The CAO will use the appropriate qualification code to identify the reason why the individual qualified for assistance under D category. This entry is mandatory for adults and children. The qualification code may need to be added, changed or deleted based on the activity of the individual affected. See Appendix C for a complete list of codes.
Every individual must provide verification of all factors used to establish GA status. Specific verification requirements are listed under each criterion.
The CAO will record the verification of eligibility for GA status.
The CAO will assist the individual in obtaining the necessary verification, if he cannot obtain it himself.
An individual may qualify for GA if he is
Under age 18 - an individual under age 18 may qualify for GA regardless of marital or emancipation status or school attendance.
The following are emancipated:
NOTE: The only way a married minor becomes unemancipated is if the marriage is annulled.
NOTE: If the minor returns to live with his parents, he will not be considered emancipated unless he remains free of parental control.
Exception: If the minor is under the care and control of the county children and youth authority, and not married, the only way he can become emancipated before age 18 is by court action.
An unemancipated minor who is otherwise eligible may receive GA if:
55 Pa. Code §§145.63(b)(1)(i) & (ii)
Exception: The sole exception to this requirement is limited to a situation where a child is receiving Federal, State or local adoption assistance and the child’s inclusion in the budget group would increase the benefits of the budget group.
NOTE: A GA minor parent must comply with minor parent requirements. See Section 106.41, GA Minor Parents.
Age 18-20- and attending a secondary or secondary-level vocational or technical school full-time and expected to graduate before he is age 21.
The caretaker/relative must report if a student age 18 through 20 stops attending school.
The CAO will verify age for every individual. If the child is a student age 18 through 20, the CAO will also verify school enrollment, attendance, and date of graduation. The CAO will also verify school attendance on a quarterly basis in March, June, September and December.
Acceptable verification includes, but is not limited to, birth certificates, hospital certificates, school records or statement, and graduation notices. Once age has been documented, it does not need to be verified again.
REMINDER: The CAO will first determine if the child under age 19 qualifies for TANF.
All two-parent households with children must be reviewed for TANF eligibility before GA can be authorized. See Section 129.4 for examples of TANF-U budget groups with deprivation based on unemployment. It is highly unlikely that a family with children will qualify for cash assistance as a two-parent GA household.
Individuals who are parents residing in a two-parent household with their child may qualify for GA if their child is under age 13; or 13 and older and disabled. The disability must be verified.
It is not necessary for both parents and the child to apply for GA. One parent may apply as long as the child is not eligible for TANF on the basis of a deprivation factor, or the child does not meet the requirements for citizenship or refugee status. Or, one parent along with the child can apply.
However, when only one parent applies, that parent must provide all income and resource information for the other parent. Eligibility is determined as if both were in the applicant group. The appropriate earned income deductions are applied to any earned income of either parent. The resulting net income is then compared to the FSA for one. This computation applies regardless of whether the parents are married.
Once the budget group composition and the ages of the budget group members are verified, they do not have to be verified again. If a change occurs in the budget group such as the addition of another member, that budget group member’s date of birth must be verified. The new member’s birthdate can be verified by, but is not limited to, hospital records, birth certificates, etc.
An individual may be eligible for GA if he has a temporary or permanent physical or mental disability that:
55 Pa. Code §141.61(c)(1)(iii)
If the disability involves drug or alcohol addiction, the CAO will first determine status under disability. An individual with a temporary disability must seek appropriate treatment as a condition of eligibility unless the individual has good cause for not seeking treatment.
NOTE: If drug or alcohol abuse is a secondary diagnosis, participation in treatment is not required when the disability in the primary diagnosis is permanent.
REMINDER: A individual who is unable to engage in any gainful employment because of a disability must apply for SSI as a condition of eligibility unless the disability is expected to be temporary. An individual with a disability which is permanent or expected to last for twelve months or more must apply for SSI/SSDI and should be referred to the Disability Advocacy Program (DAP). If the sole diagnosis is drug addiction or alcoholism, do not refer the case to DAP. These individuals are not eligible for SSI/SSDI. See Supplemental Handbook Chapter 820, Disability Advocacy Program. However, individuals may be eligible for SSI if they suffer from an addiction and another disability. Please refer to Section 106.22 for noncitizens ineligible for SSI.
