340:65-3-1. Eligibility determination
(a) Eligibility determination. The eligibility determination process includes the applicant filing a signed application, the worker certifying or denying benefits, and all subsequent activities required to receive continuous benefits. • 1 The applicant has the right and responsibility to participate in the eligibility determination process and is relied on as the first source of information.
(1) Someone acting on the applicant's behalf, such as an authorized representative or a person with power-of-attorney, may complete the application for all programs except for Temporary Assistance for Needy Families (TANF). The applicant must complete and sign a TANF application. • 2
(2) For another person to apply on the applicant's behalf, the applicant must designate the person as the authorized representative on the signed application or the person must provide a completed Form 08MP008E, Authorized Representative Request, or a statement signed by the applicant giving the person permission to act on his or her behalf. • 3 The SoonerCare (Medicaid) programs allow others to apply for the applicant without a written designation.
(b) Filing an application. A household must complete an application to apply for the Child Care Subsidy Program, Low Income Home Energy Assistance Program (LIHEAP), SoonerCare (Medicaid) Program, Supplemental Nutrition Assistance Program (SNAP), State Supplemental Payment (SSP), TANF, Diversion Assistance (DA), or Family Violence Emergency Assistance (FVEA). The applicant may request one or more benefits on the same application with the exception of LIHEAP because it is not an ongoing benefit.
(1) The applicant may apply for benefits online via okdhslive.org, with a worker in an Oklahoma Human Services (OKDHS) office, or by downloading a paper application and bringing or mailing it to an OKDHS office. DA and FVEA applications may not be submitted online. • 4
(2) When someone applies on behalf of the applicant and lives in a different county, the person may apply in his or her county of residence or in the applicant's county of residence. • 5
(3) When the applicant applies for TANF cash assistance in a county in which he or she does not live, the applicant's TANF Work activities are assigned in the county offering more participation opportunities for him or her. • 6
(4) When the applicant applies online via okdhslive.org, the system auto-assigns the application based on the applicant's ZIP code.
(c) Signature requirements. The applicant, guardian, or someone acting on the applicant's behalf, such as an authorized representative or a person with power of attorney must sign the application, prior to benefit approval.
(1) TANF, DA, and FVEA applications must be signed by the applicant. When the TANF applicant lives with his or her spouse, they must both sign the application. • 7
(2) The applicant may voluntarily withdraw the request for benefits or services before or after signing the application.
(3) An applicant who is:
(A) eligible for Medicare signs the application using the name on his or her Medicare Health Insurance Benefits (HIB) card; or • 8
(B) not eligible for Medicare signs the application using the name shown on his or her Social Security card.
(d) Interview requirements. Interview requirements vary by program. • 9
(1) For TANF, DA, and FVEA, a face-to-face interview is required prior to benefit approval, renewal, and when reviewing a TANF Work plan. The face-to-face interview may be conducted in the OKDHS office, at a home visit, or through a virtual video conference. When none of these options are feasible due to a hospitalization or other extenuating circumstance and prior approval from Adult and Family Services (AFS) TANF staff is obtained, a phone interview may be conducted at application or renewal. • 10 All TANF Work reviews must be completed face-to-face.
