Incapacity and Disability

Revised December 31, 2013

Purpose:

A person must be unable to work due to a mental or physical impairment to meet incapacity or disability criteria for ABD cash or a referral to the HEN program.

  • WAC 388-447-0001 What are the incapacity requirements for referral to the Housing and Essential Needs (HEN) program?
  • WAC 388-449-0001 What are the disability requirements for the Aged, Blind or Disabled (ABD) program? (Emergency WAC currently in effect)

Clarifying Information

Disability program specialists are responsible for determining disability and incapacity for ABD cash and referral to the HEN program.

Applications

  1. Refer ABD cash applicants to the disability program specialist (DPS) when the person claims they have a physical or psychological impairment preventing them from working. These cases require Disability Decision by the DPS. If the person does not meet the disability criteria for ABD cash, the disability program specialist will determine incapacity criteria for the HEN Referral program using the Sequential Evaluation Process (SEP).
  2. Referrals to the disability program specialist include:
    1. Application date.
    2. Any medical records.
    3. Information about unpaid medical bills.
    4.  Date of SSI application.
    5. Information about active medical coverage.
  3. The disability program specialist follows the Disability and Incapacity Evaluation Process in the Social Services Manual.
  4. Clients applying for or receiving long-term care services from Home and Community Services (HCS) are assessed by social service specialists at those administrations. Refer ABD applicants to the HCS social service specialist for a functional assessment.

Disability Review Process

  1. When the Disability Program Specialist sends the Financial Services Specialist a DSHS 14-118 to terminate disability (ABD cash) due to a SSA denial or no longer meeting disability criteria:
    1. Send the person notice that ABD cash is terminated with the free form text provided by the DPS.
  2. When the Disability Program Specialist sends the Financial Services Specialist a DSHS 14-118 to terminate disability (ABD cash) due to no current medical evidence, the FSS:
    1. Sends the person notice that ABD cash is terminated for lack of current medical

Incapacity Review Process

  1. When the Disability Program Specialist sends the Financial Services Specialist a DSHS 14-118 to terminate HEN Referral due to no current medical evidence, the FSS:
    1. Sends the person notice that HEN Referral eligibility is terminated for lack of current medical evidence with the free form text provided by the DPS.
    2. If the FSS receives a DSHS 14-118(X) with a decision after a "no current medical" termination is issued, the FSS:
      1. Extends HEN Referral eligibility if approved and notifies the person that benefits are extended; or
      2. Issues a supplemental notice of termination with details from the new DSHS 14-118(X), if the benefits are terminated.

Terminations for failure to cooperate with treatment

  1. Terminate assistance when you receive the DSHS 14-118 Disability/Incapacity decision stating the person failed to satisfactorily participate in treatment or follow through with a Medicaid application.
  2. If the person reapplies prior to termination, refer the client to the disability program specialist.

Employment

  1. When an incapacitated person becomes employed, the FSS determines if the person remains financially eligible. If the person is no longer financially eligible, the FSS terminates assistance and informs the DPS of the termination.
  2. If the person is still financially eligible, the FSS contacts the disability program specialist to determine if the person is gainfully employed. The ISW will inform the FSS of their decision.