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Issue Alert - 12-11-04

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Date:

Nov 29, 2012

Program Area:

Family Independence Program (FIP) and Refugee Cash Assistance (RCA)

Issue Summary:

Effective 11/01/2012, BEM 228 and BEM 230A require new work and work participation program Bridges deferral and participation codes.

Persons Affected:

All FIP and RCA groups with a member who has requested a deferral from work or work participation program requirements because that group member has a mental or physical disability that is expected to last more than 90 days.

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail: info@ccj-mi.org Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


Background

This Issue Alert is based on Bridges Policy Bulletins (BPB) 2012-020 and 2012-021 and modifications to BEM 228 and BEM 230A. 

Pursuant to BEM 230A, when a member of a FIP or RCA group either claims to be disabled or indicates her/his inability to participate in work or the work participation program for more than 90 days because of a mental or physical condition, that group member should be deferred in Bridges, regardless of whether the member has applied for RSDI/SSI.  Examples of “mental or physical condition” are: mental or physical injury, illness, impairment or learning disabilities. The group member may claim disability and/or her/his inability to participate in work or the work participation program at any time (at application, redetermination, or the ongoing benefit period). 

What's Happening?

In order to be deferred from work or the work participation program because of a “long-term disability,” the group member must meet the requirements set forth in BEM 230A.  This section describes the process that DHS uses for determining whether a group member’s claimed disability is “long-term” and the Medical Review Team’s (MRT) decision pursuant to BEM 228 and BEM 230A. 

 

The Three-Step Process

DHS considers a “long-term disability” to be a condition lasting more than 90 calendar days.  Determining whether a group member’s claim of disability is “long-term” is a three-step process.  The group member who made the claim of disability must fully cooperate with the entire process.  If the member fails to cooperate, her/his FIP case may be closed for failure to cooperate/verify. 

 

·         Note regarding pregnancy-related complications:  A group member who makes a claim of only a pregnancy-related disability (not other, additional, forms of disability) must be deferred for a “problem pregnancy,” not pursuant to the three-step process outlined below.  In accordance with BEM 230A, page 8, a group member who requests a deferral due to pregnancy-related complications must provide medical verification that she is unable to participate in work or the work participation program.  She is not subject to the requirements for establishing “long-term disability” described below if she requests a deferral for more than 90 days for pregnancy-related complications.

 

Step #1 = Establishment of the Disability

·         Once a group member claims a disability, s/he must provide DHS with verification of the disability when DHS asks for it.  The verification must indicate that the member’s disability will last longer than 90 calendar days.  (If the member fails to return the verification, a disability is not established, and s/he will not be deferred from work or the work participation program based on a long-term disability.  For this reason, the member will be required to participate in work or the work participation program as a mandatory participant.)

·         While waiting for the member to provide verification of her/his disability, in Bridges, the DHS caseworker will code the Deferral/Participation Reason as “Establishing Incapacity while awaiting the verification that indicates the disability will last longer than 90 days.”

 

Step #2 = Definition of the Disability

·         Once a group member has successfully verified that her/his disability will last more than 90 days, the DHS caseworker must submit a completed medical packet and obtain a Medical Review Team (MRT) decision.  Before the caseworker can submit the medical packet, the member must cooperate and provide DHS with the requested verification that is needed in order to define the disability.  Such verification may include the DHS-49 series, medical, and/or educational documentation.  (If the member fails to provide said verification, DHS will close the member’s FIP case for failure to provide requested verification.)  (See also BAM 815 – Medical Determination and Obtaining Medical Evidence.)

·         Once the caseworker has submitted the completed medical packet to the MRT, while awaiting the MRT’s decision, in Bridges, the DHS caseworker will code the Deferral/Participation Reason as “Establishing Incapacity while awaiting the MRT decision.” 

 

Step #3 = Referral to the MRT

·         Referring the case to the MRT includes the following actions:  Requesting a utilization report from Central Office; having the member sign a DHS-1555-E (Release of Information); checking the box for “work participation program” on the DHS-49-A, completing the DHS 49-A-E, and when a member claims that s/he is visually impaired, requiring her/him to provide verification of an ophthalmologist or optometrist or completing the DHS-49-I; submitting all required medical documentation to the MRT; and manually setting a reminder in Bridges for follow up in three months.  (Some conditions may be verified by other test results or evaluations, such as school/therapist/other professional records.)

·         While awaiting the MRT’s decision, in Bridges, the DHS caseworker will code the Deferral/Participation Reason as “Establishing Incapacity.” 

 

Once these three steps have been successfully completed, the MRT is responsible for making a decision. 

 

The MRT’s Decision

Once the MRT has made its decision, the decision will be sent to the caseworker and the member.  The MRT will find that the member is in one of the following four groups: work-ready, work-ready with limitations, work-ready with limitations served by DHS, or disabled and potentially eligible for RSDI or SSI.  These designations are discussed below.