(2) The applicant must complete a phone or face-to-face interview that may be a virtual video conference interview, for the:
(A) Child Care Subsidy Program;
(B) SSP Program;
(C) SoonerCare (Medicaid) long-term care programs, such as ADvantage Waiver, nursing home care, or personal care;
(D) SoonerCare (Medicaid) programs that categorically relate to the aged, blind, and disabled population, such as Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Disabled and Working Individuals (QDWI);
(E) SNAP; • 11 or
(F) Supplemental Security Income-Disabled Children's Program. • 12
(e) Worker responsibilities. During the eligibility determination process, the worker is responsible for: • 14
(B) applicant's right to request a fair hearing and be represented at the hearing by any person the applicant chooses, per OAC 340:2-5. The applicant may request a fair hearing when there is a:
(ii) disagreement with any action taken on the case;
(C) applicant's legal responsibility for reporting all facts pertinent to eligibility;
(D) types of changes the applicant must report within 10-calendar days;
(E) penalty for failing to report changes;
(F) program requirements and information needed to establish eligibility for each program for which the applicant applied. The worker uses Form 08AD092E, Client Contact and Information Request, to request an interview or verification and gives the applicant at least 10-calendar days to comply, per OAC 340:65-3-2.1; • 17
(G) type of assistance OKDHS provides in establishing eligibility;
(H) permission the applicant gives OKDHS to obtain information from sources other than the applicant by signing the application; and
(I) applicant's responsibility to cooperate with federal and state officials when his or her case is selected for a Quality Control review;
(2) collecting information necessary for determining the applicant's initial and continuing eligibility. Information is considered verified when not questionable or inconsistent with known facts, and the information provider is the primary source of the information. Unless questionable, the worker accepts, without further verification, the:
(A) applicant's statement concerning:
(iv) living in the home of a relative payee;
(v) a minor parent living in the home of a relative;
(vi) Social Security number (SSN);
(vii) household members; and
(viii) third party insurance;
(B) unearned income information obtained through:
(i) Beneficiary and Earnings Data Exchange System (BENDEX), from the Social Security Administration (SSA);
(ii) Supplemental Security Income (SSI)/State Data Exchange System (SDX), from SSA;
(iii) Unemployment Insurance Benefits (UIB), from the Oklahoma Employment Security Commission (OESC); and
(iv) workers' compensation documents from the Workers' Compensation Commission; and
(C) alien status information obtained through Systematic Alien Verification for Entitlements (SAVE), from the United States Citizenship and Immigration Services (USCIS);
(3) contacting other persons who may be able to help establish eligibility when the applicant is unable to participate in the eligibility determination because of a physical or mental disability, inability to speak English, or other difficulties;
(4) determining if the applicant currently receives benefits from another state, when he or she resided in Oklahoma for less than 12 months; • 18
(5) recognizing expressed or implied needs that include:
(A) determining if there is a need for crisis intervention;
(B) addressing the applicant's social services needs; and
(C) making appropriate referrals; • 19 and
(6) denying the application when sufficient facts are available to substantiate ineligibility or the applicant fails to cooperate in determining eligibility. • 20
(f) SSN requirement. • 21 The applicant must provide a verifiable SSN or a pending SSN application for every person requesting food benefits, SSP, SSI-DCP, LIHEAP, or TANF benefits. The requirement for a verifiable SSN also applies to all persons whose needs are included for SoonerCare (Medicaid) benefits, except newborn children deemed eligible, per OAC 317:35-6-60, and undocumented aliens requesting emergency medical services, per OAC 317:35-5-25. • 22
(1) The applicant's statement regarding each household member's SSN is sufficient unless the information is inconsistent or other facts or observations cause the worker to question the statement. • 23
(A) Persons for whom a SSN is required, but not available must be referred to the appropriate SSA office for SSN enumeration using Form 08AD101E, SSN Enumeration Referral. The return of Form 08AD101E to OKDHS validates the application(s) or indicates which persons have not provided SSA-appropriate original evidence of age, identity, and citizenship. • 24
(B) Parents of newborns who participate in Enumeration at Birth (EAB) receive Form SSA-2853-OP3, Message From Social Security, from hospital personnel. This receipt form is verification the newborn was enumerated at birth.
(2) When the person fails or refuses to furnish or to apply for a SSN, the worker takes action per (A) and (B) of this paragraph.
(A) For TANF purposes, the person's needs are included; however, the worker imposes a 25 percent payment standard reduction penalty until an application for or a SSN is provided. • 25
(B) For food benefit, LIHEAP, and SoonerCare (Medicaid) purposes, only the needs of the person for whom a SSN is not provided or applied for are not included. • 26
(g) Citizenship requirement. All persons applying for federal or state public assistance benefits, such as Child Care Subsidy, SNAP food benefits, LIHEAP, SoonerCare (Medicaid), SSP, or TANF must declare the citizenship or alien status for each household member applying for such benefits on the application or benefit renewal. • 27 When the payee requests benefits for additional household members between application and benefit renewal, the payee completes and signs Form 08MP022E, Declaration of Citizenship Status, to declare the citizenship or alien status of the additional household members. • 28 Refer to OAC 317:35-5-25 for citizenship and alien status requirements for persons applying for SoonerCare (Medicaid) benefits.
