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 the 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 be 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 - 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.
Cash
Assistance - If a household member fails to report earned
income in a timely manner (per 9121),
the resulting overpayment shall be computed without allowing the
60% earned income deduction for those earnings that were not timely
reported. Timely reported earnings would be allowed the 60 percent
earned income deductions 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.