Agency for Workforce Innovation August 2007

1. Medical Limitations and Incapacity Agency for Workforce InnovationAugust 2007

2. 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

3. What is a Deferral? • 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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. Medical Deferral-Documentation Requirements • Medical deferrals have specific requirements prior to entry in the OSST system • Medical deferrals • Alcohol, drug, and mental health deferrals

10. 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

11. Medical Deferral-Documentation Requirements • 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

12. 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

13. Medical Deferral-SSI/SSDI Applicants • 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

14. 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

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

16. 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

17. 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

18. Answer • 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.

19. 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

20. 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?

21. Answer • 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

22. Is It Numbers VS People?

23. 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

24. Answer • 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

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

34. 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

35. 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.

36. If you have any questions, comments, or concerns, please contact the Welfare Transition Team through the Agency for Workforce Innovation’s Call Center at 1-866-352-2345 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.