NOTE: If, in the doctor’s opinion, an individual is considered employable only by use of health-sustaining medication for an acute or chronic medical condition, he may be eligible for medical assistance with the same benefit package available to GA recipients. In this instance, a doctor will have to provide information regarding the diagnosis and the medication being used. See MAEH 305.42 and 305, Appendix A.
The CAO will determine GA status based on a physical or mental disability from the information provided on the Employability Assessment Form (PA 1663) (see Appendix B) or the Temporary Disability Reassessment Form (PA 1664) (see Appendix C). See Section 106.332 for guidelines.
55 Pa. Code § 141.61(c)(1)(iii)(B)
These forms must be completed and signed by one of the following medical providers: a physician, physician’s assistant, certified registered nurse practitioner or psychologist. Information from a chiropractor, podiatrist, or oral surgeon is not acceptable medical verification. Documentation supporting the diagnosis of temporary or permanent disability may accompany the form at the discretion of the medical provider.
It is permissible to accept documentation of a physical or mental disability from other sources including, but not limited to, the SSA, the Department of Veterans Affairs (DVA) or from the DHS’s Medical Review Team (MRT). The PA 1663 or PA 1664 will still be used if documentation from another source is unavailable, is incomplete or does not relate the disability to employability. If any of this documentation is older than six months and does not involve a documented permanent or chronic condition, a new assessment is required.
For an individual with a pending Social Security Administration (SSA) disability application, an updated PA 1663/1664 or any additional documentation is not required until the SSA decision. If SSA denies the disability (or if the decision is appealed and the SSA denies the appeal), remove the status code 50 and retain qualification code 04 or 24, whichever applies. At that time, if the individual’s disability documentation is outdated, request that the individual submit an updated PA 1663/1664 form to the CAO within 30 days.
The DVA-determined disability will be used to establish GA only if the disability is 50 percent or more. If the DVA-determined disability is less than 50 percent, then a more comprehensive medical determination and employment evaluation must be completed.
NOTE: If DVA hospitals or DVA outpatient centers will not complete the PA 1663 or PA 1664, a veteran must obtain the documentation from another source using DHS forms. The CAO will help the veteran find another medical provider for documentation purposes, if necessary.
The individual must provide proof of the disability and its effect on his ability to work as follows:
55 Pa. Code §141.61(c)(1)(iii)(A)
NOTE: The CAO will make a referral to DAP if the worker believes that the individual is not able to provide the necessary documentation because of a mental disability. See Supplemental Handbook, Chapter 820, Disability Advocacy Program.
If an applicant is not able to provide proof of his disability, he is not eligible for GA. He will remain ineligible until he provides proof of his disability or qualifies under another criterion.
55 Pa. Code §141.61(c)(1)(iii)(C)
The CAO will document any change in circumstances that may affect the individual’s eligibility for GA.
The CAO will review and verify the disability at application and reverify the disability at reapplication only when there is potential for change in the individual’s condition as previously indicated by a medical provider or because of a change either in circumstances or the DHS’s regulations. Redetermination of the existence of the disability is not necessary while the individual continues to receive SSA or DVA benefits based on disability.
55 Pa. Code §§ 133.23(a)(2)(ii) and (3)(i)
NOTE: Mental Health (MH) or Intellectual Development (ID) types of disabilities, particularly the degree of mental defect, do not often change although the employability aspects of the diagnosis may change. Additionally, some applicants and recipients with MH or ID disabilities may also experience difficulty finding medical providers. Consequently, applicants and recipients with these types of disabilities may find it hard to obtain medical verification to establish their MH or MR disability. Therefore, it is important that every effort be made to assist individuals in obtaining the required medical documentation. The CAO will make a referral to DAP if the IMCW believes that the individual is not able to provide the necessary documentation because of a mental disability. See Supplemental Handbook, Chapter 820, Disability Advocacy Program.
