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COMBINED MANUAL

ISSUE DATE 04/2022

SPECIAL MEDICAL CRITERIA

0011.36

● If the special medical criteria still applies, extend them on the special medical criteria category and DO NOT use banked months. When the caregiver is no longer eligible for the special medical criteria extension category, they must use the banked months before being re-assessed for a different extension category. After the banked months have been exhausted, evaluate the caregiver to see if there is eligibility for an extension under another extension category. See TEMP Manual TE13.041 (Special Medical Criteria – MAXIS Coding Tips).

No later than the time of the face-to-face interview, explain to any participant with a code of “8” (member is required at home to care for an ill or incapacitated family member) on the “ES Status” field of the STAT/EMPS panel that time can be accrued if they can document that the special medical criteria were met for 1 or more months beginning January 1998. If special medical criteria for a person needed in the home was not approved but it can be documented that they should have been approved on special medical criteria, this policy may also be applied. The participant can authorize the county agency to help document the special medical criteria during this period. To track these cases, enter a CASE/NOTE when you discover months that a participant met the special medical criteria from January 1998 to present. The CASE/NOTE should include the months accruing time under the special medical criteria (mm/yy to mm/yy), the household member who met special medical criteria, and the type of documentation provided.

Review eligibility for the special medical criteria and/or extension at least once per year, more often if there is any indication that the condition will change or is due to be reviewed. If the person meeting the special medical criteria leaves the home, the caregiver will no longer be eligible for this FSS category or extension criteria. See TEMP Manual TE13.040 (Special Medical Criteria – Evaluation Tips.

DWP: If at any time during the DWP application process or during the 4-month DWP eligibility period, an applicant or participant meets SMC conditions, they are considered unlikely to benefit from DWP. Convert the case to MFIP. See 0008.06.24 (DWP Conversion or Referral to MFIP).

SNAP, MSA, GA, GRH: No provisions.