The GA-related category PD is assigned to individuals who do not meet the eligibility requirements for any other category of NMP. Individuals assigned category PD must meet one of the GA eligibility requirements detailed in Section 305.41 through Section 305.45.
A GA-PD recipient must apply for SSI if he or she is under age 65 and disabled according to Section 305.42
NOTE: The CAO must approve presumptive eligibility for Healthy Horizons (PH 00), PJ, or TJ for a GA-related person who appears to meet the Social Security disability requirements. (Section 305.26.)
Each applicant must provide proof of GA-PD eligibility before authorization. For the GA-related NMP (PD) applicant who establishes eligibility, MA benefits will be approved as of the date all conditions of eligibility are proven. Specific verification requirements are listed under each criterion. The CAO will record the verification of eligibility for GA-PD. The CAO will help the individual get proof if he or she cannot get it alone.
NOTE:
For
PD, the date on which possible coverage would begin is the date all eligibility
conditions are met and verified. The period when someone can receive coverage
for time that has already passed starts on the first day of the third
month before the month when the individual applies. The period between
when someone applies and when possible coverage begins is also considered
to be in the retroactive period.
Example: An individual applies March 15. All conditions of PD are met as of April 2. The individual provided medical bills for December 3, January 5, January 18, February 24, March 5, and March 17. The PD retroactive period is from December 1 through April 1.
Individuals who are parents living in a two-parent household with their child who is either under age 13 or age 13 or older and proven to be disabled may be eligible for GA-PD if the child does not qualify for TANF.
55 Pa. Code § 141.61(c)(1)(ii)
NOTE:For purposes of this section, a disabled child is a child who gets Social Security disability benefits or Supplemental Security Income (SSI).
The two parents and child do
not all need to apply for GA-PD. One parent may apply for GA-PD if (a)
the child is not eligible for TANF on the basis of a deprivation
factor and (b) the child does
not meet the requirements for citizenship
or refugee
status. Another choice is for one parent to apply along with the child.
NOTE:
The
two-parent guidelines for PD (NMP) apply to both parents, whether or not
they are married, as long as paternity
has been
established for the child in a two-parent household. The income of both
parents must be considered in the eligibility determination.
Once the household composition and ages of the people who live together are verified, they do not have to be verified again unless there is a change in who lives in the household. Acceptable proof includes written evidence, public records, birth certificates, or anything else that shows the individual’s statement is true.
An individual is GA-PD if he or she has a temporary or permanent physical or mental disability that:
55
Pa. Code § 141.61(c)(1)(iii)
Permanently prevents the individual from working in any job in which he or she will earn a salary.
Temporarily
prevents the individual from working in any job in which he or she
will earn a salary
.
NOTE:
If the medical provider
believes that an individual can work only by using a health sustaining
medication for a medical condition, the individual is considered GA-PD
eligible. A medical provider must give information about the condition
and the name of the drug. The medicine can be an over-the-counter medicine.
NOTE: If the disability involves drug or alcohol addiction, the CAO must first determine GA-PD status under this section.
NOTE: An individual with a temporary disability must seek the correct treatment to be considered eligible, unless the individual has good cause for not seeking treatment.
55 Pa. Code § 141.61(c)(1)(iii)(F)
Reminder: An individual who cannot work at a job because of a disability must apply for SSI to be eligible for GA-PD, unless the disability is not expected to last. An individual with a disability that is permanent or expected to last for 12 months or longer more must apply for SSI/RSDI. The CAO will refer the individual to the Disability Advocacy Program (DAP), unless the only diagnosis is drug addiction or alcoholism. (Supplemental Handbook, Chapter 820, Disability Advocacy Program.) The CAO will explore eligibility for federal category PH 00, PJ, or TJ.
The CAO must determine GA-PD status based on a physical or mental disability from the information in one of the following forms:
Employability Assessment Form (PA 1663)
Temporary Disability Reassessment Form (PA 1664)
Health-Sustaining Medication Assessment Form (PA 1671)
NOTE: The PA 1671 is given to the applicant to fill out if the individual says that he or she is taking medications for a medical condition but can still work at a job. (See Appendix A for guidelines.)
