Library: Policy

340:65-5-1. Case changes

Revised 9-15-22

(a) Change reporting requirement for Temporary Assistance for Needy Families (TANF), State Supplemental Payment (SSP), and SoonerCare (Medicaid). Recipients of TANF, SSP, and SoonerCare (Medicaid) for the aged, blind, and disabled must report any changes in circumstances that increases, reduces, or closes benefits within 10-calendar days.

(1) The worker:

(A) gives the client 10-calendar days to provide proof to verify the reported change (B) acts on changes that increase, reduce, or close benefits within 10-calendar days of the date the change is reported and required proof is received, per (d) of this Section.

(2) Failure to report changes timely may result in a client error overpayment. • 1

(3) Examples of changes the client must report include:

(A) household income; • 2

(B) household resources; • 3

(D) the client's address or phone number; • 5

(E) legal alien status of non-citizens; • 6

(F) insurance coverage, per Oklahoma Administrative Code (OAC) 317:35-5-43; and

(G) in addition, for TANF program:

(i) deprivation of parental support, per OAC 340:10-10-1 through 340:10-10-4;

(ii) when a TANF Work activity stops or starts, per OAC 340:10-2-1 through 340:10-2-8; and

(iii) when a child in the assistance unit stops attending school, per OAC 340:10-13-1.

(b) Change reporting for the Supplemental Nutrition Assistance Program (SNAP). SNAP has three household categories with different change reporting responsibilities; annual reporters, semi-annual reporters, and change reporters. Refer to OAC 340:50-9-5 for change reporting requirements. • 7

(c) Change reporting for the Child Care Subsidy Program. Child Care Subsidy recipients must report income changes within 10-calendar days when the household's gross income exceeds federal income eligibility threshold for the household size, per OAC 340:40-9-2(a) and Oklahoma Human Services (OKDHS) Appendix C-4, Child Care Eligibility/Copayment Chart. • 8

(d) Changes in cash benefits. When a change of circumstances occurs after certification that requires an increase or a reduction in the SSP or TANF cash benefit amount, the worker processes the change to be effective the first day of the month following the next advance notice or non-advance notice deadline date, per OKDHS Appendix B-2, Deadlines for Case Actions. • 9 When the change:

(1) increases the cash benefit, the worker makes the change by the next non-advance deadline date. The worker also determines if a supplement is due for the current month. When one is due, the worker issues the supplement within 10-calendar days of the date the change is reported and required proof is received; or • 10

(2) reduces the cash benefit, the worker makes the change within 10-calendar days of the date the change is reported and verified to be effective by the next advance notice deadline date. The worker also evaluates whether prior benefits were properly issued. When more benefits were issued than the household was entitled to, the worker completes an overpayment, per each program's overpayment rules.

(e) Notices. A computer-generated notice is sent to the client when the action taken increases, reduces, suspends, or closes benefits. A computer-generated notice is not sent when the action taken does not affect the benefit level.

(1) Advance notice is required when the action taken reduces, closes, or suspends benefits for a reason other than those listed per (2) of this subsection. Refer to OKDHS Appendix B-2 for advance notice deadline dates.

(2) When advance notice is not required, refer to OKDHS Appendix B-2 non-advance notice deadline dates. Advance notice is not required when the action taken does not suspend, close, or reduce benefits, or when:

(A) all members included in the benefit die;

(B) the TANF payee dies and there is not a relative available to serve as a new payee;

(C) benefits are transferred from one assistance category to another without a resulting reduction or interruption in benefits; • 11

(D) care is approved in a skilled nursing facility or an intermediate nursing care facility that requires closure of the person's SSP benefit or the SoonerCare (Medicaid) Qualifying Individuals - group 1 benefit;

(E) the household moves out-of-state;

(F) an automatic increase in income occurs because of federal legislation, such as a cost-of-living increase to all Social Security, Supplemental Security Income, Railroad Retirement, or Veterans' benefits beneficiaries;

(G) the client is admitted to a public institution where his or her needs are fully supplied;

(H) the client provides a signed, written statement:

(i) stating he or she no longer chooses to receive assistance; or

(ii) requesting benefit closure or reduction to avoid or repay an overpayment;

(I) the client's whereabouts are unknown. This may occur when the post office returns the client's OKDHS mail and indicates no known forwarding address. SNAP and Child Care Subsidy benefits are not closed for this reason. Refer to OAC 317:35-5-67 to review the SoonerCare (Medicaid) return mail rule; • 12

(J) a TANF child is removed from the home because of a judicial determination or because the legal guardian voluntarily placed the child in foster care for more than 30-calendar days;

(K) a change occurs in federal or state law;

(L) SSP benefits must be are reduced to comply with federal law pertaining to maintenance of effort or a state mandate; • 13 or

(M) the client requests a reduction in or closure of the child care benefit or a change in child care provider for the Child Care Subsidy program, per OAC 340:40-9-2 and 340:40-9-3.

