DI 21501.130 Michigan APTD/AB State Plan
A. Blindness—(Section 400.56, Compiled laws of 1948, as amended.)
1. RULE 400.10(5), ADMINISTRATIVE RULES:
“Eligibility for aid to the blind shall not be contingent upon the recipient's willingness to submit to an operation recommended for the possible restoration of his sight.”
2. RULE 400.10(6), ADMINISTRATIVE RULES:
“Blindness as a basis for determining eligibility for aid to the blind shall exist when an individual is found to have a visual acuity of 20/200 or less in the better eye with correction, or is found to have a limitation of the fields of vision such that the widest diameter of the visual field subtends an angular distance not greater than 20 degrees, through an examination by an ophthalmologist or an optometrist licensed to practice in Michigan.”
B. Permanent and Total Disability—(Item 295. Introduction—Definitions)
1. SECTION 25a, Act 280:
“Aid to the permanently and totally disabled shall be provided... in accordance with rules and regulations of the state department, to any needy individual... who is permanently and totally disabled.... The commission may furher define by rule the words 'permanently and totally disabled'.”
2. RULE 7, PART 1-B, ADMINISTRATIVE RULES:
“In aid to the disabled, a person will be considered to be permanently and totally disabled if it has been established by medical and other evidence:”
“That he has a physical or mental impairment or a combination of impairments which cannot be corrected within the foreseeable future, and”
“That by reason of such impairment(s) he is substantially precluded from engaging in useful occupations for which he is otherwise qualified; or that by reason of such impairment(s) he is unable without the help of another person to carry on the minimum activities essential to daily living....”
It will be noted that Rule 7 contains two provisions, both of which must be met in order to establish eligibility for AD. Provision “a” relates to the permanent nature of the impairment, while provision “b” establishes the basis for determining the disability is total by relating it to the effect on activity of the individual.
Permanently, or permanence, refers to an impairment substantiated by medical evidence which is not likely to improve, or cannot be corrected, within the foreseeable future whether or not the individual undergoes treatment.
Corrected means eliminated or improved to the extent that the person would be able to engage in useful occupations.
Foreseeable future is defined as 12 months or less.
Totally, or totality, refers to the extent the impairment results in restricted activity, either in the person being substantially precluded from engaging in a useful occupation for which he is otherwise qualified or in need for the help of another person to carry on the minimum activities essential to daily living. This evaluation is based on a combination of medical and social information.
Substantially precluded relates to the extent the impairment has left the person unable to engage in useful occupations with sufficient regularity and predictability to receive regular payments for his efforts or to carry on homemaking responsibilities on a continuing basis.
Useful occupations are productive activities, such as employment, which add to the economic wealth or produce goods or services to which the public attaches a money value; or they demand the time and attention of the doer for the benefit of others, such as homemaking.
Homemaking in order to be considered a useful occupation, involves home management, decisionmaking responsibilities, and providing essential services within the home for at least one other person.
4. ACCEPTABLE DIAGNOSIS FOR PERMANENT AND TOTAL DISABILITY
Certain permanent impairments have been found to cause total disability in such a large proportion of patients that the identification of these diagnoses creates a strong presumption of both totality and permanence. These are listed below as Group #1 impairments. Other diagnoses may indicate impairments of a permanent nature, i.e., with probable duration of 12 months or more, but determination of totality must be based on the need for help of another person or an inability to engage in useful occupations (See item 295.5, Joint Conference and Certification, Section B; Totality). Mental disabilities other than Group 1 which may be considered are limited to the list given below. In respect to all impairments, however, the medical consultant must be satisfied that the medical evidence is adequate to positively identify a specific diagnosis.
These impairments are designated as Group #1 diagnoses and are as follows:
Leukemia, progressive, no remission or short remissions
Advanced multiple sclerosis
Malignancy, progressive or inoperable
Osteomyelitis of pelvis or vertebra of chronic or intractable nature, marked systemic involvement
Gross cerebral spasticity
Advanced muscular dystrophy
Advanced rheumatoid arthritis
Cardiac conditions, including only Class .3 and .4 of American Heart Association
Mental deficiency, of any type with an I.Q. of 50 or less
Paraplegia, as a result of spinal cord injury or poliomyelitis
Other mental disabilities which may be considered are limited to the following:
Chronic schizophrenia, including only cases in sufficient remission to render the patient's residence in the community safe to himself and others.
