340:40-9-2. Case changes
(a) Change reporting.Between eligibility determinations, per Section 98.21(e)(1) of Title 45 of the Code of Federal Regulations (45 C.F.R. § 98.21(e)(1)), the household must report within 10-calendar days of the change occurring, when the household's gross income exceeds the income eligibility threshold for the family size, per Oklahoma Department of Human Services (DHS) Appendix C-4, Child Care Eligibility/Copayment Chart. • 1
(1) A computer-generated notice issues at certification and renewal informing the client of the current income eligibility threshold for his or her family size and instructs the client to report when the household income exceeds this amount.
(2) When the client fails to report an income increase timely that, if reported, would have resulted in benefit closure, the worker makes an overpayment referral to Adult and Family Services Benefit Integrity and Recovery per Oklahoma Administrative Code (OAC) 340:40-15-1.
(b) Action taken on reported changes.The worker must act on all changes reported by the household between renewal periods.• 2Benefits do not decrease unless the client requests a decrease to avoid or reduce an overpayment or the reported change results in closure of the child care benefit per (f) of this Section. • 3
(c) Changes that increase subsidized child care benefits.When the client reports a change within 10-calendar days of the change that increases the amount of child care approved or decreases the family share copayment, the client and the worker jointly plan the effective date of the change. • 4When the client does not report the change within 10-calendar days of the change, the earliest date the worker increases the subsidized child care benefits is the first day of the month in which the client reports the change.
(d) Additional child request.When an additional child requires subsidized child care benefits, the worker completes the request within two-business days of the client providing all necessary verification to determine eligibility.When eligible, the child may be approved for subsidized child care benefits beginning with the date of request. • 5
(e) Change in provider.When a client reports a change in provider, the change is effective the date the change in provider occurs, regardless of whether the client reports the change timely. • 6The worker completes provider changes within two-business days of the date the client reports the change.
(f) Closure of subsidized child care benefits.When the client is no longer eligible for subsidized child care benefits, the closure date varies depending on circumstances.Refer to DHS Appendix B-2, Deadlines for Case Actions, for advance-notice deadline dates. • 7
(1) The worker closes the subsidized child care benefits effective 10-calendar days from the date action is taken, when the:
(A) payee for the child care benefit changes.When this occurs, a new application is needed per OAC 340:40-3-1(a)(1)(C);
(B) only child(ren) approved for subsidized child care leaves the home; • 8
(C) client already received income in excess of the income threshold per DHS Appendix C-4;
(D) client moves out of state; or
(E) client was approved for child care in error. • 9
(3) The worker closes the child care benefit effective the last calendar day of the renewal month when:
(A) the client does not meet a need factor;
(B) the client is not pursuing child support or other potential income per OAC 340:40-7-9;
(C) the child reached the maximum age limit per OAC 340:40-7-3; or
(6) When the client requests closure of the child care benefit, the earliest date the worker closes the child care is the date action is taken.
(7) When the client does not complete the benefit renewal timely, the system closes the child care benefit effective the last day of the renewal month.
(g) Reopen action.When a client's subsidized child care benefits close, benefits may be reopened within 30-calendar days of the closure effective date using current eligibility information unless the client must complete a new application per OAC 340:40-3-1(a)(1).Child care benefits are not decreased unless the renewal is due per 45 C.F.R. § 98.21(a). • 12
INSTRUCTIONS TO STAFF 340:40-9-2
1. (a) The client may report changes in person, by phone, fax, or email.
(b) The worker confirms with the client any case changes reported by persons other than the client before processing the change.
2. (a) For example, when the client reports new income, the worker sends Form 08AD092E, Client Contact and Information Request, to the client requesting proof within 10-calendar days. When the client:
(1) does not provide the requested verification, benefits are not decreased until renewal; or
(2) provides requested verification, the worker updates Family Assistance/Client Services (FACS) and the system determines if the benefits are changed.
(b) Refer to (c) and Instructions to Staff (ITS) # 4 of this Section when the client requests increased child care benefits.
3. An example of when the client may request benefits be decreased to avoid or reduce an overpayment occurs when the family share copayment is lower than it should be at certification or renewal because the worker incorrectly calculated income or the client did not accurately report income.
