106 C.M.R. 703.190 – TAFDC Disability Exemption Process

(A) Requirements.
1. (1) For a parent to be considered disabled for TAFDC purposes, his or her medical impairment must meet or equal the Social Security Disability standards in accordance with 20 CFR Part 416, Subpart I (the Social Security Disability standard), or meet or equal the Social Security Disability standard except that the medical impairment must only have lasted or is expected to last for a continuous period between 90 days and 12 months.
2. (2) The applicant or client must apply for Social Security Disability benefits in accordance with 106 CMR 702.710: SSI and SSP Benefits: SSI Benefits and appeal any denials at the Social Security Administration, if requested to by the Department.
(B) Disability Determination Process. The determination of whether a parent meets the definition of disability as defined above shall be made by the agency or organization under contract/agreement with the Department to provide disability evaluation services (hereafter referred to as the Department’s agent).
(C) Cooperation in the Disability Determination Process.
1. (1) An applicant or client is responsible for establishing that he or she is disabled.The Department shall assist the applicant or client in obtaining the necessary information and may require the applicant or client to attend an exam by the Department’s agent.
  1. (a) The applicant or client must provide the Department with:
    1. 1. a description of his or her impairments and a list of his or her medical providers; and
    2. 2. information regarding the vocational factors used in determining the Social Security Disability standard.
  2. (b) If an applicant or client, without good cause, does not appear for a scheduled medical examination, does not provide required medical releases, or otherwise does not cooperate in the disability determination process, the Department’s agent shall make a determination of disability based only on the information received from the applicant or client and other available sources. Religious or personal reasons opposing medical examinations or tests do not constitute good cause.
2. (2) The Department and, if applicable, its agents, shall take reasonable steps to assist applicants and clients in obtaining information necessary to make a determination.
  1. (a) The worker and/or agent of the Department is responsible for assisting the applicant or client in completing the Disability Supplement when, after inquiry by the worker, such assistance is requested.
  2. (b) The Department’s agent is responsible for:
    1. 1. gathering the information needed to make a disability determination by contacting any physician, psychologist, and/or hospital identified by the applicant or client, to obtain information on any impairment that may potentially affect the applicant’s or client’s ability to work provided such impairments have been identified by the applicant or recipient or is otherwise evident in the record; and
    106 CMR DEPARTMENT OF TRANSITIONAL ASSISTANCE
    1. 2. arranging for a competent medical authority (see 106 CMR 701.600: Definition of Terms) to examine the applicant or client for additional information or tests, as necessary, to clarify incomplete or ambiguous information submitted to the Department by a competent medical authority as defined in 106 CMR 701.600.
(D) When the Department’s agent must make a determination, it shall determine whether the applicant or client has an impairment or combination of impairments that meets or is equivalent to the disability standards found at 106 CMR 703.190.
(E) The Department’s agent shall make a determination that an applicant or client is not disabled only if:
1. (1) the agent has considered all clinical or vocational evidence submitted by the applicant or client or obtained by the Department. The Department shall consider a test and diagnosis done more than 30 days prior to the completion of the applicant’s or client’s Disability Supplement if it is still relevant to the applicant’s or client’s current impairments; and
2. (2) the clinical information available establishes that one or more of the findings needed to meet the applicable medical standard is not satisfied and additional clinical information would not enable the applicant or client to meet the medical standard.
(F) When an applicant or client makes a first claim for a disability exemption (see 106 CMR 703.100) within a continuous 60-month period, disability is presumed. The applicant or client will be considered exempt until the Department’s agent makes its determination. If the agent finds that the applicant or client is not disabled, the exemption will end.
(G) When an applicant, who has previously been denied by the Department’s agent, makes another claim of disability within a continuous 60-month period; and
1. (1) the applicant has used 24 months of time-limited benefits (see 106 CMR 703.120), eligibility must be established using the verification described in 106 CMR 701.380(B)(7).
  1. (a) If the applicant is requesting a time-limited benefits extension (see 106 CMR 703.130), the verification described in 106 CMR 701.380(B)(7) may also be used to excuse the applicant from meeting the work activities related to qualifying for a time- limited benefits extension.
  2. (b) If the applicant is not requesting a time-limited benefits extension, the verification described in 106 CMR 701.380(B)(7) may be used to excuse the applicant from meeting the work program requirement (see 106 CMR 703.150), if applicable;
2. (2) the applicant has not used 24 months of time-limited benefits, the verification at 106 CMR 701.380(B)(7) may be used to excuse the applicant from meeting the work program requirement (see 106 CMR 703.150), if applicable. If the verification described in 106 CMR 701.380(B)(7) is provided, eligibility for TAFDC will be presumed but the applicant will not be considered exempt under 106 CMR 703.100. The final disability determination will be made by the Department’s agent. The length of this good cause period will be determined by the specified verification until the final disability determination is made by the Department’s agent.
(H) When a client, who has been previously denied by the Department’s agent, makes another claim of disability within a continuous 60-month period (see 106 CMR 703.120); and
1. (1) the client has used 24 months of time-limited benefits (see 106 CMR 703.130), the verification described in 106 CMR 701.380(B)(7) may be used to excuse the client from meeting the work activities related to qualifying for a time-limited benefits extension; or
2. (2) the client has not used 24 months of time-limited benefits (see 106 CMR 703.120), the verification described in 106 CMR 701.380(B)(7) may be used to excuse the client from meeting the work program requirement, if applicable.
  106 CMR DEPARTMENT OF TRANSITIONAL ASSISTANCE
If the verification described in 106 CMR 701.380(B)(7) is provided, eligibility for TAFDC will be presumed but the applicant will not be considered exempt under 106 CMR 703.100. The final disability determination will be made by the Department’s agent. The length of this good cause period will be determined by the specified verification until the final disability determination is made by the Department’s agent.
(I) The decision of the Department’s agent as to whether an applicant or client is disabled shall also be the decision of the Department. A Department hearings referee may affirm, modify or reverse the finding of the agency or organization providing disability evaluation services.