October 13, 1999
REPORTING REQUIREMENTS FOR CONTINUED ELIGIBILITY FOR STATE ASSISTANCE
By: Robin Cohen, Principal Analyst
You asked (1) how often state law requires “state assistance” recipients to report to their Department of Social Services (DSS) caseworkers for the purpose of redetermining continued eligibility and (2) if there are additional reporting requirements which are not explicitly mandated in law.
Since you did not define the type of state assistance your constituent is receiving, or the programs under which it is paid, we will provide this information for the Aid to Families with Dependent Children (AFDC), Temporary Family Assistance (TFA), Food Stamp, Medicaid, State Supplement, and State-Administered General Assistance (SAGA) programs. The first four are federal, and the redetermination and reporting requirements for each is generally prescribed in federal law.
This report looks at state law and regulations governing redetermination, monthly reporting, and interim activity. It does not address notice requirements and other related rules, or initial application and eligibility rules, except to the extent they are the same as those for subsequent reviews.
Redetermination and reporting rules for federal-state programs are set largely in federal regulation. State law generally requires redetermining eligibility at least once a year, but it makes exceptions for programs serving the elderly. Redetermination periods vary between three months and one year, depending upon the program. It also requires clients to report changes in their financial circumstances as they occur.
State regulations provide very detailed requirements for continuing eligibility, including the intervals between reviews, the nature of the review, the forms that must be submitted, and the penalties for failing to comply. DSS attempts to schedule redetermination interviews on the same day for people (1) receiving benefits from more than one program and (2) who must come into the district office for their interviews.
State law requires DSS to reinvestigate all cases receiving “aid from the state” at least once every 12 months, but it allows for biennial reinvestigations for recipients of “assistance” to the elderly and disabled with stable circumstances. (CGS Sec. 17b-104). (Federal Medicaid law requires at least annual redeterminations, which would appear to prohibit DSS from implementing this change for the elderly and disabled, at least for Medicaid. The state received a waiver of federal Food Stamp rules to allow for 24-month redeterminations for elderly and disabled recipients with stable circumstances.)
State law further requires anyone receiving State Supplement, Medicaid, TFA, SAGA, or Food Stamps (but not AFDC), or their legally liable relative, to notify the DSS commissioner, in writing, within 10 days after learning of or receiving property, wages, income, or resources of any kind. Any change in the information a client furnishes on an application or redetermination form must likewise be reported, either orally or in writing, within 10 days of the change. The requirement can be waived for good cause, which generally arises when circumstances beyond a client's control prevent him from complying (CGS Sec. 17b-85).
And the law establishes an exit interview procedure for TFA recipients who are about to lose their benefits to alert them to the possibility of continuing non-medical assistance, such as employment services (CGS Sec. 17b-112 (g)).
Numerous DSS regulations govern redeterminations. While in general all program beneficiaries must have their eligibility regularly redetermined, the frequency of these reviews varies considerably.
The regulations define redetermination periods in two ways: for AFDC, TFA, SAGA, and SSP, the periods correspond to calendar months; Food Stamp redetermination periods are equivalent to the Food Stamp certification period, since these assistance units (AU) (i.e., one or more individuals who apply for or receive assistance together under a DSS program) are certified as eligible for a set amount of time. (SAGA and TFA redeterminations are covered in separate regulations.)
The redetermination period begins the first month during or after the month that an assistance unit (except a Medicaid spend-down assistance unit) becomes eligible for benefits. A spend-down unit's (i.e., a unit whose income is too high but it has excess medical bills) redetermination period begins in the month that it meets all eligibility requirements, except for excess income. For active cases, the month following the redetermination month is the first month of the new redetermination period (DSS Uniform Policy Manual (UPM), Sec. 1545.10(A)(2).
The maximum intervals between redeterminations are also set in regulation. Generally, assistance units are assigned the longest review period possible, and the redetermination cycle may be varied for specific cases or target groups on the basis of such factors as error-prone profiles or individual case history. The following table lists maximum intervals for each program. TFA rules are a bit more complex and are explained separately below.
