OKDHS - OAC 340:65-3-8. Determination of continuing eligibility

340:65-3-8. Determination of continuing eligibility

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Revised 6-1-11

(a) Determination of continuing eligibility. Determining continuing eligibility is a process which must be carried out at appropriate intervals. The appropriate interval for reviewing eligibility depends on the type of benefit received. The worker is responsible for:

(1) advising the recipient at each contact of the recipient's responsibility to report changes within ten calendar days of the date the change becomes known;
(2) making contacts at unspecified intervals to ensure continuing eligibility;
(3) synchronizing the review dates for all benefits received by the household when possible; • 1 and
(4) determining continuing eligibility.

(b) Review or recertification time frames. The periodic review or recertification time frame varies depending on the program.

(1) A review must be completed at six month intervals with a:

(A) Temporary Assistance for Needy Families (TANF) recipient due to:

(i) pending required immunizations per OAC 340:10-14-1;
(ii) payment standard reductions because of program violations per OAC 340:10-3-57(g);
(iii) hardship extension approvals per OAC 340:10-3-56(a)(2)(E);
(iv) earned income per OAC 340:10-3-31 through 340:10-3-40; or
(v) a work-eligible person exempt from TANF Work activities because of incapacity or to care for a disabled family member living in the household per OAC 340:10-2-1;

(B) child care recipient per OAC 340:40-9-1; or
(C) food benefit recipient subject to a semi-annual review per OAC 340:50-9-5 (i) and (j).

(2) A review or recertification must be completed at 12-month intervals, unless an earlier review date is warranted, with a:

(A) TANF recipient;
(B) State Supplemental Payment (SSP) recipient;
(C) child care recipient who is receiving TANF or SSP benefits;
(D) food benefit household subject to an annual review per OAC 340:50-9-5 (g) and (h);
(E) food benefit household whose recertification must be completed at 12-months per OAC 340:50-9-6 ; or
(F) SoonerCare (Medicaid) recipient per OAC 317:35. • 2

(3) The worker completes a food benefit recertification at 24 month intervals for households subject to an annual review per OAC 340:50-9-6.

(c) Eligibility review or recertification. The recipient is sent notification when the review or recertification is due for food benefits, subsidized child care benefits, TANF, SSP, or SoonerCare (Medicaid) benefits. The recipient must complete the review or recertification in order to continue receiving benefits. • 3

(d) Signature requirements. The recipient, guardian, or a person acting on the recipient's behalf, such as an authorized representative or a person with power-of-attorney must sign the review. TANF reviews must be signed by the recipient. If the recipient is living with his or her spouse, both must sign the review. The only exception to the signature requirement is for a SoonerCare (Medicaid) review completed over the telephone. • 4

(e) Interview requirements. Whether an interview is required for a review or recertification varies depending on the program. • 5

(1) A face-to-face interview is required for the:

(A) TANF Program; or
(B) Supplemental Security Income-Disabled Children's Program SSI-DCP service plan review per OAC 340:70-8-1.

(2) A telephone or face-to-face interview is required at recertification for households receiving food benefits except for (e)(3)(C) of this Section.
(3) An interview is not required for:

(A) any of the SoonerCare (Medicaid) programs as long as the review is complete, including the signature, all required verification provided, and none of the information is questionable. When information is not complete or is questionable, the worker contacts the recipient to obtain needed information; • 6
(B) the Child Care Subsidy Program reviews unless the child care recipient receives child care benefits because of a protective or preventive reason per OAC 340:40-7-8; or
(C) food benefit households completing a:

(i) review, not a recertification, at six or 12-month intervals; or
(ii) recertification when all household members are elderly or disabled and there is no earned income in the household.

(f) Eligibility determination. An eligibility determination is made once the review or recertification is signed, all required information has been provided, an interview, if required, is conducted, and all information evaluated. • 7

(1) The eligibility determination may be to:

(A) complete the review without changes;
(B) complete the review with changes; or
(C) close the benefit or benefits. • 8

(2) Benefits closed may be reopened when the recipient provides required information by the last day of the month of closure. • 9

INSTRUCTIONS TO STAFF 340:65-3-8

Revised 6-1-11

1.  Synchronizing review dates for all programs provides better client service as it reduces the number of times the client must complete a review.

2.  For SoonerCare (Medicaid) rules, refer to:

(1) OAC 317:35-6-61 for SoonerCare (Medicaid) benefits for pregnant women and families with children;

(2) OAC 317:35-7-62 for a child in state or tribal custody;

(3) OAC 317:35-7-61 for SoonerCare (Medicaid) programs that categorically relate to the aged, blind, or disabled population such as:

(A) State Supplemental Payment (SSP);

(B) Qualified Medicare Beneficiary (QMB);

(C) Specified Low-Income Medicare Beneficiary (SLMB);

(D) Qualified Disabled and Working Individuals (QDWI); and

(E) Qualified Medicare Beneficiary Plus (QMBP);

(4) OAC 317:35-15-7 and OAC 317:35-15-9 for Personal Care;

(5) OAC 317:35-17-12 and OAC 317:35-17-15 for Advantage Waiver; and

(6) OAC 317:35-19-22 and OAC 317:35-19-23 for nursing facility services.

