Library: Policy

340:65-3-8. Continuing eligibility determination

Revised 9-14-24

(a) Continuing eligibility determination. The worker determines continued eligibility at appropriate intervals, per (b) of this Section. The worker is responsible for:

(1) informing the recipient of his or her change reporting responsibilities, per Oklahoma Administrative Code (OAC) 340:65-5-1, at each contact;

(2) contacting the recipient when possible changes are indicated to ensure continuing eligibility;

(3) synchronizing renewal dates for all benefits received by the household when possible; • 1 and

(4) determining continuing eligibility.

(b) Benefit renewal time frames. The periodic renewal time frame varies depending on the program.

(1) A benefit renewal is completed at six-month intervals with a:

(A) Temporary Assistance for Needy Families (TANF) recipient due to:

(i) pending required immunizations, per OAC 340:10-14-1;

(ii) payment standard reductions because of program violations, per OAC 340:10-3-57(g) or (h);

(iii) hardship extension approvals, per OAC 340:10-3-56(a)(2)(E);

(iv) earned income, per OAC 340:10-3-31 through 340:10-3-40; or

(v) a work eligible person's exemption from TANF Work activities because of his or her incapacity or to care for a disabled family member living in the household, per OAC 340:10-2-1; or

(B) food benefit recipient subject to a mid-certification renewal, per OAC 340:50-9-5(d) and (e).

(2) A benefit renewal is completed at 12-month intervals, unless an earlier renewal date is warranted, with a:

(A) TANF recipient unless (b)(1)(A) of this Section applies;

(B) State Supplemental Payment (SSP) recipient who does not receive Supplemental Security Income (SSI). • 2 When the recipient receives SSI, the system passively renews the SSP and SoonerCare (Medicaid) benefit; • 3

(D) food benefit household subject to an annual mid-certification renewal, per OAC 340:50-9-5(b) and (c);

(E) food benefit household whose Supplemental Nutrition Assistance Program (SNAP) certification renewal is completed at 12-month intervals, per OAC 340:50-9-6; or

(F) SoonerCare (Medicaid) recipient, per OAC 317:35, when the recipient does not receive SSI. • 4 When the recipient receives SSI, the system passively renews the SoonerCare (Medicaid) benefit. • 3

(3) The worker completes a SNAP certification renewal at 24-month intervals for households subject to an annual mid-certification renewal, per OAC 340:50-9-5(b) and (c).

(c) Benefit renewal notification. The recipient receives a notice when the benefit renewal is due, informing the recipient he or she must complete the benefit renewal within a specified time frame to continue receiving benefits. • 5

(1) The worker sends Form 08AD092E, Client Contact and Information Request, to TANF recipients.

(2) A computer-generated notice is sent to:

(A) child care recipients;

(B) food benefit recipients due for mid-certification renewal and certification renewal; and

(3) Since SoonerCare (Medicaid) and SSP recipients who receive SSI are passively renewed, they receive a notice informing them that their benefits were renewed. The renewal notice includes the income used to renew their benefit(s). Recipients are asked to sign and return the renewal notice if the income shown on the notice is incorrect. When the notice is signed and returned, the worker contacts the recipient to obtain current information. • 3

(d) Signature requirements. The recipient, guardian, or a person acting on the recipient's behalf, such as an authorized representative or a person with power-of-attorney, signs the benefit renewal for all programs except TANF. The recipient signs TANF renewals. When the recipient lives with his or her a spouse, both must sign the TANF renewal. • 6

(e) Interview requirements. Benefit renewal interview requirements vary depending on the program. • 7

(1) Per Section 206.10 of Title 45 of the Code of Regulations, the TANF program requires a face-to-face certification renewal interview every 12 months. The face-to-face interview may be conducted in the OKDHS office, at a home visit, or through a virtual video conference.

(2) A phone or face-to-face interview is required for a:

(A) SNAP certification renewal, except for (e)(3)(C) of this Section, per OAC 340:50-3-1; or

(B) Supplemental Security Income-Disabled Children's Program service plan renewal, per OAC 340:15-3-1. • 8

(3) An interview is not required for:

(A) any of the SoonerCare (Medicaid) programs when the client signs and completes the renewal, provides all required proof, and none of the information is questionable. • 2 When necessary, the worker contacts the recipient to complete the renewal; • 9

(B) passive renewals completed for SoonerCare (Medicaid) or SSP recipients;

(D) food benefit households completing a:

(i) mid-certification renewal, at six- or 12-month intervals; or

(ii) SNAP certification renewal when all household members are elderly or disabled and there is no earned income in the household, per OAC 340:50-3-2(a)(2).