Table 1. Maximum Redetermination Cycles for Various DSS Programs
AFDC (control group only)—non-monthly reporting cases and those without low error-prone profiles
At least once every six months
AFDC (control group only)—monthly reporting cases and those with low error-prone profiles
At least once every 12 months
Aid to the Aged, Blind, and Disabled (AABD, a.k.a. State Supplement)—cases with earnings
At least once every six months
AABD—cases without earnings and Medicaid
At least once every 12 months
At least once every 12 months
Table 1 (Continued)
Medicaid—medically needy spend-down
At least once every six months (corresponds to the six month excess income spend-down period)
SAGA medical (non-spenddown) and SAGA cash transitional (1)
Once every three months
SAGA medical spenddown and SAGA cash assistance for unemployables, couples, and families
Once every six months
SAGA cash assistance—monthly reporting
Once every 12 months
(1) SAGA “draft” rules (referenced above) differ from the written regulations. DSS caseworkers are using the draft rules in the district offices.
DSS may conduct unscheduled redeterminations whenever circumstances warrant, provided the AU is given “adequate notice” (UPM, Sec. 1545.10(B)).
The SAGA regulations follow the AFDC redetermination process, but the maximum intervals for conducting a regularly scheduled redetermination differ for SAGA cash and medical. The regulations require at least annual redeterminations for both cash and medical assistance on the stated assumption that the assistance unit's circumstances will have changed somewhat within that time. If someone is receiving both cash and medical assistance, the redetermination is done “on the same periodic schedule.” Likewise, when all the members of a Food Stamp household receive SAGA cash, the redeterminations for both programs must be scheduled in the same month, although not necessarily on the same day.
For SAGA medical cases in which there is a spend-down (i.e., someone has excess income which, over a six month period, he will spend down on medical bills to make him financially eligible for assistance), redeterminations must be done at least every six months, which corresponds with the end of the spend-down period.
Family and unemployable cash assistance, transitional, and medical assistance units must have a face-to-face redetermination at least once every 12 months (UPM Sec. 8080.15, superseded, in part, by draft rules).
TFA has four types of redeterminations. When two become due in the same month, DSS consolidates them into one.
The first is the six-month counter review. This review is held only for AUs who have received time-limited benefits for six months when at least one mandatory employment services (ES) participant in the unit (1) is not taking part in a structured ES activity as specified in his employment plan and (2) has not become employed. These reviews require an in office, face-to-face interview. Benefits for the entire AU are terminated when a counter review is not completed without good cause.
DSS does mandatory periodic income reviews every six months based on the number of months someone has received TFA benefits, regardless of whether the AU is subject to the time limit. These are done to (1) gather information about the AU's income, (2) emphasize the importance of work, (3) update the case file, and (4) make any necessary eligibility changes. The regulations specify that the reviews can be conducted simultaneously with any other scheduled redetermination. Benefits are terminated for the entire AU when a review is not completed without good cause. At DSS' s discretion, these reviews can be done in an office interview or through the mail.
A third redetermination is the 12-month redetermination. Unlike the six-month review, these are held for both time-limited and exempt families. The purpose of the redetermination is similar to that for the six-month one. Specifically, it is intended to (1) determine ongoing eligibility, (2) gather information about the AU, (3) review employment efforts of mandatory ES participants, (4) review the exemption status of time-limited families, and (5) update case files. Clients must come into a DSS office for an interview. As with the other two reviews, benefits are terminated when AUs fail to complete the review without good cause.
The last interview is aptly called the “exit” interview. These are scheduled for all time-limited assistance units in the 20th month of assistance or in the fifth month of an extension. Its purpose is to inform the AU that services, such as time-limited rental assistance, emergency housing, and energy assistance, may continue to be available to the family. The opportunity to apply for an extension is given at this time. These interviews are mandatory and benefits are terminated if the review is not completed without good cause. The caretaker relative must appear at the DSS office for a face-to-face interview (UPM Sec. 8520.10).
Redetermination Cycles That Coincide
The regulations attempt to minimize client trips to DSS offices by providing for redeterminations on the same periodic schedule when clients are receiving benefits from more than one program. For instance, Medicaid recipients who are also receiving cash assistance are redetermined on the same periodic schedule as the one used for cash assistance. Food Stamp recipients are redetermined on the same periodic schedule as the corresponding “public assistance” (PA) program if (1) all members of the AU are PA recipients and (2) circumstances warrant redetermination cycles of equal length (UPM, Sec. 1545.10(E)).
A “TFA related” Food Stamp unit is one that contains at least one member who also receives TFA benefits. These families, and those receiving Medicaid and TFA, are redetermined using the same periodic schedule established for TFA units only, as described above, except they are not subject to the six-month counter review. They are subject to a six month eligibility “calendar” review, the 12 month redetermination, and the exit interview (UPM, Sec. 1545.11).
