SMRT Disability in MN: Eligibility, Process, and Appeals

The State Medical Review Team, or SMRT, is the unit inside the Minnesota Department of Human Services that decides whether you qualify as disabled for state programs like Medical Assistance when you don’t already have a disability award from the Social Security Administration. If you’re pursuing SMRT MN disability certification, the path runs through your county: you apply for Medical Assistance, say you have a disability, and your county, tribal, or state eligibility worker sends a referral to SMRT. SMRT then reviews your medical records on paper and issues a decision.¹

Two boundaries are worth knowing up front. If the Social Security Administration has already found you disabled, you do not need SMRT at all; that federal letter proves disability for state programs.² And SMRT does not pay cash benefits like SSI or SSDI. It only certifies disability status so Minnesota can open the door to its own programs.³

What a SMRT Certification Lets You Access

A SMRT disability certification is the key that unlocks a defined set of Minnesota services:

Medical Assistance (Minnesota’s Medicaid), including MA for Employed Persons with Disabilities (MA-EPD) and MA under the TEFRA option for children with disabilities in higher-income households.
Home and community-based service waivers: Brain Injury, Community Alternative Care, Community Access for Disability Inclusion, and Developmental Disability.
Community First Services and Supports (CFSS).
Special Needs Basic Care (SNBC), a managed-care plan for people aged 18 to 64 with disabilities.
Family Support Grant.
Emergency Medical Assistance.⁴

A SMRT certification also supports excluding a person from managed-care enrollment, establishing certain trusts (including pooled trusts for people 65 and older), and creating asset-transfer penalty exceptions.⁴ SMRT itself does not make disability determinations for SNAP, General Assistance, or Minnesota Supplemental Aid, but those programs will accept a SMRT certification that was originally issued for another program.⁵

How SMRT Decides Whether You’re Disabled

SMRT uses the Social Security Administration’s definition of disability. For adults, that is a physical or mental impairment, or combination of impairments, that prevents you from engaging in substantial gainful activity and is expected to result in death or last continuously for at least 12 months. For children under 18, the impairment must cause marked and severe functional limitations and meet the same 12-month duration requirement.⁶

The team applies SSA’s five-step sequential evaluation:

Step 1: Are you currently engaged in substantial gainful activity? If yes, the claim is denied.
Step 2: Do you have a severe impairment, diagnosed by an acceptable medical source, that limits work or daily activities beyond a minimal level and meets the 12-month duration requirement? If not, denied.
Step 3: Does the impairment meet or equal a condition in SSA’s “Blue Book” listings? If yes, you are certified. For children, the question is whether the impairment functionally equals a listing, meaning marked limitations in two of six functional domains or an extreme limitation in one.
Step 4 (adults only): Can you perform past relevant work? If yes, denied.
Step 5 (adults only): Can you adjust to other work, considering age, education, and work experience? If not, you are certified.⁷

Age carries more weight at Steps 4 and 5 as applicants reach 50, 55, and 60, consistent with the SSA framework.⁷ SMRT does not look at your income. Income and asset tests are handled separately when you apply for the specific program.⁶

How to Start a SMRT Review

You cannot apply to SMRT directly. The process begins when you apply for Medical Assistance and indicate you have a disability. Your county, tribal, or state eligibility worker then submits a referral through the state’s Integrated Services Delivery System. A referral should be submitted even if you have a pending SSA application, because the federal process can take much longer.⁵

Once the referral is in the system, SMRT mails you a packet of forms:

DHS-6125, the Adult Disability Worksheet, or DHS-6126, the Children’s Disability Worksheet.
DHS-6124, Authorization to Release Protected Health Information, which lets SMRT collect your medical records.
DHS-3883, the Education and Work History Form.
DHS-3549, the General Consent/Authorization for Release of Information.³

Wait to send documents until a referral has been verified in the system. Completed paperwork can be sent through the SMRT online upload portal, by fax to 651-431-7457, or by mail to PO Box 64248, St. Paul, MN 55164-0248. The SMRT hotline is 651-431-2493 or 800-235-7396.³

What Medical Evidence to Submit

SMRT decisions are made entirely on paper. There are no in-person meetings or interviews, which makes the quality of your documentation the single biggest factor you control.⁸ Gather medical records, test results, and doctor letters from the past year. The physical exam report should be no more than three months old. Include specialist reports, therapy evaluations, and psychological assessments where relevant.⁹

For children, SMRT also wants the most recent Individualized Education Plan or Individual Family Service Plan and any school-district evaluation summary reports. If a child is in Applied Behavior Analysis therapy, include a current Individual Treatment Plan and updated progress notes.⁹

The Arc Minnesota recommends adding a “bad day” letter, a personal narrative that explains how the disability affects daily life beyond what clinical records show. Put your Person Master Index (PMI) number on every page of every document, and send copies only, never originals.⁸

How Long It Takes

Advocacy groups estimate at least three months from the date SMRT receives the referral and supporting documents, with Disability Hub MN noting a possible range of six weeks to a full year.²¹ Legislative reports put the average at 88 days in fiscal year 2021 and 79 days in fiscal year 2018, with the pandemic-affected fiscal year 2020 average climbing to 116 days.¹⁰¹¹¹²

Common sources of delay include incomplete referral information from the county, slow responses from the applicant, unsigned medical-record authorizations, and lag time in getting records from providers. SMRT may also need to schedule a consultative exam if the existing evidence is thin, which adds time.⁷ If your situation is urgent, ask about expedited processing.

