Eligibility Reviews/ Food Assistance Recertifications - Requirements for Cash Assistance and Medical Programs
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Eligibility Reviews/ Food Assistance Recertifications - Requirements for Cash Assistance and Medical Programs

Revised October 28, 2007

Purpose: This section explains how often we review someone's eligibility based on the benefits they receive and their circumstances and when ACES will set a review period to match the review end date or certification end date of other programs.
WAC 388-434-0005How often does the department review my eligibility for benefits?

WAC 388-434-0005

WAC 388-434-0005

Effective October 1, 2004

WAC 388-434-0005 How often does the department review my eligibility for benefits?

  1. If you receive cash assistance, the department reviews your eligibility for assistance at least once every twelve months.   

  2. When it is time for your eligibility review, the department requires you to complete a review.  We use the information that you provide to determine your eligibility for all assistance programs. 

  3. If you complete an interview for assistance with a department representative and sign the printed Application for Benefits (AFB) form, you do not have to complete a separate review form.

  4. For cash assistance, an eligibility review form or the AFB must be dated and signed by both husband and wife, or both parents of a child in common when the parents live together.

  5. For medical assistance, a signature is not required to complete your review.

  6. We may review your eligibility at any time if we decide your circumstances need to be reviewed sooner.

  7. At your review, we look at:

    1. All eligibility requirements under WAC 388-400-0005 through 388-400-0035, 388-503-0505 through 388-503-0515, and 388-505-0210 through 388-505-0220.

    2. Changes since we last determined your eligibility; and

    3. Changes that are anticipated for the next review period.

  8. If you receive medical assistance, we set your certification period according to 388-416-0010, 388-416-0015, 388-416-0020, and 388-416-0035.

  9. You are responsible for attending an interview if one is required under 388-452-0005.

  10. If you do not complete the eligibility review for cash assistance, we consider you to be withdrawing your request for continuing assistance:

    1. Your cash assistance benefits will end.

    2. Your medical benefits will continue for twelve consecutive months from the month we received your most recent application or eligibility review.

  11. We will send you written notice as described under chapter 388-458 WAC before assistance is suspended, terminated or a benefit error is established as a result of your eligibility review.

  12. If you currently receive Categorically Needy (CN) medical assistance, and you are found to no longer be eligible for benefits, we will determine if you are eligible for another program.  Until we decide if you're eligible for any other programs, your CN medical assistance will continue per 388-418-0025

  13. When you need a supplemental accommodation under 388-472-0010, we will help you meet the requirements of this section.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

CLARIFYING INFORMATION

 

  1. Eligibility Review period defaults:

    ACES sets a review period for cash and medical benefits based on the AU's circumstances and other benefits the AU receives from the department. The table below shows the length of certification period the system will set if not matching a review period to another program.

AU Circumstances

Default Review Period
General Assistance 12
Refugee Cash Assistance Up to 8
TANF/ SFA 12
TANF/SFA or GA – AU is Homeless 6
TANF/SFA – AU has Migrant / Seasonal Farm workers 6
ADATSA 6
C99, L99, and MN with Spend-down 6
AEM 3
All other medical not associated with a cash grant 12

  1. Matching cash review periods and Basic Food certification periods:

    When possible, ACES will automatically match the cash review periods and Basic Food / TANF related family medical certification periods to minimize the number of reviews as described below:

    1. Basic Food approved first:

      1. If there are at least six months left in the Basic Food certification period, ACES sets the mid-certification review (MCR) and eligibility review end dates for the new cash / medical benefit to match dates for Basic Food.

      2. If there are less than six months left in the Basic Food certification period, ACES sets a 12-month review period and with the MCR due at six months for the new cash / medical benefit. The system will not change the review end date for Basic Food.


NOTE: When the system does not automatically match the mid-certification review and eligibility review end dates because there are less than six months in the certification period, staff can match these dates by initiating a review for Basic Food.

  • If we do not initiate a review to manually match the certification / review periods, the MCR due dates and review periods will not match. The household will receive more than one MCR.