Former TFA recipients eligible for extended Medicaid benefits (those families (1) whose cash benefits are terminated and either an adult in the unit is employed at the time of the termination or becomes employed within six months or (2) whose benefits were terminated due to excess child support income) have their eligibility redetermined after 12 months (UPM, Sec. 2540.09).
Face-to-face interviews are required for AFDC and Food Stamp assistance units at least once every 12 months; they are not required for State Supplement and Medicaid units. Families have the option of either an office interview or one at home. DSS policy specialists stated that the home visit can be substituted when a client is ill or has a work conflict. Face-to-face interviews are also required every 12 months for SAGA monthly reporting and transitional AUs.
AUs are notified of scheduled interview appointments when the redetermination notice is issued.
Non-monthly reporting AFDC AUs who have six month redeterminations can have their eligibility redetermined by mail at alternate redeterminations.
The regulations apply the rule requiring combined application interviews at the time of redetermination to Food Stamp units that are composed entirely of AFDC recipents and have the AFDC redetermination scheduled in the same month as the Food Stamp determination. While office interviews are not required for State Supplement AUs, DSS attempts to complete a combined interview for these clients who appear for an in-office Food Stamp redetermination interview, receive notice of their State Supplement redetermination, and want assistance in completing the redetermination.
Initial appointments are scheduled no earlier than five business days after the mailing date of the redetermination notice and no later than the 15th day of the redetermination month. The AU is responsible for requesting a new appointment if it misses or cannot keep the original one. The regulations do not say what happens when the unit fails to do so (UPM, Sec. 1545.20 (C)).
Waiving the Office Interview. The rules for waiving an in-office interview for AFDC and Food Stamp redeterminations are the same as those that apply to program applicants, except a home visit, in lieu of a telephone interview, is necessary for families to meet the 12 month face-to-face requirement.
If the AU has good cause to miss the office interview, DSS must reschedule it for as late as the 20th day of the month following the redetermination month or conduct a home visit or telephone interview. It must continue “cash assistance” benefits beyond the redetermination month unless the assistance unit refuses to cooperate or is otherwise found ineligible. A home visit rather than a telephone interview is conducted if the face-to-face redetermination requirement has not been met within the past 12 months and will not be met by the next scheduled redetermination if the current office interview is waived (UPM, Sec. 1545.20 (E)).
At DSS's discretion, office interviews for TFA redeterminations can be changed to mail or home visits. When determining whether to make the change, the caseworker considers factors that prevent someone from attending the office interview, such as a client being homebound and his work schedule (Sec. 8520.10).
When someone misses an interview, DSS does not schedule a second appointment unless the person has called the office to reschedule. If not, it discontinues benefits. Benefits must continue until the redetermination is processed if the AU has caused a delay in processing the redetermination and has good cause (i.e., in DSS's opinion, circumstances beyond the client's control reasonably prevent him from complying with a department requirement) for failing to complete the redetermination in a timely fashion. Benefits are likewise continued if DSS is unable to process the redetermination by the end of the redetermination period. Neither of these continuation provisions applies to delays in exit interview redeterminations.
Unscheduled and Rescheduled Appointments. The regulations permit DSS to not interview AUs who show up at the office unscheduled, provided a new appointment can be scheduled by the 15th day of the redetermination month. When an interview is postponed in these instances, the AU must be allowed to submit the redetermination document before leaving the office if they have not already filed it.
DSS reschedules appointments at the request of the AU. These must be rescheduled by the 15th day of the redetermination month, unless the AU requests otherwise to allow 10 days for the unit to provide required verification or complete other required actions and provided DSS with enough time to process the redetermination (UPM, Sec. 1545.20 (E) and (G)).
Who May File a Redetermination. For AFDC, State Supplement, and Medicaid redeterminations, only the following people may complete the redetermination:
1. the State Supplement or Medicaid recipient;
2. the caretaker relative;
3. the spouse; or
4. a court-appointed fiduciary, or a responsible adult acting on behalf of someone who is incompetent or incapacitated.
The Food Stamp redetermination must be completed by the designated head of the AU, its designated authorized representative, or a responsible member of the unit (UPM, Sec. 1545.30).
For TFA redeterminations, the person applying can be the person for whom continued benefits will be provided, a fiduciary, or a qualified individual acting on the recipient's behalf (UPM, Secs. 8520.05 and 8520.10).