(f) Eligibility determination. The worker determines eligibility after the benefit renewal is signed, all required proof is provided, an interview, if required, is conducted, and all information evaluated. • 10

(1) The worker may:

(A) complete the benefit renewal without changes;

(B) complete the benefit renewal with changes; or

(2) When benefits close and the recipient provides required proof by the last day of the closure month, benefits may be reopened. • 12

INSTRUCTIONS TO STAFF 340:65-3-8

Revised 9-14-24

1. Synchronizing benefit renewal dates for all programs provides better client service as it reduces the number of times the client completes a benefit renewal.

2. Refer to Quest articles "State Supplemental Payment (SSP) & ABD Renewals" and "Steps to Completing Annual Reviews."

3. As a Supplemental Security Income (SSI) Criteria state, Oklahoma is required to redetermine the State Supplemental Payment (SSP) and SoonerCare (Medicaid) eligibility of SSI recipients without requiring them to provide any information when their case records contain reliable information or when more current information is available to Oklahoma Human Services (OKDHS). This means the system passively renews their eligibility without worker action. The system automatically generates a Family Assistance/Client Services (FACS) case note for every passively renewed case. When SSI recipients also receive Supplemental Nutrition Assistance Program (SNAP) food benefits, the worker completes mid-certification renewals and certification renewals, per Oklahoma Administrative Code (OAC) 340:50-9-5.

4. For SoonerCare (Medicaid) rules, refer to:

(1) OAC 317:35-6-61 for SoonerCare (Medicaid) benefits for pregnant women and families with children;

(2) OAC 317:35-7-62 for a child in state or tribal custody;

(3) OAC 317:35-7-61 for SoonerCare (Medicaid) programs that categorically relate to the aged, blind, or disabled population, such as:

(A) SSP;

(B) Qualified Medicare Beneficiary;

(C) Specified Low-Income Medicare Beneficiary;

(D) Qualified Disabled and Working Individuals;

(E) Qualified Medicare Beneficiary Plus; and

(F) Tax Equity and Fiscal Responsibility Act; and

(4) OAC 317:35-15-7 and 317:35-15-9 for Personal Care;

(5) OAC 317:35-17-12 and 317:35-17-15 for Advantage Waiver; and

(6) OAC 317:35-19-22 and 317:35-19-23 for nursing facility services.

5. (a) Methods the recipient may use to submit the SNAP semi-annual or annual benefit renewal or Child Care Subsidy program annual benefit renewal include:

(1) accessing www.okdhslive.org and submitting the benefit renewal electronically;

(2) getting help from OKDHS or a community partner to access www.okdhslive.org and submit the benefit renewal electronically;

(3) downloading Form 08MP004E, Renew My Benefits, from OKDHS - Forms and Applications for Service and completing, signing, and hand-delivering, mailing, or faxing it to OKDHS; or

(4) contacting the OKDHS office to complete the benefit renewal with a worker using the FACS system.

(b) Methods the recipient may use to submit a Temporary Assistance for Needy Families (TANF) benefit renewal include:

(1) contacting the OKDHS office to complete the benefit renewal with the worker using FACS and signing Form 08MP001E, Request for Benefits, and Form 08MP003E, Responsibilities and Signature for Benefits;

(2) completing Form 08MP001E, Form 08MP002E, Eligibility Information for Benefits, and Form 08MP003E with the worker during a home visit; or

(3) accessing www.okdhslive.org and submitting the benefit renewal electronically.

(c) Methods the recipient may use to submit an SSP benefit renewal or a SoonerCare (Medicaid) benefit renewal for recipients not in the Oklahoma Health Care Authority (OHCA) online enrollment, include:

(1) contacting the OKDHS office to complete the benefit renewal with the worker using FACS and signing Form 08MP001E and Form 08MP003E;

(2) completing Form 08MA001E, Medical Assistance Benefit Review Report;

(3) completing Form 08MP004E, Renew My Benefits; or

(4) accessing www.okdhslive.org and submitting a medical benefit renewal electronically.

