant or recipient.(c) "Disabled" means the inability to engage in any substantial gainful activity (SGA) by reason of any medically determinable physical or mental impairment(s) which has lasted or can be expected to last for a continuous period of not less than 12 months with available treatment or result in death.(d) "Physical impairment" means a diagnosable physical illness.(e) "Mental impairment" means a diagnosable mental disorder. We exclude any diagnosis of or related to a substance use disorder.(2) We review if you meet disability requirements when:(a) You apply for ABD cash benefits;(b) You become employed; or(c) A disability review is required under WAC 388-449-0150.(3) You are likely to meet disability requirements if:(a) You are determined to meet SSA disability criteria by the Social Security Administration (SSA);(b) You are determined to meet SSA disability criteria by disability determination services (DDDS) based on the most recent DDDS determination;(c) SSA stops your supplemental security income (SSI) payments solely because you are not a citizen;(d) You are eligible for services through the developmental disabilities administration (DDA) for a medical condition that is expected to last 12 months or more or result in death;(e) You are eligible for long-term care services from the aging and long-term support administration (ALTSA) for a medical condition that is expected to last 12 months or more or result in death;(f) You have been civilly committed to eastern or western state hospital;(g) You have been placed in eastern or western state hospital for an offense you have been found not guilty by reason of insanity;(h) You have been diagnosed as having an intellectual disability based on a full scale score of 70 or lower on the Wechsler adult intelligence scale (WAIS); or(i) You are approved through the sequential evaluation process (SEP) defined in WAC 388-449-0005 through 388-449-0100. The SEP is the sequence of five steps. Step 1 considers whether you are currently working. Steps 2 and 3 consider medical evidence and whether you are likely to meet or equal a listed impairment under Social Security's rules. Steps 4 and 5 consider your residual functional capacity and vocational factors such as age, education, and work experience in order to determine your ability to do your past work or other work.(4) If you have a physical or mental impairment and you are impaired by a substance use disorder and do not meet the other disability criteria in subsections (2)(a)- (c) of this section, we decide if you are eligible for ABD cash by applying the sequential evaluation process described in WAC 388-449-0005 through 388-449-0100. You are not eligible for ABD cash benefits if you are disabled primarily because of a substance use disorder.(5) In determining disability, we consider only your ability to perform basic work-related activities. "Basic work-related activities" are activities that anyone would be required to perform in a work setting. They consist of: Sitting, standing, walking, lifting, carrying, handling, and other physical functions (including manipulative or postural functions such as pushing, pulling, reaching, handling, stooping, or crouching), seeing, hearing, communicating, remembering, understanding and following instructions, responding appropriately to supervisors, co-workers, and usual work situations, maintaining appropriate behavior, and adapting to changes in a routine work setting.(6) We determine you are not likely to meet disability criteria if SSA denied your application for SSI or Social Security Disability Insurance (SSDI) based on disability in the last 12 months unless: (a) You file a timely appeal with SSA;(b) SSA decides you have good cause for a late appeal; or(c) You give us medical evidence of a potentially disabling condition that SSA did not consider or medical evidence confirming your condition has deteriorated.Wash. Admin. Code § 388-449-0001
Amended by WSR 13-24-040, filed 11/26/13, effective 1/1/2014Amended by WSR 15-03-031, Filed 1/12/2015, effective 2/12/2015Amended by WSR 22-07-020, Filed 3/8/2022, effective 4/8/2022Amended by WSR 23-01-057, Filed 12/14/2022, effective 1/14/2023Amended by WSR 24-07-052, Filed 3/14/2024, effective 4/14/2024Statutory Authority: RCW 74.04.005, 74.04.050, 74.04.055, 74.04.057, 74.04.510, 74.08.090, 74.08A.100, 74.04.770, 74.04.0052, 74.04.655, 74.08.043, 74.08.335, and 2011 1st sp.s. c 36. 12-10-042, § 388-449-0001, filed 4/27/12, effective 6/1/12.