WorkFirst HandBook

Resolving Issues

6.8 Exemptions

The Exemptions section includes:

• 6.8.1 What are exemptions?
• 6.8.2 Infant exemptions
• 6.8.3 Older needy caretaker relative exemptions
• 6.8.4 Caring for a child with special needs
• 6.8.5 Caring for an adult relative with disabilities
• 6.8.6 Adults with chronic and severe disabilities
• 6.8.7 SSI Referrals
• 6.8.8 DVR Referrals
• 6.8.9 Can exempt parents voluntarily participate?
• 6.8.10 eJAS codes
• 6.8.11 Exemptions - Step-by-Step Guide

6.8.1 What are exemptions?

Exemptions waive participation for individuals who are not able to actively participate in working, looking for work or preparing for work. We may lift participation requirements and approve exemptions for parents of infants and older needy caretaker relatives. Individuals may be granted an exemption if they:

1. Are the parent or legal guardian of an infant age 12 months or less,
2. Are a needy caregiver relative and aged 55 or older,
3. Have a severe and chronic medically verified condition (including individuals likely to be approved for SSI or other federal benefits),
4. Are required to be in the home to care for a child with special needs, or
5. Are required to be in the home to care for an adult relative with a severe and chronic medical condition.

Individuals who have health or family issues that temporarily interfere with their ability to work should be deferred (instead of exempt) from job search and other WorkFirst activities. See WFHB 6.3, Deferrals , for more information.

Documentation to support an exemption may come from a variety of sources based on the individual's situation. Medical documentation must be objective and adequate to identify the severity of the disability. Exemptions cannot be approved without the appropriate documentation.

6.8.2 Infant exemptions

For the Infant Exemption see WFHB 5.1, Pregnancy to Employment and WAC 388-310-0300 and WAC 388-310-1450 (exemption from full-time participation for a maximum of twelve months in a lifetime if caring for an infant less than one year of age).

6.8.3 Older needy caretaker relative exemptions

For an older, needy caretaker relative, proof of age (55 or older) is all that is needed to approve an exemption. These exemptions do not require periodic reviews to determine if the relative continues to meet exemption criteria.

6.8.4 Caring for a Child with Special Needs

We may approve an exemption for an individual who is needed in the home to care for a child with a special medical, developmental, mental or behavioral condition when the child is determined to require specialized care or treatment that significantly interferes with the individual's ability to prepare for work, look for work or work.

Documentation may include statements by a public health nurse, physician, mental health provider, school professional, other medical professional, HCS, MHD and/or a RSN.

To determine whether the individual qualifies for an exemption:

• Require the individual to provide documentation within 30 days, or up to 90 days if needed, which supports the need for the exemption including medical documentation.
• Complete a social worker assessment as needed
• Review the documentation and determine exemption approval or denial. If the documentation shows the parent can participate 10 hours or less per week, approve the exemption.

The exemption must be reviewed at least every 12 months to determine if the person continues to meet the exemption criteria. Depending upon the individual's circumstances, the review period may be shorter. You may also consider convening a case staffing as you review the case. See the 3.5 Case Staffing section for more information.

See 6.4 Children: Special Needs section for more information about children with special needs. See also Examples of Caring for a Child with Special Needs.

6.8.5 Caring for an adult relative with disabilities

We may approve exemptions for individuals needed in the home to care for an adult relative with a verified disability who cannot be left alone for significant periods of time and the individual is the only one available to provide care. Exempt the individual if she or he can only participate 10 hours or less per week because of providing this care.

Documentation includes evidence of disability from a medical/mental health professional or from DDD, DVR, MHD, RSN or HCS. The exemption approval process and review requirements are the same as those for Children with Special Needs.

6.8.6 Adults with chronic and severe disabilities

We may approve exemptions or long-term deferrals for adults with chronic and severe disabilities. To make the exemption/deferral decision:

• Follow the process described in WFHB 6.6, Disabilities to obtain objective medical evidence to document the need for an exemption/deferral.
• Complete a social worker assessment.
• Complete any needed Equal Access screening or update of the individual's Accommodation Plan.
• Use the medical evidence to determine if the condition is chronic and severe.
• Chronic means the condition is expected to last 12 months or more.
• Severe means the person is able to participate 10 hours or less per week.

If the medical evidence shows the person has a chronic and severe physical, mental or emotional disorder:

• Approve XB and make an SSI referral, following the process in 6.8.7 below. If the person refuses to cooperate with the SSI referral process, determine good cause for refusal to participate.
• Also approve a 12-month XG or XM deferral if the medical condition is responsive to treatment and treatment is available.
• If the medical condition is not expected to respond to treatment, the person is potentially eligible for an exemption. However, we do not approve the exemption unless the SSI referral process shows the person is unlikely to qualify for SSI.

SSI referrals (XB), exemptions (ZD) and long-term deferrals (XG or XM) must be reviewed at least every 12 months to determine if the person continues to have a chronic and severe medical condition.

6.8.7 SSI Referrals

A person with chronic and severe disabilities may be approved for SSI, resulting in more income and long-term assistance and on-going medical assistance. However, it can take six to 12 months (or more) to get a final decision.

