WAG 03-06-05-a: Exception Reasons

PM 03-06-05-a

One or more of the following reasons must exist for an exception to be approved or continued. The Family Community Resource Center must obtain the verification indicated for the reason(s) appropriate to the customer's situation. The Family Community Resource Center submits the verifications to the Bureau of Policy Development (BPD) with a case summary that contains the Family Community Resource Center recommendation regarding the exception and, if applicable, a review date.

SSI Disability application pending

  1. (FCRC) Print a SOLQ clearance to verify the status of the customer's SSI application.
  2. (FCRC) Obtain a CAU determination using the Medical Evaluation series (Forms 183A, 183B, and 183C), the same as for a medical barrier (see WAG 21-01-04-a).

    NOTE 1: Always use Client Assessment Unit (CAU) Memorandum (Form 183F) to send Forms 183A and 183B to CAU. Mark the box labeled "60-month Exception." Marking this box alerts CAU that they need to make 2 determinations on the medical information submitted: 1) probably eligible for SSI and 2) medical condition.

    NOTE 2: Obtain Form 183A from each doctor the person sees. Ask the customer to sign Authorization to Release Medical Records (Form 4701H) for each provider to be sent Form 183A. A person with multiple health problems usually sees more than one doctor. In addition to Form 183A, the doctor's progress notes are usually needed. 

    1. If CAU already approved a medical barrier that has not expired, use that determination as follows.
      • If CAU indicated the customer should apply for SSI, no further CAU approval is needed.
      • If CAU did not indicate the customer should apply for SSI, resubmit the previous information with Form 183F to CAU requesting a determination of "probably eligible for SSI."
  3. (CAU) Decides if the customer is "probably eligible for SSI." If not "probably eligible for SSI," determines if the customer meets the Medical Condition reason. CAU notifies the FCRC via Form 183C of their decision. TANF customers who request an exception based on disability who are found "probably eligible for SSI" by CAU must have legal representation in order for an exception to be approved for that reason.
  4. (FCRC) If the SSI application is on appeal, verify representation with a written statement from the advocate.

    If the customer does not have representation, refer the customer to an advocate. The customer must follow through with the referral. If no advocate is available or the advocate refuses to represent the customer, representation is not required.

  5. (FCRC) Include cooperation with the SSI application and appeal process and with the advocate in the Responsibility and Services Plan (RSP).
  6. (FCRC) Send the following information to BPD, along with the case summary and recommendation.
    • Forms 183A, 183B, and 183C.
    • Written proof that the person is represented by an advocate, if SSI is under appeal.

Medical condition

CAU must determine that the customer is unable to work at least 30 hours per week.

  1. Obtain a CAU determination using the Medical Evaluation series (Forms 183A and 183B), the same as for a medical barrier (see WAG 21-01-04-a).

    NOTE 1: Always use Client Assessment Unit (CAU) Memorandum (Form 183F) to send Forms 183A and 183B to CAU. Mark the box labeled "60-month Exception." Marking this box alerts CAU that they need to make 2 determinations on the medical information submitted: 1) probably eligible for SSI and 2) medical condition. Include a copy of signed Form 4701H for each medical provider.

    NOTE 2: If CAU determines that the person is "probably eligible for SSI," they inform the FCRC of that via Form 183C.  Include cooperation with the SSI disability process in the customer's RSP.

  2. If CAU already approved the customer for a medical barrier, submit the current CAU determination on Forms 183A, 183B, and 183C to BPD as verification.

    NOTE: Also use this reason for a customer with an SSI application pending if CAU determines they have a medical barrier but do not meet SSI disability standards. 

  3. Submit the written verification to BPD along with the case summary and recommendation.

Intensive program for barrier that prevents full-time work

  1. Verify the program is an approved part of the Responsibility and Services Plan (RSP) with a copy of the RSP.
  2. Obtain written verification from program staff that indicates what the customer's barrier is, how they are participating in the program (including the number of hours per week), and how the barrier may affect their ability to work. Verification may be via Change Progress Report Form (Form 2151A), letter, or other document.
  3. If the customer claims domestic or sexual violence is a barrier to working, see PM 21-01-05-a for definitions of domestic and sexual violence. See PM 21-01-05-b  for acceptable verifications.  
  4. Submit the written verification to BPD along with the case summary and recommendation.

Approved education or training program

  1. Submit a copy of the customer's RSP to verify that his or her education or training program was approved before the end of the 60 months.
  2. Obtain written verification from the school or training provider that the customer is expected to complete the program within 6 months after the 60th month.
  3. Submit the written verification to BPD along with the case summary and recommendation.

Family care barrier

CAU must approve the family care barrier in the same manner as for a customer who has not requested an exception (see WAG 21-01-04-c). When a customer with less than 60 months requests an exception due to care of a child or spouse, follow the procedures to determine if the clock should stop and the procedures for an exception request.

  1. Submit Forms 183A, 183B, and a signed copy of Form 4701H to CAU to obtain a decision.
  2. If CAU approves the customer for a family care barrier, enter code M or Q in Item 73 and code 156 DRD with the CAU review date in Item 80.
    1. Reduce the counter and send Form 4335 if the barrier was reported before the end of month 60.
    2. Do not change the counter if the family care barrier was reported after the end of month 60.
  3. Submit Forms 183A, 183B, and 183C and medical information to BPD along with the case summary and recommendation.

Child approved for MFTD waiver

  1. Review the case to verify if Item 80 code 331 HCBC (MFTD) is present.
    1. If Item 80 code 331 is present, no additional verification is needed.
    2. If the case does not have code 331, contact New Manual MaterialCentral Office 238 at (217) 217-557-7818 to determine if the child has been approved for a waiver.
  2. Submit the case summary and recommendation to BPD.