4. (a) The worker documents changes, when applicable, in the FACS Interview Notebook under the Income and Child Care tabs, in the FACS Eligibility Notebook under Auth. Daycare and Child Care tabs, and FACS Case Notes.
(1) When the change action results in a decrease in the family share copayment, the system maps the copayment change to the authorization and generates a notice to the client.
(2) The worker does not make a change in the Auth. Daycare tab for a copayment only change.
(3) The worker must enter a change action in the Auth. Daycare tab when the unit type or number of days and hours the client needs child care increases.
(b) Changes that increase subsidized child care benefits include, but are not limited to:
(1) a change in income resulting in a family share copayment decrease.
(A) The client's family share copayment for the month he or she reports the change is based on actual income. Prior to reducing the family share copayment for the current or previous month, the client must provide verification of the actual income for that month.
(B) When the client reports a loss of need factor, care is continued until the renewal unless (f)(4) or (5) of this Section applies. When the client reports loss of employment, the worker removes the earned income after verifying the job loss and the date and amount of last pay.
(C) The earliest date the change is made in the "effective date" field E5 of the FACS Eligibility Notebook Child Care tab (Section E) is the first day of the current month;
(2) a change in family size resulting in a family share copayment decrease.
(A) When a household member leaves the home, he or she is "removed from the benefit section" in the "status" field F25 of the Household tab in FACS.
(B) When a child remains in the home and no longer needs child care, he or she is coded in the system as "not included in benefit - income and resources are considered in benefit computation" in the "status" field F25. The worker closes the authorization in the Auth. Daycare tab with the appropriate reason code. The earliest date the worker closes the child care authorization is the date action is taken.
(C) The worker enters a change action to the Child Care tab for the next effective month. The change action causes the system to recalculate the family share copayment and map it to the "copay" field K70 for the remaining authorizations. When the change decreases the copayment, the change is effective the following month. When the change increases the copayment, the copayment remains locked in at the lower level until renewal;
(3) an increase in the unit type or number of days or hours the client needs child care.
(A) The worker makes the change as needed and planned for each affected child when the client reports the change within 10-calendar days.
(B) When the change is not reported timely, the earliest date the worker increases days and hours is the first day of the month the client reports the change.
(C) The number of days approved for the first month may be less than a full month of care when the increased level of care was not needed for the entire month; and
(4) an increase in the rate paid by the Oklahoma Department of Human Services (DHS) after the special needs approval process is completed, per OAC 340:40-7-3.1.
(A) When approved, Adult and Family Services (AFS) Child Care Subsidy staff changes the unit type effective the first of the month following approval.
(B) When the child does not attend the child care facility until after approval, the special needs rate is effective the first day the child enters the facility.
(c) The child care provider must submit Form 10AD121E, Child Care Claim, to request supplemental payment when the client did not correctly record attendance.
(1) Unless extenuating circumstances beyond the client's or provider's control exist, DHS Financial Services (FS) Electronic Payment Systems (EPS) Unit staff does not supplement the provider when the client fails to swipe attendance correctly.
(2) Circumstances beyond the client's or provider's control include, but are not limited to, a worker or system error.
(d) The worker submits Form 10EB004E, Report of Electronic Benefits Transfer (EBT) Child Care Payment Adjustments, to DHS FS EPS to request a provider supplement to correct problems not associated with correct attendance swiping.
(1) Examples of when the worker completes Form 10EB004E, include:
(A) a decrease in the family share copayment;
(B) an incorrect birth date being entered; or
(C) an incorrect rate given.
(2) The worker enters correct data into the system for the current month prior to submitting Form 10EB004E.
(3) After submitting Form 10EB004E to the FS EPS Unit, the worker documents in case notes the months included in the supplement, the reason Form 10EB004E was needed, and the date it was submitted.
5. (a) The worker documents in FACS Case Notes:
(1) the request date;
(2) the child's name and birth date;
(3) what days and hours the client needs child care;
(4) how child care needs were previously met; and
(5) if child support or any other income must be pursued for the child.
(b) The client must declare the citizenship or lawful alien status of the child by signing Form 08MP022E, Declaration of Citizenship Status, prior to adding the child to the child care benefits. A child 14 years of age and older is also subject to citizenship requirements, per OAC 340:65-3-1(g)(3).