If the individual’s disability is drug or alcohol addiction, the CAO will deny or discontinue benefits if the individual fails without good cause to participate in and comply with the treatment, even when the abuse is a secondary diagnosis. See Section 106.35. An individual with a disability which is permanent or expected to last for twelve months or more must apply for SSI/SSDI and should be referred to DAP. If the sole diagnosis is drug addiction or alcoholism, do not refer the case to DAP. These individuals are not eligible for SSI/SSDI. See Supplemental Handbook Chapter 820, Disability Advocacy Program.
55 Pa. Code §133.23(a)(1)(vii) and (viii)
NOTE: Entry into a training program or employment does not automatically mean that a individual is no longer disabled. However, if the CAO suspects that the individual’s medical status has changed, the CAO will obtain documentation. For a individual active with OVR or an MH/ID Base Service Unit, the CAO will obtain documentation from the OVR medical consultant or the MH/ID Base Service Unit psychologist or physician. This ensures that the documentation is provided by a specialist familiar with the individual’s physical or mental disability and its effect on employability.
The CAO will use the DHS’s Employability Assessment Form (PA 1663) or the Employability Re-Assessment Form (PA 1664) to determine GA categorical eligibility. The forms must be completed and signed by a medical provider such as a physician, physician’s assistant, certified registered nurse practitioner or psychologist. (Podiatrists and oral surgeons may not sign a medical assessment form.) Each form contains instructions to help the medical provider complete the information the CAO needs. If the individual is determined employable by use of health-sustaining medications, he/she will be ineligible for GA cash benefits.
55 Pa. Code §141.61(c)(1)(iii)(B)
NOTE: All medical and mental health information is confidential, and its use is limited to eligibility for public assistance. Any other use or disclosure is strictly prohibited.
REMINDER: An individual who provides verification of the receipt of SSA disability benefits or of a DVA claim award indicating a 50 percent or more disability is not required to submit a PA 1663.
Also, an individual who has applied for SSA disability benefits is not required to submit a new PA 1663/1664 until the SSA makes a decision. See Section 106.331, Documentation of Disability.
DHS will pay the cost of a medical examination for cash and Medicaid applicants and recipients. Refer to Section 305.4 of the Medical Assistance Handbook.
55 Pa. Code §141.61(c)(1)(iii)(B)
When verification of disability is requested using the PA 1663, the CAO will:
The CAO will help make the necessary arrangements if the individual seems unable to follow through in scheduling the appointment.
When the PA 1663 is returned, the CAO will determine GA categorical eligibility by reviewing the medical provider’s opinion of the individual’s employability. Medical providers are requested to provide information about the individual’s diagnosis, related medications and functional limitations on the PA 1663. Supporting documentation may be attached at the discretion of the medical provider. The provider’s statements and documentation must be consistent and must support the assessment of the individual’s physical/mental capacity to verify disability.
Based on information contained in the PA 1663 or PA 1664, if applicable, the CAO will determine eligibility for applicants and recipients as follows:
55 Pa. Code §141.61(c)(1)(iii)(B)
If Block #1, Permanently Disabled, is checked and the “Examination Results” section is completed, i.e., a diagnosis is entered and at least one of the blocks labeled A through E is checked, the individual is categorically eligible for GA. Refer the individual to DAP for SSA/SSI benefits.
NOTE: Employment Status - Exempt.
If Block #2, Temporarily Disabled 12 months or more, is checked and the “Examination Results” section is completed, i.e., a diagnosis is entered and at least one of the blocks labeled A through E is checked, the individual is categorically eligible for GA. Refer the individual to DAP for SSA/SSI benefits. Set an end date for benefits and explain to the individual that benefits will automatically expire on the date the disability is expected to end unless additional documentation is submitted. Give the individual a PA 1664 and tell him that this form must be returned at least ten days prior to the eligibility end date to avoid an interruption of benefits.
