11000 - Incorrect Benefits And Fraud Determinations

 

11100 Incorrect Benefits- Prevention of incorrect benefits is the responsibility of every DCF staff member, client, and child care provider. Incorrect benefits include both underpayments and overpayments for clients and child care providers. Incorrect benefits also include underpayments and overpayments of Education or Job Skills Training activity cost payments or support services payments.

 

NOTE: Work Programs support service payments are not considered overpayments when the agency is unable to act on available information due solely to monthly system processing deadlines or timely notice requirements. Work Program payments are unconditional and unrestricted and are not considered overpayments if used by the client for purposes other than those intended.

 

11110 Underpayments - An underpayment is the amount of assistance that a client did not receive but was entitled to. For cash programs, corrective cash payments shall not be considered income or a cash asset in the month paid or in the following month. (See 6410.) benefits shall be restored even if the case is currently closed.

 

Staff shall, at a minimum, document how the underpayment was calculated and the reason benefits must be restored. There are two types of underpayments; supplemental benefits and restored benefits. Supplemental benefits are underpayments which are established for the current calendar month or one month prior to the current calendar month. Restored benefits are underpayments which are established for benefit months two or more months prior to the current calendar month. Only restored benefits can be used to offset an outstanding claim. (See KEES User Manual.)

 

11111 Situations Requiring Restoration of Benefits or Supplemental Benefits - Underpayments shall be corrected promptly using the program policies in effect for the month(s) in which the underpayment of benefits was made.

 

The following are the various situations in which a household may be entitled to restoration of benefits:
 

  1. benefits are lost due to Agency error;
     
  2. Agency failed to give the household sufficient time to verify a deduction and, as a result, its benefits were lowered [see1322.3 (3)];
     
  3. Agency fails to take action within time frames on reported changes that increase the household's benefits (see 9121 or 9122);
     
  4. Fair hearing decision in favor of the household;
     
  5. Administrative Disqualification Hearing decision reversed by court (see 11290);
     
  6. Lost benefits ordered as a result of a class action or other suits (Example: USDA court orders);
     
  7. Categorically eligible persons approved for retroactive SSI who are entitled to the medical deduction and uncapped shelter deduction per 2511. (Food Assistance Only.)
     

In the following situation a recipient may be entitled to supplemental benefits:

 

  1. Change reported and verified timely but future month benefit is already authorized due to the automatic system update. This benefit can include the Work Incentive payment when loss of employment causes eligibility for TANF benefits.