Physical or Mental Incapacity of a Parent

[41-430]

Deprivation Due to Incapacity

Deprivation due to a physical or mental incapacity of a parent exists when the parent of an otherwise eligible child has a physical or mental illness, defect, or impairment that reduces substantially, or eliminates the parent's ability to support or care for the child for a period which is expected to last at least 30 days and which is supported by acceptable evidence. Refer to Determination of Incapacity [41-430.2].

If an applicant is denied in intake because the incapacity is not expected to last 30 days or more, and it is subsequently established that the incapacity did exceed the 30 days, and all other eligibility requirements are met, the denial shall be rescinded and aid paid from the date that aid would have been paid had the application been approved.

Deprivation exists if the incapacity:

Prevents the parent from working full-time:
- At a job which he/she has customarily engaged.
- On another job for which he/she is equipped by education, training or experience, or which can be learned by on-the-job training, OR
Is the reason employers refuse to employ him/her for work the parent could do. (This includes behavioral disorders which interfere with the securing and maintaining of employment), OR
Prevents the parent from accomplishing as much on a job as a regular employee, and is the reason he/she is paid on a reduced basis even though working full-time, OR
Qualifies the parent and he/she is employed in a job which is rehabilitative, therapeutic or in a sheltered workshop not considered to be a full-time job, OR
Reduces substantially or eliminates the parent's ability to care for the child.

Determination of Incapacity

[41-430.2]

The determination that incapacity exists shall take into consideration the limited employment opportunities of handicapped individuals and be based upon the following acceptable evidence:

A current award letter or by viewing the latest check from:
- SSI/SSP.
- Social Security (RSDI).
- Note: Be sure that the benefits listed above are based on disability and not on the age of the parent.
- Disability Insurance (DIB).
- Workman's Compensation.
A DM-1 or DM-3 from a previously closed ATD case, providing the DM-3 was approved GROUP I DISABILITY (no review due date).
An “Authorization to Release Medical Information” (CW 61) or other written statement from a licensed physician or certified psychologist, that provides information sufficient to substantiate the determination of incapacity and includes the following:
- An onset date of the condition (this date is entered in the Medical Conditions Detail page.)
- A diagnosis of the parent's condition and explanation of the extent to which it prevents him/her from engaging in employment or why it reduces substantially, or eliminates the parent's ability to support or care for the child.
- The expected duration of the condition, and date of the next scheduled examination or appointment.
- The doctor's name, address and telephone number.

Where a written statement cannot be obtained without delay, for reasons beyond the control of the applicant, a verbal statement from the licensed physician or certified psychologist verifying incapacity as specified above may be accepted pending written verification up to a maximum of 60 days.

If obtained verbally, documentation must include the date verification was obtained, the name of the person who supplied the verification, and the name of the county person who obtained the verification.

Requesting Written Medical Verification

Aid may be established or continued for 30 days pending a medical verification.

The applicant/recipient should be informed that the physician should bill Medi-Cal for the cost of the physical examination connected with establishing incapacity. If Medi-Cal refuses to cover the cost of the examination or completion of the CW 61, the applicant/recipient is responsible for the cost.

30 Day Time Frame: The “Authorization to Release Medical Information” (CW 61) must be returned within the 30-day period, unless a verbal verification of incapacity has been obtained from the physician; then allow an additional 30 days. Document in the Journal Detail page in CalSAWS the date verbal verification was obtained, the name of the person who supplied verification and the name of the person who obtained the verification. THE CASE IS TO BE HELD IN INTAKE UNTIL WRITTEN VERIFICATION IS RECEIVED.

Not Received in 30 Days: If written verification is not received by the 30th day or the 60th day, when verbal verification has been obtained, discontinue the case if no other form of deprivation exists, and/or the applicant/recipient must register with CWES or discontinue the individual from the case, for failure to register for work, whichever action is appropriate.

Review of Incapacity

[1-430.3]

If the individual's condition is expected to last more than one year, a review of the incapacity must be done at the time of the annual redetermination (RD). If the individual's condition is expected to last less than one year, a review is to be completed at the time the condition is expected to end or at RD, whichever is later (not to exceed one year). If there is reason to believe there has been a change in the applicant/recipient's condition a review may be done earlier, if needed.

A review means a NEW medical verification must be OBTAINED within the month the condition is expected to end.

The medical statement verifies incapacity for deprivation and allows exemption from other requirements; therefore, if there is no current medical verification on file by the first of the month following the expiration date, there is no eligibility due to incapacity or exemption from other requirements.

Incapacity Lasting Longer Than 12 months