Agency for Workforce Agency for Workforce InnovationInnovation

August 2007August 2007

Medical Limitations and Medical Limitations and IncapacityIncapacity

What is a Deferral?

Background

Federal law requires all work-eligible recipients to

Complete an initial assessment

Develop a plan towards self-sufficiency

Participate in work activities to achieve goals

However, not everyone can participate in work activities

Some individuals will have temporary good cause reasons for not participating in work or other activities

Some individuals will have ongoing good cause for not participating in work activities due to medical reasons

What is a Deferral?

Individuals with an inability to complete work activity requirements or cannot participate full-time in work activities should have a deferral entered on their case in the One-Stop Service Tracking (OSST) system

A deferral is simply a flag on a case that shows a participant may have limitations to work

What is a Deferral?

There are several deferral types in the OSST system Lack of childcare

Lack of transportation

Medical

Alcohol, drug and mental health

Domestic violence

Caring for a family member that is disabled and living in the home full time

Caring for a school age child that is disabled and living in the home

What is a Deferral?

What is a Deferral?

These “flags” may be entered on a case if the participant is not able to comply as a result of Not having reliable or adequate childcare

within a reasonable distance of home, work or school based on mode of transportation

Not having reliable transportation, including public transportation

Dealing with the effects of or past effects of domestic violence

Etc.

What is a Deferral?

The RWB should have a local operating procedure that outlines when a deferral should be entered in the system and what actions a staff member should take to help the participant overcome the barrier to participation

The local operating procedure should also include the type of documentation required to confirm certain deferral types

Example

A participant reports that (s)he does not have transportation to complete work activities The RWB requires the staff member to

review with the participant options for transportation

Review public transportation options

Review bus routes

Review places to go to school and work within walking or biking distance

The RWB requires the staff member to discuss a plan to overcome the barrier

Medical Deferral-Documentation Requirements

Medical deferrals have specific requirements prior to entry in the OSST system

Medical deferrals

Alcohol, drug, and mental health deferrals

Medical Deferral-Documentation Requirements

Before a medical or alcohol, drug and mental health deferral can be entered in the OSST system, the program participant must provide proof of a limitation signed by a licensed physician, 414.065 (F.S.)

The physician must be licensed under Florida Statutes chapter 458 or 459

In addition to a note documenting that the participant has a medical limitation or need for treatment, the Florida Administrative Code 65A-4.206 requires the RWB to collect specific information

Documentation must specify

The nature of the disability

The duration of incapacity

The number of hours per week the individual can participate in activities

The percentage of the individual’s disability

Other limitations on participation

Medical Deferral-Documentation Requirements

Medical Deferral-SSI/SSDI Applicants

Individuals applying for Social Security Income (SSI) or Social Security Disability Income (SSDI) payments may also be deferred from participation in work activities if they meet all requirements

Florida Statutes section 445.024 requires the participant to document current application for SSI/SSDI

The participant must document medical limitations through a statement signed by a licensed physician

Medical Deferral-SSI/SSDI Applicants

Participants that have applied for SSI/SSDI must still participate in program and work requirements

According to 414.105 (8), F.S.

Participants that have applied for SSI/SSDI must meet program requirements based on medical ability to comply until a final determination is made

Medical Deferral-SSI/SSDI Applicants

Question

What happens if a participant provides you with a doctor’s note stating simply, “the participant cannot do any work?”

Answer Get more information

If the initial note simply states that the participant cannot work, cannot go to school or has limitations

Establish steps with the participant to secure more information

Remember Florida Administrative Code requires the RWB to obtain certain information to engage the participant appropriately and develop a plan

Answer Enter the receipt of the document in

the OSST system

There are a lot of options regarding data entry Enter the appropriate medical deferral

(less than 30 days) with a “Begin Date” and enter a follow-up date to review any new information

Enter a medical deferral with a “Referral Date”

Enter an “other” deferral until you secure more detailed information

Develop a clear plan Have the participant bring in more

information

If the participant has a permanent disability, discuss applying for SSI/SSDI

Have the participant attend assessments

Ensure that treatment elements are included in the plan-e.g., counseling, treatment, etc.