  • The system initiates a review for associated cases at the next ER or recertification. When we complete the review, the end dates and MCR due dates will match.

  1. Cash / Family medical approved first:

    1. ACES extends the current cash / medical review periods to match the certification period end date for Basic Food.

    2. ACES sends the mid-certification review for all programs that require a report in month five of the certification/review period. The review is due in month six.

  1. Use of the DSHS 14-078(X), Eligibility Review or ACES Interactive Interview: 

    We normally use form DSHS 14-078(X) to redetermine eligibility for a continuing cash assistance grant. Staff can use an interactive interview in place of this form. We can also use the DSHS 14-078(X) when:

    1. Adding an adult to a financial grant;

    2. The worker decides that changes in the person's circumstances make a complete review of eligibility necessary;

    3. Completing a program change except when:

      1. We approved emergency assistance at application while still determining eligibility for financial or medical assistance; or

      2. Changing programs between GAU, W, or X;

    4. Reopening a case that was:

      1. Closed because the person did not complete their eligibility review if they reapply within one month from the date we closed the person's benefits.

      2. Closed in error, and was closed for less than three months.

    5. Determining financial eligibility for open medical cases; or

    6. Redetermining medical eligibility when the medical certification period has been closed for less than 30 days.

  2. Adding a request for assistance to an eligibility review:
    See CLARIFYING INFORMATION #3 under WAC 388-410-0010.

  3. Medical assistance:

    1. The certification period for Family medical (F04) and Children's (F06 & F07) medical is 12 months.

    2. We can redetermine if someone is eligible for medical benefits using any form of information available in the case including information from older:

      1. Applications;

      2. Eligibility reviews; or

      3. Information we receive from other agencies through automated cross matches or interfaces.

    3. We review medical programs automatically at each review of eligibility for cash assistance or Basic Food.

  4. Reviews not completed:  When someone does not complete an eligibility review, ACES automatically:

    1. Sends a termination notice at least ten days before the end of the month the review is due; and

    2. If the review is not completed by deadline, ACES:

      1. Closes cash benefits for all members of the assistance unit; and

      2. Continues medical benefits for the assistance unit for twelve months from the last completed application, eligibility review, or Basic Food application/recertification.

WORKER RESPONSIBILITIES

  1. Review of current circumstances:

    1. As part of the review ensure that:

      1. The person answered all questions clearly and completely; and

      2. For cash assistance the person(s) has signed and dated the application or ER. Both husband and wife, or both parents of a child in common must sign when the parents live together.

    2. Review the record for the Necessary Supplemental Accommodations (NSA) plan (see NSA).

    3. Review the record to see if earlier actions or changes may have an impact on eligibility.

    4. Review for eligibility factors, especially:

      1. Income:

        1. Review income to see if net income meets expenses for rent, utilities, and other expenses the assistance unit pays.

        2. For medical programs, we must get proof of income at each review.

      2. Resources: (Except for: Children's medical, recipients of Family Medical, or Basic Food AUs that are Categorically Eligible)

        1. Review resources the household claims to see if there are any changes to resources we earlier excluded or decided were not available.

        2. Review funds in joint checking accounts that we excluded earlier.

        3. Review the plan to exclude business property of a self-employed person to decide if the property leads to full or partial self support.

        4. Review the value of liquid and nonliquid resources. Look for an increase in the value of real estate, cash value of life insurance, and securities that can be sold such as stocks, bonds, and certificates of deposit.

    5. Review and get proof of eligibility factors that have changed.

    6. Review and document previous proof to ensure that:

      1. Previously verified factors are clear and complete in the case file; and

      2. We are not asking the person to give us duplicate or unneeded proof.

    7. Document proof you received.

    8. Take action on incorrect payments you discover. Send the person a letter about the actions you took.

  2. Referrals:  Review all mandatory and voluntary referrals and complete referrals as needed.

  3. Incomplete and late reviews:  A household is ineligible for benefits if they do not complete a required interview, complete a review form (if asked to do so), or give us proof we ask for.

