(a) Scope and applicability.  The physical or mental incapacity of a natural or adoptive parent exists when one parent has a physical or mental defect, illness, or impairment that substantially reduces or eliminates the parent's ability to support or care for the otherwise eligible child(ren) for at least a 30 day period.  The physical or mental incapacity must be supported by competent medical and social evidence.  Both parents may be included in the assistance unit if either parent is incapacitated due to a reduced ability to provide support or care, regardless of whether the parent who is not incapacitated is employed, and regardless of the incapacitated parent's usual function as a homemaker or wage earner.  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 whether an individual is incapacitated, rather, these factors are indicators to the Oklahoma Health Care Authority, Level of Care Evaluation Unit (LCEU) of the various ways a physical or mental impairment affects a parent's ability and the extent to which 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.  • 1   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;  • 2
• (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 his or her customary occupation, but is able to work at employment for which her or she is equipped by education, training, and experience 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 the application for TANF is based on the incapacity of a parent who is currently receiving 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.  • 3  If disability or blindness has not been pre‑determined by the previous criteria, a referral is made to LCEU for a decision on incapacity for TANF eligibility.

• (1) Determination of incapacity by LCEU.  Medical information is obtained by the social services specialist and sent to LCEU for use in determining incapacity.  • 4    Payment for existing medical information, one general physical examination by a medical or osteopathic physician of the parent's choice, transportation, or subsistence can be authorized.  • 5 
• The Form ABCDM-80-D (new form number 08MA022E), Medical Social Summary, submitted to the LCEU by the county office provides sufficient medical and social information to enable that unit to make a prompt and proper decision.  • 6   On receipt of Form ABCDM-80-D (new form number 08MA022E), a medical review team within LCEU is responsible for:
• • (A) determining incapacity;  • 7
  • (B) setting an effective date of eligibility for incapacity;
  • (C) requesting additional medical and social information when it is necessary for a decision;
  • (D) authorizing specialists' examinations, if needed;
  • (E) setting a date when another medical social summary is needed or stating no further medical social summary is needed; and,
  • (F) recommending the advisability of a training plan.  • 8
• (2) Specialist's examination.  If, on receipt of the medical information and medical social summary, the LCEU needs additional medical information, that unit makes the appointment for the specialist's examination.  The medical member of the team selects a physician and authorizes the examination.  • 9    The parent is immediately notified by the social services specialist of the appointment and advised that failure to keep the appointment without good cause will result in denial of the application or case closure when redetermining continuing incapacity.  Good cause is determined by the social services specialist if the parent notifies the social services specialist at least 24 hours prior to the date of the examination that the appointment cannot be kept.  • 10    If the parent notifies the social services specialist he or she has no intention of keeping the appointment or fails to keep the appointment, the reason is documented and LCEU is immediately notified by memo and the decision of good cause is made by LCEU.  If the appointment was missed due to illness of the parent, the illness must be supported by a written statement from a doctor or if missed for another reason, the reason must be supported by an affidavit signed by someone other than the parent or his or her representative and sworn to before a notary public or other person authorized to administer oaths.  If LCEU determines good cause, another appointment is arranged by LCEU.  If good cause is not established by LCEU, a decision regarding incapacity cannot be made.  The social services specialist is responsible for explaining to the parent that eligibility cannot be determined without additional information, giving the parent the opportunity to reconsider, to withdraw his or her application, or request closure of the TANF case in writing.  If the parent still refuses a specialist's examination and does not wish to withdraw the TANF application or request closure of the case, the application is denied or the case is closed as incapacity cannot be established.

(d) Incapacity not established.  LCEU makes the determination whether incapacity can be established based on the medical and social information provided.  If incapacity cannot be established, LCEU describes the specific factors upon which they relied to make the decision.  • 11    The application is denied or the case is closed.

(e) Determination of incapacity at specified times other than at the time of application.  • 12    Whether the parent's initial incapacity was based on an SSA determination of blindness or disability or by LCEU the steps outlined in (1) - (5) of this subsection are followed.  If incapacity is no longer determined by either SSA or LCEU, the case is closed.

• (1) If the parent continues to receive SSI based on disability or blindness or SSA disability benefits, no further determination of incapacity is made as long as this individual continues eligible for SSA disability benefits or SSI based on disability or blindness.
• (2) If the parent no longer receives SSA or SSI because SSA has determined the individual no longer meets the disability or blindness definition, Form ABCDM-80-D (new form number 08MA022E), Medical Social Summary, is completed and submitted to LCEU for a determination of continuing incapacity for TANF in accordance with subparagraph (c)(2) of this Section.
• (3) If 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 LCEU.
• (4) If the parent continues to receive SSP on the basis of a decision by LCEU, no further determination of incapacity is made as long as the parent continues eligible for SSP because of disability or blindness.
• (5) If LCEU determines that the individual no longer meets the definition of disability or blindness but the assistance unit meets all other conditions of TANF eligibility, continuing incapacity is determined in accordance with (c)(2) of this Section.

(f) Determination of incapacity at the time of reapplication.  When TANF based on incapacity was previously denied or terminated for reasons other than incapacity and the parent reapplies within 12 months of the date on which LCEU made an incapacity decision, it is not necessary to have incapacity redetermined at the time of reapplication if LCEU had approved incapacity previously for a period extending beyond the date of reapplication.  • 13   If the TANF reapplication is based on the incapacity of a parent who is currently receiving SSP or SSI benefits based on disability or blindness or SSA disability benefits, it is not necessary to have incapacity determined at the time of reapplication.  • 14