(1) When the applicant declares that some or all of the household members applying for benefits are aliens, the worker must follow SAVE procedures, per OAC 340:65-3-4, to determine the validity of documents provided to verify legal alien status.
(2) The worker must follow each program's rules regarding citizenship and alien status requirements to determine benefit eligibility, per:
(A) OAC 340:40-7-5 for Child Care Subsidy benefits;
(D) OAC 317:35-5-25 for SSP; and
(E) OAC 340:10-15-1 for TANF.
(A) Lawful status in the United States (U.S.) is considered verified when:
(i) the person applying for benefits provides a SSN or SSA completed Form 08AD101E indicating SSA accepted the person's SSN application; and
(ii) OKDHS, through the automated SSN enumeration data exchange transaction with SSA, is able to verify the person's SSN. • 30
(B) Prior to receiving benefits, when OKDHS is unable to verify the SSN with SSA for a person 14 years of age or older, the person must provide a:
(i) signed and notarized Form 08MP005E, Citizenship Affidavit, attesting to his or her U.S. citizenship or alien status; or
(C) When the person fails or refuses to provide a signed and notarized Form 08MP005E or one of the documents per (g)(3)B)(ii) of this Section, the worker denies or closes benefits for that person. • 32
(4) The application, benefit renewal, and Form 08MP022E contain a statement informing the applicant that OKDHS reports fraudulent claims of citizenship or lawful alien status to the U.S. Attorney and, when a fraudulent claim is made, the person may be subject to criminal prosecution.
(5) When the worker discovers a person who signed Form 08MP005E attesting to U.S. citizenship or legal alien status made a false claim:
(A) the worker sends a memo and supporting documentation to the appropriate AFS Program. The memo must include:
(i) the time frame, benefit type, and amount the person fraudulently applied for or obtained; and
(ii) how the worker discovered the claim was false;
(B) AFS Program staff in consultation with Legal Services (LS) staff, review the memo and supporting documentation to determine if the person made a false claim. LS staff files a complaint with the U.S. Attorney for the applicable district based upon the venue in which the affidavit was executed when appropriate.
(h) Eligibility determination. The worker determines eligibility after the applicant or other authorized person signs the application, completes an interview, when required, and provides required proof.
1. (a) Except for children in Oklahoma Human Services (OKDHS) or tribal custody whose cases remain in the county of jurisdiction, applicants may apply for and receive benefits in an OKDHS office, or apply online via okdhslive.org.
(b) The timeframe needed to determine eligibility varies depending on the capabilities of the applicant and the amount of verification required. Refer to Oklahoma Administrative Code (OAC) 340:65-3-5 for application processing time limits for all Adult and Family Services (AFS) benefits.
(c) When the applicant informs the worker he or she does not have the information needed to determine eligibility, the worker offers to assist the applicant in obtaining the information. The worker's assistance may range from explaining how or where to obtain proof to the worker obtaining proof when the applicant is unable to do so. The worker is not required to obtain proof for an applicant who is simply unwilling to do so.
(b) Due to the Temporary Assistance for Needy Family (TANF) program requirement to assess employment barriers and the family's service needs, the applicant must complete the application. The worker makes a home visit or conducts a virtual video conference when it is difficult or inadvisable for the applicant to come to the OKDHS office.
3. (a) For the Child Care Subsidy program, when the natural or adoptive parent lives in the home but is too incapacitated to apply, another person living in the home may apply for the parent. The other person must provide proof of the parent's inability to apply, per OAC 340:40-3-1(a)(2)(E).
(b) For SNAP, any responsible household member may apply or designate an authorized representative. When a parent is temporarily out of the home, the worker determines the children's eligibility based on the responsible person's eligibility.
4. (a) Methods the applicant may use to apply for SNAP, Child Care Subsidy, State Supplemental Payment, TANF, and, when OKDHS is responsible for determining eligibility, SoonerCare (Medicaid include:
(1) completing the application electronically by:
(A) accessing www.okdhslive.org; or
(B) getting help from OKDHS or a community partner to complete the application on www.okdhslive.org;
(2) downloading a paper application from OKDHS-Forms and Applications for Service and, completing, signing, and bringing, mailing, or faxing it to OKDHS; or
(3) completing the application with a worker in an OKDHS office or an embedded work location using the Family Assistance/Client Services (FACS) system.