(c) When one or both of the child's parents is absent from the home, the worker informs the client he or she must complete required child support forms for the child. When the client does not complete required forms, the worker denies the additional child request and closes child care benefits for the child's siblings at renewal. The worker must send a denial notice using Form 08MP038E or code an authorization denial for the additional child. For information about the mandatory pursuit of child support and other potential income, refer to OAC 340:40-7-9.
(d) When the child brings additional income to the household, the worker adds the child's income to current household income for the next effective month. Per (b) of this Section, the copayment does not increase due to the addition of a child and his or her income until the renewal is due.
(e) The worker chooses "social services" in the "benefit" field F24 and "added to the benefit" in the "status" field F25 to add the child in the Household tab of FACS. The worker enters a change action in the Child Care tab "action taken" field E3, the following month in the "effective date" field E5, and enters the authorization for the child in the Auth. Daycare tab.
6. (a) A provider change is considered a non-adverse action when no other change occurs in the child care plan.
(1) The worker closes the authorization for the first provider using "change in providers" in the "reason" field K16 and "advance notice not required" in the "notice indicator" field K92 in the Auth. Daycare tab. The earliest date the authorization is closed is the date action is taken.
(2) The worker opens the authorization for the new provider beginning with the date the change occurs and uses "change of providers" in the "notice indicator" field K92.
(b) The new provider's point-of-service machine shows the entire family share copayment owed for the month even when part of the copayment was applied to the previous provider. The worker calls the new provider and explains:
(1) the client used a different provider for part of the month so part of the family share copayment is owed to the previous provider for the initial month;
(2) when the provider receives the Totals Report for the first week the children start care, it will show how much copay, if any, to collect from the client. Prior to receiving payment for the first week of care, the provider has the option of:
(A) requiring the client to pay the entire copayment until the provider knows how much of the month's copayment was applied at his or her facility; or
(B) accepting a receipt from the client showing how much copayment he or she paid to the first provider and waiting until the Totals Report confirms part of the copayment is owed before charging the client; and
(3) when the provider requires the client pay the entire copayment, he or she must reimburse the client for the amount not applied to his or her facility after receiving payment from DHS.
(c) When the client pays the entire family share copayment to the first facility and that much care was not given, the first provider reimburses the client for the difference. When the provider refuses to do so, the worker contacts AFS Child Care Subsidy or the Office of the Inspector General staff for assistance.
(d) When the first provider reports the client left without paying the full family share copayment owed, the worker informs the provider that DHS only pays for services provided after the family share copayment is deducted. It is the provider's responsibility to collect the family share copayment from the client. The worker counsels with the client about the importance of paying his or her family share copayment.
(e) When the worker closes the child care authorization using a reason code other than "change of providers" before authorizing the new provider, the worker must choose "application approval" rather than "change of providers" in the "notice indicator" field. The system only accepts "change of providers" in the "notice indicator" field when the reason code on the closed authorization is:
(1) 4 – change in providers;
(2) 7 – ineligible provider;
(3) 7A – provider contract terminated – State Office use only;
(4) 36 – FSS BR-1 (Form 08MP004E) not completed; or
(5) 99 – State Office use only.
(f) When the provider change comes to the attention of the worker after benefit closure and benefits are not reopened, the worker only authorizes care for the new provider through the closure date. In this instance, the worker enters a begin and an end date on the authorization.
(g) When the client requests a provider change for a child attending an Early Head Start-Child Care Partnership (EHS-CCP) grant program or an Oklahoma Early Childhood Program (OECP), the worker removes the diverted income from the "total diverted income" field E47 on the Child Care tab when the new facility does not offer an EHS-CCP grant program or an OECP. The child remains eligible for a weekly unit type until renewal. At renewal the worker reevaluates the client's child care plan hours.
7. When the worker determines that the client is no longer eligible for child care benefits, the worker must close child care benefits by the 27th day of the month, when possible, because the Information Management System (IMS) sends eligibility information to EPPIC on the 28th day of the month for the following month.
(1) When the client requests benefit closure, advance notice is not required so the worker may close child care benefits effective the day of request unless the client requests closure between the 28th and 31st of the month. In this instance, the worker closes child care effective the first day of the next month. Otherwise, the authorization remains open on EPPIC for the entire next month.
