WAG 03-18-01-a: CAU Disability Determination

PM 03-18-01-a

If, at Intake, the client claims to be disabled, review the case file and SOLQ Inquiry information. If the client has been denied SSI due to "not disabled" within the 12 months before the month of TA application and does not have an appeal of the SSI denial pending, ask the client if:

• there has been a change in their medical condition since the SSI denial, or
• there has been a change in other factors such as length of time since working, or reaching age 50, 55, or 60, or
• there is new medical evidence that was not available for the SSI decision.

If the client claims there is not a change in medical condition, available evidence, or other factors, the client is not disabled and is not eligible for Transitional Assistance under Category P3. Review for eligibility under one of the other "not-employable" criteria under Category 07.

If the client claims there is a change, or if the client was not denied SSI in the past 12 months or has an SSI appeal pending, obtain current medical information as follows:

1. (FCRC) During the screening interview, advise the client that current medical information is necessary.
2. (FCRC) If a current medical report is available from the client's doctor or psychiatrist, use that report. If a previous exam was made to determine incapacity for TANF and the findings are current, use that report. Also use any significant medical reports from institutions or hospitals where the person was a patient.
3. (FCRC) If there are no medical reports available from the case record, complete the case information on Report of Incapacity (Form 183A). Ask the client to sign a consent to release medical records for each provider or agency to be contacted (see WAG 03-08-01). Issue Form 183A with attached consent form to the client. Advise the client to return the completed form at the eligibility interview.
4. (FCRC) If current medical reports are not available, or if the client requests help in obtaining medical information, call the SSI Advocacy Services Section to schedule an appointment. SSI Advocacy gives the FCRC the date, time, and place of appointment.
5. (FCRC) Complete Confirmation of Appointment for Physical Examination (Form 3410) in triplicate. Ask client to sign a consent to release medical records (see WAG 03-08-01). Give the original Form 3410, and Form 183A with attached consent form to the client. Send the first copy of Form 3410 to the medical provider, and file the 2nd copy in the case record.
6. (FCRC) Complete the caseworker observations on Form 183B. Form G, attachment to Mail-In Application for Medical Benefits (Form HFS 2378H), may be used in place of Form 183B.
7. (Provider) Completes Form 3410 and Form 183A, and returns them to the FCRC.
8. (FCRC) If Form 183A is not returned by the medical provider within 2 weeks following the date of the examination, contact SSI Advocacy.

   If the client failed to keep the appointment and did not reschedule, review the case file. If the client is eligible for TA under another criteria, authorize Category 07 TA. If the file does not establish TA eligibility, deny the application.

   If the client has rescheduled the appointment, allow the application to pend. If the application pends beyond the established time frame, the delay is third party delay. 

9. (FCRC) When received, send completed Form 183A, Form 183B, [or Form G, attachment to Mail-In Application for Medical Benefits (HFS 2378H)], Client Assessment Unit (CAU) Memorandum (Form 183F), copy of signed consent form, and available medical reports to: 

   Client Assessment Unit
   PO Box 19492
   Springfield, IL 62794-9492

   NOTE: If the client was denied SSI due to "not disabled" in the past 12 months and is claiming a change in medical condition, available evidence, or other factors, send Form 183A and Form 183B [or Form G, attachment to Mail-In Application for Medical Benefits (HFS 2378H)] to CAU under a covering memorandum. Advise CAU of the SSI denial date and the client's statement of the change in medical condition or other factors. Also attach medical information in the case file that has been previously reviewed by CAU. 

10. (CAU) Returns Form 183A, Form 183B [or Form G, attachment to Mail-In Application for Medial Benefits (HFS 2378H)], and Form 183C, along with all supporting medical information, to the FCRC.
11. (FCRC) If CAU returns Form 183C requesting further information, call SSI Advocacy to refer the client for further information. The Department will make payment to secure the additional information.

    NOTE: Do not refer clients to SSI Advocacy for further information without a request from CAU.

    Schedule an appointment with SSI Advocacy. Send Instructions to Client (Form 267) and Form 3410 to the client showing the date and time of the appointment. Enter on Form 3410 the information requested by CAU.

    Allow sufficient time for the client to receive Form 267 and Form 3410 before the appointment date.

    If the client fails to keep the appointment or fails to call to reschedule the appointment, the client is not eligible for Transitional Assistance under Category P3. Review the case file for eligibility under one of the other "not employable" reasons under Category 07. 

12. (FCRC) If CAU returns Form 183C with a determination of "not disabled," the client is not eligible for P3 TA. Deny the application with TAR 18. Review eligibility for Category 07 GA-TA eligibility. If CAU finds the person is eligible or is probably eligible for Category 07 GA-TA due to regularly taking prescribed medication, see WAG 03-18-03.
13. (FCRC) If CAU returns Form 183C with a determination of "disabled," refer the client to SSA to apply for SSI.