3.  Methods the recipient may use to complete the review for the:

(1) Supplemental Nutrition Assistance Program (SNAP), Child Care Subsidy Program, and the SoonerCare (Medicaid) population in Oklahoma Health Care Authority (OHCA) Online Enrollment include:

(A) completing the review electronically by:

(i) accessing www.okdhslive.org; or

(ii) getting help from a community partner to access www.okdhslive.org;

(B) downloading Form 08MP004E, Renew My Benefits, from www.okdhslive.org and completing, signing, and bringing, mailing, or faxing it to OKDHS; or

(C) going into the local human services center (HSC) to complete the review with a worker using the Family Assistance/Client Services (FACS) system;

(2) SoonerCare (Medicaid) population in Online Enrollment may also include:

(A) using OHCA Online Enrollment; or

(B) downloading Form SC-1, SoonerCare Health Benefits Application from OHCA - Forms and Instructions, and completing, signing, and mailing it to OHCA or bringing or faxing it to OKDHS;

(3) SNAP recertification, SSP, Temporary Assistance for Needy Families (TANF), or SoonerCare (Medicaid) review for populations not in OHCA Online Enrollment include:

(A) downloading Form 08MP001E, Request for Benefits, Form 08MP002E, Eligibility Information for Benefits, and Form 08MP003E, Responsibilities and Signature for Benefits from OKDHS - Forms and Applications for Service, and completing, signing, and bringing, mailing, or faxing them to OKDHS; or

(B) going into the local HSC to complete the review with a worker using the Family Assistance/Client Services (FACS) system;

(4) SSP and SoonerCare (Medicaid) populations not in Online Enrollment also include downloading Form 08MA001E, Medical Assistance Benefit Review Report, from OKDHS - Forms and Applications for Service and completing, signing, and bringing, mailing, or faxing it to OKDHS; or

(5) Supplemental Security Income-Disabled Children's Program (SSI-DCP) include the worker and family completing Form 08MA017E, SSI-DCP Service Plan.

4.  (a) An electronic signature is considered the same as a pen and ink signature.

(b) No additional information is entered after the recipient signs the review. Additional information is entered in FACS Case Notes.

5.  (a) When an interview is required, information discussed with the recipient to determine if changes are needed includes:

(1) information or verification provided by the recipient;

(2) information contained on the data exchange screens, when inconsistent with recipient statement; and

(3) for TANF, the recipient's TANF Work plan.

(b) If information is questionable, contact with collaterals or making a home visit may be advisable. Refer to OAC 340:65-3-4 for home visit requirements and information about data exchange screens.

(c) When the recipient receives some benefits that require an interview and some that do not:

(1) for the benefits that require an interview, the review is not complete until the interview has been conducted; and

(2) for the benefits that do not require an interview, the review may be completed prior to the interview for the other benefits.

6.  Attempts to contact the recipient to determine continued eligibility may be in person or over the telephone. FACS Case Notes is documented with all factors of eligibility and any contact with the recipient.

7.  (a) Once the recipient completes the review, the information is analyzed to determine for each program benefit:

(1) what changes have occurred;

(2) whether the recipient provided all required verification;

(3) whether an interview, if required, occurred; and

(4) what changes must be made on the system.

(b) The review is complete after:

(1) all review information has been entered in the Interview and Eligibility Notebooks of the Family Assistance/Client Services (FACS);

(2) information contained on the review, in the verification provided, and on data exchange screens have been evaluated for changes;

(3) any additional information has been entered in FACS Case Notes to explain any changes made and how continued eligibility was determined; and

(4) the system is updated.

8.  (a) When it's determined that the review is incomplete because the recipient failed to sign the review, did not provide all required verification, or did not complete a required interview, attempts are made to contact the recipient to advise what is lacking. FACS Case Notes are documented with what is lacking and all attempts to obtain needed information.

(b) When the recipient does not provide required information timely, benefits are closed with the next effective date.

9.  (a) After closure, benefits may be reopened when the recipient provides the required information by the last day of the month of closure.

(1) Benefits are reopened to the date of closure for SoonerCare (Medicaid) populations not in Online Enrollment, Child Care Subsidy, TANF, and SSP.

(2) For SNAP, benefits are reopened and prorated to the date the recipient provided all required information.

(b) The recipient must reapply when he or she waits until after the last day of the month of closure to provide needed information.

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