(b) Diversion Assistance includes:
(1) downloading Form 08MP001E, Request for Benefits, and Form 08MP003E, Rights, Responsibilities, and Signature for Benefits, from OKDHS-Forms and Applications for Service and completing, signing, and bringing or mailing them to an OKDHS office or an embedded work location. The applicant completes the rest of the application with the worker using FACS; or
(2) completing the application with a worker in an OKDHS office or an embedded work location using FACS.
(c) Clients are not able to apply for Family Violence Assistance at this time. The TANF Unit plans to have a contractor take these applications in the near future.
(d) Methods the applicant may use to apply for the Low Income Home Energy Assistance Program (LIHEAP) include:
(1) completing the application electronically using www.okdhslive.org;
(2) phoning an OKDHS county office to assist with submitting the online application; or
(3) calling the phone number on the www.okdhslive.org website to request Form 08LH002E, Application for Low Income Home Energy Assistance Program (LIHEAP) Application, be mailed. When mailed, it is sent with a postage-paid envelope. The applicant completes and returns the application by email, by faxing it to the number on the form, or by mail in the postage-paid envelope.
(e) Methods the applicant may use to apply for SoonerCare (Medicaid) when the Oklahoma Health Care Authority (OHCA) is responsible for determining eligibility, per OAC 317:35-5-63, include completing the application electronically by:
(1) accessing OHCA online enrollment at www.okhca.org; or
(2) getting help from OKDHS staff to complete the application using agency view for online enrollment.
5. (a) The nursing facility may prefer the application be handled locally, but the applicant's needs take precedence.
(b) Cases for children in OKDHS or tribal custody must remain in the county of jurisdiction.
6. (a) When the applicant applies for TANF in a county other than the one in which he or she lives, the worker and applicant together determine whether the applicant is best served by referring him or her to TANF Work activities in the county of residence or in the county in which he or she applied. Determining factors may include the availability of:
(1) services that best fit the applicant's skills and abilities;
(3) appropriate child care; or
(4) where the applicant's support network is located.
(b) When indicated, workers in both counties confer to develop the most appropriate TANF Work plan for the applicant.
7. (a) A signed Form 08MP001E submitted through email or fax is acceptable to establish a request date for the Child Care Subsidy program or the application date for the SNAP, TANF, and SoonerCare (Medicaid) programs. Form 08MA005E, Notification of Needed Medical Services, may also preserve the application date for SoonerCare (Medicaid) eligibility groups for which OKDHS is responsible, per OAC 317:35-5-63.
(b) In addition to an original signature, a signature submitted on an imaged document by email or fax is acceptable.
(c) An electronic signature submitted through OKDHSLive is considered the same as a pen and ink signature.
8. In rare situations, an applicant's name may not match records used to establish Medicare buy-in and/or data exchange.
(1) When an applicant has Medicare, the worker uses the name on the Medicare Health Insurance Benefits (HIB) card as the case name to facilitate matching Medicare records and completing Medicare buy-in activities.
(2) When, after certification, county staff or the state buy-in coordinator discovers that the case name and the Medicare HIB card name do not match, he or she changes the case name to match the HIB card. When county staff changes the name, he or she reports the name change to the state buy-in coordinator to avoid or resolve Medicare buy-in issues.
(3) When the applicant does not receive Medicare, the worker uses the name on the Social Security card.
(b) Workers scheduling interviews for all programs except SNAP, send Form 08AD092E, Client Contact and Information Request, because Form 08AD092E allows the worker to schedule an office or a telephone interview and request required proof at the same time.
12. The Supplemental Security Income-Disabled Children's Program 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.
13. When OHCA is responsible for determining eligibility, the OHCA rules engine approves SoonerCare (Medicaid) benefits.
14. The worker is responsible for:
(1) explaining the availability of Child Care Subsidy benefits and child support services that may help the applicant achieve the expected outcomes of self-support and self-sufficiency;
(2) giving applicants applying for SoonerCare (Medicaid) or cash assistance for a child younger than 21 years of age OKDHS Pub. No. 87-36, Early Periodic Screening, Diagnosis and Treatment, and OKDHS Pub. No. 91-25, Oklahoma Child Support Services Handbook; and
(3) giving applicants applying for Soonercare (Medicaid) and a State Supplemental Payment (SSP) for a child younger than 18 years of age OKDHS Pub. No. 86-150, Where to Turn for Help for Children with Disabilities.