Acute organic brain disorders. This group of diagnoses includes temporary reversible mental disturbances from brain damage due to infection, injury, metabolic imbalances (such as diabetes and uremia, and drugs or poisonous or toxic substances). Because of their brief duration, few cases in this category will considered permanently and totally disabled.
Chronic organic brain disorders. This group includes permanent abnormalities resulting from brain damage due to injury, poisons, tumor, infection, or hemorrhage.
Mental deficiency. This group includes those cases primarily presenting defects in intelligence existing since birth, with I.Q.'s of more than 50. For eligibility purposes it is considered to include not only cases of unknown cause, but also those such as cretins, mongoloids, hydrocephalus, and others in which an organic cause has been determined.
Psychotic disorders. These disorders involve a varying degree of personality disintegration and failure to evaluate reality correctly in various spheres. Persons in this group fail to relate themselves effectively to other people or to their own work. Major types include: involutional psychotic reaction, manic depressive reactions, psychotic depressive reactions, various schizophrenic reactions, paranoid reactions, and unclassifiable psychoses.
Psychophysiologic autonomic and visceral disorders. This group includes various physical disorders and psychosomatic disorders of involuntary bodily activities in which mental or emotional components may be present, such as: backache, skin disorders, respiratory disorders, gastro-intestinal disorders, cardiac disorders, and similar disabilities. In most instances the evaluation of disability will be based upon the degree to which actual physical symptoms of this nature restrict the patient from engaging in useful occupations. In other instances the patient may present no identifiable physical evidence for the complaint, but pain or restricted function arising from a mental or emotional origin may prevent the person from engaging regularly or predictably in useful occupations.
Psychoneurotic disorders. This group includes many types of mechanism by which the patient copes with anxiety. Although the cause of the anxiety may sometimes be unknown or unexpressed, this group does not distort or falsify reality as in psychoses. The most familiar symptoms relating to disability will be conversion reactions such as paralysis of some voluntary bodily activity without apparent physical cause, phobia reactions such as fear of certain ideas or situations, or obsessive compulsive acts which are performed although the person may not be able to explain the reason he does them.
5. ITEM 295.3 ACCEPTANCE OF TREATMENT
When the medical consultant determines that the client's impairment can be corrected by treatment to the extent that he may become able to engage in a useful occupation for which he is otherwise qualified, the effect of treatment upon eligibility is to be explained. He is to be informed that the possibility of a treatment plan must be explored, and if one can be arranged, acceptance of treatment may be a condition of eligibility.
Any proposed treatment plan must be generally acceptable to the medical profession and must not involve great personal danger to the client. In determining whether the patient's condition is treatable, the medical consultant is to evaluate the amount of risk involved in the treatment, whether there might be an actual loss of function (such as vision) through recommended surgery, whether religious scruples affect his attitude, whether genuine fear exists, whether refusal to accept treatment would endanger the lives of others, etc.
If medical evidence indicates that the condition is treatable but that the impairment cannot be corrected within 12 months, the applicant may be considered permanently disabled provided he is willing to accept treatment. If he is not willing to accept treatment, the reasonableness of his refusal must be evaluated by the state review team before assistance may be denied or cancelled on this issue. In requesting this review the county office is to forward to the state team all pertinent medical reports and social summary information upon which it has been determined that treatment will correct the impairment and that a treatment plan is available. The state review team will take into consideration any of the factors mentioned above in the second paragraph of this item which are applicable and these must be covered in the review request. The memorandum is to describe the efforts made by the county office, including the local medical consultant, to secure the client's cooperation and the reasons give for refusing treatment.
6. ITEM 295.5 JOINT CONFERENCE AND CERTIFICATION
Not pertinent except as noted below.
Permanence. The medical evidence must substantiate a specific diagnosis, according to instructions in Item 295.2. Criteria for determining permanence of the impairment are also given in that item. This is a medical decision.
Totality. Totality refers to the extent the permanent impairment may restrict the person's activities in one of the following ways:
Diagnoses for permanent and total disability designated as Group #1 and listed in Item 295.2 above are evidence in themselves that the client is permanently and totally disabled.
