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Ineligible, No Longer Eligible

Categorized In: Case Services - Closing the Case

Approved Date: November 23, 2020

Owner: Angela Fujan

In making a determination of 'ineligible' or 'no longer eligible,' no applicant or group of applicants is excluded or found ineligible solely on the basis of the type of disability. Eligibility requirements are applied without regard to:

  • Age, sex, race, color or national origin or the applicant
  • Type of expected employment outcome
  • Source of referral for VR services
  • Particular service needs or anticipated cost of services required by an applicant or the income level of an applicant or applicant's family
  • Applicants' employment history or current employment status and
  • Applicants' educational status or current educational credentials

Applicants for VR services may be determined ineligible due to:

  • Having no physical or mental impairment;
  • Having an impairment that does not constitute or result in a substantial impediment to employment;
  • Being unable to benefit from the provision of VR services in terms of an employment outcome. Prior to making this determination VR must demonstrate the applicant's inability to work based on clear and convincing evidence; or
  • Not requiring VR services to prepare for, secure, retain, or regain employment.

Applicants receiving SSI/SSDI.  Individuals who receive SSDI or SSI on the basis of thier disability meet all eligibility requirements, unless VR demonstrates by clear and convincing evidence they are incapable of benefiting in terms of reaching an employment outcome due to the severity of their disability. (Refer to VRIS - Eligibility - Social Security Recipients)

No Longer Eligible. Any client previously determined eligible including clients receiving SSI/SSDI may later be determined no longer eligible, based on the severity of their impairment, if the client cannot benefit from the provision of VR services in terms of an employment outcome. Prior to making this determination, VR must demonstrate this based on clear and convincing evidence which includes the use of trial work experiences.

An Ineligibility determination requires:

Full Consultation. An ineligible or no longer eligible determination is to be made only after providing the client or his/her representative, an opportunity for full consultation. 

Office Director ReviewThe office director makes the final ineligibility determination.

Informed in Writing. The client must be informed in writing of an ineligible or no longer eligible determination, including the reasons for the determination and the means by which the client may express and seek remedy for any dissatisfaction. 

If the reason for ineligibility is based on "unable to benefit from the provision of VR services in terms of an employment outcome,” additional steps apply:

  • Trial Work Experience (TWE) must be conducted and include any necessary supports, if there is not clear and convincing evidence to provide the specialist a high degree of certainty (beyond a reasonable doubt) the individual is incapable of benefiting from services
  • 12 month review is required after the case is closed to determine if the ineligibility decision of "unable to benefit" remains accurate. Additional reviews will be conducted annually thereafter, if requested by the individual or their representative.

Federal and State Rehabilitation laws require an individual intends to achieve an employment outcome and meet all the following criteria to be eligible for VR services:

  • must have a significant impairment, 
  • impairment must result in a substantial impediment to employment,
  • must be able to benefit from services through an employment outcome
  • must require Vocational Rehabilitation Services to prepare for, enter into, engage in, advance in, or retain gainful employment consistent with your strengths, resources priorities, concerns, abilities, capabilities, interests, and informed choice.
  1. Review and assess data, including specialist observation, medical records, information provided by the individual or the individual's family, particularly information used by education officials, and determinations made by officials of other agencies to make the eligibility determination. If the individual does not meet all the above eligibility criteria, an ineligibility or no longer eligible determination is completed. 
  2. Provide full consultation of the specific, objective factors the decision is based upon with the individual and involved parties is required.  Full consultation involves a discussion to explain the ineligibility determination. This conversation needs to be made in person, by phone, or as a last resort written communication unless the client/recipient has died, or there is no way to contact the individual. It must include the specific evidence and rationale of the ineligibility determination. Best Practice would be to review the 'Office Director Letter' with the applicant during this discussion to explain all aspects of the letter and be available to answer any questions. 
  3. Refer to appropriate federal, state, or local programs and/or service providers best suited to address independent living and/or employment related needs. See Information and Referral (I & R) to Other Programs
  4. Complete documentation. Complete a detailed task note to include this specific evidence based information and rationale for the determination.
  5. Office Director reviews case and makes the final determination. If the office director made the original determination or was involved in making the original determination, the review is to be conducted by a different office director who will make the final determination.
  6. Send Office Director letter with the CAP information for all ineligibility or no longer eligible decisions. (For 511 cases see process below)
  7. Close case. Choose the appropriate Ineligible exit status in QE2- 6, 8, 21, or 22 depending on criteria on Exit Status Decision TreeThe case should not be closed in the computer system (QE2) until the 30 days has elapsed from the date of the final determination since the client/recipient has 30 calendar days to appeal. Client Appeals/Rights, Procedures 

