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

(Revised 04/01/08 ML3136)

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Verifications needed to complete a claim must be obtained by using Notice F814 – Claims/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 verification is obtained for Medicaid or TANF.  

 

Examples:

1. Worker received a quarterly wage match on combination SNAP change reporting/Medicaid case. The worker is required to follow up on the wage match for Medicaid and sends a Medicaid request for verification. The household provides verification of the quarterly wage match. The verification shows earnings that were not reported by the household. The worker must establish a client error claim using 10-10-10.
2. Worker received a quarterly wage match on combination SNAP simplified reporting/Medicaid case. The worker is required to follow up on the wage match for Medicaid and sends a Medicaid request for verification. The household provides verification of the quarterly wage match. The verification indicates 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.   

 

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 SNAP 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 whether a claim exists, the worker must apply the maximum timeframe of 10-10-10 in all instances.

• 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  or review.

 

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.

 

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.

 

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.

 

When completing corrective action on a case, corrective action must be established based on the reporting requirement the household was subject to when the error occurred or should have been subject to if the incorrect reporting requirement was applied.

 

Examples:

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 for October through March, the claim is established using procedures for a simplified reporting household.
2. Ongoing change reporting household.  On June 4 client reported new employment.  Worker sent F442 on June 4 requesting verification of the new source income allowing the household 10 days to provide verification.  Verification was not received.  Household was approved for July with no income and changed to a simplified reporting household.  

Since this household was change reporting and failed to provide information, the F401 should have been sent to close the case.  Worker discovered the error in August.  When completing the claim for July and August, the claim is established using procedures for a change reporting household.

3. A household initially applied in August for SNAP/TANF and was certified as a change reporting household.  In November, the TANF case was set to close and the household was changed to simplified reporting for December benefits.  In February, the worker discovered the household failed to report a source of income at application.  When completing the claim for August through November, the claim is established using procedures for a change reporting household.  When completing the claim for December through February, the claim must be established using procedures for a simplified reporting household.  

 

Change Reporting

For change reporting households, when completing a claim, actual month's circumstances must be used for the eligibility items determined to be in error.  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).  If an underpayment would result instead of a claim and the household failed to report or report timely, benefits are not restored.

 

Examples:

1. A household reports and verifies unearned income of two individuals. At a later date the worker discovers that a third household member has been receiving unearned income for several months. When calculating the claim, the verified income of the two individuals remain unchanged. Actual verified income of the third individual is used in establishing the claim.
2. A household applies in March and reports receiving weekly unearned income at application.  The application is approved in April.  In June, the worker discovers the weekly unearned income should have been converted.  The claim is established for March, April, May and June using actual unconverted income for each month.  

 

Simplified Reporting

For simplified reporting households when completing a claim circumstances that should have been used at initial certification, the six month report, review, or when a change was reported/discovered or should have been reported that required action must be used for the eligibility items determined to be in error, taking into consideration any other changes reported during that time.  If income conversion applies, the corrected converted amount from the initial month, six month report or review (not corrected converted income from each month in error) must be used to determine the claim taking into consideration any other changes reported during that time.  If an underpayment would result instead of a claim and the household failed to report or report timely, benefits are not restored.

    

Examples:

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 review 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.

 

A household initially applies on October 2 and reports and verifies income for the husband.  No income is declared for the wife. The application is approved on October 14 and 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. The wife is paid every other Friday.  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. Since the wife would not have received all of her October income at the time the application was approved, September converted income is used to determine the claim for October. In computing the amount of the overissuance for any subsequent month, September converted income 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.

3. A household reports and verifies September and October earnings at initial certification in October and is certified from October through September.  The household is paid on the first of each month. The worker incorrectly used September income.  As all income from the month of application was available, October income should have been used. In March, the worker discovers the error and also learned the household received a pay raise in December. The raise put the household over the household’s gross income limit.

In computing the amount of the overissuance for October through January, the worker would recompute the household’s benefits based on October income. As the pay raise in December put the household’s income over the gross income limit, the household would have had until the 10th of January to report the change. The case should have closed the end of January as the household was not eligible with income over the GIL. The claim for February and March is based on a total overpayment.  

4. 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.  Claims are only completed for mandatory reportable changes.     
5. 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.  

 

Correcting the Reporting Requirement

When completing corrective action on a case that was assigned the incorrect reporting requirement, the indicator is corrected as follows.

 

For cases that should have been simplified reporting:

• If correcting the indicator prior to the date the six-month report is generated in TECS, the indicator is changed for all prior months.

• If correcting the indicator beyond the date the six-month report should have been generated in TECS, the indicator is not changed for prior months.  The indicator is changed for month seven forward.

 

Six-month reports are generated on the 6th to the last working day of month 5.  Policy approval is required when correcting the indicator for paid benefit months.

 

For cases that should have been change reporting:

• The indicator is corrected for all prior months.

 

Examples:

1. Change reporting SNAP household started employment in April. The household should have reported the new employment by May 10.The county did not become aware of the new employment until October. The worker is completing corrective action in December.  

Had the household reported correctly, this case would have become simplified reporting starting with June.  The six-month report would have been due in November for December benefits.

 

Corrective action must be completed for June through November based on the income that would have been used had the income been reported, taking into consideration any other changes reported during that time.  As April does not represent a full months income, May income is used to determine the claim.  Corrective action must be completed for December using what should have been used had a six month report been filed in November.  This would be base month income from October and any of the other mandatory reportable changes at six-month report.  The case will then roll until review unless the household reports a change.

 

The information/verification necessary to complete the claim (May and October income and mandatory reportable changes at six month report) must be requested using the F814 – Claims/Required Verification. If the household fails to provide the verification within 10 days of the mail date on the F814, the F401 must be sent to close the case.

 

The SR indicator is changed to Y for December forward. Documentation must explain why the six-month report indicator was not changed back to June.

 

If the SR indicator is changed back to June, the system will send a six-month report the end of December due in January for February. This is incorrect and could result in incorrect benefits for February forward. The system is programmed to look back each month to see if the household has been simplified reporting for the last 5 benefit months. If it has a six-month report is sent out.  

 

2. Change reporting household began employment in August 07.  The household should have reported the new employment by September 10, 2007. The county did not become aware of the new employment until November. The worker is doing corrective action in December.  

Had the household reported correctly, this case would have become simplified reporting starting with October.  The six-month report is due in March for April 2008 benefits.  

 

Corrective action must be completed for October through December based on the income that should have been used had the income been reported, taking into consideration any other changes reported during that time. As August does not represent a full months income, September income is used to determine the claim. The case will then roll until six-month report unless the household reports a change.  

 

The information/verification necessary to complete the claim (September income) must be requested using the F814 – Claims/Required Verification. If the household fails to provide the verification within 10 days of the mail date on the F814, the F401 must be sent to close the case.     

 

The SR indicator must be changed back to October so the six-month report is mailed correctly in February.  

3. Elderly household with no earned income applies in October and is certified as simplified reporting. In March the household files a six-month report. The worker determines the household was assigned the incorrect reporting requirement at the time of application. The SR indicator must be change to N for October through March. Actual month circumstance for each month must be used to determine if the household would have been required to report a mandatory reportable change based on change reporting requirements.  f the household would have been required to report a mandatory reportable change, the worker must correct the benefit.

 

Trafficking Claims

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

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