(b) If a participant is exempt or deferred from work participation requirements:

1. (1) The exemption or deferral will be granted as soon as it is established but no later than thirty (30) days from the date it is claimed;
2. (2) The time limit will not count in the months he or she is exempt/deferred;

3. (3)

   1. (A) The appropriate exempt/deferral reason will be applied.
   2. (B) See the Resource Section for a list of codes; and
4. (4) The Program Eligibility Specialist will advise the participant that the deferred/exempt months do not count towards the twelve-month time limit.

(c) Work participation exemptions.

1. (1) The only persons who may be considered exempt, and therefore are not required to participate in work activities while exempt, are parents who are caring for a child:

   1. (A) Under three (3) months of age; or
   2. (B) Between three (3) and twelve (12) months of age if child care for such child is not available, as determined by the local office.
2. (2) A parent may be exempted for the above reason for a maximum lifetime limit of twelve (12) months.

(d) Work participation deferrals.

1. (1)

   1. (A) A participant will be temporarily deferred from participation any time he or she meets the criteria for one (1) of the deferral situations listed below:

(c) (c) See subsection (f) of this section for detailed information on medical disability verification;

1. (ii) A woman in the third trimester of pregnancy;

   1. (iii)

(b) (b) Note. If the family member will require care for an extended period of time, the Program Eligibility Specialist should explore other resources or available services, e.g., a home health aide, that would enable participation;

1. (iv)

(b) (b) The local office will make the determination as to whether a particular supportive service is necessary for participation;

1. (v) The person is unable to participate in work activities due directly to the effects of domestic violence;

   1. (vi)

(b) (b) This decision will be made at the local office level.

1. (c) (c) Circumstances include, but are not limited to, natural disasters;

   1. (vii) In two-parent families, one (1) parent may be deferred from participation to care for the minor child or children, when appropriate; and

      1. (viii) A parent or caregiver over sixty (60) years of age.
   2. (B) While in deferred status, the participant may elect to participate in a work activity or another appropriate activity if he or she voluntarily chooses to do so.
   3. (C) Supportive services will be provided for the deferred individual who chooses to participate in a work activity.

2. (2) Note.

   1. (A) Any month a participant is deferred or exempt from work participation activities will not count toward the state's twelve-month time limit.
   2. (B) Also, there is no limit on the length or the number of deferrals a participant can receive, provided requirements are met.
   3. (C) Therefore, an exempt/deferred individual automatically receives a month-for-month extension to the twelve-month time limit for each deferred/exempt month.
3. (3) A review of the deferral will be made at least once a month by phone or mail.

(e) Verifying deferral reasons.

1. (1) If a participant meets one (1) of the deferral reasons, verify the reason for deferral and document the case record accordingly.
2. (2) A participant who alleges that he or she is needed in the home to care for individuals with disabilities (child or adult relative) will be required to provide medical verification of the relative’s disability and the need for the individual to care for the relative.

3. (3) For medical deferrals (illness or incapacity to last no more than six (6) months):

   1. (A) A doctor’s statement or other medical documentation should be obtained;
   2. (B) The statement should clearly state or otherwise indicate that the person is unable to engage in work activities because of the medical condition; and
   3. (C) Whenever possible, give an estimated length of incapacity.

4. (4) Note.

   1. (A) A participant who is deferred and provides additional medical statements advising that the illness or incapacity will last longer than the initial six (6) months will be referred to the medical review team.
   2. (B) See subsection (f) of this section.

(f) Medical review team (MRT) referral process.

1. (1) The Program Eligibility Specialist will follow the process outlined in this section if the participant alleges a long-term disability as a barrier to participating in a work activity.

2. (2)

   1. (A) A participant who has been seeing a medical provider for an alleged disabling condition will not be required to have the DCO-107, Confidential Report of Medical Examination of Patient, completed by the provider.
   2. (B) Instead, the Program Eligibility Specialist will obtain a completed and signed DHS-1400, Provider Agreement.
   3. (C) The completed DCO-108, Social Report, and the signed DHS-1400 will be sent to the medical review team (MRT).
   4. (D) The medical provider’s name and address and the date of service must be included with the referral to the MRT.
   5. (E) The MRT will request the medical information directly from the provider.

3. (3)

   1. (A) A participant who is Medicaid eligible and who has not seen a medical provider for the disabling condition within the past twelve (12) months will be required to see a medical provider and provide the information regarding the name and address of the provider and the date the participant was last seen by the medical provider.
   2. (B) Upon receipt of this information, the Program Eligibility Specialist will send the completed DCO-108 and the signed DHS-1000 to the MRT.

4. (4)

   1. (A) A participant who is not Medicaid eligible and who has not seen a medical provider within the past twelve (12) months will be referred to the MRT.
   2. (B) A completed DCO-108 and a signed DHS-4000 will be sent to the MRT.
   3. (C) The local office will advise the MRT that the participant is not Medicaid eligible and has not seen a medical provider.
   4. (D) The MRT will refer the participant to a medical provider.

5. (5)

   1. (A) If there is an appeal pending, a doctor’s statement must be in the case and the participant should be deferred until the case has reached the final appeal and been denied or decided not to appeal anymore and thus becomes mandatory.
   2. (B) If the appeal has not been filed, the Program Eligibility Specialist will notify the MRT that the Social Security Administration has denied the participant’s claim.

(g) Holidays.

1. (1)

   1. (A) Participants engaged in work activities will be allowed ten (10) holidays and up to an additional eighty (80) hours of excused absences in a twelve-month period, with no more than sixteen (16) hours of excused absences in any month.
   2. (B) Once the participant has exhausted the allowed excused absences, good cause can be documented if deemed appropriate, but the hours cannot count as actual participation hours.

2. (2) The approved holidays are as follows:

   1. (A) New Year’s Day;
   2. (B) Dr. Martin Luther King Jr.’s Birthday;
   3. (C) Washington’s Birthday;
   4. (D) Memorial Day;
   5. (E) Independence Day;
   6. (F) Labor Day;
   7. (G) Veterans Day;
   8. (H) Thanksgiving Day;
   9. (I) Christmas Eve; and
   10. (J) Christmas Day.

(h) Excused absences.

1. (1) Missed hours of work may be counted as actual hours of work participation under the excused absence policy if all of the following criteria are met:

   1. (A) The participant was actually scheduled to work for the period of the absence;
   2. (B) No more than sixteen (16) of these hours will count as actual hours in any month; and
   3. (C) No more than eighty (80) of these hours will count as actual hours in a year (twelve-month period). Example: Mr. Waters was scheduled to work Monday through Friday but does not report to work Wednesday, Thursday, or Friday due to illness. Mr. Waters’ employer will not be paying him for the missed days. The Program Eligibility Specialist verifies that Mr. Waters has not received prior excused absence credit in that month. The Program Eligibility Specialist can credit Mr. Waters with two (2) days of excused absences (sixteen (16) hours of actual participation). The third missed day cannot count as actual hours of participation. In the case narrative, the Program Eligibility Specialist should clearly document which days and how many hours of excused absences or holiday time are being counted as actual hours of participation.
2. (2) Note. Paid leave time is an acceptable substitute for actual working hours.