(d) Methods the recipient may use to renew for SoonerCare (Medicaid) when OHCA is responsible for determining eligibility, per OAC 317:35-5-63, include:

(1) accessing OHCA online enrollment at www.okhca.org;

(2) downloading federal Form OMB No. 0938-1191, Application for Health Coverage & Help Paying Costs, from OHCA - Forms and Instructions, or healthcare.gov and completing, signing, and mailing it to OHCA; or

(3) getting help from OKDHS staff to complete the renewal using agency view for online enrollment.

6. (a) An electronic signature is the same as a pen and ink signature.

(b) The worker documents any additional proof received after the recipient signs the benefit renewal in FACS case notes.

7. (a) Refer to OAC 340:65-3-2.1 for interview scheduling time frames.

(b) When an interview is required, information discussed with the recipient includes:

(1) changes reported on the benefit renewal and any proof the recipient needs to provide or provided;

(2) information contained on the data exchange screens, when inconsistent with recipient statement;

(3) for TANF, the recipient's TANF Work plan, deprivation, and the child(ren)'s school attendance and immunization status; and

(4) a reminder of the types of changes the recipient must report.

(c) When information is questionable, the worker may contact a person outside of the household to confirm information the recipient provided or make a home visit. Refer to OAC 340:65-3-4 for information regarding home visit requirements, collateral contacts, and data exchange screens.

(d) When the recipient receives some benefits that require an interview and some that do not, for the benefits that:

(1) require an interview, the benefit renewal is not complete until the interview is conducted; and

(2) do not require an interview, the benefit renewal may be completed prior to the interview for the other benefits.

8. The Supplemental Security Income-Disabled Children's Program (SSI-DCP) service plan may also be conducted during a home visit. The worker completes Form 08MA017E, SSI-DCP Service Plan, with the child's parent, guardian, or caretaker.

9. Attempts to contact the recipient to determine continued eligibility may be in person or over the phone. The worker documents all eligibility factors and any contact with the recipient in FACS case notes.

10. (a) After the recipient completes the benefit renewal, the worker analyzes the information for each program benefit to determine:

(1) what changes occurred;

(2) whether the recipient provided all required proof;

(3) whether an interview occurred when required; and

(4) what changes to make on the system.

(b) The benefit renewal is complete after the worker:

(1) evaluates information contained on the benefit renewal, in the verification provided, and on data exchange screens to determine if changes occurred and clears any discrepancies;

(2) for TANF:

(A) updates the TANF Work plan with the recipient;

(B) discusses and completes Form 08TA006E, Important Notice About the Effect of Lump Sum Payments on TANF Benefits, with the recipient; and

(C) updates deprivation information with the recipient that includes:

(i) completing Form 08TA012E, Cooperation Agreement and Request for Good Cause, when deprivation is based on absence and obtaining updated information regarding the non-custodial parent when known;

(ii) completing Form 08MA022E, Medical Social Summary, and obtaining current medical information, when deprivation is based on incapacity and updated information is required, per OAC 340:10-10-2; or

(iii) ensuring the parents meet conditions, per OAC 340:10-10-3, when deprivation is based on unemployment; and

(3) enters all benefit renewal information, including changes, in the FACS Interview and Eligibility Notebooks;

(4) documents any changes made and how continued eligibility was determined in FACS case notes; and

(5) updates the system using Systems Help instructions located in Quest under Adult and Family Services Online Services.

11. (a) When the worker determines the benefit renewal is incomplete because the recipient failed to sign the benefit renewal, did not provide all required proof, or did not complete a required interview, the worker attempts to contact the recipient, when a contact number is available, to inform him or her what is lacking. The worker documents the contact and any attempts to obtain needed proof in FACS case notes.

(b) When the recipient does not provide required proof timely, the worker closes benefits effective the next advance notice deadline date, per OKDHS Appendix B-2, Deadlines for Case Actions.(c) Client Worker Activity (CWA) reports are available to help workers track pending benefit renewals. Review Quest articles "Case Scan Report" and "CWA Report" for more information.

12. (a) After closure, the worker may reopen benefits when the recipient provides the required proof by the last day of the closure month.

(1) The worker reopens benefits effective the closure date for SoonerCare (Medicaid) populations not in online enrollment, Child Care Subsidy, TANF, and SSP.

(2) For SNAP, refer to OAC 340:50-9-5(k).

(b) When the recipient waits until after the last day of the closure month to provided need proof, the recipient must reapply .