Current through Vol. 42, No. 1, September 16, 2024
(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.
(3) Examples of changes the client must
report include:
(A) household
income;
(B) household
resources;
(C) household
composition;
(D) the client's
address or phone number;
(E) legal
alien status of non-citizens;
(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.
(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.
(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. 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
(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;
(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;
(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; 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.
(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.
(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, 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.
(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.
(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.
(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.
(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.
Amended at 10 Ok Reg 4465, eff 8-5-93 (emergency);
Amended at 11 Ok Reg 1687, eff 5-12-94; Amended at 18 Ok Reg 2096, eff 7-1-01 ;
Amended at 23 Ok Reg 1907, eff 7-1-06; 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 692, eff
6-1-13
