Current through September 24, 2024
(1) Entitlements.
The county office shall restore to the household benefits which were lost
whenever the loss was caused by an administrative error, or whenever an
administrative disqualification decision for intentional program violation is
subsequently reversed, or whenever federal regulations specifically state that
a household is entitled to restoration of lost benefits. Benefits shall be
restored for not more than twelve months prior to whichever of the following
occurred first:
(a) The date the state agency
receives a request for restoration from a household; or
(b) The date the state agency is notified or
otherwise discovers that a lost to a household has occurred.
(2) The county office shall
restore to households benefits which were found by any judicial action to have
been wrongfully withheld.
(3) If
the judicial action is the first action the recipient has taken to obtain
restoration of lost benefits, then benefits shall be restored for a period of
not more than twelve months from the date the court action was
initiated.
(4) When the judicial
action is a review of a county office action, the benefits shall be restored
for a period of not more than twelve months from the first of the following
dates:
(a) The date the state agency receives
a request for restoration; or
(b)
If no request for restoration is received, the date the fair hearing action was
initiated; but
(c) Never more than
one year from when the state agency is notified of or discovers the
loss.
(5) Errors
Discovered By The County Office. If the county office determines that a loss of
benefits has occurred, and the household is entitled to restoration of those
benefits, the county office shall automatically take action to restore any
benefits that were lost. No action by the household is necessary. However,
benefits shall not be restored:
(a) If the
benefits were lost more than 12 months prior to the month the loss was
discovered by the county office in the normal course of business; or
(b) If the benefits were lost more than 12
months prior to the month the county office was notified in writing or orally
of a possible loss to a specific household.
(6) Notification And Method Of Restoration.
(a) Notification to the Household.
1. When it is determined by the county office
that a loss of benefits has occurred, the household shall be notified, in
writing, of the following:
(i) Entitlement to
restored benefits;
(ii) The amount
of benefits to be restored;
(iii)
Any offsetting that was done;
(iv)
The method of restoration; and
(v)
The right to appeal through the fair hearing process if the household disagrees
with any aspect of the proposed lost benefit restoration.
2. Reserved for Future Use.
3. Reserved for Future Use.
(b) Method of Restoration.
1. Regardless of whether a household is
currently eligible or ineligible, the county office shall restore lost benefits
to a household by issuing an allotment equal to the amount of benefits that
were lost. The amount restored shall be issued in addition to the allotment
currently eligible households are entitled to receive.
2. Deviations. The county office shall honor
reasonable requests by households to restore lost benefits in monthly
installments if, for example, the household fears that excess coupons may be
lost or stolen, or that the amount to be restored is more than it can use in a
reasonable period of time.
(c) Household Composition Changes. Whenever
lost benefits are due a household and the household's membership has changed.
the county office shall restore the lost benefits to the household containing a
majority of the individuals who were household members at the time the loss
occurred. If the county office cannot locate or determine the household which
contains a majority of the household members, the county office shall restore
the lost benefits to the household containing the individual who was head of
the household at the time the loss occurred.
(d) Reserved for Future Use.
(e) Reserved for Future Use.
(7) Computing The Amount To Be
Restored. After correcting the loss for future months and excluding those
months for which benefits may have been lost prior to the twelve (12) month
time limits described in Section 1240-1-21-.01, the county shall calculate the
amount to be restored as follows:
(a)
Incorrect Allotment. If the household was eligible but received an incorrect
allotment, the loss of benefits shall be calculated only for those months the
household participated.
(b) Delay,
Denial, or Termination. If the loss was caused by an incorrect delay, denial,
or termination of benefits, the months affected by the loss shall be calculated
as follows:
1. If an eligible household's
application was erroneously denied, the month the loss initially occurred shall
be the month of application or for an eligible household filing a timely
reapplication, the month following the expiration of its certification
period.
2. If an eligible
household's application was delayed, the months for which benefits are lost
shall be calculated in accordance with procedures in Section 1240-1-17 of the
Family Assistance Manual for determining the delay was caused by the household
or by the county office.
3. If a
household's benefits were erroneously terminated, the month the loss initially
occurred shall be the first month benefits were not received as a result of the
erroneous action.
4. After
computing the date the loss initially occurred, the loss shall be calculated
for each month subsequent to that date until either the first month the error
is corrected or the first month the household is found ineligible.
(c) Determination of Eligibility.
For each month affected by the loss, the county office shall determine if the
household was actually eligible. In cases where there is not information in the
household's case file to document that the household was actually eligible, the
county office shall advise the household of what information must be provided
to demonstrate eligibility for these months. For each month the household can't
provide the necessary information to demonstrate its eligibility, the household
shall be ineligible.
(d)
Calculation of Benefits. For the months the household was eligible, the county
office shall calculate the allotment the household should have received. If the
household received a smaller allotment than it was eligible to receive, the
difference between the actual and correct allotment equals the amount to be
restored.
(e) Offsetting Claims. If
a claim against a household is unpaid or held in suspense as provided in
Section 1240-1-20 of the Family Assistance Manual, the amount to be restored
shall be offset against the amount due on the claim before the balance, if any,
is restored to the household. At that point in time when the household is
certified and received an initial allotment, the initial allotment shall not be
reduced to offset claims, even if the initial allotment is paid
retroactively.
(8)
Disputed Benefits.
(a) Household Disagrees
With State Agency.
1. If the county office
determines that a household is entitled to restoration of lost benefits, but
the household does not agree with the amount to be restored as calculated by
the county office or any other action taken by the county to restore lost
benefits, the household may request a fair hearing within 90 days of the date
the household is notified of its entitlement to restoration of lost
benefits.
2. If a fair hearing is
requested prior to or during the time lost benefits are being restored, the
household shall receive the lost benefits as determined by the county office,
pending the results of the fair hearing.
3. If the fair hearing decision is favorable
to the household, the county shall restore lost benefits in accordance with
that decision.
(b) State
Agency Disagrees With Household.
1. If a
household believes it is entitled to restoration of lost benefits but the
county office, after reviewing the case file, does not agree, the household has
90 days from the date of the county office's determination to request a fair
hearing. The county office shall restore lost benefits to the household only if
the fair hearing decision is favorable to the household.
2. Benefits lost more than 12 months prior to
the date the county office was initially informed of the household's possible
entitlement to lost benefits shall not be restored.
(9) Entitlement To Lost Benefits
For Individuals Who Were Disqualified For Intentional Program Violation.
(a) Individuals disqualified for intentional
program violation are entitled to restoration of any benefits lost during the
months they were disqualified only if the disqualification decision is
subsequently reversed. The months covered in the restoration must not exceed 12
months prior to the date the county received notification.
(b) For each month the individual was
disqualified, the amount to be restored, if any, shall be determined by
comparing the allotment the household received with the allotment the household
would have received had the disqualified member been allowed to
participate.
(c) If the household
received a smaller allotment than it should have received, the difference
equals the amount that should have been restored.
(d) Participation in an administrative
disqualification hearing in which the household contests the State Agency
assertion of intentional program violation shall be considered notification
that the household is requesting restored benefits.
Authority: T.C.A. §§ 14-27-104,
14-27-106, 14-27-109, 14-27-110;
7 CFR
273.17.