(f) Closing benefits. The worker closes a Child Care Subsidy, SoonerCare (Medicaid), SSP, SNAP, or TANF benefit only at the household's request or after ineligibility is established, per each program's eligibility rules. • 14

(g) Reinstating or reopening benefits. Within 30-calendar days of notice issuance, the client may request reduced benefits be reinstated or closed benefits be reopened at the previous benefit level due to an incorrect action or a change in circumstances. • 15

(1) When benefits were reduced and the worker determines the client remains eligible at:

(A) the previous benefit level, the worker restores benefits to the previous benefit level for all Adult and Family Services (AFS) programs;

(B) an increased benefit level, benefits are increased based on specific program rules; or

(i) effective the next advance notice deadline date for TANF, SSP, and SoonerCare (Medicaid);

(ii) when the renewal is due for Child Care Subsidy and SNAP. When the renewal is not due, benefits are:

(I) not reduced for Child Care Subsidy, per OAC 340:40-9-2(a); or

(II) reduced in limited circumstances for SNAP. Refer to OAC 340:50-9-5 for appropriate circumstances.

(2) For TANF, SSP, and SoonerCare (Medicaid), when benefits were closed or suspended and the client remains eligible, but at a reduced benefit level, benefits are reopened using current eligibility information. • 16

(3) When Child Care Subsidy benefits are reopened and the renewal is not due, benefits are not reduced below the benefit level at closure. Child care benefits may only be reduced at renewal, per OAC 340:40-9-2(a).

(4) When SNAP benefits are reopened and the benefit renewal is not due, benefits may only be reduced in limited circumstances. Refer to OAC 340:50-9-5 for appropriate circumstances.

(h) Fair hearing information. When the client requests a fair hearing within 90-calendar days of the date action is taken for SNAP, or 30-calendar days for all other AFS programs, the worker follows fair hearing procedures, per OAC 340:2-5.

(1) When the client requests a fair hearing within 10-calendar days following the notice issuance date and requests, pending the hearing's outcome, that benefits be continued at the same benefit level as authorized immediately prior to the adverse action notice, the worker reopens or reinstates benefits to the previous benefit level.

(A) For SNAP, the client is not required to request benefits be continued at the same level when he or she requests a fair hearing within 10-calendar days. Benefits are continued at the previous level unless the client waives benefit continuation.

(B) For all AFS programs, the worker explains to the client when benefits are continued at the previous level and the appeal is not decided in the client's favor, he or she is expected to repay the benefits.

(C) Benefits remain open at the previous level unless another change occurs before a hearing decision is made that requires benefits be reduced or closed. • 17

(2) When the client does not request the fair hearing within 10-calendar days of the notice date, the worker does not restore benefits unless the client provides information verifying the client remains eligible at the previous benefit level, the worker determines an incorrect action was taken, or the hearing is decided in the client's favor. • 18

(3) Per OAC 340:2-5, the OKDHS Legal Services Appeals Unit makes a decision regarding the fair hearing and sends a decision letter to the client and the OKDHS office.

(A) The worker is responsible for taking the action needed to carry out the hearing decision and, when appropriate, sending an overpayment referral to the AFS Benefit Integrity Unit. • 18

(B) When benefits were reinstated or reopened and the hearing decision is not in the client's favor, the worker reduces or closes benefits effective the first of the month following the month the final hearing decision is reached.

INSTRUCTIONS TO STAFF 340:65-5-1

Revised 9-15-22

1. Overpayment procedure rules are located at:

(1) Oklahoma Administrative Code (OAC) 340:65-9 for the Temporary Assistance for Needy Families (TANF) and State Supplemental Payment (SSP) programs;

(2) OAC 340:40-15 for the Child Care Subsidy program;

(3) OAC 317:35-13-5 for the SoonerCare (Medicaid) program; and

(4) OAC 340:50-15 for the Supplemental Nutrition Assistance Program (SNAP).

2. Refer to income rules at:

(1) OAC 340:10-3-26 through 340:10-3-40 for the TANF program;

(2) OAC 340:15-1-4, 340:15-1-6, and 317:35-7-38 for the SSP program; and

(3) OAC 317:35-5-42 for the populations related to the aged, blind, and disabled (ABD), including long term care (LTC).

