340:65-5-1. Case changes
(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 within 10-calendar days any changes in circumstances that increases, reduces, or closes benefits.
(1) The worker:
(A) gives the client 10-calendar days to provide proof to verify the reported change; and
(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. • 1
(2) Failure to report changes timely may result in a client error overpayment. • 2
(3) Examples of changes the client must report include:
(A) household income; • 3
(B) household resources; • 4
(C) household composition; • 5
(D) the client's address or phone number; • 6
(E) legal alien status of non-citizens; • 7
(F) insurance coverage, per Oklahoma Administrative Code (OAC) 317:35-5-43; and
(G) in addition, for TANF program:
(iii) when a child in the assistance unit stops attending school, per OAC 340:10-13-1.
(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. • 9
(d) Change processing deadline. After certification, all reported changes must be processed, per OKDHS Appendix B-2, Deadlines for Case Actions, to be effective the first day of the month following the deadline date.
(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. When advance notice is required, 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 category of assistance to another without a resulting reduction or interruption in benefits, such as changing from disability to aged benefits; • 10
(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 (QI-1s) 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 beneficiaries of Social Security, Supplemental Security Income, Railroad Retirement, or Veterans' benefits;
(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 closure or reduction of benefits to avoid or repay an overpayment;
(I) the client's whereabouts are unknown. This may occur when OKDHS mail directed to the client is returned by the post office indicating no known forwarding address. SNAP and Child Care Subsidy benefits are not closed for this reason; • 11
(J) a TANF child is removed from the home because of a judicial determination or voluntary foster care placement by the legal guardian for more than 30-calendar days;
(K) a change occurs in federal or state law;
(L) SSP benefits must be reduced to comply with federal law pertaining to maintenance of effort or a state mandate; • 12 or
(f) 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. • 13
(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
(C) a reduced level than the last action taken, the worker reduces benefits further:
(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:
(I) benefits are 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. • 14
(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.
(g) 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 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 pending the outcome of the hearing.
(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 day. Benefits are continued at the previous level unless the client waives continuation of benefits.
(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. • 15
(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. • 16
(3) Per OAC 340:2-5, the DHS Legal Services Appeals Unit makes a decision regarding the fair hearing and sends a decision letter to the client and the county office.
(A) The worker is responsible for taking the action needed to carry out the hearing decision. • 17
(B) When benefits were reinstated or reopened and the hearing decision is not in the client's favor, benefits are continued through the end of the month in which the final decision on the fair hearing is reached and an overpayment referral is sent to AFS Benefit Integrity and Recovery, when appropriate.
INSTRUCTIONS TO STAFF 340:65-5-1
1. The worker is responsible for updating the applicable Family Assistance/Client Services (FACS) tabs and recording a brief explanation of the action taken and reason for taking the action in FACS Case Notes. In addition to rules in this Section, refer to Oklahoma Administrative Code (OAC) 317:35-7-36 for SoonerCare (Medicaid) case changes.
2. Overpayment procedure rules are located at:
(1) 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).
3. Refer to income rules at:
(3) OAC 317:35-5-42 for the populations related to the aged, blind, and disabled (ABD), including long term care (LTC).
4. Refer to resource rules at:
5. (a) Refer to household composition rules at:
(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 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 for the rest of the assistance unit at the same time.
(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 date of request.
(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).
(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 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 FACS tabs and recording in FACS case notes the date the client requested benefits for the additional person, when the person moved into the household, details about the person's eligibility, and how the person 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) When after certification a person not included in the assistance unit asks to be made payee for the TANF benefit, 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 why the current payee must be removed. 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;
(3) OAC 317:35-7-15 and 340:65-3-2 for the SoonerCare (Medicaid) program; and
7. 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.
8. For SNAP, refer to:
(4) OAC 340:50-5-67 for legal alien status of non-citizens rules.
9. For Child Care Subsidy, refer to:
(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.
10. When a person transfers from a TANF benefit to SSP, an advance notice is almost always required because the public assistance benefit for that person reduces. An advance notice is not required when the TANF cash assistance amount remains the same or increases.
12. 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.
13. 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.
14. 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.
15. The worker notifies the hearing officer of actions taken while a hearing decision is pending.
16. When, within 30-calendar days of closure, the worker reopens the client's benefit without a gap in benefits because of a reconsideration of administrative action, per OAC 340:65-5-6, the worker attaches a cover letter to the fair hearing request to notify the DHS Legal Services (LS) Appeals Unit that benefits were reopened.Per OAC 340:2-5-70(c), the DHS LS Appeals Unit dismisses the fair hearing request when DHS withdraws the action the client appealed and restores benefits.
17. When the appeal is not decided in the client's favor, the worker sends Form 08MP038E to the client explaining the action taken.