15. The worker determines the month and effective date of the applicant's eligibility or ineligibility and the system issues the notice based on the reason for the case action.
(1) The system does not issue a computer-generated notice when the worker denies an application using the reason code of "death or code 01" or "other or code 69."
(2) When the worker uses the reason code of "other or code 69," the worker issues Form 08MP038E, Notice of Action Taken, to explain the reason for the denial.
17. When the worker completes Form 08AD092E, he or she only checks the items required to determine eligibility based on program specific policy. For example, the worker does not require proof of resources to determine eligibility for a SNAP food benefit application, in most instances, or self-employment records when no one is self-employed.
18. When the household lived in another state(s) within the last 12 months, the worker contacts the former state(s) by phone or using Form 08AD080E, Out-of-State Inquiry, to determine if the household currently receives assistance from that state(s). When the household receives cash assistance or food benefits from the other state, the worker does not approve the household for assistance in Oklahoma until the month after the assistance ends in the other state.
(2) When the applicant plans to remain in Oklahoma, Child Care Subsidy benefits may be approved for the same month benefits are approved in the other state provided there is a planned closure date. This is possible because the benefit is paid to the child care provider not the recipient.
(3) Per OAC 340:50-5-28, a person residing in a domestic violence shelter included in an active food benefit household may participate as a separate household in the same month when the active household includes the person who subjected the shelter resident to abuse.
(4) SoonerCare (Medicaid) may be approved for nursing care in Oklahoma for the same month the person received nursing home care in another state when the applicant intends to remain in Oklahoma. When approved, the worker subtracts the verified nursing home vendor payment paid by the client in the other state from the vendor payment in Oklahoma.
19. When the applicant requests help with social service needs, the worker may give or send the applicant OKDHS Pub. No. 09-454, Statewide Helpline Numbers, or OKDHS Pub. No. 09-454SV, in Spanish. The publication contains statewide hotline numbers and space for the worker to enter the statewide 211 information and referral phone number and contact information for local community services.
21. The worker informs the applicant that OKDHS matches the Social Security number (SSN) of each person included for benefits with data from the:
(1) Social Security Administration (SSA) on benefits and wages;
(2) Oklahoma Employment Security Commission on unemployment benefits and wages;
(3) Internal Revenue Services on unearned income;
(4) Workers' Compensation Commission on workers' compensation benefits;
(5) financial institutions that participate in the Asset Verification System, when the applicant requests a SoonerCare (Medicaid) program for aged, blind, and disabled populations; or
(6) other agencies.
(b) Per OAC 340:50-5-68 for food benefits, a newborn is not required to have a SSN or pending SSN application until the next certification renewal or within six months following the baby's birth month, whichever is later.
(c) Per OAC 340:40-7-4 for Child Care Subsidy benefit rules, the applicant is not required to provide a SSN for any member of the household.
23. a) When the worker questions the applicant's statement, the worker is required only to verify that the SSN is valid and the name and SSN given by the applicant appear on the document supplied as proof. The applicant may provide a copy of each household member's Social Security card or another document that contains the person's name and SSN, such as an award letter or W-2 form as proof. The worker may use documentation in other public assistance case records or the data exchange files as proof. The worker documents the source used in FACS Case Notes.
(1) When the document provided appears to be false or altered, the worker requests a secondary proof document.
(A) When the person's name and SSN match on both documents, the worker accepts the information. The worker includes the person in the benefit when he or she meets all other factors of eligibility.
(B) When the SSN enumeration (ENU) transaction returns a discrepancy message because the SSN was not verified through data matching with SSA, the applicant must supply a copy of the person's Social Security card or proof from SSA that a SSN application is pending for the person.
(C) Refer to Quest article "Resolving a Social Security Number (ENU) Discrepancy" for information to resolve ENU discrepancy.
