6.3 Participation While Resolving Issues

Revised On: March 25, 2024

Legal References:

• RCW 74.08A
• WAC 388-310-1400

The Participation While Resolving Issues section includes:

• 6.3.1 What is supporting participation?
• 6.3.2 Stacking activities and issue resolution
• 6.3.3 How do we code participation?
• 6.3.4 What are the types of participation while resolving issues?
• 6.3.5 How do we treat participants with medical issues who do not have Washington Apple Health?
• 6.3.6 Participants with medical issues who do not have Washington Apple Health - Step-by-step Guide
• 6.3.7 What kinds of documentation/evidence should I request?
• 6.3.8 Supporting participation - Step-by-Step Guide
• 6.3.9 What is Foundational Community Support (FCS)?
• 6.3.10 Foundational Community Support (FCS)- Step-by-Step Guide
• 6.3.11 What is Coordinated Entry?

6.3.1 What is supporting participation?

The purpose of WorkFirst is to help WorkFirst families become economically stable through employment as quickly as possible. Many families need support to participate in WorkFirst activities. Supporting participation in job search, employment, and/or issue resolution is fundamental to their success.

The main purposes of the comprehensive evaluation, stacking activities and the social service assessments are:

• Identifying how best to support the participant's self-sufficiency through employment.
• Providing needed supports that meet the participant's identified needs.
• Creating a long-term plan for participants who are exempt and unable to participate.
• Helping participants who cannot participate to stabilize their situation as soon as possible when they can't participate in countable activities so they can progress.
• Addressing issues, increasing participation and transitioning to work or employment readiness activities as soon as possible, to resolve issues like mental health, chemical dependency, family violence, learning disabilities, or working with DVR.

Participants are usually able to participate in other activities while also addressing issues that interfere with full-time employment. See the Stacking Activities Chart for a list of core and non-core activities that can be added to a participant's IRP and help them progress while meeting WorkFirst participation requirements. Consider adding the following core activities:

• Independent life skills training (code these hours under the LS eJAS component code). For more information on independent Life Skills training, please refer to section 7.3.6 - What is Independent Life Skills Training?
• Community Work, Work Experience or Community Jobs.

Consideration for a full deferment from Career Scope activities should only occur when it isn’t possible for the participant to accept employment or participate in at least 20 hours of Career Scope activities. In these cases, the participant may need to participate in issue resolution activities prior to participating in Career Scope.

For example, a participant may need Residential (In-Patient) treatment for alcohol or substance abuse/chemical dependency.

It is necessary to defer job search or other activities while the participant is in residential treatment for a short time (usually 28 days but may require up to 90 days). Depending upon the individual circumstances and treatment plan, the participant can resume participating in job search or other activities while also completing the Outpatient Treatment Plan. Determine if other activities are available if the participant is waiting to enter treatment.

See section 6.6, Disabilities if the participant claims to have a disability or medical issue that limits their ability to work, look for work or prepare for work.

For deferrals, allow 30 days to gather documentation. The Case Manager can support the participant to obtain needed evidence such as medical evidence, chart notes, or testing. Beyond 30 days, the participant must provide ‘good cause’.  For example, the participant must show that the information has been requested but not received within the 30-day time period. If the evidence is not received within 30 days, the WFPS/WFSSS sends an appointment letter to determine if "good-cause" exists and invites the participant in the to discuss participation.

6.3.2 Stacking and Issue Resolution Activities

Participants who are resolving countable "X" code issues, such as mental health (XG) or Family Violence (XF), can stack other activities to increase their hours of participation. Stacking activities is combining other needed WorkFirst activities, such as job search, life skills, unpaid work, participating, and seeking stable housing with the countable "X" code,. See section 3.3.2, section 6.6, Disabilities, and the Stacking Activities Chart for more information

Continued communication and monitoring between the WorkFirst Staff or Case Manager and others who are working with the participant are necessary to ensure:

• Multiple services/referrals are offered to the participant;
• Appropriate information is shared;
• The IRP is amended as appropriate;
• Participation requirements are enforced; and
• The participant receives appropriate support services and child care.

The WorkFirst partner agencies and most contractors normally can tell how many hours a particpant expects to participate in their program activities. The Case Manager develops the IRP accordingly. See section 3.3.2.3 and 3.3.2.4 for more information about how to meet program/participation goals and build an IRP.

Use the Individual Responsibility Plan (IRP) to clearly state the required participation and the supports available.

