Okla. Admin. Code § 340:65-5-1

Current through Vol. 42, No. 6, December 2, 2024

Section 340:65-5-1 - Case changes

(a)Change reporting requirement for Temporary Assistance for Needy Families (TANF), State Supplemental Payment (SSP), and SoonerCare (Medicaid). Recipients of TANF, SSP, and SoonerCare (Medicaid) for the aged, blind, and disabled must report any changes in circumstances that increases, reduces, or closes benefits within 10-calendar days.

(1) The worker:

(A) gives the client 10-calendar days to provide proof to verify the reported change

(B) acts on changes that increase, reduce, or close benefits within 10-calendar days of the date the change is reported and required proof is received, per (d) of this Section.

(2) Failure to report changes timely may result in a client error overpayment.

(3) Examples of changes the client must report include:

(A) household income;

(B) household resources;

(C) household composition;

(D) the client's address or phone number;

(E) legal alien status of non-citizens;

(F) insurance coverage, per Oklahoma Administrative Code (OAC) 317:35-5-43; and

(G) in addition, for TANF program:

(i) deprivation of parental support, per OAC 340:10-10-1 through 340:10-10-4;

(ii) when a TANF Work activity stops or starts, per OAC 340:10-2-1 through 340:10-2-8; and

(iii) when a child in the assistance unit stops attending school, per OAC 340:10-13-1.

(b)Change reporting for the Supplemental Nutrition Assistance Program (SNAP). SNAP has three household categories with different change reporting responsibilities; annual reporters, semi-annual reporters, and change reporters. Refer to OAC 340:50-9-5 for change reporting requirements.

(c)Change reporting for the Child Care Subsidy Program. Child Care Subsidy recipients must report income changes within 10-calendar days when the household's gross income exceeds federal income eligibility threshold for the household size, per OAC 340:40-9-2(a) and Oklahoma Human Services (OKDHS) Appendix C-4, Child Care Eligibility/Copayment Chart.

(d)Changes in cash benefits. When a change of circumstances occurs after certification that requires an increase or a reduction in the SSP or TANF cash benefit amount, the worker processes the change to be effective the first day of the month following the next advance notice or non-advance notice deadline date, per OKDHS Appendix B-2, Deadlines for Case Actions. When the change:

(1) increases the cash benefit, the worker makes the change by the next non-advance deadline date. The worker also determines if a supplement is due for the current month. When one is due, the worker issues the supplement within 10-calendar days of the date the change is reported and required proof is received; or

(2) reduces the cash benefit, the worker makes the change within 10-calendar days of the date the change is reported and verified to be effective by the next advance notice deadline date. The worker also evaluates whether prior benefits were properly issued. When more benefits were issued than the household was entitled to, the worker completes an overpayment, per each program's overpayment rules.

(e)Notices. A computer-generated notice is sent to the client when the action taken increases, reduces, suspends, or closes benefits. A computer-generated notice is not sent when the action taken does not affect the benefit level.

(1) Advance notice is required when the action taken reduces, closes, or suspends benefits for a reason other than those listed per (2) of this subsection. Refer to OKDHS Appendix B-2 for advance notice deadline dates.

(2) When advance notice is not required, refer to OKDHS Appendix B-2 non-advance notice deadline dates. Advance notice is not required when the action taken does not suspend, close, or reduce benefits, or when:

(A) all members included in the benefit die;

(B) the TANF payee dies and there is not a relative available to serve as a new payee;

(C) benefits are transferred from one assistance category to another without a resulting reduction or interruption in benefits;

(D) care is approved in a skilled nursing facility or an intermediate nursing care facility that requires closure of the person's SSP benefit or the SoonerCare (Medicaid) Qualifying Individuals - group 1 benefit;

(E) the household moves out-of-state;

(F) an automatic increase in income occurs because of federal legislation, such as a cost-of-living increase to all Social Security, Supplemental Security Income, Railroad Retirement, or Veterans' benefits beneficiaries;

(G) the client is admitted to a public institution where his or her needs are fully supplied;

(H) the client provides a signed, written statement:

(i) stating he or she no longer chooses to receive assistance; or

(ii) requesting benefit closure or reduction to avoid or repay an overpayment;

(I) the client's whereabouts are unknown. This may occur when the post office returns the client's OKDHS mail and indicates no known forwarding address. SNAP and Child Care Subsidy benefits are not closed for this reason. Refer to OAC 317:35-5-67 to review the SoonerCare (Medicaid) return mail rule;

(J) a TANF child is removed from the home because of a judicial determination or because the legal guardian voluntarily placed the child in foster care for more than 30-calendar days;

(K) a change occurs in federal or state law;

(L) SSP benefits must be are reduced to comply with federal law pertaining to maintenance of effort or a state mandate; or

(M) the client requests a reduction in or closure of the child care benefit or a change in child care provider for the Child Care Subsidy program, per OAC 340:40-9-2 and 340:40-9-3.

