Social Security disability evaluation of cases involving primary headache disorders

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The Social Security Administration (SSA) has issued a new Ruling about evaluating disability cases involving primary headache disorder.

Primary headache disorders are a collection of chronic headache illnesses characterized by repeated exacerbations of overactivity or dysfunction of pain-sensitive structures in the head. Examples include migranes, tension headaches and trigeminal autonomic cephalalgias.  They are typically severe enough to require prescribed medication and sometime warrant emergency department visits.  Physicians diagnose primary headache disorder only after excluding alternative medical and psychiatric causes of the symptoms, and after review of the full medical and headache history and conducting a physical and neurological examination.  The International Diagnosis of Headache Disorders -3 criteria are used to as diagnostic criteria and are included in the Ruling.

A diagnosis or statement of symptoms is insufficient to establish primary headache disorder as a medically determinable impairment.  To establish primary headache disorder as a medically determinable impairment, there must be consideration of the following findings by an acceptable medical source:

— A primary headache disorder diagnosis which must document review of medical history, a physical examination, and excluding alternative medical or psychiatric causes.

— An observation of a typical headache event by the acceptable medical source.  In the absence of such direct observation, Social Security can consider a third party observation of a typical headache event.

— Remarkable or unremarkable findings on laboratory tests. Social Security will not purchase tests related to headaches or allegations of headaches.

— Response to treatment.  Evidence documenting ongoing headaches that persist despite treatment may constitute medical signs to help establish a medically determinable impairment.

Although primary headache disorder is not a listed impairment, it can, alone or in combination with other impairments, medically equal a listing.  Epilepsy (listing 11.02) if the most closely analogous listed impairment to primary headache disorder.

If primary headache disorder does not medically equal a listed impairment, Social Security assesses residual functional capacity.   For example, symptoms such as photophobia may cause difficulty sustaining attention and concentration.  (SSR 19-04p, August 26, 2019.)

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Additions to Resource Family Approval program

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The California Department of Social Services (CDSS) has provided information about additions to the Resource Family Approval (RFA) program made by AB 1930.  The RFA program created a new approval process for foster family homes, relative and non-relative extended family members interested in caring for children in foster care.  AB 1930 made three changes to the program.

First, AB 1930 extended the Foster Family Home and Small Family Home Insurance Fund to resource families.  The fund covers claims for bodily or personal injury to foster children during the foster care relationship.  Previously the fund only applied to foster family homes and small family homes.

Second, AB 1930 provides caregiver immunity for any act or omission made by the caregiver when acting as a reasonable and prudent parent, and for any act or omission of a child or nonminor dependant while in the caregiver’s home.  Immunity does not apply when the act exceeded a caregiver’s duty, the act was made with malice or bad faith or was the result of recklessness or gross negligence of the caregiver, the act or omission did not comply with instructions from the county placement agency, and when liability is expressly imposed by another statute.

Finally, AB 1930 created exceptions to confidentiality of the RFA Written Report, including authorizing release to the applicant or resource family, a tribal agency, a county child welfare agency or probation department, CDSS, a licensed foster family agency, a county adoption agency, a licensed adoption agency, or the child welfare agency of a sending state.  (ACL 19-72, August 26, 2019.)

Funding for emergency caregiver placement

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Emergency Caregiver Funding for families with whom a child or non-minor dependant has been placed on an emergency basis has been continued.  This funding is also available for placements for a “compelling reason” pending approval as a Resource Family.

In addition, effective July 1, 2019, Emergency Caregiver funding must be paid to an emergency caregiver with whom an Indian child is placed pending approval as a Tribally Approved Home.  A TAH is a home that has been licensed or approved for placement of an Indian child by the Indian child’s tribe, or a tribe or tribal organization designated by the Indian child’s tribe, for foster care or adoptive placement using standards established by the Indian child’s tribe

To initiate funding on or after July 1, 2019, there must be a placement prior to approval in California on an emergency basis, or, for pending Resource Family Approval only, placement for a compelling reason.  Then the emergency caregiver must submit a Resource Family Approval application or initiate the Tribally Approved Home process with the tribe.  Finally, the caregiver must submit an application for emergency assistance.  The beginning date of aid is the date of placement.

