Current through Vol. 42, No. 1, September 16, 2024
(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. 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) 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 provides 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. 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, or Diversion Assistance (DA). The applicant
may request one or more benefits on the same application except for LIHEAP
because it is not an ongoing benefit.
(1) The
applicant may apply for benefits online, with a worker in an Oklahoma Human
Services (OKDHS) office or an embedded work location, or by downloading a paper
application and bringing or mailing or faxing it to an OKDHS office or an
embedded work location..
(2) When
someone applies on behalf of the applicant, the person may apply in any
county.
(3) When the applicant
applies for TANF cash assistance, OKDHS assigns the applicant's TANF Work
activities based on his or her needs, convenience, and career
pathway.
(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) The applicant must sign TANF and DA
applications. When the TANF applicant lives with his or her spouse, they must
both sign the application.
(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
(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.
(1)
Per Section 206.10 of Title 45 of the Code of Regulations, OKDHS staff must
complete a face-to-face TANF certification renewal interview every 12 months.
The face-to-face interview may occur in the OKDHS office, at a home visit, or
through a virtual video conference.
(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;
(F) Supplemental Security Income-Disabled
Children's Program, or
(G) TANF,
except for the certification renewal every 12 months.
(3) An interview is not required when a
person applies for:
(A) LIHEAP; or
(B) SoonerCare (Medicaid), when the Oklahoma
Health Care Authority is responsible for determining eligibility, per Oklahoma
Administrative Code (OAC)
317:35-5-63.
(e)
Worker responsibilities.
During the eligibility determination process, the worker is responsible for:
(1) informing the applicant of the:
(A) OKDHS responsibility for reaching a
decision and notifying the applicant of eligibility or ineligibility within the
appropriate time limits, per OAC
340:65-3-5;
(B) applicant's right to request a fair
hearing and obtain representation from any person the applicant chooses, per
OAC 340:2-5. The applicant may request a fair hearing when there is a:
(i) delay beyond the established time limits
for determining eligibility, per OAC
340:65-3-5; or
(ii) disagreement with any action taken on
the case;
(C) applicant's
legal responsibility to report 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 verification and gives the applicant at least 10-calendar days to
comply, per OAC
340:65-3-2.1;
(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 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:
(i)
residency;
(ii)
relationship;
(iii) age;
(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; and
(B)
unearned income information obtained through:
(i) Beneficiary and Earnings Data Exchange
System, from the Social Security Administration (SSA);
(ii) Supplemental Security Income/State Data
Exchange System, from SSA;
(iii)
Unemployment Insurance Benefits (UIB), from the Oklahoma Employment Security
Commission; 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;
(3) contacting other persons who may be able
to help establish eligibility;
(4)
determining if the applicant or other persons seeking assistance currently
receive benefits from another state, when he or she has resided in Oklahoma for
less than 12 months;
(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;
and
(6) denying the
application when sufficient facts are available to substantiate ineligibility
or the applicant fails to cooperate in determining eligibility.
(f)
SSN requirement.
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.
(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.
(A) The OKDHS worker refers persons for whom
an SSN is required, but not available, 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.
(B) Parents of
newborns who participate in Enumeration at Birth 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 an 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 an SSN is
provided.
(B) For SNAP, LIHEAP, and
SoonerCare (Medicaid) purposes, only the person's needs for whom an SSN is not
provided or applied for are not included.
(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. 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. 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 the household members applying for benefits are aliens, the worker
follows SAVE procedures, per OAC
340:65-3-4, to determine the
validity of documents provided to verify legal alien status.
(2) The worker follows 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;
(B) OAC
340:50-5-67 for SNAP food
benefits;
(C) OAC
340:20-1-8,
340:20-1-10, and
340:50-5-67 for LIHEAP;
(D) OAC
317:35-5-25 for SSP;
and
(E) OAC
340:10-15-1 for
TANF.
(3) The citizenship
requirements per (g)(3)(A) through (C) and (g)(4) of this Section are pursuant
to Section
71 of Title 56 of the Oklahoma
Statutes (56 O.S. § 71) and 74 O.S. § 20j.
(A) Lawful status in the United States (U.S.)
is verified when:
(i) the person applying for
benefits provides an 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.
(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
(ii) U.S. birth
certificate, U.S. passport, a Certificate of Naturalization or other acceptable
document, per OAC
317:35-5-25 to verify lawful
status.
(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.
(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, reviews 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.
Amended at 18 Ok Reg
2096, eff 7-1-01; Amended at 20 Ok Reg 918, eff 6-1-03; Amended at 22 Ok Reg
827, eff 5-12-05; Amended at 23 Ok Reg 1907, eff 7-1-06; Amended at 25 Ok Reg
265, eff 11-1-07 (emergency); Amended at 25 Ok Reg 958, eff 6-1-08; Amended at
26 Ok Reg 1272, eff 6-1-09; Amended at 28 Ok Reg 880, eff 6-1-11; Amended at 29
Ok Reg 812, eff 7-1-12; Amended at 30 Ok Reg 686, eff
6-1-13