(2) When the client provides income information on June 29th and the worker determines the client's income exceeds the income eligibility threshold, 10-calendar days' notice is required. The worker must wait until July 1st to close child care benefits effective July 10th. When the worker closes the child care benefit on June 29th to be effective July 9th, the EPPIC system does not recognize the July 9th closure and continues to allow eligibility for the entire month of July. When the client continues to use child care after July 9th, even though the child care benefit is closed in IMS, EPPIC continues to approve child care, resulting in a client overpayment.
8. When more than one child receives care on a case and one of the children leaves the home, the worker closes the authorization for the child who is leaving the home 10-calendar days from the date the worker takes action unless an earlier date is agreed upon by the parent or caretaker.
9. This may occur when AFS staff discovers after approval that the worker misapplied rules or the client provided incorrect information at certification or renewal that would have denied or closed benefits. Examples of misapplication of rules may occur when the worker did not make sure a self-employed client met the minimum wage rule, per OAC 340:40-7-8(a)(3), or did not ensure the client was pursuing potential income, per OAC 340:40-7-9, prior to certification or renewal. An example of the client providing incorrect information may occur when the client did not report a second job or provided a falsified employer statement that, if correct information was provided, would have led to an over-income denial as the client's income was over the income eligibility threshold, per DHS Appendix C-4, Child Care Eligibility/Copayment Chart.
10. When the worker closes the subsidized child care benefits because the family's anticipated income exceeds the income eligibility threshold, per DHS Appendix C-4 the worker must determine if the client's income for the current month exceeds the income eligibility threshold.
(1) When the client is income eligible for the current month, the earliest date the worker closes the subsidized child care benefits is the last day of the current month. This may occur when the client starts new employment.
(2) When the client's income for the current month exceeds the income eligibility threshold, the worker closes the subsidized child care benefits effective 10-calendar days from the date the worker takes the action.
11. (a) When the client wants to change child care providers during the 90-calendar day child care approval period, care by a different provider is not approved.
(b) To continue the child care for 90-calendar days, the worker closes the Child Care tab in FACS (E-section) using the appropriate reason code.
(c) When the client meets a need factor during the 90-calendar day approval period or within 30-calendar days of the 90-calendar day approval period ending, the client must provide proof of the need factor, per OAC 340:40-7-8, and current income, when applicable, before the worker:
(1) reopens the child care based on current eligibility information; and
(2) updates the reason code, number of units, and unit type on the authorization, when needed.
(d) The worker documents the reopen action and current eligibility information in FACS case notes.
12. (a) Using current eligibility information means the effective date of a reopen action that decreases benefits is the same effective date as would have occurred if the benefit had not closed.
(1) For example, when the client does not complete the benefit renewal before deadline, the subsidized child care benefits close effective the last day of the month. If the benefit renewal had been completed before deadline, the worker would have decreased benefits effective the first of the next month. Therefore in a reopen action, the worker applies an increase in copayment or a decrease in the number of units or unit type approved effective the first day of the month following the closure. When the client has new income at renewal and has not received a full paycheck, refer to Unfinished Issuance Examples & Coding|Quest for coding examples.
(2) When child care closes during the 12-month eligibility period, the worker reopens benefits using the same eligibility information on the system prior to closure. For example, during the eligibility period the client requests closure of his or her subsidized child care benefits because the family has an alternative caregiver for the child. Within 30-calendar days of the requested closure, the client reports that the alternative caregiver did not work out and subsidized care is needed. The worker reopens benefits using the same eligibility information on the system prior to closure. The worker does not increase the copayment or decrease the days and hours of care until renewal.
(b) The worker reopens benefits within 10-calendar days of the date he or she receives new or additional information or realizes benefits were closed in error. When the worker does not take action timely, he or she must enter a new authorization.
(c) When the worker reopens the benefit more than 10-calendar days from the authorization closure date and the client swiped attendance and received a denied message, the provider must complete and submit Form 10AD121E, Child Care Claim, to the Financial Services EPS Unit to receive payment.
(d) When the worker reopens child care following a 30-calendar day Presumptive Eligibility period, refer to Presumptive Eligibility Coding|Quest for coding examples.
(e) When the client does not meet the criteria to reopen the subsidized child care benefits, the client must reapply using application processes, per OAC 340:40-3-1.