Oklahoma Department of Human Services
Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd. • Oklahoma City, OK 73105
(405) 521-3646 • Fax (405) 521-6684 • Internet: www.okdhs.org
 
340:65-3-8. Determination of continuing eligibility
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Revised 6-1-13

 

(a) Determination of continuing eligibility.  Determining continuing eligibility is a process that 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 his or her responsibility to report changes within 10 calendar days of the date the change becomes known;
  • (2) making contact with the recipient when possible changes are indicated to ensure continuing eligibility;
  • (3) synchronizing the renewal dates for all benefits received by the household when possible;  • 1 and
  • (4) determining continuing eligibility.

(b) Benefit renewal time frames.  The periodic renewal time frame varies depending on the program.

  • (1) A benefit renewal 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 his or her 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 mid-certification renewal per OAC 340:50-9-5(i) and (j).
  • (2) A benefit renewal must be completed at 12-month intervals, unless an earlier renewal 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 mid-certification renewal per OAC 340:50-9-5(g) and (h);
    • (E) food benefit household whose Supplemental Nutrition Assistance Program (SNAP) certification renewal 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 SNAP certification renewal at 24-month intervals for households subject to an annual mid-certification renewal per OAC 340:50-9-5(g) and (h).

(c) Benefit renewal notification.  The recipient is sent notification when the benefit renewal is due, advising the recipient he or she must complete the benefit renewal within a certain time frame in order to continue receiving benefits.   • 3

  • (1) The worker sends Form 08AD092E, Client Contact and Information Request, to:
    • (A) SoonerCare (Medicaid) long-term care and other recipient groups, not in online enrollment;
    • (B) SSP recipients; and
    • (C) TANF recipients.
  • (2) The computer-generated notice titled "Renew My Benefits" is sent to:
    • (A) child care recipients;
    • (B) SoonerCare (Medicaid) recipients in the online enrollment population; and
    • (C) food benefit recipients due for mid-certification renewal.
  • (3) The computer-generated notice titled "Continue My SNAP Benefits" is sent to food benefit recipients due for certification renewal.

(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 benefit renewal for all programs except TANF.  TANF renewals must be signed by the recipient.  If the recipient is living with his or her spouse, both must sign the renewal.   • 4

(e) Interview requirements.  Whether an interview is required for a benefit renewal 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 renewal per OAC 340:70‑8-1.
  • (2) A telephone or face-to-face interview is required at SNAP certification renewal 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 renewal is complete, including the signature, all required proof provided, and none of the information is questionable.  When information is not complete or is questionable, the worker contacts the recipient to obtain required proof;   • 6
    • (B) the Child Care Subsidy program renewals 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) mid-certification renewal, at six- or 12-month intervals; or
      • (ii) SNAP certification renewal when all household members are elderly or disabled and there is no earned income in the household.

(f) Eligibility determination.  The worker determines eligibility after the benefit renewal is signed, all required proof is provided, an interview, if required, is conducted, and all information evaluated.   • 7

  • (1) The eligibility determination may be to:
    • (A) complete the benefit renewal without changes;
    • (B) complete the benefit renewal with changes; or
    • (C) close the benefit or benefits.   • 8
  • (2) Benefits closed may be reopened when the recipient provides required proof by the last day of the month of closure.   • 9

INSTRUCTIONS TO STAFF 340:65-3-8

  

Revised 6-1-13

 

 

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

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 317:35-15-9  for Personal Care;

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

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

3.   (a) Methods the recipient may use to submit the Supplemental Nutrition Assistance Program (SNAP) semi-annual or annual benefit renewal and Child Care Subsidy program semi-annual benefit renewal, or SNAP certification renewal include:

(1) accessing www.okdhslive.org and submitting the benefit renewal electronically;

(2) getting help from OKDHS or a community partner to access www.okdhslive.org and submitting the benefit renewal electronically;

(3) downloading Form 08MP004E, Renew My Benefits, from OKDHS - Forms and Applications for Service and completing, signing, and hand-delivering, mailing, or faxing it to OKDHS; or

(4) going into the local county office or another county office more convenient for the client to complete the benefit renewal using the OKDHSLive kiosk available in the lobby or with a worker using the Family Assistance/Client Services (FACS) system.