3. Refer to resource rules at:

(1) OAC 340:10-3-1 through 340:10-3-9 for the TANF program;

(2) OAC 340:15-1-4 and 317:35-7-38 for the SSP program; and

(3) OAC 317:35-5-41 through 317:35-5-41.11 for populations related to ABD and OAC 317:35-17-10 and 317:35-19-20 for the (LTC) population for the SoonerCare (Medicaid) program.

4. (a) Refer to household composition rules at:

(1) OAC 340:10-3-56 and 340:10-3-57 for the TANF program;

(2) OAC 340:15-1-5 and 317:35-7-36 for the SSP program; and

(3) OAC 317:35-7-36 for the population related to ABD and OAC 317:35-17-9 and 317:35-19-20 for the SoonerCare (Medicaid) LTC population.

(b) For TANF, when the client requests benefits for an additional person prior to certification, a new application is not needed. The client must complete completes a new application when he or she requests benefits for an additional person after certification.

(1) To evaluate an additional person's eligibility, the worker first determines if the person is required to be included in the assistance unit, per OAC 340:10-3-56.

(A) When the person must be included, the worker completes the TANF renewal at the same time as the additional person request.

(B) When the person is not required to be included in the assistance unit and including the person will reduce the TANF benefit, the client may choose not to include the person. The worker is responsible for informing the client of his or her options.

(C) After certification, when the client chooses not to include the person or the person is not eligible for another reason, the worker sends Form 08MP038E, Client Notice of Action Taken, to inform the client of the denial.

(2) When the additional member is eligible, the worker adds the person to the TANF benefit effective the request date.

(A) When the additional person increases the TANF benefit, the worker prorates the initial month's supplemental benefits, per OAC 340:65-3-5(5). The worker uses Information Management Systems (IMS) transaction F17C to issue the supplement.

(B) When the additional person must be included and has countable income that reduces the TANF benefit, the worker adds the person and reduces the TANF benefit effective the first day of the month following the advance-notice deadline date, per Oklahoma Human Services (OKDHS) Appendix B-2 Deadlines for Case Actions.

(C) When the additional person must be included and including the person causes the assistance unit to no longer be eligible for TANF benefits, the worker closes the TANF benefit effective the first day of the month following the advance-notice deadline date, per OKDHS Appendix B-2.

(3) The worker is responsible for updating the applicable Family Assistance/Client Services (FACS) tabs and recording in FACS case notes:

(A) the date the client requested benefits for the additional person;

(B) when the person moved into the household;

(C) details about the additional person's eligibility; and

(D) how the person and his or her income affects the benefit amount for the assistance unit.

(c) For TANF, when the client reports that a person included in the assistance unit left the home, the worker removes the person's needs effective the first day of the month following the advance-notice deadline date, per OKDHS Appendix B-2. When the person dies, the worker removes the person effective the date of death, using reason code 01 and sends Form 08MP038E when other household members are included in the benefit.

(d) For all programs, when the client reports a household member's name changed, the worker updates the person's name in FACS after the client provides the person's Social Security card showing the correct name.

(e) After certification, when a person not included in the assistance unit asks to be made the TANF benefit payee, the person must complete a new application and the worker must review household eligibility before making the change. The worker documents the new circumstances in FACS case notes, including the reason for removing the current payee. The new payee must have a certain degree of relationship to the child for whom benefits are requested, per OAC 340:10-3-56 and 340:10-9-1.

(f) For rules regarding who can be payee for programs other than TANF, refer to:

(1) OAC 340:65-3-2 for the SSP program;

(2) OAC 340:40-3-1 and 340:65-3-2 for the Child Care Subsidy program;

(3) OAC 317:35-7-15 and 340:65-3-2 for the SoonerCare (Medicaid) program; and

(4) OAC 340:50-3-1 and 340:65-3-2 for SNAP.

5. When the client moves to another county, refer to OAC 340:65-1-3 Instructions to Staff # 1(d) for transfer procedures.

6.For rules regarding legal alien status of non-citizens, refer to:

(1) OAC 340:65-3-1 for all programs;

(2) OAC 340:10-15-1 for the TANF program; and

(3) OAC 317:35-5-25 for the SoonerCare (Medicaid) program and SSP.

7. For SNAP, refer to:

(1) OAC 340:50-7-22, 340:50-7-29, and OAC 340:50-7-30 for income rules;

(2) OAC 340:50-7-1 and 340:50-7-6 for resource rules;

(3) OAC 340:50-5-1 through 340:50-5-10.1 for household composition rules; and

(4) OAC 340:50-5-67 for legal alien status of non-citizens rules.