Answer

Answer

Develop a clear plan

Remember to

Discuss with the participant what (s)he wants to do

Discuss with the participant what (s)he can do

Question

But, will we get credit for participants that cannot participate in activities for the required number of hours due to a medical incapacity, including a permanent disability?

Any participant included in the participation rate denominator and not completing the required number of hours to be included in the numerator will impact the participation rate

Answer

Is It Numbers VS People?

Answer

It is not numbers versus people

We engage all participants

The participation rate simply shows the percentage of those that we engage who participate in the minimum number of hours required in a countable work activity

If a participant cannot complete the minimum number of hours in a countable work activity today due to a medical limitation, the RWB may not get credit in the participation rate (this month)

However, the participant may be able to comply in countable work activities in the future if we work with them today

The participant may be able to secure a job in the future if we work with them today

Answer

Answer

Florida’s All-Family Participation Rate is 50 percent

Florida’s Two-Parent Participation Rate is 90 percent If a parent has a medical incapacity coded as

lasting greater than 30 days in OSST, the family will be removed from the Two-Parent Participation Rate and included only in the All-Family Participation Rate

Answer

We all have dreams

We all have goals

We all deserve a chance to reach our full potential

All participants join our program deserving that chance

Answer We are empowering

people to

Make a plan towards self-sufficiency

Stick with the plan

Achieve their goals

This includes participants with barriers

This includes participants with limited abilities

Medical Deferrals-Participation

Participants with limitations

Participants must be engaged to the extent possible as identified by a licensed physician in work activities

We may need to make accommodations

May need to work with employers to make accommodations

We can work with community partners to offer tools, work stations and other accommodations for participants that have special needs

Participants with limitations must be engaged in alternative activities like counseling, treatment, therapy, etc. to move towards being able to be engaged in work activities and self-sufficiency

What is the Career Specialist’s Responsibility?

Treat all participants equally

We treat everyone regardless of inclusion in the numerator in the participation rate

Engage the participant

Develop a plan with the participant that includes treatment, therapy, counseling, etc.

Hold the participant accountable for successes and failures

What is the Career Specialist’s

Responsibility?

Review medical information provided by the participant

Set up assessments

Provide information about Vocational Rehabilitation and The Center for Independent Living

What is the Career Specialist’s

Responsibility? Assign participants to APPROPRIATE

activities based on ability to comply, medical information, assessment results, and goals

List steps that will assist participants with health issues as well as help them achieve self-sufficiency

Medical Deferral We want all participants

working to resolve or manage their barriers so they can

Begin full-time participation as soon as possible

Work towards self-sufficiency

What Are Other Ways We Can Engage Our Medically Deferred Population?

Answer Empower the participant

Encourage or assist the participant with writing a list of issues (s)he wants to discuss with the doctor

Have the participant write a list of things (s)he wants (home, car, a high paying job, feeling better, respect, medical insurance)

Discuss what type of activities (s)he can engage in to work towards those goals

Make sure (s)he is ready to ask the physician what (s)he can do

Medical Deferral

Please remember:

We treat all of our participants equally

Compliance with federal laws

The Age Discrimination Act of 1975

Section 504 of the Rehabilitation Act of 1973

The Americans with Disabilities Act of 1990

Title VI of the Civil Rights Act of 1964.

If you have any questions, If you have any questions, comments, or concerns, please comments, or concerns, please

contact contact

the Welfare Transition Team the Welfare Transition Team

through the Agency for Workforce through the Agency for Workforce Innovation’s Call Center at Innovation’s Call Center at

1-866-352-23451-866-352-2345

An equal opportunity employer/program. Auxiliary aids and services are available upon request to individuals with disabilities. All voice telephone numbers on this document may be reached by persons using TTY/TDD equipment via the Florida Relay Service at 711.