Current through Register Vol. 35, No. 18, September 24, 2024
The income support division (ISD) is responsible for
administering food, cash, energy, and medical assistance programs. These
programs are funded through federal or state sources and provide assistance to
individuals who meet certain eligibility factors. State and federal regulations
determine eligibility factors for each program. ISD determines if an individual
qualifies for a program, and ensures that eligible individuals receive the
assistance as quickly as possible and, in any event, within the application
time frames for the applicable program.
A. Proof of eligibility: Determining
eligibility for assistance requires that certain verification regarding an
applicant/recipient's circumstances be made available to ISD. This verification
is retained in the case record or noted in the case narrative.
(1) Applicant/ recipient responsibility: The
applicant/recipient is responsible to provide and obtain the verification
necessary to determine eligibility.
(2) ISD responsibility: ISD is responsible
for the following:
(a) to explain program
participation requirements and the program specific eligibility factors to
applicants/ recipients;
(b) to
explain the information and documents that must be provided to establish
eligibility under each eligibility factor for a specific program;
(c) to offer and provide assistance in
obtaining verification of an eligibility factor when the applicant/recipient
indicates that verification may be difficult or costly to obtain; difficulty in
obtaining verification may arise as a result of such circumstances as an
applicant/recipient's limited ability to read, speak or understand the English
language, mental impairments, physical illness, disability, lack of funds, lack
of transportation or lack of knowledge about how to obtain the information;
assistance by ISD includes explaining written information orally in the
applicant/ recipient's language, providing an interpreter, providing an address
or telephone number of a person or agency, making telephone or written
inquiries, allowing an applicant/ recipient to use the telephone, locating a
document, instructing an applicant in obtaining a document, requesting a
document on behalf of an applicant/recipient or contacting a collateral
contact; the assistance offered and provided is based on the particular needs
of the applicant and ISD's ability to address those needs;
(d) to inform applicants/recipients in
writing of their responsibility to provide necessary verification.
(3) Incomplete information: When
available information is inconclusive, incomplete or indefinite, ISD shall be
responsible for explaining, in writing, what questions remain and how they can
be resolved. The explanation must make it clear that eligibility cannot be
established without the information or documents and that failure to provide
them shall result in denial, reduction or termination of assistance.
(a) The applicant/recipient shall also be
informed they may reapply at any time but that the information, documentation
or actions may affect the reapplication. If the applicant/ recipient does not
provide all of the verification needed, a decision shall be made to the extent
possible, based on the existing verified information.
(b) For MAGI medicaid purposes, reasonable
compatibility will be effectuated in accordance with
42 CFR
435.952.
(c) When assistance is denied, reduced,
delayed or terminated due to failure to provide information or documents as
requested, the case record must contain the explanation that such failure is
the basis for the action. The client shall be informed in writing of the
action.
B.
Failure to provide verification: An applicant/recipient cannot be considered
eligible for assistance until necessary verification is obtained. To the extent
possible, ISD shall make eligibility determinations based on verified
eligibility issues rather than failure to provide information.
C. Applicants/ recipients may submit
documentary evidence in person, by mail, facsimile, or other electronic device
or through an authorized representative.
