An applicant or customer with a temporary or chronic medical condition may have an illness or injury serious enough to prevent the person from working or participating in activities.
When a determination of a medical barrier is pending or is under appeal, do not require the customer to participate in a work or training activity. You may include a work and training activity in the customer's RSP while the determination is pending only if the customer:
- is able to participate in the activity despite the medical barrier, and
- volunteers to participate in the activity.
Activities relevant to establishing the medical barrier (e.g., keeping medical appointments, obtaining medical information, etc.) must be included as part of the customer's RSP. Self-sufficiency activities other than work and training activities (e.g., parenting classes) that are appropriate to the customer, may be included in the RSP as long as the customer's barrier does not prevent the customer from participating in them. A sanction may be imposed based on failure to participate in other self-sufficiency activities if the customer does not have good cause.
The Client Assessment Unit (CAU) decides whether or not the person has a temporary or chronic medical barrier. The decision is based on medical reports and social data. FCRC staff gather medical evidence, use observation, and include other case facts when submitting a request to CAU for a determination that a barrier exists. A minor ailment or injury, such as a cold, broken finger, or rash, is not normally serious enough to be a barrier. A licensed physician (including a licensed psychiatrist, osteopath, or other medical doctor) or licensed or certified psychologist must verify the person's physical or mental impairment and its effect on their ability to work or participate in work and training activities. Send the information to CAU for a determination of medical status.
A CAU determination is not required to approve a medical barrier due to pregnancy six (6) weeks prior to expected delivery date and twelve (12) weeks after delivery. Approve a medical barrier without submitting medical information to CAU if a verified pregnancy and delivery is within this time frame.
If a pregnant woman states she is unable to work due to complications earlier than the 6-week period prior to her due date, a CAU determination is required.
When CAU determines that the person has a medical barrier, they also determine if the medical barrier is "chronic" or "temporary." When CAU determines that the person can do some type of work, their finding will be one of "no medical barrier." Provide the applicant or customer with written notice of the decision on a medical barrier.
Refer a person to the Division of Rehabilitation Services (DRS) if the medical barrier determination is approved and a referral is appropriate.
Once CAU finds "no medical barrier", the person's RSP may include Work and Training actitivies unless the person appeals the CAU decision. If the appeal decision upholds CAU's denial, revise the RSP to include Work and Training activities. Once a decision has been made by CAU, or by Hearings if appealed, do not resubmit medical information to CAU unless there is a change in the person's condition. If the person claims a new condition, or a worsening of the original condition, follow the process for a pending medical barrier.
Once a medical condition is verified, continue to recognize the barrier until a review shows the person is medically able to work or participate in work and training activities. When medical help is available, the applicant or customer must accept treatment, unless they have good cause. For example, good cause exists if the treatment is experimental or unusual and could be very risky to the applicant or customer.
When CAU determines that a person should also apply for SSI, they will advise the FCRC that the person needs to apply for SSI disability benefits. Refer a customer who needs assistance with the SSI application or appeal process to a legal clinic for advocacy.
Once CAU determines that a person should apply for SSI, they are required to apply for SSI as a condition of eligibility for cash benefits. If the person fails or refuses to apply for SSI and is required to be in the TANF case, SWAP the case. If the person is an optional unit member, delete the person from the case.
Once SSI application is made, update the RSP to include cooperation with the SSI disability process. This includes cooperation with the Social Security Administration, and following through with legal assistance if referred for advocacy. If the person refuses or fails without good cause to cooperate with the SSI determination of disability, impose a sanction.
Review of Medical Barrier
Review the medical barrier as needed, based on specific case facts. Send the customer's current medical records and relevant social data to CAU for a determination of whether a customer's medical condition continues to prevent them from working or completing work and training activities. If the customer still has a medical barrier, continue to recognize it until the next review.
If the customer no longer has a medical barrier, send the customer a notice of the decision. The notice states that the customer must now complete work and training activities or be subject to sanction for failure to participate.