Library: Policy
340:50-5-4. Definition of elderly or disabled household member
Revised 9-15-21
(a) Definition of elderly or disabled. Per 271.2 of Title 7 of the Code of Federal Regulations (7 C.F.R. § 271.2), an elderly or disabled household member is defined as a person who:
(1) is 60 years of age and older;
(2) receives Supplemental Security Income (SSI) under Title XVI of the Social Security Act or disability or blindness payments under Titles I, II, XIV, or XVI of the Social Security Act;
(3) receives federal- or state-administered supplemental benefits under Section 1616(a) of the Social Security Act based upon the disability or blindness criteria used under Title XVI of the Social Security Act;
(4) receives federal- or state-administered supplemental benefits under Section 212(a) of Public Law 93-66;
(5) receives disability retirement benefits from a government agency because of a disability considered permanent under Section 221(i) of the Social Security Act;
(6) is a veteran with a service-connected or non-service-connected disability rated by the United States Department of Veteran's Affairs (VA) as total or paid as total by the VA under Title 38 of the United States Code. Benefits may be considered compensation or pension;
(7) is a veteran considered by the VA to be in need of regular aid and attendance or permanently housebound under Title 38 of the United States Code;
(8) is a surviving spouse of a veteran who VA considers in need of regular aid and attendance or permanently housebound or is a surviving child of a veteran and considered by the VA to be permanently incapable of self-support under Title 38 of the United States Code (U.S.C.);
(9) is a surviving spouse or surviving child of a veteran and VA considers to be entitled to compensation for a service-connected death or pension benefits for a non-service-connected death under Title 38 of the U.S.C and has a disability considered permanent under Section 221(i) of the Social Security Act. "Entitled" as used in this definition refers to those veterans' surviving spouses and children who are receiving VA compensation or pension benefits, or who were approved for the payments but are not receiving them yet;
(10) receives an annuity payment under Section 2(a)(1)(iv) of the Railroad Retirement Act of 1974 and, is determined to be eligible to receive Medicare by the Railroad Retirement Board or Section 2(a)(1)(v) of the Railroad Retirement Act of 1974, and is determined to be disabled based upon the criteria under Title XVI of the Social Security Act; or
(11) receives interim assistance benefits pending the receipt of SSI or is a recipient of disability related medical assistance under Title XIX of the Social Security Act, provided that the eligibility to receive these benefits is based upon disability or blindness criteria that are at least as stringent as those used under Title XVI of the Social Security Act, as set forth at 20 C.F.R. Part 416, Subpart I, Determining Disability and Blindness as defined in Title XVI.
(b) Required verification. Per 7 C.F.R. § 273.2(f)(1)(viii), the household must verify that the household member meets one of the disability definitions, per (a)(2) through (11) of this Section before certifying the person as disabled when it affects the eligibility determination. • 1 For a household member to meet the disability definition, per:
(1) (a)(2) through (a)(4) of this Section, the household must provide proof that the household member receives benefits under Titles I, II, X, XIV, or XVI of the Social Security Act;
(2) (a)(6) of this Section, the household must provide a statement from the VA that clearly indicates the disabled household member receives VA disability benefits for a service-connected or non-service-connected disability and that the disability is rated as total or paid at the total rate by VA;
(3) (a)(7) and (8) of this Section, proof that the household member receives VA disability benefits is sufficient verification of disability;
(4) (a)(5) and (9) of this Section, the household member must have a condition(s) that keeps him or her from pursuing a substantial, gainful activity for 12 months despite adherence to prescribed treatment. Refer to the Social Security Administration's (SSA) current list of disabilities considered permanent, per 20 C.F.R. § 416.925 and 20 C.F.R. Appendix 1 to Subpart P of Part 404. • 2 When it is:
(A) obvious to the worker that the person has one of the listed disabilities, the household is considered to have verified the household member's disability; or
(B) not obvious to the worker, the household must provide a statement from a physician or licensed or certified psychologist certifying that person has one of the nonobvious disabilities listed;
(5) (a)(10) of this Section, the household must provide proof the household member receives a Railroad Retirement disability annuity from the Railroad Retirement Board and was determined to qualify for Medicare; or
(6) (a)(11) of this Section, the household must provide proof that the individual receives interim assistance benefits pending SSI receipt or SoonerCare (Medicaid) benefits based on categorical relationship to disability.
(c) Disability related to purchasing and preparing meals. A household member who is 60 years of age and older and his or her spouse may be considered a separate household, per §273.1(b)(2) and Oklahoma Administrative Code 340:50-5-1 when the person suffers from a disability considered permanent by SSA, per 20 C.F.R. § 416.925 and 20 C.F.R. Appendix 1 to Subpart P of Part 404, or a non-disease-related, severe, permanent disability and is unable to purchase and prepare meals. • 3 When it is:
(1) obvious that the person is unable to purchase and prepare meals because he or she suffers from a severe physical or mental disability, the person is considered disabled for this provision even when the disability is not listed on the SSA list; or
(2) not obvious, the household must provide a statement from a physician or licensed or certified psychologist certifying that the person is unable to purchase and prepare meals because he or she suffers from one of the nonobvious disabilities mentioned in the SSA list or some other severe, permanent physical or mental disease or non-disease-related disability.
INSTRUCTIONS TO STAFF 340:50-5-4
Issued 9-15-21
1. The worker must document what proof was provided to verify the household member meets one of the disability definitions in Family Assistance/Client Services (FACS) case notes.
2. The worker may contact the Oklahoma Health Care Authority's Level of Care Evaluation Unit for assistance when needed.
3. The worker must document how he or she determined that the household member is unable to purchase and prepare meals in FACS case notes.
