6.8 Exemptions

Revised October 19, 2017

Legal References:

The Exemptions section includes:

  • 6.8.1 What are exemptions?
  • 6.8.2 Infant exemptions and infant exemption extensions
  • 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 have mandatory participation requirements?
  • 6.8.10 Can exempt parents voluntarily participate?
  • 6.8.11 eJAS codes
  • 6.8.12 Exemptions - Step-by-Step Guide

6.8.1 What are exemptions?

Exemptions waive requirements for participants who aren't able to actively participate in working, looking for work or preparing for work. We may lift participation requirements and approve exemptions for parents of children under two and older needy caretaker relatives. Grant participants an exemption if they:

  1. Are the parent or legal guardian of a child under two 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. Must be in the home to care for a child with special needs, or
  5. Must be in the home to care for an adult relative with a severe and chronic medical condition.

Defer participants who have health or family issues that temporarily interfere with their ability to work (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 participant's situation. Medical documentation must be adequate to identify the severity and duration of the disability. Exemptions can't be approved without the appropriate documentation.

6.8.2 Infant exemptions and infant exemption extensions

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 twenty-four months in a lifetime if caring for a child less than two years 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 service specialist 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 medical evidence to document the need for an exemption/deferral.
  • Complete a social service specialist 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. You can require the client to apply for medical coverage, as needed, to access treatment. (See WAH Application IRP for suggested IRP language).
  • If the medical condition is not expected to respond to treatment:
    • Do not add the XG or XM to monitor participation in treatment, and
    • If the parent is unlikely to qualify for SSI, approve an exemption (ZD)
      • Examples:
        • The parent does not meet the citizenship requirements for SSU.
        • The parent is denied at the SSI final level (post-appeal) and medical evidence still verifies that they have a chronic and severe disability.

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 health care coverage. 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 ABD process) as follows:

  • The social service specialist (Disability Specialist or WorkFirst Social Service Specialist, as decided locally):
    • Uses information on the DSHS 14-050 and any medical evidence 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 diagnostic reports (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 Washington Apple Health.
    • 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 Service Specialist 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 service specialist assigned to the case will:
    • Refer 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 service specialist 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 Service Specialist 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 have mandatory participation requirements?

Exempt parents may have mandatory participation requirements when they have a severe and chronic disability.  WorkFirst will provide services or refer these parents to service providers that will help them:

  • Pursue SSI or another type of federal disability benefit, which may include gathering objective medical evidence as described in WAC 388-449-0015 in preparation of the SSI application process; and/or
  • Participate in available treatment that is recommended by the parent's medical or mental health provider or chemical dependency professional.

6.8.10 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.

6.8.11 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)

6.8.12 Exemptions - Step-by-step guide

The WorkFirst Program Specialist or Social Service Specialist works with individuals as described below.

  1. Needy Caretakers : Approves exemptions for needy caretaker relatives who are age 55 or older and codes it on the eJAS component code screen as " ZA "
  2. Infant Exemptions : Follows the process in WFHB 5.1, Pregnancy to Employment, to determine eligibility for the infant exemption see WFHB 5.1, Pregnancy to Employment
  3. Caring for a child or adult : Allows individuals who are needed in the home to care for a child or adult relative:
    1. 30 days to gather needed verification.
    2. May allow up to an additional 60 days, as needed, to give the individual more time to gather documentation, reviewing the case at least every 30 days.
    3. Reviews medical or other documentary evidence, including evaluations from the SSI facilitator or public health nurse, and approves the exemption if the parent is only able to participate 0 to 10 hours per week.
    4. May set up a case staffing, as needed, following the process in section WFHB 3.5 Case Staffing, (making sure to include the appropriate staff or medical professionals).
    5. After the exemption decision is made:
      1. Makes any needed changes to the IRP.
  4. Medical Exemption : For individuals with chronic and severe physical, mental or emotional conditions:
    1. Uses the process in WFHB 6.6, Disabilities , to obtain medical evidence.
    2. Approves XB and considers SSI if the medical evidence shows the condition is expected to last 12 months or more and the individual can participate 10 hours or less per week. (See SSI Track Flow Chart for details.)
      • Requires the parent to pursue SSI or another type of federal disability benefit in their IRP which may include gathering objective medical evidence as described in WAC 388-449-0015 in preparation of the SSI application process and
      • Requires treatment in their IRP, if recommended by their treating medical or mental health provider or by a chemical dependency professional.
    3. Also approves a 12-month XG or XM deferral, requiring treatment only, if treatment is available and expected to improve the medical condition.
    4. Completes a DVR referral if the person wants to become employable.
    5. Refers the case back to WorkFirst at any point the person does not appear SSI eligible, and approves a ZD exemption or continues the XG/XM long-term deferral.

Resources

 

Related WorkFirst Handbook Chapters

Other Resources