Eligibility Review Requirements for Cash Assistance and Medical Programs

Revised March 25, 2011

Purpose:

This category contains the following sections:

A. ELIGIBILITY REVIEW REQUIREMENTS FOR CASH ASSISTANCE AND MEDICAL PROGRAMS

  • WAC 388-434-0005 The department reviews each client's eligibility for benefits on a regular basis.

B. RECERTIFICATION PROCESS FOR FOOD ASSISTANCE

  • WAC 388-434-0010 How do I get Basic Food benefits after my certification period has ended?

Eligibility Reviews/ Food Assistance Recertifications - Process for Basic Food

Revised December 27, 2012

Purpose:

WAC 388-434-0010 How do I get Basic Food benefits after my certification period has ended?

To keep getting Basic Food benefits after your certification period in WAC 388-416-0005 has ended, we must determine if you are still eligible for benefits. This is called recertification.


Clarifying Information - WAC 388-434-0010

  1. Equal Access:
    Someone who needs Equal Access accommodations has more time to meet certification requirements. If a person receives these services and meets the requirements to be certified within 20 days after the end of their previous certification period, their benefits start on the first of the month of the new certification period. See Equal Access.
  2. Forms / processes a person can use to recertify Basic Food:
    Someone can recertify Basic Food benefits by:
    • Completing DSHS 14-001 (X) Application for Benefits;
    • Completing DSHS 14-078(X) Eligibility Review;
    • Participating in the interactive ACES Application for Benefits (AFB); or
    • Completing the online application.
  3. Adding a request for assistance to an eligibility review:
    See CLARIFYING INFORMATION #3 under WAC 388-406-0010.
  4. Notice of expiration:
    If we certified an AU for three or more months, we send them a letter to tell them that their food benefits are ending by the first day of the last month of their certification period.
  5. When the system automatically initiates reviews for associated cash and food AUs:
    Associated AUs are ones that have the same head of household in ACES. The system matches the certification/review periods for associated cash and food AUs at review as described below:
    • If we initiate a review for cash benefits and there is an active associated Basic Food AU, ACES also initiates a review for Basic Food.
    • If we initiate a review for Basic Food benefits and there is an active associated cash AU, ACES also initiates a review for cash.
  6. Verification at recertification:
    • If someone does not give us proof we ask for by the end of their certification period or within 10 days of the date we asked for it, we count the proof as late.
    • A person has until the end of the month after the month their certification ended to give us any late or missing proof without losing benefits.
    • If someone gives us an application or proof to finish a recertification after the 10-day timeframe and after the end of the month following the certification end month, the person must reapply for benefits.
EXAMPLE John's certification period ends on May 31st. On May 15th, he turns in an eligibility review. On May 23rd, John's worker asks for proof of income and gives him until June 2nd to give us the information. On June 12th, John turns in his proof of income. If John is still eligible for benefits, his worker reinstates the benefits back to June 1st.
EXAMPLE: Same as above, except John does not submit the outstanding verification until July 5th. Because John missed the one-month window to recertify, he must reapply for benefits.
 EXAMPLE:  Vicky's certification ends on April 30th. On April 1st, she turns in a review. On April 5th, her worker asks for proof of her circumstances by April 15th. Vicky does not give us the required proof timely, and her worker denies the application to recertify her food benefits. On May 4th, Vicky turns in the required proof. If Vicky is still eligible for benefits, her worker reinstates the benefits back to May 1st.

EXAMPLE:  Bill's certification period ends 7/31.  He turns in the ER form 7/28, but doesn’t contact the CSO for an interview.  His benefits terminate 7/31. 

On 8/25 Bill contacts the CSO and completes his recertification interview that same day.  The worker must pend completion of the ER because Bill hasn't provided proof of income.  Bill has until the end of August to provide the income verification in order to have benefits reinstated back to 8/1. 

The worker should send an information request letter on 8/25 to Bill giving the him until 8/31 to provide the information.  If Bill doesn't provide the income proof by 8/31the case remains closed and Bill must reapply.

NOTE: People have 10 days to provide information or proof we need to determine if they are eligible. The denial letter we send if they do not give us the proof we ask for informs them what they must do to have us reconsider the denied recertification. 

