WAG 19-06-01-l: Code X

new textCATEGORIES SELECTED

Code X lists for categories 02, 03, 04, 06, 92, and 93. 

Category 02, 03, 92, and 93

This code identifies a case with someone determined disabled by CAU who is due for a review of disability by CAU. The PAL code title is REEXAMINATION DUE.

new textCategory 04, 06

This code identifies a case with a person who has a pending, appealed or approved CAU determination for a:

  • medical barrier to participation in work, training, or other self-sufficiency activities; or
  • family care barrier to provide care for a related child under age 18 or a spouse in the home due to their medical condition.

The PAL code title varies depending on the status of the barrier request:

  • Approved barrier - REEXAMINATION DUE; or 
  • Pending CAU barrier determination - REVIEW MEDICAL BARRIER STATUS. PENDING; or
  • Appealed CAU barrier determination - REVIEW MEDICAL BARRIER STATUS. APPEAL.

CASEWORK ACTION

When a case is selected as Code X, do the following, depending on the code title:

new textReexamination Due (All Categories)

The code selects for 02, 03, 04, 06, 92, 93 cases the month before a reexamination is due. For example, a case with a 156 DRD code of 04/02 will select for the 03/02 PAL.

  1. Immediately initiate Medical Evaluation series (Forms 183A, 183B, and 183F).
    1. For 04 and 06 cases, review Item 73 coding on Form 552 to determine which person in the case has an approved barrier and requires the reexam:
      • When a person is coded 2 in Item 73, person's own medical barrier, complete the forms for that person.
      • When a person is coded M in Item 73, care of a child, complete the forms for the related child.
      • When a person is coded Q in Item 73, care of spouse, complete the forms for the spouse.
  2. Send the completed forms along with any previous medical evaluations to CAU for their decision.
  3. Review continued eligibility upon receipt of the CAU determination.
    1. Update code 156 DRD in Item 80 on Form 552 if a reexam is needed.
    2. Delete code 156 DRD in Item 80 and update Item 73 if CAU determines no barrier exists (04 and 06 cases) or the person is not disabled (02, 03, 92, and 93 cases).
    3. For 04 and 06 cases, update the Responsibility and Services Plan (RSP).

Review Medical Barrier Status (TANF)

Pending Medical Barrier Determination

new changeThe code selects for 04 and 06 cases four months after the date a person claimed a barrier to work and training, and Code 156 SUP. BY has been coded P. For example, a case with a 156 DRD code of 04/11 will select for the 08/11 PAL. The code will continue to select until Code 156 is changed or removed.

Determine the status of the barrier request and take action accordingly. 

See WAG 21-01-04-a and WAG 21-01-04-c.

Appealed CAU Medical Barrier Determination

new changeThe code selects for 04 and 06 cases four months after a CAU determination of "no medical barrier" or "no family care barrier" has been appealed, and Code 156 SUP. BY has been coded A. For example, a case with a 156 DRD code of 09/12 will select for the 01/13 PAL. The code will continue to select until Code 156 is changed or removed.

Determine the status of the appeal and take action accordingly.

See WAG 21-01-04-a and WAG 21-01-04-c.