GA Program Overview

1
GA Program Overview

• The person must be in financial need. This
  means that they have less than
• 1,000 in non-exempt resources (using same rules
  as the TANF program)
• 339 in countable income (for one person)
• GA provides cash grants and medical care to
  low-income adults without a dependent child and
  unable to work for at least 90 days because of a
  medical or mental disorder (incapacitated).

Prepared for CFC by ESA staff, August 2009
2
GAU versus GAX

• GAU the person has a verifiable incapacity
• The person cant work, but isnt required to have
  a specific work history or minimum period of
  unemployment.
• The primary disorder preventing work cant be
  substance abuse or chemical dependency.
• To enter the program, incapacity must exist for
  at least 90 days from the date of application.
  To continue benefits, current evidence must show
  no material improvement in the physical or mental
  disorder.
• GAX the person is likely to qualify under SSI
  disability standards.
• Person must have a medical disorder that will
  last at least 12 consecutive months or end in
  death.

3
GAU versus GAX/SSI Examples

• Clients who qualify for GAU but not GAX have
  disorders that
• Respond to treatment. Examples Fractures,
  tissue injuries, anxiety disorder.
• Cause significant restrictions on work in
  combination with vocational factors. Examples
  Personality disorders, borderline intellectual
  functioning, spine disorders.
• Are chronic but slow to become disabling.
  Examples Arthritis, morbid obesity, post
  traumatic stress disorder, dementia.

Washington State Department of Social Health
Services
4
GA-X Eligibility Determination Process
GA-X stands for expedited Medicaid because
eligibility is decided by the state in advance of
a federal determination.

• Social Workers complete a disability assessment
  every time they determine a person is
  incapacitated.
• When the person passes the assessment, their
  medical records are sent to a contracted
  physician or psychologist, whichever is
  appropriate.
• The contractor reviews the medical records
  against Social Securitys disability criteria to
  decide if the person is likely to be approved for
  SSI. If so, they certify Medicaid (approves
  GA-X).
• Medical coverage reverts from Medicaid to Medical
  Care Services when Social Security denies the
  persons disability claim for SSI after
  appropriate administrative appeals have been
  pursued.

Washington State Department of Social Health
Services
5
Interim Assistance Reimbursement

• Social Security regulations and state statutes
  consider both GA and SSI as public assistance,
  which allows states to be reimbursed from
  retroactive SSI benefits.
• Clients must sign an Interim Assistance
  Reimbursement Agreement (IARA) to receive GA
  while waiting for a decision on their SSI
  application and be informed of the requirement to
  reimburse the state.
• The state must provide the IARA to the Social
  Security Administration (SSA) within 30 days of
  the clients signing it for Social Security to
  honor the agreement.
• Only the cash grant payments are reimbursed.
• With a valid IARA on file at SSA, the
  reimbursement process is
• SSA notifies the DSHS Office of Financial
  Recovery (OFR) that client is approved for SSI,
  when disability began, and amount of retroactive
  payment due.
• OFR retrieves the persons GA payment history,
  matches it to the past period of disability and
  payment and reports the total amount of benefits
  paid to SSA.
• SSA deducts that amount from the amount of
  retroactive payments and sends to OFR.

Washington State Department of Social Health
Services
6
Program Duration and Rates

• Average months on assistance between July 1997
  and June 2008
• 15.1 months for GAU and
• 27.1 months for GAX (which includes any time on
  GAU)
• 18 of GAU clients cycled on and off the caseload
  at least once in SFY08.
• In FY08, 61 of GAU clients exited the caseload
  within 6 months, of these 33 did not reappear in
  any program within 12 months.
• 74 of GAX cases closed between September 2008
  and March 2009 eventually got on SSI. The
  average time from application to approval for
  these cases was 12.1 months.

Washington State Department of Social Health
Services