When You Can Get Expedited Review

Four categories of cases now qualify for expedited SMRT processing under Minnesota law effective June 15, 2025:

People in a facility who cannot be discharged without long-term care supports or home and community-based services.
People with life-threatening medical conditions needing urgent access to treatment or medication.
People with a condition on SSA’s Compassionate Allowance List.
Children under age two who have screened positive for a rare disease recognized by national medical registries or evidence-based standards.¹³

The 2025 reforms created a dedicated expedited unit inside DHS and, for the first time, allow hospitals to initiate expedited referrals directly. Previously only county and tribal agencies could start the process. Hospitals making an expedited referral must help the patient complete a Medical Assistance application and submit the supporting medical evidence. For expedited waiver-service reviews, lead agencies must complete MnCHOICES assessments within 15 business days.¹³

How Long Certification Lasts

SMRT certifications are time-limited, lasting between one and seven years depending on age and diagnosis.² When your period nears its end, the county sends a new referral for a Continuing Disability Review. During a CDR, SMRT gathers current medical evidence and asks whether the severity of your impairment has improved since the last review, applying the “Medical Improvement Review Standard” rather than the initial five-step evaluation.⁷

CDRs use their own forms: DHS-6125B for adults and DHS-6126B for children.³⁵⁴ If your SMRT certification ends while you are receiving General Assistance, the agency must give you 30 days to obtain new verification before taking any negative action on benefits.

What to Do if SMRT Denies Your Claim

You have 30 days from the date on the denial letter to file a written appeal, using form DHS-0033. If you want benefits you already receive to continue during the appeal, you must file within 10 days of receiving the notice.¹⁴¹⁵

Hearings are held before a Human Services Judge, usually by telephone. You can bring a representative or attorney, present new evidence, and call witnesses, but evidence must be submitted at least three days before the hearing. The judge issues a recommendation that the chief Human Services Judge reviews before a final decision, typically within 90 days. If that final decision goes against you, you can ask for reconsideration in writing within 30 days or appeal to state district court within 30 days.¹⁴

Realistic expectations matter here. In fiscal year 2021, 69 of 599 SMRT denials were appealed. Of the appeals decided, 65 percent were dismissed, 23 percent were affirmed, and none were overturned, consistent with the pattern in earlier reporting years.¹⁰ Strengthening your medical record before appeal, with help from an advocate or attorney, is often more productive than relying on the appeal alone.

Where to Get Help

The Minnesota Disability Law Center, a program of Mid-Minnesota Legal Aid and the state’s federally designated Protection and Advocacy agency, offers free legal assistance to people with disabilities, including on Medical Assistance matters. You can reach them at 612-334-5970 or 1-800-292-4150.¹⁶ Mid-Minnesota Legal Aid more broadly handles denial and termination of public benefits for low-income people and people with disabilities.¹⁷ For a broader lawyer referral, DHS points to LawHelpMN.org or 888-354-5522.¹⁴

For non-legal guidance, Disability Hub MN and The Arc Minnesota publish checklists and plain-language step-by-step explanations. Disability Hub MN also suggests asking your county worker about any interim services you may qualify for while your SMRT review is pending.¹

1
Disability Hub MN. State Medical Review Team Common Questions
2
The Arc Minnesota. Arc Guide to State Medical Review Team SMRT
3
Minnesota Department of Human Services. State Medical Review Team
4
Minnesota Department of Human Services. Certification of Disability
5
Minnesota Department of Human Services. SMRT Eligibility Policy
6
Minnesota House of Representatives Research Department. State Disability Determinations
7
Minnesota Department of Health. SMRT Training and Process
8
The Arc Minnesota. Arc Guide to the State Medical Review Team
9
Disability Hub MN. SMRT Application Checklist
10
Minnesota Legislature. Activities of the State Medical Review Team Fiscal Year 2021
11
Minnesota Legislature. Activities of the State Medical Review Team Fiscal Year 2018
12
Minnesota Legislature. Activities of the State Medical Review Team Fiscal Year 2020
13
Minnesota Department of Human Services. DHS Bulletin on SMRT Expedited Process
14
Minnesota Department of Human Services. Appeals FAQ
15
The Arc Minnesota. Arc Guide to a Department of Human Services Decision Appeal
16
LawHelp Minnesota. MN Disability Law Center
17
Minnesota Department of Health. Mid-Minnesota Legal Aid