(f)Closing benefits. The worker closes a Child Care Subsidy, SoonerCare (Medicaid), SSP, SNAP, or TANF benefit only at the household's request or after ineligibility is established, per each program's eligibility rules.

(g)Reinstating or reopening benefits. Within 30-calendar days of notice issuance, the client may request reduced benefits be reinstated or closed benefits be reopened at the previous benefit level due to an incorrect action or a change in circumstances.

(1) When benefits were reduced and the worker determines the client remains eligible at:

(A) the previous benefit level, the worker restores benefits to the previous benefit level for all Adult and Family Services (AFS) programs;

(B) an increased benefit level, benefits are increased based on specific program rules; or

(C) a reduced level than the last action taken, the worker reduces benefits further:

(i) effective the next advance notice deadline date for TANF, SSP, and SoonerCare (Medicaid);

(ii) when the renewal is due for Child Care Subsidy and SNAP. When the renewal is not due, benefits are:

(I) not reduced for Child Care Subsidy, per OAC 340:40-9-2(a); or

(II) reduced in limited circumstances for SNAP. Refer to OAC 340:50-9-5 for appropriate circumstances.

(2) For TANF, SSP, and SoonerCare (Medicaid), when benefits were closed or suspended and the client remains eligible, but at a reduced benefit level, benefits are reopened using current eligibility information.

(3) When Child Care Subsidy benefits are reopened and the renewal is not due, benefits are not reduced below the benefit level at closure. Child care benefits may only be reduced at renewal, per OAC 340:40-9-2(a).

(4) When SNAP benefits are reopened and the benefit renewal is not due, benefits may only be reduced in limited circumstances. Refer to OAC 340:50-9-5 for appropriate circumstances.

(h)Fair hearing information. When the client requests a fair hearing within 90-calendar days of the date action is taken for SNAP, or 30-calendar days for all other AFS programs, the worker follows fair hearing procedures, per OAC 340:2-5.

(1) When the client requests a fair hearing within 10-calendar days following the notice issuance date and requests, pending the hearing's outcome, that benefits be continued at the same benefit level as authorized immediately prior to the adverse action notice, the worker reopens or reinstates benefits to the previous benefit level.

(A) For SNAP, the client is not required to request benefits be continued at the same level when he or she requests a fair hearing within 10-calendar days. Benefits are continued at the previous level unless the client waives benefit continuation.

(B) For all AFS programs, the worker explains to the client when benefits are continued at the previous level and the appeal is not decided in the client's favor, he or she is expected to repay the benefits.

(C) Benefits remain open at the previous level unless another change occurs before a hearing decision is made that requires benefits be reduced or closed.

(2) When the client does not request the fair hearing within 10-calendar days of the notice date, the worker does not restore benefits unless the client provides information verifying the client remains eligible at the previous benefit level, the worker determines an incorrect action was taken, or the hearing is decided in the client's favor.

(3) Per OAC 340:2-5, the OKDHS Legal Services Appeals Unit makes a decision regarding the fair hearing and sends a decision letter to the client and the OKDHS office.

(A) The worker is responsible for taking the action needed to carry out the hearing decision and, when appropriate, sending an overpayment referral to the AFS Benefit Integrity Unit.

(B) When benefits were reinstated or reopened and the hearing decision is not in the client's favor, the worker reduces or closes benefits effective the first of the month following the month the final hearing decision is reached.

Okla. Admin. Code § 340:65-5-1

Amended at 10 Ok Reg 4465, eff 8-5-93 (emergency); Amended at 11 Ok Reg 1687, eff 5-12-94; Amended at 18 Ok Reg 2096, eff 7-1-01 ; Amended at 23 Ok Reg 1907, eff 7-1-06; Amended at 28 Ok Reg 880, eff 6-1-11 ; Amended at 29 Ok Reg 812, eff 7-1-12; Amended at 30 Ok Reg 692, eff 6-1-13

Amended by Oklahoma Register, Volume 35, Issue 24, September 4, 2018, eff. 9/17/2018

Amended by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/15/2021

Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/15/2022