Eligibility exists on a totality basis if the person has a permanent impairment that causes him to require the help of another person in the minimum essentials of daily living. The need for help from another person is to be determined by evaluating that which is necessary to maintain the client's life, health, or safety in his present living plan. A client whose impairment results in need for regular housekeeping, nursing, or protective care for another person (not necessarily full-time care) meets this requirement:
Regular care as used in this section indicates that care is required from an adult (age 18 or over) who calls at the home at least on a weekly basis. It is necessary to identify in the case record the adult who actually gives the care or assumes responsibility for supervising the adequacy of care given by another person, who may or may not be an adult. Care may be of the following types:
Nursing care includes personal care of the client including maintenance of body hygiene, care of clothing and bedding, attending to health needs arising from the impairment, putting on or fastening an appliance required by the impairment, lifting or carrying the client.
Housekeeping includes the basic tasks of maintaining the normal operation of the client's household, such as cleaning, cooking, maintenance of heat, washing and ironing, shopping, and related activities.
Protective care includes supervision or personal care because of the client's mental incompetence.
At the original determination of eligibility or at any future determination, a decision must be made regarding the adequacy of the living plan for those who need care as there may be situations in which the person's condition and lack of care may render his residence in the community unsafe to himself or others. Refer to Item 298 and Item 340 for information regarding guardianship.
Eligibility exists on a totality basis to the extent the disability substantially prevents the person from engaging on a regular and predictable basis in useful occupations for which he is otherwise qualified, such as employment or homemaking. In making the decision on this basis, the caseworker carries the major responsibility because of the importance of gathering and summarizing the pertinent information which together with the medical findings will give a true and total picture of the person's functioning in his environment and thus be sufficiently supportive to establish total disability.
Employment. In deciding that a person is unable to be employed his age, training, native capacity, skills and work experience, entent of his adjustment to disability, constitute important data to be considered in relation to his ability to perform certain activities well enough and with sufficient regularity to receive regular payments for his current efforts.
Homemaking. A finding that a person is unable to perform the occupation of homemaking requires a determination that, because of his impairment, he is unable to perform a significant combination or grouping of activities concerned with homemaking for himself and another person, such as shopping for food and supplies; planning and preparing meals; washing dishes; cleaning house; making beds; washing and ironing clothes; lifting and carrying infants; care, training, and supervision of children; in primitive facilities it may mean carrying water, carrying fuel, building fires. The ability to carry on homemaking the number of hours required also is an important consideration.
A finding of permanent and total disability may be made for the person who has a permanent disability and still has sufficient capacity to perform all of the above services for himself and another person except he is unable to perform for the number of hours daily that are involved, or predictably enough to meet the responsibilities involved. Research has shown that homemaking requires a minimum of 48 hours weekly for a family of 4 persons, with the use of labor-saving devices; if a child is under 1 year of age, total time needed is often 65 hours weekly. (The person who has been carrying on homemaking only for himself cannot be considered eligible because he has not been engaged in a useful occupation according to the definitions given above in Item 295.)
The decision regarding totality is a joint decision of the medical consultant and the contact worker.
The determination of total disability is not affected by performance of the following types of activity, although they may or may not be remunerative:
Activity which is essentially occupational therapy.
“Made work” in or out of home made possible only by the sympathy and compassion of others in assisting in the work or purchasing the product.
Work not normally considered a necessary occupation, and if the client ceased doing it, no one else would be hired to replace him.
Work in a recognized sheltered workshop.
Work which is a part of a supervised training program of Services for the Blind. Vocational Rehabilitation, or other training agency with whom the Department has a working agreement.
Any time the Division of Vocational Rehabilitation Services for the Blind, or similar training agency withdraws and the person continues with the activity, it can no longer be classified as “not affecting disability.”
If an AD recipient engages in a regular and predictable manner in a useful occupation other than the types of activity described above, the grant may be continued not more than three months provided the recipient is otherwise eligible. During this period the county office is to submit pertinent information to the state review team for a decision regarding the future predictability of the person's ability to carry on. However, a grant may not be opened while the person is engaged in a useful occupation on this basis. All income from the above-described activities is to be considered in determining the amount of the grant after expenses of earning the income as given in Item 320.11 have been deducted. If the net income is sufficient to meet his needs, the client is not eligible for assistance.