Calculating the Amount of Claims 430-05-80-30

(Revised 10/01/06 ML3044)

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Verifications needed to complete the claim must be obtained by using Notice F814 – Required Verification – allowing the household 10 days to provide the information. The worker must only request verification of new information that they become aware of.

 

Exception:

Quarterly wage matches through IEVS.  IEVS alerts are only acted on if verificaiton is obtained for Medicaid or TANF.  

 

If the case is closed and the household fails or refuses to respond to the request, the worker must document in the case file that there is an outstanding claim issue. If the household applies at a later date, the household must cooperate by providing the information necessary to calculate the claim. If the household continues to fail or refuse to provide the information, the application must be denied.

 

If the case is an ongoing Food Stamp case and the household fails or refuses to respond to the request, the worker must send the F401. The case will close at the end of the advance notice period. The worker must document in the case file that there is an outstanding claim issue. If the household reapplies at a later date, the household must cooperate by providing the information necessary to calculate the claim. If the household continues to fail or refuse to provide the information the application must be denied.

 

If the household responds and indicates they need assistance in obtaining the information, the worker must attempt to obtain the information from the appropriate source. If the appropriate source fails to respond and provide the needed verification, the worker must complete the claim based on the best information provided by the household. The worker must document the attempt to verify income and the income used.

 

In determining the amount of a claim in all instances, the worker must apply the maximum timeframe of 10-10-10.

• The household has until the 10th day of the month following the month the change occurred to report.   

• The worker then has 10 days to act.

• In all instances 10-days must be allowed for the 10-day advance notice.  Even though 10-day advance notice may not have been required (change reported in writing and signed by the household),  policy requires that 10 days must be allowed.  

 

Exception:

10-10-10 does not apply at initial application,  recertification or at the six month report for simplified reporting households.

 

Actual circumstances must be reviewed for each month. It may appear that there is an overissuance for one month but no claim established due to 10-10-10.

 

For change reporting households, when completing a claim for income that was used incorrectly, not reported or reported incorrectly actual income must be used, even if income conversion applies (income paid weekly or biweekly).

 

Example:

A household reports and verifies the earnings of two individuals. At a later date the worker discovers that a third household member has been working for several months. When calculating the claim, the verified earnings of the two individuals remain unchanged. Actual verified income of the third individual is used in establishing the claim.

 

For simplified reporting households when completing a claim for income that was used incorrectly, not reported or reported incorrectly, circumstances that should have been used at initial certification, the six month report, recertification, or when a change was reported/discovered or should have been reported that required action must be used.  If income conversion applies, the corrected converted amount from the initial month, six month report or recertification (not corrected converted income from each month in error) must be used to determine the claim.

 

Claims must be established based on the reporting requirement the household was subject to when the error occurred.

1. A household changed from a simplified reporting household to a change reporting household at the time of the six month report in March for April.  It was discovered that the household failed to report a source of income at the initial application in October. When completing the claim, the claim is established using procedures for a simplified reporting household.
2. It is discovered at the six-month report that a household’s actual income exceeded the GIL (gross income limit) in month two of the certification period and the household was not eligible for a benefit.   The household had until the 10th of month three to report and did not.  The household’s income exceeded the GIL in month, three and four, was under the GIL in month five, and was over the GIL in month six.  Months four, five, and six are total overpayments because the case should have closed at the end of month three.
3. A household initially applies on October 2 and reports and verifies income for the husband.  No income is declared for the wife. The household is certified from October 2 through September 30. In January, the worker discovers the wife had income at the time of initial certification and it was never reported.  In December the wife also received a raise, but the raise would not have put the household over the gross income limit.

 

In computing the amount of the overissuance for October, the verified amount of income that the wife was receiving at the time of certification is used. In computing the amount of the overissuance for any subsequent month, the verified amount of income the wife received at the time of certification would also be used. The December raise would be disregarded, as it did not put the household over the gross income limit. The claim would be for the months of October through January.

4. A household reports and verifies earnings at initial certification in October. The worker incorrectly computes the monthly income and certifies the household October through September. In January, the worker discovers the computation error and also learned the household received a pay raise in December. The raise does not put the household over the household’s gross income limit.

In computing the amount of the overissuance, the worker would recompute the household’s benefits based solely on the verified amount of income that the household reported and verified at initial certification.  As the pay raise in December did not put the household’s income over the gross income limit, the household was not required to report the increase in income until March when the six month report was due. The pay raise would not be used in calculating the claim.  The claim would be established for October through January.

5. Household provides verification of a quarterly wage match for Medicaid in an ongoing combination food stamp simplified reporting case. The verification shows gross income does not exceed 130% of poverty for the household size. This information must not be acted on to decrease benefits. There is no claim, as the household was not required to report these earnings. This must be clearly documented in the casefile.   
6. Household provides verification of a quarterly wage match for Medicaid in an ongoing combination food stamp change reporting case. The verification shows earnings that were not reported by the household.  The worker must establish a client error claim using 10-10-10.
7. Household was initially certified in November as a simplified reporting household and was over the gross income limit but eligible for a benefit. In month three a household member obtained employment that was discovered at the six month report in April. There is no claim in this case as the household was not required to report when income exceeded the GIL for the household size.  
8. At six month report in April, it is discovered that household income exceeded the GIL in January.  Based on information obtained, the household had until February 10th to report that income exceeded the GIL. In determining if a claim exists for March and April, the household’s income exceeded the GIL for its household’s size. However, the household was eligible for a benefit for both March and April. There is no claim as the household remained eligible and had the income been reported, would have resulted in a decrease in benefits.  

 

When a household fails to report or to timely report earned income, the earned income deduction is not allowed when establishing the overissuance. The Earned Income Penalty Violation Code (PV) is entered on the EAIN screen for only the earned income not reported or not reported in a timely manner.

 

When completing a claim for expenses, only the incorrect expenses are changed. All other expenses remain unchanged unless there is other information reported timely.

 

Example:

The standard utility allowance was allowed in error. The household also has rent and child care expenses. When completing the claim, the standard utility allowance is removed and the rent and child care expenses remain unchanged, unless there is other information reported timely.

 

If an underpayment would result instead of a claim and the household failed to report or report timely, benefits are not restored.

 

If a worker failed to act on a timely reported change, the first month overissued is the first month the worker would have made the change based on 10-10-10.

 

If a 10-day advance notice would have been required for the month the claim is being established (individual did not report timely or worker did not act timely), it is assumed, for the purpose of calculating the claim, that the 10-day advance notice period would have expired without the household requesting a fair hearing.

 

The amount of an overissuance is the difference between the amount of entitlement and the amount received.

 

Trafficking Claims

Claims from trafficking related offenses will be the amount of the trafficked benefits as determined by:

1. the individual’s admission;
2. adjudication; or
3. the documentation that forms the basis for the trafficking determination.