Deferrals ("X" codes) taking longer than 90 days require verification and approval by:

• A multi-disciplinary case-staffing;
• Supervisor or higher level authority approval; or
• Documentation provided by a health-care or other professional.

Develop an IRP that specifies the activities the participant is to be taking to resolve the issues and the expected time to resolve the issue. For example, "Follow recommended treatment plan," or "attend all physical therapy sessions as prescribed by physician."

Review the case every 30 days to ensure the participant is making satisfactory progress in resolving the issue unless they're not engaged in activities each month. For example, a participant is ordered 90 days bed rest by their physician. In these cases, review periods can exceed 30 days but require approval by:

• A multi-disciplinary case-staffing;
• Supervisor or higher level authority approval; or
• Documentation provided by a health-care or other professional.

For information on how to treat excused and unexcused absences, please refer to section 3.7.1.5 - How do we treat excused and unexcused absences?

6.3.3 How do we code participation?

Use the appropriate "X" or referral codes in eJAS to identify the participant's issues, authorize support services, and/or make referrals to other resources.

Example: Following 90 days of Intensive In-Patient treatment, the participant must attend 2 AA meetings and 1 group therapy session per week. Transportation to and from meetings or appointments do not count as actual hours of participation.

• The AA meetings last 2 hours each (4 hours total).
• The group therapy session is hours (2 hours total).

The actual number of hours spent in treatment-related activities is 6 hours.

Hours spent in independent life skills activities are coded in eJAS under the component code "LS". The scheduled hours of participation should be as close to 32 to 40 hours per week as possible.

The Case Manager develops an IRP that brings the participant up to full-time participation in countable activities as soon as they're able. We also want to make stabilization and issue resolution activities short-term if we can, so the participant can transition into work-focused activities that lead to employment and economic stability.

6.3.4 What are the types of participation while resolving issues?

Described below are various types of stabilization and issue resolution and specific eJAS codes used. More information can be found on each type in other sections of the WorkFirst Handbook.

6.3.5 How do we treat participants with medical issues who do not have Washington Apple Health?

Parents who do not have  Washington Apple Health due to citizenship verification requirements and who have an activity requirement that is dependent on  Washington Apple coverage are not required to participate in these activities until Washington Apple Health eligibility is established. Until Washington Apple Health coverage is established, these participants are coded with the component code 'CV'. This is an indicator code only and has no IRP or monitoring requirements.

However, participants are required to participate in other WorkFirst activities identified as appropriate through the comprehensive evaluation or assessments that are not dependent on Washington Apple Health coverage.

Once citizenship verification requirements are met and Washington Apple Health is approved, the component code 'CV' is removed and participation requirements changed to include appropriate health care services.

For participants with chemical dependency issues, please refer to section 6.7.4- Who is financially eligible for substance abuse treatment?

6.3.6 Participants with medical issues who do not have Medicaid - Step-by-Step

Participants who are unable to participate in any other activities due to a medical issue.

If a participant has a severe enough medical issue to prevent participation in any other activities:

1. Document in the appropriate eJAS note section the reason the participant is unable to participate
2. Update the eJAS component screen with the indicator component code 'CV'

Participants who are able to participate in other stacked activities

If a participant has a medical issue, but is also able to participate in other activities:

1. Update the eJAS component screen with the indicator 'CV' (in lieu of using component code 'XM' or 'XG' if the participant had Washington Apple Health coverage and was able to seek treatment services)
2. Update the eJAS component screen with the appropriate stackable activities in which the participant is able to participate
3. Develop the IRP for the required activities
4. Document in the appropriate eJAS notes the number of hours per week the participant would normally be expected to participate in medical issue resolution if he/she had Washington Apple Health coverage
5. Document the participant's other required activities in the appropriate eJAS notes

6.3.7 What kinds of documentation/evidence should I request?

See section 6.6, Disabilities, for documentation required for participants with an emotional, mental or physical disorder.

