07.03.03.08

.08 Long Term Disability.

A. Impairment.

(1) An otherwise eligible individual who is impaired and whose medical report shows an impairment of 12 months or more, or if less than 12 months the impairment will result in the individual's death, or a parent or caretaker relative on behalf of an impaired child in the assistance unit, shall:

(a) Be referred to the Social Security Administration for determination of eligibility for SSI or other benefit; and

(b) Sign an Interim Payment Reimbursement Authorization as described in §B of this regulation.

(2) To remain eligible for assistance as a disabled individual who is exempt from work requirements as described in Regulation .07-1 of this chapter, an individual who is potentially eligible for SSI or any other benefit, or a parent or caretaker relative other than a parent of a disabled child in the assistance unit, shall:

(a) Apply for the benefit; and

(b) Provide all information for an eligibility determination by actively cooperating with appropriate agencies by pursuing an SSI application on their own or through a personal representative.

(3) An individual 16 years old or older who does not apply for all potential benefits or actively cooperate with the pursuit of all potential benefits as described in §A(2) of this regulation shall be sanctioned for noncompliance in accordance with Regulation .19 of this chapter.

(4) When an individual does not have the resources to obtain a medical report to verify the impairment, an individual's physician shall be paid a fee:

(a) Of $60 from administrative funds for each examination; and

(b) Not to exceed $40 for laboratory work.

B. Interim Payment Reimbursement Authorization.

(1) The individual shall pursue SSI as a condition of eligibility.

(2) The individual shall sign an Interim Assistance Reimbursement Authorization which permits the:

(a) Social Security Administration to send the individual's initial SSI payments to the Department or the local department; and

(b) Department or the local department to deduct from the payments an amount equal to the interim assistance provided.

(3) Failure of the adult to sign the Interim Assistance Reimbursement Authorization shall result in ineligibility of the entire assistance unit as described in Regulation .19A(1) of this chapter.

(4) Interim assistance is the amount of TCA assistance provided to an individual during the period:

(a) Beginning the month the recipient applies for SSI benefits; and

(b) Ending the month the SSI payments begin.

(5) The Department or the local department shall be reimbursed from the initial SSI payments for the full value of interim assistance provided, except that when the first month's SSI payment is prorated, the reimbursement shall be prorated from the effective date of SSI eligibility.

(6) When the total amount of SSI received by the Department or the local department is greater than the amount of reimbursement, the Department or the local department shall pay the excess to the recipient within 10 working days after the date of receipt of the payment.

(7) If the individual dies before SSI eligibility has been determined, the:

(a) State retains the right to receive benefits due for the retroactive period; and

(b) Department or the local department shall return any excess payment to the Social Security Administration district office that served the individual after deducting the amount of interim assistance for the retroactive period.

C. Presumptive SSI Payment.

(1) A presumptive SSI payment is made by the Social Security Administration for a maximum of 6 months pending the final eligibility determination.

(2) The individual shall report receipt of SSI presumptive eligibility payments to the local department within 10 days of receipt.

(3) The individual is ineligible for the period during which presumptive SSI is paid.