Redetermination Forms. AFDC, State Supplement, Medicaid, and Food Stamp units must complete a redetermination form at each redetermination. The form may be the same one used for applications or a form designed specifically for the redetermination. The form is issued at the same time as the notice. AUs who do not complete the form within the time limits may be subject to benefit discontinuance or interruption (UPM, Sec. 1545.25).
Time lines for filing forms in the various programs are presented in Table 2:
Table 2. Redetermination Form Filing Deadlines
Deadlines for Filing Redetermination Forms
Food Stamps—non-monthly reporting AUs certified for one or two months and issued the redetermination notice at the time of certification
15th day after the date the redetermination notice sent
All other programs and Food Stamp non-monthly reporters
15th day of the redetermination month
Monthly reporting AUs
Day of the redetermination month when the monthly report form is normally due (UPM, Sec. 1545.35)
Certain AFDC, Food Stamp, and SAGA AUs must report changes in their circumstances to DSS each month. Food Stamp and AFDC recipients (which are a limited number of people in a control group located in Manchester and New Haven and would therefore not affect your constituent) must submit monthly reports if (1) they have earnings; (2) received an earned income payment, other than a one-time payment, such as a federal Earned Income Tax Credit lump sum payment; (3) receive, or are expecting to receive unemployment or workers' compensation benefits; or (4) have income deemed to them from certain “deemors.”
Food Stamp units do not have to make monthly reports if (1) the only members receiving these earnings are State Supplement recipients, (2) they consist of migrant workers, (3) they consist entirely of adult members who are elderly or disabled and who have no earned income, or (4) they consist entirely of homeless members.
A Food Stamp unit which has at least one member who is also receiving TFA benefits with earnings less than the federal poverty level does not have to report monthly but it must report if any member has earnings above this level (UPM, Sec. 1550.05).
Reporting Form. Assistance units required to report must submit a form which contains all the requested information, includes all required information, and is received by DSS on or before the due date. DSS considers the form complete when all questions that are supposed to be answered are completed; “yes” answers are adequately explained; income verification is provided; and the form is signed by a responsible unit member or an authorized representative in the case of a Food Stamp unit (UPM, Sec. 1550.10).
Interim activity relates to changes that may affect eligibility or benefit levels in AFDC, Food Stamp, State Supplement, or Medicaid cases and that occur between the time someone applies for benefits and when he is redetermined, or between fair hearings. Except for Food Stamp monthly reporting units, AUs must report changes to DSS within 10 calendar days of the change.
AUs, with the exception of Food Stamp monthly reporters, must verify the changes within 10 days of the date DSS requests it. Food Stamp AUs that qualify for an excess medical deduction have the option of verifying the expenses monthly or only verifying an increase in total medical expenses of $25 or more that was not anticipated for the certification period. Food Stamp AUs who qualify for the child support deduction must report changes greater than $50 in the amount of legally obligated child support actually paid when the changes were not anticipated in the certification period. DSS offers assistance to AUs if it would be difficult for them to provide verification in a timely manner.
A unit that fails to report or verify changes in a timely manner may (1) lose eligibility if it is contingent on verification, or (2) forfeit DSS consideration of the circumstances in determining eligibility or benefit levels for either a current or retroactive period.
Changes can be reported in writing, in person, or by telephone. The request must be made in writing if an AFDC or Medicaid unit wants to add a non-mandatory member.
To prevent multiple correspondence, the regulations permit AUs receiving aid from more than one program to not report changes separately, even if multiple case workers may be helping the unit.
The regulations define circumstances under which DSS will accept an untimely report or verification of interim activity (“good cause”), and hence not take an adverse action. These include illness, severe weather, death in the immediate family, and other circumstances beyond the unit's control (UPM, Sec. 1555.05).
TFA Interim Activity. For TFA cases, interim activity is also reported when the changes may affect eligibility or benefits, but it is also required when the change affects the unit's time-limited status or other DSS requirements.
Employment-related changes that must be reported include (1) new jobs, (2) earnings changes when the total family earnings reach or exceed the FPL, (3) job terminations, and (4) changes of earnings or other information about work that DSS requests.
These changes must be reported within 10 calendar days, unless there is good cause for not doing so. But caretaker relatives must report within five days from the date it becomes clear that a child in the unit will be absent from the home for more than 90 days. If this latter report is not timely and good cause is not given, the caretaker's benefits are terminated for six months.
Reports can be made in writing, in person, or by telephone, except requests to add members to the unit must be in writing. The day the DSS office receives the notification is considered the date the change was reported (UPM, Secs. 8520.20 and 8510.10).