As shown on the SSI Track Flow Chart , determine who may receive facilitated SSI applications (similar to the GAX process) as follows:

• The social worker (Incapacity Specialist or WorkFirst Social Worker, as decided locally):
• Uses the results of the social worker assessment and the DSHS 14-332 , Disability Assessment, to determine when a person potentially meets SSA disability criteria. See Helpful Social Services Manual Links for more information.
• Determines if additional medical evidence may be needed, including:
• Chart notes back to the original diagnosis by a physician and copies of lab results (such as X-rays, blood work and MRI's).
• Psychological exam, which may include psychological testing to establish or rule out conditions such as cognitive impairments. You can expect to purchase an evaluation if the person has never accessed the services of a psychologist or psychiatrist under Medicaid.
• Helps the parent obtain the evidence, as needed, and ensure they understand they do not need to pay the costs, if any.
• If the person has already applied for SSI on his or her own, notifies the SSI Facilitator so they can track the application,
• If SSI appears unlikely:
• Removes the XB code
• Approves a ZD exemption or maintains the long-term XG or XM deferral
• Considers a DVR referral, and
• Refers the case back to WorkFirst staff.
• If SSI appears likely, refers directly to the SSI Facilitator with the DSHS 14-050 and all relevant medical records.
• If it is unclear whether SSI appears likely, creates the contracted physician disability packet, including:
• DSHS 14-050 , Statement of Health, Education and Employment
• Recent medical records and all relevant medical records that help to establish duration of impairment or show treatment history.
• Completes the DSHS 14-507, Disability Assessment: TANF Referral in the barcode TANF Disability Assessment subsystem.
• Refers the case to the contracted physician using the barcode TANF Disability Assessment subsystem. See TANF Contracted Physician Referral Desk Aid for instructions.
• Regardless of who is handling the contracted physician referral and/or SSI facilitation, the WorkFirst Social Worker will:
• Issue needed support services
• Maintain eJAS component codes,
• Maintain the person's IRP, and
• Provide any desired DVR referrals.
• The contracted physician will:
• Certify when a person appears to meet SSI Disability criteria
• Authorize purchase of additional medical evidence and/or describe additional steps to take when evidence is inadequate
• Provide a DSHS 14-507, Disability Assessment: TANF Decision form with their disability determination and reasons for approval or denial.
• The social worker assigned to the case will:
• Refers denials back to WorkFirst as exempt or in long-term deferral. The only activity we require for these cases is treatment if it is available and helpful. The social worker also considers a DVR referral if the parent wants to work.
• The SSIF will:
• Facilitate and track the person's SSI claim.
• Review SSI denials to decide whether to pursue reconsideration.
• Authorize additional testing with an approved ETR if needed for the reconsideration.
• Refer cases that are not appropriate for SSI reconsideration back to the WorkFirst Program Specialist or Social Worker for exemption or continued long-term deferral and possible DVR referral.
• The SSIF also tracks SSI applications that parents have filed on their own, but found unlikely to be approved.

6.8.8 DVR Referrals

You may also refer individuals with a chronic and severe medical condition to DVR, following the process in the Social Services Manual - DVR , if they want to become employable. If accepted into the program, DVR can provide:

• Services to eliminate, circumvent, or mitigate an impediment(s) to employment;
• Support services, like transportation, adaptive devices, child care, and services to family members; and
• Assessment, diagnostic and evaluation services to develop employability plans.
• See Reporting DVR Plan Hours for coding and reporting hours.

6.8.9 Can exempt parents voluntarily participate?

Exempt individuals may voluntarily participate. WorkFirst will provide services or refer voluntarily participating individuals to other service providers to help them enhance their employability and move into employment.

For those who voluntarily participate, do not remove the eJAS exemption codes so you can ensure that sanction will not be imposed for failure to participate.

6.8.10 eJAS codes

Use the following codes on the eJAS component code screen when an individual is approved for an exemption or long-term deferral:

• ZA (approved exemption for an older caretaker relative)
• ZB (approved exemption for an individual needed in the home to care for a disabled adult relative)
• ZC (approved exemption for an individual needed in the home to care for a child with special needs)
• ZD (adult with severe and chronic disabilities that are not amenable to treatment)
• XB (pursuing SSI/L&I/VA or other benefits) Used to indicate cases being assessed for a facilitated SSI application or accepted for SSI Facilitation.
• XD (indicates the parent has DVR-required rehabilitation activities and/or time spent with the DVR counselor)
• XG (mental health condition and required to access available, helpful treatment)
• XM(physical condition and required to access available, helpful treatment)

Resources

Related WorkFirst Handbook Chapters

• 6.1 Resolving Issues - Overview
• 3.5 Case Staffing
• 6.4 Children: Special Needs
• 6.6 Disabilities

Other Resources

• Examples of Caring for a Child with Special Needs
• Reporting DVR Plan Hours
• TANF Contracted Physician Referral Desk Aid
• SSI Track Flow Chart
• DSHS 14-332, Disability Assessment
• DSHS 14-050, Statement of Health, Education and Employment
• Helpful Social Services Manual Links
• DSHS 14-012(X), Authorization to Obtain/Release Information form