209.13 Incapacity: Case Tech Determines Incapacity SR 00-06, 02/00 (FAM-A)

Either the Division of Family Assistance (DFA) case technician at the District Office (DO) or the Medicaid Administration Bureau (MAB), depending upon case circumstances, makes the determination of incapacity.

Case Technician

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 SSI or SSA based on disability or is eligible but not receiving it due to recoupment. Because MAB must also keep an incapacity file, provide MAB with Form 177, Non-Medical Evaluation of Disability, and Form 940, Cover Memo for Medical Eligibility Information;

• returns Form 921, Determination of Incapacity Status, on which a physician or psychologist certifies the individual as incapacitated for at least 30 continuous days. Set a review date for the end of the incapacity (as stated on the form) or for the first redetermination, whichever is earlier. Send the Forms 921, 177, and 940 to MAB for review;

• has been previously determined to be permanently incapacitated by MAB;

• reapplies within 90 days of being denied or terminated from a case in which their incapacity has already been established, provided the reason for the denial or termination was not related to incapacity or earnings from employment;

• 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 mentally retarded, has resided in a state-operated ICF/MR, and was officially discharged within 90 days of applying for assistance. Require documentation of congenital mental retardation confirmed by a psychological evaluation at any time after age ten, or a psychological evaluation before age ten confirming an IQ of 40 or less.

Notify MAB of changes in an incapacitated parent’s medical status.

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 is eligible for medical and financial assistance for the month in which the MAB determination was made and for the next full calendar month unless the client requests an earlier termination of assistance or refuses, or fails, to submit medical records and the forms necessary for the medical eligibility determination.

MAB

MAB makes a determination of incapacity when the applicant is unable to return a Form 921 which clearly defines an incapacity. MAB initiates decision-making upon receiving one or both of the following forms from the case technician: Form 915, Medical Evaluation Initial, or Form 920, Psychiatric Evaluation Initial.

When there is a potential for change in the status of an incapacity, MAB is alerted by DFA to review continuing medical eligibility:

• when the case is due for medical review; or

• when the case is due for redetermination.

If the medical review date is later than the redetermination date, a redetermination of incapacity is not necessary until the medical review date.