·         Work-ready: Members who have been determined to be work-ready are able to fully engage in work or the work participation program without accommodation.  The caseworker will change the Deferral/Participation Reason from “Establishing Incapacity” to “MWA Activity or JET.”  Bridges will automatically generate the DHS-4785 and a referral to the work participation program.

·         Work-ready with limitations: Members who have been determined to be work-ready with limitations are required to participate in work or the work participation program as defined by the MRT.  The caseworker will change the Deferral/Participation Reason from “Establishing Incapacity” to “work-ready with limitations.”  Bridges will automatically generate the DHS-4785 and a referral to the work participation program.  The member is not required to apply for RSDI/SSI. 

·         Work-ready with limitations served by DHS: DHS must serve members who the MRT has determined to be work-ready with limitations, but who are unable to be served by the work participation program.  These members are mandatory participants.  They do not engage in the work participation program, but they are required to engage in self-sufficiency activities that DHS monitors.  The DHS caseworker is responsible for assigning these members self-sufficiency activities up to the medically permissible limit of the group member and monitoring progress. 

·         Another way that a group member can be placed in to the “work-ready with limitations served by DHS” category is when the member is engaged in the work participation program, and the work participation program subsequently decides that it is no longer able to serve the member due to the member’s verified new or increased medical condition.  When this occurs, DHS may determine that the member will be best served by DHS.  In both cases, the caseworker will change the Deferral/Participation Reason from “Establishing Incapacity” to “work-ready with limitations at DHS.”  The member is not required to apply for RSDI/SSI. 

·         Disabled and potentially eligible for RSDI/SSI:  The caseworker will change the Deferral/Participation Reason from “Establishing Incapacity” to “incapacitated more than 90 days.”  The member is required to apply for RSDI/SSI.  The caseworker will verify that the application/appeal is pending and monitor the case once every three months to verify the application/appeal. 

 

Requesting a New MRT Decision

Once the MRT’s decision has been made, if the member indicates that s/he has new medical evidence or a new condition that will result in the member having a “long-term disability,” the caseworker will gather new verification (similar to the process discussed above) and send for an updated MRT decision.  If the member fails to provide new medical evidence, the caseworker will not send the case back to the MRT and the previous MRT decision stands.

_______________________________________________________________________

 

CCJ has a number of practical questions about the implementation and effects of the policy, including those listed below, the answers to which are not clear at this time.  CCJ is working to get answers to these questions and will send out an update when the answers are known.

 

1.   How will DHS “count” these newly-coded months towards the 48-month time limit? Will the coding of the months determine how/whether they are counted toward the time limit?  Will the coding be permanent or can it be changed at a later time?  

2.   What happens if the MRT decides that a member is not disabled, the member participates in the work participation program, and JET later determines that they are unable to serve the member because of the member’s medical condition? Does this change the coding? Does this change whether the month is “counted” toward the time limit?

3.   Will the new coding system affect whether benefits are federally-funded or state-funded?  How?

What Should Advocates Do?

1.   Educate clients and community organizations about this change.

2.   Provide information to CCJ about families that are being harmed by the policy.  Please call CCJ at the number at the top of this document to find out how to communicate information to CCJ.

3.    Help clients request and present information at administrative hearings when appropriate.

Be aware of the above-mentioned unanswered questions. Share information with CCJ and other advocates about the effects of the new policy.

What Should Clients Do?

1.   Ask your caseworker for help if you do not understand what information is needed, or if there is not enough time to get the requested information before it is due back at DHS.  If you cannot reach your caseworker, you should contact the caseworker’s supervisor.  If you do not know your caseworker’s or supervisor’s name, you can call DHS’s customer service center, ASK MICH, for help.  Their phone number is 1-855-275-6424.

2.   Keep all envelopes that you receive from DHS so that you know the date the envelope was actually mailed.  Write the date that you actually received the correspondence on the outside of each envelope.

3.   Seek legal advice if you are told that your FIP case will close or has already closed. 

4.   Read your notices carefully.  If your FIP is ending, you have the right to request a hearing.  If DHS receives your hearing request within the deadline given in the notice, you will continue to receive FIP at the current level until the judge issues a Hearing Decision.  (But, remember that if you lose at the hearing, you may have to pay DHS back any/all money that you got but were not supposed to.)

5.   If you need legal advice, you should contact an attorney.  If you need help finding an attorney, you can call Michigan Lawyer Referral.  They help you find an attorney in your area who may be able to help you.  Their phone number is 1-800-968-0738.  Also, some legal aid offices handle cases that involve these sorts of issues.  You can find a legal aid office in your county by visiting the Michigan Legal Aid web site.  The site address is michiganlegalaid.org. 

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org. You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.
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