Documentation for a participant caring for a child with special needs (see 6.4 Children: Special Needs) may include health-care professionals as described above in WACs 388-449-0010 or 388-447-0005 or other documentation provided by:

• Public Health Nurse (PHN)
• The child's school district
• Developmental Disabilities Administration (DDA) Case Manager
• Licensed Child Care provider
• Certified Mental Health Professional (CMHP)
• Certified Mental Retardation Professional (CMRP)

6.3.8 Supporting Participation - Step-by-step guide

1. The Case Manager follows the instructions in Section 6.6, Disabilities, for emotional, mental or physical disorders
2. For all other deferrals, the Case Manager consults with the individual and the following participants, as appropriate, to determine the need for issue resolution participation.
   1. The Case Manager or a Disability Specialist;
   2. SSI facilitator;
   3. Treatment provider; and/or
   4. Community service provider
3. The Case Manager then:
   1. Enters the appropriate code in eJAS.
   2. Enters the specific activities, scheduled hours and the expected end date for the activities on the IRP, describing in detail the activities and/or treatment the participant is required to complete, with the exception of drug related issues or other protected information .
   3. Stacks activities to increase hours of participation to the extent the participant is able, and adds the information to the IRP.
   4. Authorizes support services needed to complete their IRP requirements.
   5. Documents the actions in eJAS.
   6. Monitors participation monthly following the procedures in Section 3.7.2, Documenting and Reporting Participation.
   7. Gets supervisor or higher approval for issue resolution IRPs that take longer than 90 days.

6.3.9 What is Foundational Community Support (FCS)?

Foundational Community Support (FCS) is a voluntary supported employment and coordinated entry referral program to help individuals on Medicaid who have physical, mental health, and/or housing needs. Once referred WellPoint conducts a thorough assessment to determine eligibility based on criteria for supported employment and supportive housing services.

Who can receive FCS services?

Participants who are in an X component for:

• A chronic or severe physical or mental health issue
• Substance use disorder inpatient/outpatient treatment

What is FCS eligibility criteria?

Supported Employment participants must be:

• Enrolled in Medicaid
• Over the age of 16

Meet at least one health needs-based criteria:

• Mental health need for improvement, stabilization, or prevention of deterioration of functioning resulting from the presence of a mental illness
• Need for outpatient SUD treatment
• Need for assistance with three or more activities of daily living (ADLs) receiving long-term care services or need for hands-on assistance with one or more ADL
• Objective evidence of physical impairments, and because of this, the individual needs assistance with basic work-related activities

Meet at least one risk factor:

• Unable to be gainfully employed for at least 90 consecutive days due to a mental or physical impairment (example: assessed and determined eligible for HEN or ABD)
• SUD with repeated inpatient treatment episodes (two or more instances within past two years)
• Diagnosed mental health and/or SUD that is a risk of deteriorating without intervention
• An inability to obtain or maintain employment resulting from age, physical disability, or traumatic brain injury

Supportive Housing participants must be:

• Enrolled in Medicaid
• Over the age of 16

Meet at least one of the health needs-based criteria:

• Mental health need for improvement, stabilization, or prevention of deterioration of functioning resulting from the presence of a mental illness
• Need for outpatient SUD treatment
• Need for assistance with three or more activities of daily living (ADLs) receiving long-term care services or need for hands-on assistance with one or more ADL
• Complex physical health need, which is a long continuing or indefinite physical condition requiring improvement, stabilization, or prevention of deterioration of functioning including ability to live independently without support

Meet at least one risk factor:

• Homeless for at least 12 months or homeless on at least four separate occasions in the last three years (combined to equal at least 12 months)
• Two or more contacts within an institutional setting within the past 12 months or 90 or more consecutive days.
• Two or more adult residential care stays within the past 12 months
• Frequent turnover of in-home caregivers
• Predicative Risk Intelligence System (PRISM) score of 1.5+

How does a participant enroll in FCS?

• Participants can self-refer by contacting WellPoint directly.
  • If already engaged with FCS, Case Manager adds the appropriate X component activity to the IRP.
• Participants can be referred to WellPoint by WorkFirst staff.
  • The Case Manager contacts WellPoint via phone on the participant's behalf to set up an intake.
  • Develops an IRP including the participant's scheduled intake date and time.

What services does FCS provide?

WorkFirst participants who are eligible and seeking supportive employment and/or housing and struggling with mental or physical incapacities may receive the following assistance:

• Looking for the right job
• Preparing for interviews
• Focusing on helpful routines and employment related life skills
• Maintaining employment
• Locating safe and affordable housing
• Working with landlords and completing applications
• Learning independent living skills

6.3.10  Foundational Community Support (FCS)- Step-by-Step Guide

WorkFirst Staff:

1. Provides the participant with information about FCS benefits and:
   
   1. WellPoint's contact information for self-referral; or
   2. Assists the participant with a phone call to WellPoint in a warm-hand-off process to schedule an intake appointment with the participant to determine eligibility for FCS benefits.
2. Obtains a signed DSHS 14-012 Consent Form listing WellPoint to exchange information for service coordination.
3. Develops an IRP for participation in FCS supported employment activities under Special Records.
4. If not engaged in an issue resolution component, add the issue(s) resolution component that best fits the reason for the referral to FCS.
5. If already engaged in an issue resolution activity, add one additional hour to the existing issue resolution component to capture the hour of FCS participation.
6. Authorizes support services needed to complete the participant's IRP requirements.
7. Documents the action in eJAS using the corresponding issue resolution note type.
8. Gives the participant a copy of the eJAS WorkFirst Participation Verification form for actual hour verification and explain the reporting requirements.
9. Monitors participation monthly following the procedures in Section 3.7.2, Documenting and Reporting Participation.

 6.3.11 What is Coordinated Entry?

Coordinated Entry provides a streamlined access point for those experiencing homelessness through a crisis response system. The system is usually provided by the county, providing access to an assessment and referral process for each housing service and support available in their communities. 

Who can contact Coordinated Entry?

Anyone seeking housing due to homelessness can contact Coordinated Entry to explore their options for assistance and services available to their specific needs. Services are available for the following unhoused populations;

• Youth/teens
• Survivors of Domestic Violence
• Single Adults 
• Families 
• People with Disabilities

How to contact Coordinated Entry?

Washington State Department of Commerce holds the funding sources and distributes funding to the housing programs and services statewide. Commerce has many resources to share with those experiencing homelessness, the Family and Adult Coordinated Entry Sites for people experiencing homelessness is a list of providers per county within the state with location phone numbers and websites. Each county in the state provides an intake assessment to evaluate the needs of the applicant. The details from his intake allows the Coordinated Entry partner to provide tailored information and referrals for the available resources that meet their specific needs. 

What is discussed during the assessment? 

Multiple questions are asked during the assessment with the housing case managers with Coordinated Entry, such as, is the person currently housed and in jeopardy of losing housing? Or, is the person living on the streets in a place inhabitable for humans? During the assessment, the case manager collects the information and if the agency has access to the Homeless Management Information Systems (HIMIS) they record the assessment/data to assist with determining housing needs/supports. 

Referrals to housing services depend on the specific need of each individual or family. The role of WorkFirst staff is to provide the appropriate Coordinated Entry information to those in need of housing or at jeopardy of losing housing, to find supports available in their local area. WorkFirst staff can use the Family and Adult Coordinated Entry Sites for people experiencing homelessness resource and provide the local community contact information for those in need. 

How can WorkFirst staff support unhoused participants? 

If the participant is unhoused, seeking shelter, fleeing from a domestic violence abuser, or living in a situation that's unfit for human habitation, and need to connect with Coordinated Entry, WorkFirst staff can complete the following actions;

• Provide the participant the Coordinated Entry number for their local county. 
• Call Coordinated Entry with the participant.
• Develop an IRP with the participant to the Coordinated Entry.
  • The phone number for Coordinated Entry must be in the IRP.
  • Provide the participant the TANF Housing Service Plan to have completed by the housing provider case manager.  
    • Request the participant provide their WorkFirst case manager the completed TANF Housing Service Plan at the next meeting to support the development of their IRP.
  • Provide the participant resources as needed. 

If the participant has already contacted Coordinated Entry and are working with housing providers WorkFirst staff can complete the following actions;

• Develop an IRP with the participant, with a XH component for the hours the participant is engaging in housing related services. 
  • The housing agency contact information must be in the IRP.
  • Provide the participant the TANF Housing Service Plan to have completed by the housing provider case manager. 
    • Request the participant provide their WorkFirst case manager the completed TANF Housing Service Plan at the next meeting to support the development of their IRP. 
  • Provide the participant resources as needed.

Resources

Related WorkFirst Handbook Chapters

• 1.2 Required Participation
• 2.2 Support Services
• 2.3 WCCC
• 3.2.1 Comprehensive Evaluation
• 3.3.1 IRP
• 5.1 Pregnancy to Employment Pathway
• 6.1 Resolving Issues - Overview
• 6.4 Children: Special Needs
• 6.5 Family Violence
• 6.6 Disabilities
• 6.7 Substance Abuse/Chemical Dependency 

Forms & Other Resources

• WellPoint
• Foundational Community Support Reference and Referral Guide
• Washington State Department of Commerce Homelessness and Housing Assistance
• Family and Adult Coordinated Entry Sites for people experiencing homelessness