    1. See NSA for special when the person has a NSA plan.

    2. If the person does not take the needed actions or give you the proof you need to decide if they are eligible for benefits by the end of the review month, close cash assistance.

    3. If the person fails to complete a review, has an incomplete review, or misses the required interview, continue medical assistance for twelve months from the last completed:

      1. Application;

      2. Eligibility review; or

      3. Basic Food application or recertification.

    4. If you receive a review for TANF cash and medical, but the person does not complete the required interview for cash assistance, close cash assistance and continue medical while you review continued medical eligibility.

    5. If you initiate a review for CN medical, ACES continues to issue medical benefits even if the person does not return the required proof. When pending a review, set an alert to check the case and determine if the person returned the required proof.

    6. If someone does not provide the proof you asked for, and you asked for proof for:

      1. Both cash and medical assistance, close cash and medical assistance with advance and adequate notice.

      2. Cash assistance but you also need the information for medical, close the cash and send a letter asking for the proof. Give the person 10 days to return the proof. If they do not respond, close medical assistance with advance and adequate notice.

      3. Cash assistance but not for medical, continue medical for 6 months from the last complete application, eligibility review or recertification.

    7. If you receive information to establish eligibility the month after the month the review was due, reopen the benefits effective the date you determined they were eligible. See APPLICATIONS.


EXAMPLE

Mary had a TANF and Basic Food certification period from 9/2005 - 2/2006. When Mary failed to turn in her eligibility review for March 2006, her cash and Basic Food benefits closed effective 2/28/2006.

The family is eligible for F04 medical for 12 months from their last review. Mary's completed her last review for TANF and Basic Food in September 2005. The family is still eligible for F04 medical through September 2006.

EXAMPLE

Teresa has a TANF case with a review period of January 2006 through June 2006 based on her circumstances and homeless status. In March 2006, we opened Basic Food from March 2006 through June 2006.

At her eligibility review in June, Teresa reports that she now receives $3,000 in monthly unearned income. Her worker closes cash and Basic Food benefits with advance notice. Teresa's family is not eligible for F04 medical because their income is more than the F04 standard.

Teresa's children are eligible for F07 as the family's income is below the SCHIP standard.

EXAMPLE

Cheryl's household has a TANF review period and Basic Food Certification of August 2005 through January 2006. On January 2nd, we received the review and set up an interview for January 15th.

Cheryl did not make her required interview. We terminate TANF and Basic Food effective January 31st. Since we received the ER form by the end of the review period, we continue medical while we determine eligibility for family medical.

  1. Primary source of information for medical:

    1. The case record is the primary source of information used to redetermine medical eligibility. Ask the person for more information if the case record is not enough.  (See Worker Responsibilities 1.)

    2. We don't need the actual review form DSHS 14-078(X) to determine eligibility for medical if during the past six months, the assistance unit completed:

      1. An application;

      2. An eligibility review;

      3. A Basic Food application or recertification;

      4. An in-person or telephone interview.

  2. Citizenship verification at time of review:

    1. When processing an eligibility review for any Medicaid-related AU (this includes Medical Assistance for AF/F01 and GA/G02), update the citizenship/identity verification following ACES procedures. If the record does not contain citizenship / identity verification then the CCU will follow up with the client to help obtain the missing documentation.

    2. If the CCU terminates the GA/X/G02, the G02 will auto change to G01. If the case cannot automatically change, then a tickler will be sent to the worker to re-determine eligibility for GA/G01. Please note that verification of citizenship and picture identification are not requirements for GA/G01.

    See ACES User Manual - Separate Medical Eligibility for processing.

  3. Redetermination of medical:  When our review results in someone losing eligibility for cash:

    1. Continue the same medical coverage that the person received when eligible for cash assistance while you redetermine if they are eligible for other medical programs; and

    2. Notify the assistance unit of the action you took.

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Modification Date: October 28, 2007
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