(b) In addition to the methods outlined in (a) of this instruction, the SoonerCare (Medicaid) population in Oklahoma Health Care Authority (OHCA) online enrollment may also submit the annual benefit renewal by:

(1) using OHCA online enrollment; or

(2) downloading Form SC-1, SoonerCare Health Benefits Application from OHCA - Forms and Instructions, and completing, signing, and  mailing it to OHCA or hand-delivering it to OKDHS.

(c) To complete a Temporary Assistance for Needy Families (TANF), benefit renewal, the worker and recipient complete Form 08MP001E (.pdf, 6 pp, 532 KB), Request for Benefits, Form 08MP002E, Eligibility Information for Benefits, and Form 08MP003E (.pdf, 6 pp, 582 KB), Responsibilities and Signature for Benefits using the Family Assistance/Client Services (FACS) system or paper forms.

(d) To complete a SSP benefit renewal or a SoonerCare (Medicaid) benefit renewal for recipients not in OHCA online enrollment, the worker and recipient complete:

(1) Form08MP001E (.pdf, 6 pp, 532 KB), Form 08MP002E, and Form 08MP003E  (.pdf, 6 pp, 582 KB);

(2) Form 08MA001E, Medical Assistance Benefit Review Report; or

(3) Form 08MP004E (.pdf, 11 pp, 698 KB), Renew My Benefits.

(e) To complete a Supplemental Security Income-Disabled Children's Program (SSI-DCP) renewal, the worker and family complete Form 08MA017E, SSI-DCP Service Plan.

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

(b) The worker documents in FACS Case Notes any additional proof received after the recipient signs the benefit renewal.

5.   (a) When an interview is required for SNAP and the type of proof needed is unknown, the:

(1) county office worker sends Form 08AD091E, Interview Notice, or Form 08AD093E, Telephone Interview Notice, to schedule the interview.  The county office worker uses Form 08AD091E instead of Form 08AD093E because:

(A) it provides the option of an office or telephone interview; and

(B) advises the applicant to send proof to the local county office address; and

(2) support center worker sends Form 08AD093E because it only provides the telephone interview option and advises the applicant to send proof to the Customer Services Center address.

(b) Workers scheduling interviews for all programs except SNAP, send Form 08AD092E, Client Contact and Information Request, because this form allows the worker to schedule an office or a telephone interview and request proof at the same time.

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

(1) information or proof 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.

(d) When 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.

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

(1) require an interview, the benefit renewal is not complete until the interview is conducted; and

(2) do not require an interview, the benefit renewal 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 benefit renewal, the information is analyzed to determine for each program benefit:

(1) what changes occurred;

(2) whether the recipient provided all required proof;

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

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

(b) The benefit renewal is complete after:

(1) information contained on the benefit renewal, in the verification provided, and on data exchange screens were evaluated for changes;

(2) all benefit renewal information, including changes, were entered in the Interview and Eligibility Notebooks of the Family Assistance/Client Services (FACS);

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

(4) the system is updated using instructions found on the Adult and Family Services (AFS) Application Development and Operations (ADO) Infonet web page under Systems Help for FACS and OKDHSLive!.

(5) CWA reports are available to help workers track the status of pending benefit renewals.  Information regarding each CWA report is available on the AFS Business Knowledge and User Support Infonet web page under CWA and ACES Reports.

8.   (a) When  it is determined the benefit renewal is incomplete because the recipient failed to sign the benefit renewal, did not provide all required proof, or did not complete a required interview, the worker attempts to contact the recipient to advise what is lacking, if possible.  The worker documents what is lacking and any attempts to obtain needed proof in FACS Case Notes.

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

9.   (a) After closure, benefits may be reopened when the recipient provides the required proof 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 proof.

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

Last Updated:  8/23/2014