Emergency Caregiver funding is available for up to 120 days, or until the emergency caregiver is approved as a Resource Family or Tribally Approved Home, or the child is no longer placed in the home, whichever is first.  (ACL 19-84, September 4, 2019.)

CalFresh and CFAP ABAWD percentage exemptions

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The California Department of Social Services (CDSS) has guidance regading percentage exemptions from the Able-bodied Adults Without Dependants (ABAWD) work rules and time limit for CalFresh and the California Food Assistance Program (CFAP).  Federal law gives each state a number of exemptions from the ABAWD rules equal to 12 percent of the state’s annual caseload.  These percentage exceptions allow counties to extend CalFresh eligibility to ABAWDs who would otherwise be ineligible.  Each percentage exception gives one full month of eligibility to one individual subject to the ABAWD time limit.

In general, CFAP recipients are treated the same as individual receiving CalFresh, including application of the ABAWD rules.  Individuals at risk of losing CFAP benefits because of the ABAWD time limit may receive a state-funded percentage exemption.

Any ABAWD who is temporarily excused from meeting work requirements under a percentage exemption remains subject to the ABAWD time limit rules and must meet work requirements, qualify for an exemption, or reside in an area where the ABAWD requirements are waived to continue receiving CalFresh or CFAP after their percentage exemption expires.

California has a three step process before applying a percentage exemption.  First, counties must screen for an exemption for the ABAWD time limit at application, period report and recertification using information in the case record and individualized assessments.  Second, counties should engage ABAWDs to support them in finding additional work and/or participating in qualifying work activities, including referral to local workforce partners, volunteer activities or other training or education programs.  Third, the county can provide a percentage exemption if the individual meets additional criteria as determined by the county.

The counties implementing the ABAWD time limit between September 1, 2018 and August 31, 2019 were San Francisco, San Mateo and Santa Clara.  Any CFAP percentage exceptions remaining after August 31, 2019 will be recouped and redistributed among all counties implementing the ABAWD time limit effective September 1, 2019.  (ACL 19-60, July 2, 2019.)

CalFresh cost-of-living adjustments

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The California Department of Social Services (CDSS) has issued the CalFresh cost-of living adjustments (COLA) for Federal Fiscal Year 2020. The COLA increases the Maximum Shelter Deduction, the Homeless Shelter Deduction, the Standard Deduction, the Standard Utility Allowance, the Limited Utility Allowance, the Telephone Utility Allowance and the income eligibility standards.  The COLA is effective October 1, 2019.

Counties must inform all CalFresh households of the COLA and the new utility deduction amounts no later than October 1, 2019.  Counties may use an informing notice, or can use news or media outlets and post information in certification offices, issuance locations and other sites frequented by CalFresh recipients. (ACIN I-54-19, August 21, 2019.)

Fiscal year 2020 Income Reporting Threshold

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The California Department of Social Services (CDSS) has issued the new Income Reporting Threshold (IRT) amounts for federal fiscal year 2020.  The IRT is the amount that triggers reporting requirements mid-period.  The new IRT levels are effective October 1, 2019.

Assistance Units are required to report when their total combined earned and unearned income exceeds the IRT amount.  Assistance Units with only unearned income are not required to report when that income by itself exceeds the IRT mid-period.

When a family receives income over the IRT amount and reports it to the county, the county must determine of the reported income is reasonably anticipated to continue.  If the income over the IRT will continue but not at a level that will result in ineligibility, the county must use the new reasonably anticipated income to recalculate the grant.

Counties must send an informing notice to recipients that is individualized for each assistance unit.  Counties must inform recipients of their IRT at least one per semi-annual reporting period or whenever their IRT changes.  The IRT level in which the recipient was last notified is used for reporting purposes until the county has informed the recipient of a change to their IRT.

These instructions also apply to Refugee Case Assistance, Entrant Cash Assistance and Trafficking and Crime Victim Assistance Programs.  (ACL 19-85, August 15, 2019.)