55
Pa. Code 141.61(c)(1)(iii)(B)
These forms must be completed
by a psychologist, a medical doctor, or a medical professional who is
under a doctor’s supervision and control (for example, a physician’s assistant
or certified registered nurse practitioner).
Information from a chiropractor is not acceptable medical proof.
Information from a podiatrist is not acceptable medical proof.
Information
from an oral surgeon is not acceptable medical proof.
If the medical provider allows it, the applicant can send information along with the form that helps prove that he or she has a disability.
Records from other sources including, but not limited to, the Social Security Administration (SSA), the Department of Veterans Affairs (DVA), and DHS’s Medical Review Team (MRT) can also be accepted. The PA 1663, PA 1664, or PA 1671 must still be used if records from another source are not available, are not complete, or do not show how the individual’s disability is related to his or her ability to work at a job. If any of these records is six months old or older and does not show that the applicant has a permanent or ongoing condition, then the individual needs a new evaluation.
55 Pa. Code 141.61(c)(1)(iii)(B)
A disability that is found by the DVA can be used to establish GA-PD only if the disability is 50 percent or more. If the disability is less than 50 percent, the individual needs to have a more complete medical and employment evaluation.
NOTE:
If
DVA hospitals or DVA outpatient centers do not complete the PA 1663,
PA 1664,
or PA 1671,
a veteran must get the information from another source using DHS forms.
If necessary, the CAO must help the veteran find another medical provider
to give the information.
The individual must provide proof
of the disability and its effect on his or her ability to work as follows:
For applicants, proof must be provided before eligibility for GA-PD status can be determined.
For recipients, proof must be provided within 30 days of the renewal or change in circumstances.
55 Pa. Code § 141.61(c)(1)(iii)(A)
NOTE:
The
CAO must make a referral to the Disability Advocacy Program (DAP) if the
worker believes that the individual cannot get the documentation that
is needed because of a mental disability. The worker must explore whether
the individual is eligible for a federal category PH, PJ, or TJ.
If an applicant cannot provide proof of disability, the applicant is ineligible for D or PD and remains ineligible until proof of a disability is provided. Category TD with program status code 55 may be approved as a noncontinuous eligibility (NCE) for 30 days until proof of a disability is provided. Additional 30-day NCE periods may be approved if the applicant could not make medical appointments that are needed to get required medical documentation in the first 30-day period.
NOTE: The CAO must issue an interim ACCESS card that the individual can use to pay for the medical assessment.
55 Pa. Code § 141.61(c)(1)(iii)(C).
If the medical provider notes
on the PA 1663 that the individual
has a permanent disability, then the CAO must approve benefits in the
appropriate federal disability category (PH, PJ, or TJ) as follows:
For the GA cash assistance applicant, going back to the date the first eligibility was established up until the end of the 30-day TD/55 NCE period
For the GA-related MA (PD) applicant, going back to the first date when continuing eligibility began (Section 305.26)
NOTE:
An
individual can be determined eligible for MA benefits for a period that
has already passed beginning with the first day of the third month before
the month when the individual applied, if the provider has indicated the
criteria for PD was met during the period requested, all other eligibility
requirements for PD are met including meeting income and resource
limits
and the individual meets the retroactive NMP guidelines. Section 368.3.
If the PA 1663 or PA 1664 says that the individual has a temporary disability, then the eligibility period for GA-PD is only the period that the medical provider indicates.
If the PA 1663 or PA 1664 says that the individual can be employed, then the individual is ineligible for GA-PD benefits.
The CAO records any change in
status in the case record.
The CAO will review and verify
the disability when the application is first turned in. The disability
information must be reviewed again when the individual reapplies only
if a medical provider noted that there might be a change in the individual’s
condition or if his or her circumstances or DHS's regulations have changed.
It is not necessary to go through the renewal process to prove an individual’s disability as long as he or she continues to get SSA or DVA benefits based on disability.
