11124 Computing the Overpayment - In calculating the amount of an incorrect benefit, the agency shall determine the point at which the correct information should have been reported and acted upon timely allowing for timely notice as appropriate. From that point the correct benefit for subsequent months shall be determined comparing the amount with the actual benefit issued.
For overpayments occurring when the household was subject to monthly reporting and who failed to report a change, the first month of overpayment shall be the issuance month corresponding to the income month in which the change occurred.
For overpayments occurring when the household was subject to change or simplified reporting and prospective budgeting, the first month of overpayment shall be determined by allowing for the 10-day period to timely report changes and the 10-day period for Notice of Adverse Action.
EXAMPLE: If a notice of adverse action was required but was not sent, it should be assumed that the 10-day advance notice period would have expired without the household requesting a fair hearing. If a change was not reported, the claim shall be based on the first issuance that would have been affected had the household reported the change.
In situations of unreported income, the worker shall calculate the amount
of overpayment using all nonexempt income the household actually received
in the income month for the month of overpayment and considering expenses
and deductions that were reported or were required to be reported, and
should have been allowed at the time the original benefit for the month
was determined. The budgeting method used when the benefit was initially
determined is to be applied when recalculating. For persons with prospectively
budgeted or averaged income the overpayment shall be determined using
actual income received in the calendar month of the benefit. This includes
using actual amounts for situations in which a conversion method (i.e.,
4.3 times weekly amount) would have been used in change reporting situations.
When determining an overpayment due to an agency error (such as a calculation
error), the overpayment shall be calculated using all income, expenses,
and deductions that should have been allowed at the time the original
benefit was calculated. Actual income for the months in question does
not have to be obtained from the client or employer in determining the
amount of the overpayment.
In TANF the amount of retained current child support,received in the month at issue which is in excess of the correct benefit amount, must also be applied to reduce the overpayment. If the support is not retained by the agency or is less than the correct benefit amount, the overpayment collection is not affected by the support amount.
If the household received a larger benefit than it was entitled to receive, a claim shall be established against the household equal to the difference between the benefit the household received and the benefit the household should have received. See KEES user manual for more information on setting up overpayments on the system.
NOTE: Aged-off Benefits - When determining the benefit the household actually received, staff must initially include benefits that have been aged-off the ebtEDGE System due to non-use. (The household has one year to request restoration of the unused benefits. See the EBT System Guide in the Appendix.) If the unused benefits are cancelled (expunged) after one year, then the amount of the overpayment for the respective months will modified based on the amount of expunged benefits for each month. See 11126.6.
The following special provisions apply when computing an overpayment:
Failure to Report
Earned Income Timely (Food Assistance Only) - If a household
member fails to report earned income in a timely manner (per 9121
or 9122), the resulting overpayment
shall be computed without allowing the 20 percent earned income deduction
for those earnings that were not timely reported. Timely reported
earnings would be allowed the 20 percent earned income deduction when
calculating the overpayment.
Overpayments caused
by Not Including a Person Who is Required to be Included in the Assistance
Plan - The following provisions apply:
Food Assistance
- For overpayments involving the household's or the
agency's failure to include an individual or individuals, the
agency must first attempt to determine the amount of overpayment
by determining what the household should have received, including
the individual(s), their income, resources, and deductions had
these factors of eligibility been correctly budgeted. If this
information is not readily available, it must be requested from
the household. If the household refuses to cooperate in providing
the necessary information and eligibility for the months in question
cannot be determined, the claim shall be computed by considering
that the household was totally ineligible. All claims computed
under this provision must contain adequate documentation to support
the finding of total ineligibility.
Cash Assistance
- When a client fails to timely report a change, the
agency may not learn of a person who is required to be included
in the assistance plan until some time after the date the person
should have been included. In these instances, the following provisions
are applicable. If a father's entry into the home is not timely
reported, he shall be treated as the father for the prior period
as well as current and future months. However, if in accordance
with the provisions in 2167, he is referred to CSS for a voluntary
paternity acknowledgment and he cooperates but chooses not to
sign necessary documents because he questions that paternity,
he shall not be treated as the father to the child for the prior
or current period. In this instance, a corrective benefit determination
must be based on the assumption that he would not have been treated
as the father had the change been reported timely.
Eligibility for the entire assistance unit
shall first be determined for the current and future months.
The person to be added shall be budgeted prospectively for
the first two months. (Applicable only to benefit months subject
to monthly reporting.) If otherwise eligible and any necessary
information is provided timely, the person's needs shall be
added the month after the change was reported or discovered
by the agency, whichever is earlier. If information is not
provided timely, the person's needs shall be added the month
after the month information is received. See 7401
or 9121 (4).
Eligibility for the entire assistance unit
shall then be re-determined for the prior months retroactive
to the month the individual would have been required to be
included in the plan had the change been reported timely.
Since underpayments are not granted in situations where the
change is not timely reported (see 11112
(4), the first month which can be affected would be a month
in which an overpayment occurs and could occur no sooner than
the first month following the month the change was required
to be reported (e.g., via monthly report form) allowing for
timely notice.
The redetermination for the retroactive period must include
all factors of eligibility except for nonfinancial procedural
requirements such as applying for or providing an SSN and
application for potential resources. However, non-procedural
factors such as citizenship and non-citizenship requirements,
participation in labor disputes, vehicle registration, and
financial factors must be met in the retroactive period.
If the addition of the person results in ineligibility
due to excess resources, there is ineligibility for the entire
family and the resulting overpayment must be determined and
recovery attempted per 11120.