SECTION 340:10-10-2. Physical or mental incapacity of the natural or adoptive parent

(a)   Scope and applicability. The physical or mental incapacity of a natural or adoptive parent exists when one parent has a physical or mental illness or impairment that substantially reduces or eliminates the parent's ability to support or care for his or her child(ren). To be considered incapacitated, the parent's illness or impairment must be expected to last for at least a 30-calendar day period. The physical or mental incapacity must be supported by competent medical and social evidence.

(1)   Both parents may be included in the assistance unit when either parent is incapacitated regardless of whether the parent who is not incapacitated is employedor the incapacitated parent's usual function as a homemaker or wage earner.

(2)   The reduction of the ability to provide support to an eligible child is not the same as the inability to perform work. A parent may be working or capable of work but still be incapacitated for the purposes of establishing eligibility for Temporary Assistance for Needy Families (TANF). The criterion is the reduced ability of the parent to provide support or care, not the parent's employability.

(b)   Determination of substantial reduction or elimination of ability to provide support or care. The factors in (1) - (8) of this subsection are considered evidence of a substantial reduction or elimination of a parent's ability to provide support or care. One factor by itself does not automatically determine that a parent is incapacitated. These factors are indicators to the Oklahoma Health Care Authority, Level of Care Evaluation Unit (LOCEU) of the various ways a physical or mental impairment affects a parent's ability and the extent that such ability is affected. Any factor considered must exist as a result of the parent's physical or mental impairment and must be supported by specific medical information or social facts. Factors include the:

(1)   parent's inability to perform any type of gainful employment;

(2)   parent's ability to provide care for the child(ren) is substantially impaired without help from others;

(3)   parent qualifies for placement in a job that is rehabilitative or therapeutic, or for work in a sheltered workshop that is not considered to be a competitive full-time job;

(4)   number of hours the parent is able to work is substantially reduced;

(5)   wages the parent is able to earn are substantially reduced;

(6)   parent is unable to work in his or her customary occupation, but is able to work at employment that he or she is equipped by education, training, and experience to perform, but that pays substantially less than his or her customary employment;

(7)   parent is incapable of accomplishing as much on the job as an unimpaired worker and is or would be paid on a reduced basis even though able to work full- time; or

(8)   employer's refusal to hire the parent due to of the nature of the parent's physical or mental impairment. This includes behavioral disorders and disabling conditions.

(c)   Determination of incapacity at the time of application. When deprivation at application for TANF is based on the incapacity of a parent who receives Social Security Administration (SSA) disability benefits, Supplemental Security Income (SSI) due to disability or blindness, or State Supplemental Payment (SSP) for the blind or disabled, the determination of disability or blindness that established SSA, SSI, or SSP eligibility establishes incapacity for TANF. When disability or blindness was not predetermined by the previous criteria, a referral is sent to LOCEU to make an incapacity decision for TANF eligibility.

(1)   The worker obtains medical information from the client or, with the client's permission, from the relevant health professional and sends the medical information and a completed Form 08MA022E, Medical Social Summary, to LOCEU for use in determining incapacity. The medical information must be less than 90-calendar days old in order for LOCEU to make an incapacity decision, per OAC 317:35-5-4(2)(C).

(2)   When existing medical information cannot be obtained without cost to the client, payment may be authorized for existing medical informationor one general physical examination by a medical or osteopathic physician of the parent's choice. The physician cannot be in an intern, residency, or fellowship program of the medical facility, or in the full-time employment of the Veterans Administration, Public Health Service, or other agency. Refer to OAC 317:35-3-2 for information regarding transportation and subsistence assistance.

(3)   Form 08MA022E, completed with the client, along with medical documentation provides sufficient medical and social information to enable LOCEU staff to make a prompt and proper decision. Upon receipt of the medical documentation and Form 08MA022E, a medical review team within LOCEU is responsible for:

(A)   making an incapacity decision;

(B)   setting the incapacity eligibility effective date;

(C)   requesting additional medical and social information when it is necessary for a decision;

(D)   setting the date when a re-examination and medical social summary is needed or stating no further medical social summary is needed; and

(E)   recommending a training plan, when advisable.

(d)   Incapacity not established. LOCEU determines if incapacity is established based on the medical and social information provided. When incapacity cannot be established, LOCEU describes the specific factors relied on to make the decision. The worker denies the application or closes the TANF benefit as incapacity was not established.

(e)   Incapacity determination at renewal or other specified times after certification. When the parent's initial incapacity was based on an SSA determination of blindness or disability or by LOCEU the steps outlined in (1) - (6) of this subsection are followed. When SSA or LOCEU no longer consider the parent incapacitated, the worker closes the TANF benefit.

(1)   No further incapacity determination is required when the parent continues to receive SSI based on disability or blindness or SSA disability benefits.

(2)   When the parent stops receiving SSA or SSI because SSA determines the parent no longer meets the disability or blindness definition and the parent states he or she is still incapacitated, an incapacity decision must be made by LOCEU. Form 08MA022E is completed and submitted to LOCEU for a determination of continuing incapacity for TANF,per (c) of this Section.

(3)   When SSA discontinues disability benefits or SSI benefits for a reason other than failure to meet the definition of disability or blindness and the assistance unit meets all other conditions of TANF eligibility, continuing incapacity is determined by LOCEU per (c) of this Section.

(4)   When the parent continues to receive SSP on the basis of an LOCEU decision, no further determination of incapacity is made as long as the parent continues to be eligible for SSP because of disability or blindness.

(5)   When LOCEU determines the person no longer meets the definition of disability or blindness but the assistance unit meets all other conditions of TANF eligibility, the worker requests that LOCEU determine incapacity,per (c) of this Section.

(6)   When LOCEU staff determined initial incapacity and includes a date when a new Form 08MA022E is due, the worker completes Form 08MA022E with the client and begins gathering new medical information per (c) of this Section the month before a new incapacity decision is due.

(f)   Incapacity determination at reapplication. An incapacity determination is not needed at reapplication when TANF was previously denied or closed for reasons other than incapacity, the :

(1)   parent's incapacity was established prior to denial or closure, and the incapacity approval date extends beyond the reapplication date; or

(2)   parent receives SSP or SSI benefits based on disability or blindness or SSA disability benefits.

[Source: Added at 17 Ok Reg 444, eff 11-1-99 (emergency); Added at 17 Ok Reg 2075, eff 7-1-00; Amended at 19 Ok Reg 1737, eff 6-14-02; Amended at 37 Ok Reg 1776, eff 9-15-20]