55 Pa. Code §§ 133.23(a)(2)(ii)(L) & (3)(i)
If the individual’s disability
is drug or alcohol addiction, the CAO must deny or stop benefits if the
individual does not follow a treatment plan, unless he or she has good cause for
not following it. (Section
305.44.)
An individual with a disability
that is permanent or expected to last for 12 months or longer must apply
for SSI/RSDI. The CAO will refer the individual to the Disability Advocacy
Program (DAP) and review the case first for Healthy
Horizons and then for PJ/TJ eligibility. If the only diagnosis
is drug addiction or alcoholism, the CAO will not refer the case to the
DAP.
NOTE:
Disabilities
of the Mental Health (MH) or Mental Retardation (MR) categories, particularly
as they apply to people with a certain degree of retardation, rarely change,
even though the type of job that a individual with one of these conditions
can get and keep may change. Also, some applicants and recipients with
MH or MR disabilities may have a hard time finding medical providers.
Therefore, applicants and recipients with these types of disabilities
may find it hard to get medical proof of their MH or MR disability. Every
effort must be made to help these people get the required medical proof.
The CAO will refer a individual to the Disability
Advocate if
the CAO believes that he or she cannot get the proof because of a mental
disability. (Supplemental
Handbook, Chapter 820, Disability Advocacy Program.)
NOTE: If an individual enters a training program or starts a job, it does not always mean that he or she is no longer disabled. If the CAO suspects a change in a individual’s medical condition, the CAO must get proof. For an individual active with OVR or an MH/MR Base Service Unit (BSU), the CAO must get proof in writing from an OVR medical consultant or the BSU’s psychologist or medical doctor. The individual giving the proof must know (a) what the individual’s physical or mental disability is and (b) how it affects his or her ability to get or keep a job.
An individual is eligible for GA-PD if he or she (a) cares for a child under age 13 but is not a parent of that child or (b) cares for another individual in the home who is ill or disabled. This includes a single individual who is providing foster care for a child under age 13. If the non-parental caretaker is a specified relative, the case must be TANF-related MA.
55 Pa. Code § 141.61(c)(1)(iv)
The CAO will verify the age of the child or the medical condition of the ill or disabled individual. Age can be verified through SDX.
The applicant or recipient must prove the need to stay home to care for an ill or disabled individual. The proof must be from a licensed psychologist or medical doctor explaining the following:
The individual’s disability
The need for a caretaker
How long the disability
is expected to last
The CAO will review these factors
at renewal or when the individual’s situation changes.
NOTE: The child or adult who is ill or disabled does not have to be a member of the applicant/recipient group, but must be a household member. When determining whether the caregiver can qualify, the CAO must decide if someone else in the household can provide the care without requiring GA-PD.
A individual who is undergoing active treatment for substance abuse in a drug- or alcohol-abuse program is eligible for GA-PD if the treatment program does not allow employment during treatment. The treatment program must be licensed or approved by the Department of Health or administered by an agency of the federal government.
Because abuse of drugs or alcohol may result in a serious physical or mental disability, the CAO must determine GA-PD eligibility due to a disability by following the procedures under Section 305.42.
The CAO must confirm that taking part in a treatment program does not allow for employment. The CAO must also verify the individual is going to the treatment program. Acceptable proof includes, but is not limited to, a written statement from the program director or staff and official attendance records.
NOTE:
The CAO's need to make an eligibility decision as quickly as possible
in this situation.
A individual may be GA-PD and in a treatment program for no more than nine months in his or her lifetime, even when in treatment at the end of the nine months.
This time-limit rule must be used only if there is no longer-term GA-PD eligibility criteria.
The CAO will review the case record and the Client Information System (CIS) to see if the individual ever got GA cash assistance before. If he or she never did, or if any time remains from a previous approval, the CAO will approve GA-PD for the correct number of months.
If the individual says that he or she is taking part in a treatment program, then he or she will sign a Drug and Alcohol Treatment Information Form (PA 1672). The individual will have the treatment center complete the form and then return it to the CAO with the proof needed. The CAO must determine eligibility for GA using information from the treatment center based on when the individual began treatment and how long the individual is expected to need it.
