Disability Determination


In order for you to be eligible for Medicaid and Disability Financial Assistance, you must have a qualified disability and a pending application for disability with the Social Security Administration.

So that we may process your claim, you must complete Disability Determination Packet.

In this packet, you will find the following:

  1. Social Summary Form (to be completed by the client or an authorized representative)
  2. Basic Medical Form (to be completed by medical providers)
  3. Medical Dependency Form (to be completed by medical providers)
  4. Mental Functioning Form (to be completed by medical providers)
  5. Release forms (signed by the client or an authorized representative and granting up permission to obtain any medical records from the last 18 months that support the disability claim)
  6. Verification request that the client has applied for Social Security disability

Please submit all necessary documentation within thirty days so that we may explore your eligibility.

Please note: If you are approved for Medicaid and Disability Financial Assistance, we cannot continue your coverage unless your disability application with Social Security is pending or, if you were recently denied, in the process of appeal.

All forms and required documentation should be mailed to SCDJFS Disability Determination Unit, 37 North Main Street, Akron, Ohio 44308. You or your medical provider(s) may also fax the information to 330.643.7144, ATTN: DDU. If you have questions or need further assistance, please contact the DDU Unit at 330.643.8603.