209.13 Family Services Specialist (FSS) Determines Incapacity (FAM)

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The Family Services Specialist (FSS) makes the determination of incapacity.

The child or children are automatically considered to be deprived of support or care due to a parent’s physical or mental incapacity when the applicant:

• is currently receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), or is eligible but not receiving it due to recoupment;

• provides the information requested on BFA Form 720, Determination of Incapacity for FANF Financial Assistance, from an authorized healthcare provider (a currently licensed Physician, Physician Assistant, Advanced Practice Registered Nurse, Psychologist [board certified], Pastoral Psychotherapist, Alcohol and Drug Counselor [Master Licensed Alcohol and Drug Counselor only], Independent Clinical Social Worker, Clinical Mental Health Counselor, or Marriage and Family Therapist) who certifies the individual as incapacitated for at least 30 continuous days from the date of application for assistance, or that the individual was incapacitated for at least 30 days in the 90-day period prior to the application date;

• has been previously determined to be permanently disabled or blind by the Disability Determination Unit (DDU);

• reapplies within 90 days of being denied or terminated from a case in which the individual’s incapacity has already been established, provided the reason for the denial or termination was not related to incapacity or earnings from employment;
  
  Exception: If the information on BFA Form 720 was initially submitted to document the incapacity, the FSS must also refer to the expected incapacity end date originally provided to ensure that the incapacity still exists and will continue to exist for at least 30 days from the new date of application. If the information originally submitted does not conclusively provide the expected incapacity end date based on the new application date, deprivation is not automatically confirmed and the information requested on BFA Form 720 must again be provided.

• is convalescing after being treated in an institution for the mentally ill, or was discharged within 90 days prior to applying for assistance; or

• is needy and intellectually disabled, has resided in a state-operated immediate care facility for individuals with intellectual disabilities (ICF-IID), and was officially discharged within 90 days of applying for assistance. Require documentation of intellectual disability diagnosis.

If the incapacity meets the 30-day minimum time period but no longer exists or ends before an application can be processed within time frames, the case may be eligible for financial assistance for the month in which the determination was made and for the next full calendar month, unless the individual requests an earlier termination of assistance or refuses, or fails, to submit the information requested on the necessary medical eligibility determination forms.

References: He-W 627.01; He-W 628.02; 45 CFR 233.90