NOTE GA and GA-PD will not be approved until the completed form is returned to the CAO.
The CAO will track the individual’s
progress and note his or her continued treatment. The caseworker will
send a PA 1672 to the treatment
center at the end of the individual’s first month of benefits to ask for
information about the individual’s status.
After that, contacts will be
made every three months using either the DHS form, a phone call, a written
statement, a copy of official attendance records from the director or
professional case-management staff of the program, or another form of
proof. If the individual lives at the treatment center, the proof must
show that the individual is still taking part in the treatment program.
If treatment ends early, the treatment center may let the CAO know.
NOTE:
The
treatment center does not need to let the CAO know about the individual’s
status. It is the CAO's responsibility to make sure that the tracking
continues. Caseworkers will narrate telephone contacts into the case record
and keep forms.
The individual still must let the CAO know of any changes in circumstances that may affect his or her eligibility.
The individual cannot get benefits if he or she does not follow the treatment program, unless there is a good reason for not doing so. When sending an advance notice (PA/FS 162-A) to stop benefits for this reason, the CAO must use the following citation:
“PA. Drug and Alcohol Abuse Act, 71 PS 1690.109(a)(d).”
After nine months, the individual can no longer be considered GA-PD on this basis even though the treatment for drug or alcohol abuse may continue. If the individual does not qualify on any other basis for GA-PD after nine months, the CAO must send the recipient an Advance Notice and use the following statement as the reason for the closing:
"You are eligible for Medical Assistance (MA) because you are receiving treatment in a drug or alcohol program. Receipt of benefits on this basis is limited to a maximum of nine months within your lifetime, and you will have exhausted this time limit on [effective date of the closing].
55 Pa. Code § 141.61(c)(1)(v)”
The individual will no longer be GA-PD eligible on this basis if the treatment ends before the nine months are up or if he or she becomes able to work. The individual may still be GA-PD eligible if he or she meets one of the other GA-PD criteria.
An individual who is a victim of domestic violence may qualify for GA-PD. Someone getting GA-PD for this reason is eligible for up to nine months in his or her lifetime. The time-limited factor must be used only if there is no other basis on which the individual could get GA-PD. A domestic-violence victim may qualify for GA-PD for only up to nine months in his or her lifetime even though the protective services continue after the nine-month time period has ended.
55 Pa. Code § 141.61(c)(1)(vii)
The victim must be trying to
get or getting protective services as described below:
If he or she is getting protective services, there must be proof of these services before GA can be approved. Proof can come from:
A domestic violence center.
A district magistrate office.
Law enforcement records.
Types of proof include the following:
Phone contact with a domestic violence center.
Written proof from a domestic violence center.
Police records.
Court records (a restraining order, for example).
The CAO must narrate the type of proof and where it came from in the case record.
There are several kinds of
protective services, including, but not limited to, services for the following
situations:
The victim of domestic violence is living in an emergency shelter or emergency housing for abuse victims.
An individual
is eligible for cash and MA benefits as long as the benefits are needed,
but the benefits given because an individual is a victim of domestic
violence will be available only for nine months in the individual’s
lifetime. Proof must be given each time the individual moves from
the abusive situation into a protective shelter or begins to use other
forms of protective services
The victim is getting supportive counseling from an abuse program.
The victim is getting services to prevent further potential abuse.
The victim is getting services that let him or her remain at home.
The victim is getting services at a police department or is filing assault or battery charges against the abuser.
The victim is getting a restraining order or a peace bond against the abuser.
The victim is getting any service by any branch of government (including the courts or the police) or agency that counsels or protects him or her from abuse. It is not necessary for the service to be continuous or provided every day, every week, or even every month.
NOTE: The facts and information surrounding domestic violence must adhere to Supplemental Handbook 930, Safeguarding Information. Once it has been proven that the individual is getting protective services, it does not have to be proven again.
Updated March 4, 2020, Replacing February 14, 2012