If the reason for ineligibility is based on inability to “unable to benefit from services,” the additional to the steps apply:

  • First determine whether existing information provides clear and convincing evidence the applicant cannot achieve, or does not want to achieve, an employment outcome, such as assessments and reports from previous  work experiences.
  • Trial Work Experience (TWE) must be conducted and include any necessary supports, if there is not clear and convincing evidence to provide the specialist a high degree of certainty (beyond a reasonable doubt) the individual is incapable of benefiting from services. The clear and convincing standard constitutes the highest standard used in the court of law and is to be individually applied on a case-by-case basis. The term clear means unequivocal. For example, the use of an intelligence test result alone would not constitute clear and convincing evidence. Clear and convincing evidence might include a description of assessments, including situational assessments from service providers who have concluded that they would be unable to meet the individual's needs due to the severity of the individual's disability. The demonstration of clear and convincing evidence must include, if appropriate, a functional assessment of skill development activities, with any needed supports (including assistive technology) in real life settings. VR must obtain a copy of the written reports used to make this determination and not base the ineligibility decision solely on verbal conversations with a service providers or schools.  Trial work experience(s) must be provided in competitive integrated employment settings to the maximum extent possible, consistent with the informed choice and rehabilitation needs of the individual. It must include sufficient variety and over a sufficient period of time for the specialist to determine there is clear and convincing evidence to conclude that due to the severity of the individual's disability, the individual is incapable of benefitting from the provision of VR services in terms of an employment outcome. There may be the need to complete more than one TWE. The specialist must be involved and periodically assess the individual's abilities, capabilities, and capacity to perform in competitive integrated work situations while participating in the trial work experience(s). Upon the completion of the TWE, the specialist will consult with the office director and complete a final determination of the individual's abilities, capabilities, and capacity to perform in realistic work situations and provide a full consultation of the specific, objective factors the decision is based upon with the individual and involved parties. The fact based information from the participation in the TWE will be entered into the casefile. TWE - Trial Work Experience
  • 12 month review. When ineligibility is based on a finding the individual is incapable of benefiting from VR services in achieving an employment outcome, a review to determine if the finding remains accurate is completed 12 months after the case closure date is required. Additional reviews will be conducted annually thereafter, if requested by the individual or their representative. Reviews are not required in situations where the individual has refused a review, is no longer present in the state, their whereabouts are unknown, or their medical condition is rapidly progressive or terminal. Details of the review discussion are documented in task notes, as are the details about the individual or representative declining reviews or other reasons the review was not completed. Attempts to contact and the outcome must be evidenced in task notes. Review will not be conducted in situations where the individual has refused a review, the individual is no longer present in the state, the individual's whereabouts are unknown, or the individual's medical condition is rapidly progressive or terminal.

511 Cases - Individuals intending to begin special (sub-minimum) wage employment  or SMW:

  1. Follow case closure procedures above for all ineligible, no longer eligible closures above.
  2. Send draft of Employment Not Expected from Services Letter to Program Director, Evaluation & Community Integration, to review documentation of decision. Program Director will provide feedback and a task note to QE2 that ineligibility is justified.
  3. If the individual or family/authorized representative refuse a trial work experience, refer back to DD Service Coordinator to explain how DD services may be impacted by this decision prior to completing the Refusal to Participate. Disregard this form for individuals who are NOT recipients of DD services.
  4. Complete Documentation Checklist for Youth (Age 24 and Younger) or Documentation Checklist for Adults (Age 25 and Older) and ensure all team members involved with individual have received a copy

* Please note:  if individual starts special (sub-minimum) wage employment or SMW after the VR case is closed, the 14c certificate holder is responsible to refer the person back to Nebraska VR for CCIR (Career Counseling and Information & Referral) obligations.

 


Approved Date
October 02, 2018 Show this Archived Version


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