WAG 02-09-06-c

For determination of a medical barrier, see PM 03-13-02-b.

Medical Barrier Pending or Under Appeal

revised pageWhen 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.

Support 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 Support Activities if the customer does not have good cause.

Medical Barrier Denied

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.

Medical Barrier Approved

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.

CAU Determines SSI Application is Required:

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 (PM 01-02-03). 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.

Suggested Support Activities (PM 21-04-00)

  • Medical/Family Care Services(establishing barrier, treatment)
  • Child Support/Financial Resources (cooperation with SSI advocacy)
  • Other Support activities as needed.