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Legal Q.
Jun 9, 1997

Just how sick does a person have to be to qualify for disability and medicaid benefits?

Response from Ms. Franzoi

I am unable to answer your question re:Medicaid. I suggest you call the Public Social Services Department for the county you live in. For example, in Los Angeles you would look in the phone directory under the county of Los Angeles for the number for the Public Social Services Department and request information regarding filing for Medicaid as it is called in LA County. If you are talking about Medicare and not Medicaid, Medicare requires that you be disabled and have been entitled to Social Security disability benefits for at least two years before Medicare is available. The best way to see if you qualify for Social Security disability benefits is to contact the Social Security administration. Each case is different and whether or not you are determined to be disabled will depend on the limitations you have with respect to employment. To qualify for Social Security disability benefits, you must have worked long enough to qualify for benefits. Disability under the Social Security program means severely impaired, physically or mentally, so that you cannot perform any substantial gainful work. The impairment must be expected to last at least 12 months or to result in earlier death. The determination is based on medical evidence and is usually made by a government agency in your state.

If you are talking about an individual disability policy, you need to look at the terms of the policy. Usually the policy will define disability as "unable to perform the functions and material duties of any occupation for which you are reasonably qualified based on your education, training or experience."

- Lynn Franzoi



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