(2) The worker takes appropriate action per paragraph (3) of this Instruction when the applicant:
(A) does not provide the initial or secondary proof document;
(B) provides secondary documentation that appears to be false or altered; or
(C) states he or she is using a name or SSN that is not his or hers.
(3) Appropriate action includes:
(A) applying a 25 percent program penalty to the TANF benefits, per OAC 340:10-12-1;
B) denying or closing food benefits for the person, per OAC 340:50-5-68;
(C) denying or closing SoonerCare (Medicaid) benefits for the person, per OAC 317:35-5-27; and
(D) not including the person in household size for LIHEAP.
24. (a) The worker gives or mails Form 08AD101E, SSN Enumeration Referral, and Form 08AD092E, Client Contact and Information Request, to the applicant to request proof the applicant applied for a SSN.
(b) The SSA does not assign a SSN to an alien who does not have authorization from the United States Citizenship and Immigration Services (USCIS) to work in the United States (U.S.) unless the alien has a valid non-work reason for needing a SSN. To receive benefits or services is a valid non-work reason to obtain a SSN. When making a referral to SSA for a SSN, the worker indicates the alien status on Form 08AD101E.(1) When the applicant fails to return Form 08AD101E, no further referral is necessary before the worker takes appropriate action.
(1) When the applicant fails to return Form 08AD101E, no further referral is necessary before the worker takes appropriate action.
(2) When SSA staff accepts Form 08AD101E for processing, he or she indicates acceptance of the SSN application on the completed Form 08AD101E.
(A) SSA normally issues a Social Security card for persons younger than 1 year of age within two weeks of the application date. It may take up to 14 weeks to issue an original Social Security card for a person 1 year of age and older. The worker advises the applicant to provide the SSN as soon as it is received.
(B) When SSA does not accept the applicant's SSN application because the applicant:
(i) was unable to provide the required documents, the worker makes every effort to assist the applicant in obtaining the documents; or
(ii) failed to cooperate or was not eligible for a SSN, the person's needs are not included for benefits.
(c) The Case Worker Activity (CWA) Report 21 lists the names of recipients who received benefits for at least 60-calendar days, are 1 year of age or older, and do not show a SSN on FACS. Children younger than 1 year of age do not appear on the CWA report until they receive benefits for six months.
(1) The worker sends Form 08AD092E to all households whose case number appears on CWA Report 21 requesting they provide a SSN for the household member appearing on the report within 10-calendar days.
(2) When the household does not provide the SSN within 10-calendar days, the worker takes appropriate, negative action.
27. The applicant is not required to declare the citizenship or alien status of household members not applying for benefits. The worker must determine if the income and resources of the excluded household members are considered, using household composition rules, per:
(1) OAC 340:40-7-6 for the Child Care Subsidy program;
(3) OAC 340:20-1-10 for LIHEAP;
(4) OAC 340:15-1-5 for the SSP program;
(5) OAC 317:35-7-36 for SoonerCare (Medicaid) programs for persons categorically related to the aged, blind, and disabled; and
(6) OAC 340:10-3-56 for TANF.
28. (a) Between renewal periods, the payee must complete Form 08MP022E, Declaration of Citizenship Status, before the worker adds the person to benefits.
(b) When the payee reports the additional household member at benefit renewal, Form 08MP022E is not required because the payee declares the citizenship status of the person when completing and signing the benefit renewal.
(c) When the person is 14 years of age and older, a data match with SSA must occur or the person must meet requirements, per OAC 340:65-3-1(g)(3), before the worker approves the person for benefits.
31. (a) OKDHS offices must make notary services available to clients.
(b) When the worker is unable to match the SSN for a person 14 years of age and younger, benefits may be approved when allowed by the program. Refer to OAC 340:65-3-1(f) and ITS # 20 in this Instruction for more information.
(c) The worker does not issue for persons 14 years of age and older until lawful status is verified.
32. The worker uses reason codes 31 or 40 from OKDHS Appendix U, Reasons for Negative Benefit Actions, when denying benefits for the entire household. When the worker denies or removes one or more persons from the benefits, the worker uses the reason "failed or refused to provide proof of citizenship" for the person.