8. For Child Care Subsidy, refer to:

(1) OAC 340:40-7-10 through 340:40-7-13 for income rules;

(2) OAC 340:40-7-5 for resource and legal alien status of non-citizen rules; and

(3) OAC 340:40-7-6 for household composition rules.

9. (a) When possible, the worker discusses why benefits are changing and the basis for the decision with the recipient. The worker updates applicable FACS tabs and documents in FACS case notes:

(1) what change was reported and how the change affects the client's benefits;

(2) what was discussed with the client regarding the change; and

(3) the date and type of action taken, including any supplements given or overpayments written.

(b) The worker refers to OAC 340:50-9 for food benefits changes, OAC 340:40-9 for child care benefit changes, and OAC 317:35-7-36 for SoonerCare (Medicaid) changes.

(c) Refer to OAC 340:65-5-6 for information regarding corrective action.

10. The worker uses IMS transaction F17C to issue the supplement.

11. When a person transfers from a TANF benefit to SSP, an advance notice is required when the person's public assistance benefit amount reduces. An advance notice is not required when the TANF cash assistance amount remains the same or increases.

12. Per OAC 340:50-9-5 for SNAP and OAC 340:40-9-2 for Child Care Subsidy, the worker does not close benefits because of returned mail between renewal months. The worker enters a FACS case note regarding the returned mail and inquires about the client's current address at renewal.

13. OKDHS may adjust the SSP benefit one or more times during the year to ensure OKDHS does not spend more or less on the program than was spent the previous year. OKDHS sends a special notice to the client and a broadcast message to staff when an adjustment is made.

14. (a) When the worker determines the household is no longer eligible for one or more benefits, the worker closes the benefit for the next effective date, per OKDHS Appendix B-2 using the applicable reason code, per OKDHS Appendix U, Reasons for Negative Benefit Actions.

(1) Refer to (e) of this Section for reasons when advance notice is and is not required.

(2) When the recipient is no longer eligible for a TANF cash assistance benefit, refer to:

(A) OAC 340:10-3-75 to determine if the recipient is eligible for continued medical benefits;

(B) OAC 340:50-11-27 to determine if the recipient is eligible for SNAP transitional food benefits; and

(C) OAC 340:40-9-1 and 340:40-9-2 to determine if the recipient remains eligible for Child Care Subsidy benefits.

(b) The worker documents the factual basis for benefit closure in FACS case notes. When the client requests benefit closure:

(1) without giving a reason, the worker attempts to determine the reason for the request and documents attempts in FACS Case Notes; or

(2) gives a reason for requesting benefit closure, the worker closes the benefit based on the reason given.

(c) The worker uses available information to determine if an overpayment occurred prior to closure. When the worker determines an overpayment occurred, he or she submits an overpayment referral as soon as possible, per:

(1) OAC 340:65-9 for State Supplemental Payment and TANF;

(2) OAC 340:40-15-1 for Child Care Subsidy; and

(3) OAC 340:50-15 for SNAP.

(d) The system issues a computer-generated notice based on the closure reason chosen from OKDHS Appendix U.

(1) The worker chooses reason code 01 or 'death' only when all household members receiving benefits died. When the worker closes a TANF benefit on reason code 01 because the parent died, it causes problems processing future medical claims for the children.

(2) When the worker uses code 69 for other reasons not shown on Appendix U, the worker sends Form 08MP038E, Notice of Action Taken, to explain the benefit closure reason.

(e) When the worker is able to discuss the benefit closure with the recipient, he or she determines if the client is eligible for any other benefits or has service needs. The worker takes an application or offers referrals when appropriate.

15. For rules regarding reopening or reinstating benefits, refer to:

(1) OAC 340:65-5-6 for the TANF and SSP programs;

(2) OAC 340:40-9-2 for the Child Care Subsidy program; and

(3) OAC 340:50-9-5 for SNAP.

16. Using current eligibility information means the effective date of the reopen action that reduces benefits is the same effective date as would have occurred had the benefit remained open.

17. The worker notifies the hearing officer of actions taken while a hearing decision is pending.

18. When based on an administrative action consideration, per OAC 340:65-5-6, the worker reopens the client's benefit without a gap in benefits within 30-calendar days of closure, the worker notifies the OKDHS Legal Services (LS) Appeals Unit that benefits were reopened and attaches a copy of the fair hearing request. Per OAC 340:2-5-70(c), the OKDHS LS Appeals Unit dismisses the fair hearing request when OKDHS withdraws the action the client appealed and restores benefits.

19. When the appeal is not decided in the client's favor, the worker sends Form 08MP038E to the client explaining the action taken.