If Block #3, Temporarily Disabled, less than 12 months, is checked and the “Examination Results” section is completed; i.e., a diagnosis is entered and at least one of the blocks labeled A through E is checked, the individual is eligible for GA. Set an end date for benefits and explain to the individual that benefits will automatically expire on the date the disability is expected to end unless additional documentation is submitted. Give the individual a PA 1664 and tell him the form must be returned at least ten days prior to the eligibility end date to avoid an interruption of benefits.
NOTE: On the PA 1664, the medical provider also must answer the question that appears in this section regarding patient compliance with appropriate treatment. If the No block is checked, the individual is ineligible for continued GA.
Employment Status - Exempt for the period of time specified by the medical provider.
If Block #4, Employable, is checked the individual is categorically ineligible for GA cash under this criterion. Reject the application or discontinue assistance, as appropriate.
An individual who is a non-parental caretaker required to be in the common residence to care for a child under age 13 may be eligible for GA if all the following conditions are met:
An individual who is a caretaker required to be in the common residence to provide care for any person who is ill or disabled may be eligible for GA if all the following conditions are met:
REMINDER: If the ill or disabled person is a TANF child and the caretaker qualifies as a specified relative, the case should be TANF.
The CAO will review all criterion at redetermination or if circumstances change.
NOTE: The child or the individual who is ill or disabled does not have to be a member of the budget group, but he/she must be a member of the common residence. For the individual to qualify under this criterion, the determining factor is whether there is someone else in the common residence who can provide the care without requiring GA.
Further, it is not a requirement that the caretaker provide continuous care 24 hours a day. For example, the caretaker may receive GA under this criterion if the disabled individual attends therapy or rehabilitation every day. The caretaker may also be employed. However, his or her net income must meet eligibility limits as specified in Section 106.6, GA Income Eligibility.
An individual who is currently undergoing active treatment for substance abuse in a drug or alcohol abuse program may be eligible for GA if the treatment program precludes any form of employment. The treatment must be in a program licensed or approved by the Department of Health, the Department of Drug and Alcohol Programs or administered by an agency of the Federal Government.
NOTE: Because abuse of drugs or alcohol may result in a serious physical or mental disability, the CAO will first determine GA eligibility due to a disability by following the procedures under Section 106.33.
The CAO will verify that participation in the program precludes employment. It is not required that the treatment facility or the CAO justify this preclusion based on the number of hours of active treatment. The CAO will also verify attendance. Acceptable verification includes, but is not limited to, a written statement from the director or professional staff of the program and official attendance records.
A client may be eligible for GA under this criterion for no more than nine months in his lifetime, regardless of whether he is still in treatment at the end of nine months.
This time-limited criterion should be used only if there is no other longer-term appropriate GA criterion.
The CAO must:
NOTE: The 9-month lifetime limit is converted to 275 days for tracking purposes.
If the individual never received GA under this criterion, or if any time remains from a previous authorization, the CAO will authorize GA accordingly.
If an individual has received fewer than 275 days and more than 246 days, process the budget as an NCE for the remaining days.
If the client states he is participating in a treatment program, he will sign a Drug and Alcohol Treatment Information Form (PA 1672). The client will hand-carry the form to the treatment center for completion and return it to the CAO with the necessary verification information. The only time the form will be mailed to the treatment center is if the client is or will be in residential treatment. The CAO will determine eligibility for GA based on information from the treatment center which specifies the date the client was enrolled in treatment and the expected length of treatment needed by the client.
NOTE: GA will not be authorized until the completed form is returned to the CAO.
The CAO will monitor the client’s progress and document continued participation in treatment. At the end of the first month of cash assistance receipt, a Drug and Alcohol Treatment Information Form will be sent to the treatment center requesting information about the client’s status. Following the “first month” contact, subsequent contacts will be on a quarterly basis using the Department form, phone call, a written statement or a copy of official attendance records from the director or professional case management staff of the program, or other acceptable documentation to verify continued participation and employability. If treatment is terminated early, the treatment center may advise the CAO.
