Release 87:  Effective October 1, 2017

State Family Pre-SSI/SSDI Program -
E.   Issuing Benefits and Changes


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  1. Overview of changes
  2. Participants report changes in their circumstances by telephone, office visit, report forms or other statements made in writing. The change is considered reported the day it is received by the department. When a change is reported for one program, consider it reported for all programs in which the participant participates.

    Participants must report most changes within 10 days of their occurrence. The 10-day time frame starts when the change occurs, with two exceptions:

    Sometimes the action is simply to note that a change was reported because it does not affect the benefit amount. Other times, the action will be to recalculate benefits and send the appropriate notice.

  3. Changes that must be reported
  4. Participants are required to report within 10 days all changes in income, resources and circumstances that may affect their eligibility for benefits or the amount of benefits they receive.

    Changes That Must be Reported Rule
    461-170-0011 — Changes That Must be Reported

  5. Effective dates: initial month's benefits
  6. Cash benefits: The effective date for initial month's benefits is:

    Effective Dates; Initial Month Benefits Rule
    461-180-0070 — Effective Dates; Initial Month Benefits

  7. Effective dates: other
  8. The effective date is the day that an action will be taken or a change made on a case. When a change is not made on a case by the effective date, make the change as soon as possible and supplement benefits for the current month, restore lost benefits for past months or write an overpayment as appropriate.

    The effective date for an action is determined by the type of action and the reporting system.

    Actions to close or suspend are effective on the last day of the month in which the notice period ends. The effective date for denying benefits is the earlier of the following:

    Changes causing increases can have different effective dates, depending on when the participant reports the change and whether it has to do with adding a person. If the participant reports the change prior to the month in which it will occur, the effective date is the first of the month in which it will occur, unless the change is for adding a person.

    When they report the addition of a person, the effective date is the date on which all eligibility requirements are met and verified. If benefits have been issued for the month and adding the new person would reduce benefits, add the person the first of the following month. When the change is not reported until the month it occurs or later, the effective date is the first of the month following the date the change was reported.

    Changes causing reductions are effective the first day of the month after the 10-day notice period expires. If the change will end benefits, the effective date is the last day of the month in which the 10-day notice period expires.

    Effective Dates; Adding a New Person to an Open Case Rule
    461-180-0010 — Effective Dates; Adding a New Person to an Open Case

  9. Effective dates: special circumstances
  10. Restored benefits

    When participants are underpaid benefits or have benefits denied or closed in error, they are entitled to a late payment for the benefits they should have gotten. This late payment is called a restoration of lost benefits. When a department error caused the underpaid benefits, the effective date of restoration is the date the error was made, up to a maximum period of 12 months.

    When a participant error caused the underpaid benefits, the effective date is the earlier of the month the participant notifies the department of the error, the month the agency discovers the error or the date of a hearing request.

  11. Redetermination of eligibility
  12. At initial application, a filing group is approved for benefits for a specific certification period. Prior to the certification period expiring, it is time for a redetermination of eligibility to approve or deny continuing benefits.

    The redetermination is required not only when the certification period expires, but also at any other time the department determines that eligibility for benefits is questionable. Therefore, redetermination period means the months between initial eligibility and when the certification expires, or the months between one redetermination and the next.

    The redetermination process involves review of the application and supporting verifications. Participants must cooperate in the redetermination. Failure to do so causes ineligibility and benefits are stopped.

    Redetermine eligibility at least once every 12 months for meeting the TANF program requirements.

    When the group also receives SNAP, set the period so that eligibility for SNAP and TANF will come up for review at the same time. This allows participants to apply for multiple program benefits on one application.

    The effective date for continuing eligibility at the end of the redetermination period is one of the following:

    Give the filing group 45 days from the date that the participant contacts the department to re-establish their eligibility under the same or a different medical program. If all necessary eligibility information is received prior to the end of the 45-day period, take the appropriate case action (continue current medical eligibility, change program, end benefits), and send appropriate decision notice(s). If the filing group does not establish eligibility (by responding to pended items, etc.) within the 45-day time limit, end medical benefits and send a decision notice.

    NOTE
      If circumstances or information needed to determine eligibility is expected to be received after the 45-day deadline and the participant has no control over the circumstances or information, the 45-day application process may be extended.

  13. Redetermination interview
  14. The interview requirements for a redetermination are much like the ones for an initial application. All interviews are conducted by an employee of the local office and must protect the participant's right to privacy and confidentiality. An interview is needed for SFPSS participants once every 12 months for continued program eligibility.

    Interviews should be scheduled as promptly as possible to ensure compliance with the application processing time frames. Interviews may be at the branch office, out of office or by phone. Phone interviews should only be used if branch office or out-of-office interviews are not possible.

    Periodic Redeterminations; Not EA, ERDC, REF, REFM, SNAP, or TA-DVS Rule
    461-115-0430 — Periodic Redeterminations; Not EA, ERDC, REF, REFM, SNAP, or TA-DVS


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