NOTE: The treatment center is not required to apprise the CAO of the client’s status; consequently, it is the CAO’s responsibility to ensure that the monitoring process continues. Notes on telephone contacts must be entered in the case record and forms received must be kept in the record.
The client is still required to inform the CAO of any change in circumstances that may affect his eligibility. Any GA benefits the client receives while he is no longer eligible must be processed as an overpayment.
The client is ineligible if he fails to participate in or comply with the treatment program without good cause, even when substance abuse is a secondary diagnosis
The CAO will determine GA eligibility based on a statement from the treatment center which specifies the date of admittance and the expected length of treatment needed by the client.
The client will no longer be GA eligible under this criterion if the treatment ends prior to the exhaustion of the nine months or the treatment plan changes and the individual is considered employable. The client may still receive GA if he meets one of the other criterion.
When the nine months end, the client can no longer be considered GA under this criterion even though the treatment for drug or alcohol abuse continues.
If the client does not meet any other GA criterion at the end of nine months, the client will no longer be eligible for GA.
A client who is a victim of domestic violence (DV) may be eligible for GA. An individual receiving GA under this criterion is eligible for a maximum of nine months in his/her lifetime. This time-limited criterion should be used only if there are no other appropriate GA criteria. The victim may qualify for GA for only up to nine months in a lifetime even though protective services continue after the expiration of the nine-month time limit.
55 Pa. Code § 141.61(c)(1)(vii)
The victim must be pursuing or receiving protective services as described below:
NOTE: The CAO may not require the individual to obtain a Protection From Abuse Order (PFA).
Self-attestation is not sufficient to verify eligibility for GA Cash based on a claim of domestic violence. Case comments should clearly address the verification the CAO accepted. Any verification document received must be placed in imaging.
The various types of protective services include, but are not limited to, one of the following services:
The CAO must:
NOTE: The 9-month lifetime limit is converted to 275 days for tracking purposes.
If the individual never received GA under this criterion, or if any time remains from a previous authorization, the CAO will authorize GA accordingly.
If an individual has received fewer than 275 days and more than 246 days, process the budget as an NCE for the remaining days.
NOTE: Individuals who are living in a DV shelter or who are enrolled in the Address Confidentiality Program (ACP) do not receive mail timely. Their mail is delayed by the ACP process or the mail process of the shelter. Time limitations regarding requirements for the client to respond or provide verification must be extended due to postal delays for clients enrolled in the ACP or living in a shelter. See Section 108.102.
A woman whose pregnancy has been medically verified may qualify for GA if she is not eligible for TANF.
NOTE: A statement from a medical source, that may include a medical clinic or a nurse/midwife, is required for verification.
106.38 Pre-Release Grant to Leave a Public Institution
An individual being released from a public institution is entitled to one semimonthly assistance payment immediately upon leaving the institution if they meet all other eligibility criteria. Eligibility is not established merely due to release from a public institution. The individual must otherwise be eligible for GA cash assistance. The purpose of this payment is to provide funds for the individual to make arrangements for food and shelter outside the institution.
An institution is considered to be public when a governmental unit controls the management or administration of the institution and provides the major part of the funds. This includes county and state prisons.
To be eligible for a pre-release payment, the client must qualify for GA.
An individual is considered to be released when the institution is no longer providing his food and shelter or when he is no longer living in the institution. The CAO in the county where the institution is located is responsible for issuing the pre-release payment. The payment is to be issued only if there are no other resources available to the client to make living arrangements.
NOTE: An individual being paroled to a Community Corrections Center (CCC) is not eligible for a pre-release grant. The CCC will be providing living arrangements.
The CAO may arrange to have an application taken for a pre-release grant either:
At the institution prior to the individual’s release, or
In the CAO prior to, or within 24 hours of the individual’s release
The CAO will issue the OTI prior to the individual’s release or the same day as the application interview. Code 110 is used for all one-time issuance pre-release payments.
Reissued April 11, 2019, replacing December 27, 2018