 

7.  See Letters for information on what to include in approval and denial letters.

8.  See Limited English Proficiency (LEP) for information on what we must translate in letters.

Worker Responsibilities - WAC 388-434-0010

  1. Electronic or Paper Application / Eligibility Review Form
    1. Ensure the household has completed and signed one of the following as part of the recertification process:
      1. Online application or eligibility review;

      2. Application for Benefits (DSHS 14-001);

      3. Eligibility Review (DSHS 14-078); or
      4. ACES AFB after reviewing the information for accuracy.

  2. Rights and Responsibilities (14-113) and Your DSHS Cash or Food Assistance Benefits (14-520)
    1. Face to Face Interviews
      1. When conducting a face-to-face interview, review DSHS 14-113 and 14-520 with the client and ask them to sign the forms to acknowledge their understanding. Send the forms as file only to be scanned into the client's Electronic Case Record (ECR).
    2. Phone Interviews
      1. When conducting a phone interview, review DSHS 14-113 and 14-520 with the client. Send the client a copy of the forms and request them to sign and return both forms.
  3. Recertification Interview
    1. If the client calls before the end of the certification period to do an interview but we have not received the review form:
      1. Complete the interview.
      2. Send a letter requesting for a completed and signed review form.
      3. If the review form is received after the certification period ends but before the end of the following month, issue prorated benefits from the date the form is received. Another interview is not required.
      4. If the review form is received later than the end of the month following the month the certification period ends, an intake is required before benefits can be issued.

Mid-Certification Reviews

For information on mid-certification reviews, please see the Mid-Certification Reviews section.


ACES Procedures

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

Revised April 17, 2017

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

WAC 388-493-0010 Working Family Support

Clarifying Information - WAC 388-434-0005 and WAC 388-493-0010

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

ABD cash

12

Refugee Cash Assistance

Up to 8

TANF/ SFA

12

TANF/SFA  – AU is Homeless

6

TANF/SFA – AU has Migrant / Seasonal Farm workers

6

L99, and MN with Spend-down

6

AEM

3

All other medical not associated with a cash grant

12

Working Family Support

6

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. Eligibility Review period defaults:
  2. Matching cash review periods and Basic Food certification periods:
  3. 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. Staff can initiate reviews within 45 days of the certification end date.
    • 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.
  4. 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, below.)
    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.
  5. 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 ABD/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 ABD/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 ABD/G01. Please note that verification of citizenship and picture identification are not requirements for ABD/G01.

See ACES User Manual - Separate Medical Eligibility for processing.

WORKER RESPONSIBILITIES - WAC 388-434-0005

Rights and Responsibilities

Review form DSHS 14-113(X), Client Rights and Responsibilities with the household:

  1. Review at interview for cash and food assistance:
    1. Face to Face Interviews 
      When conducting a face-to-face interview, explain the rights and responsibilities to the client and ask them to sign DSHS 14-113 to acknowledge that they understand them. Send the document as file only to be scanned into the client’s Electronic Case Record (ECR). 
    2. Phone Interviews:
      When conducting phone interviews, explain the rights and responsibilities to the client, send them a copy of form, and request them to sign and return the document. 

      Your DSHS Cash or Food Assistance Benefits

      For cash or food assistance benefits, review form DSHS 14-520, Your DSHS Cash or Food Assistance Benefits with the household: 

    3. Face to Face Interviews: 
      When conducting a face-to-face interview, explain the allowable use of benefits to the client and ask them to sign form 14-520 to acknowledge that they understand the restrictions and penalties for illegal use. Send the document as file only to be scanned into the client’s Electronic Case Record (ECR). 
    4. Phone Interviews:
      When conducting phone interviews, explain the allowable use of benefits to the client, send them a copy of form DSHS 14-520, and request them to sign and return the document. 
  2. 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 Equal Access (EA) plan (see EA).
    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:
      3. Previously verified factors are clear and complete in the case file; and
      4. We are not asking the person to give us duplicate or unneeded proof.
        1. Document proof you received.
        2. Take action on incorrect payments you discover. Send the person a letter about the actions you took.
  3. Referrals: Review all mandatory and voluntary referrals and complete referrals as needed.
  4. 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 Equal Access for additional actions required when the household has an Equal Access 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, cash assistance will auto close.
    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, cash assistance will auto close. 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, cash will auto close. Medical assistance will need to be closed with advance and adequate notice.
      2. Cash assistance but you also need the information for medical, cash will auto close. Send a letter asking for the proof needed to determine medical eligibility. 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.
  5. 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.
EXAMPLE Mary had a TANF and Basic Food certification period from 9/2010 - 2/2011. When Mary failed to turn in her eligibility review for March 2011, her cash and Basic Food benefits closed effective 2/28/2011. 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 2010. The family is still eligible for F04 medical through September 2011.
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.

WORKER RESPONSIBILITIES – WAC 388-493-0010

Working Family Support recertifications occur every six months and align with the Basic Food Mid-Certification (MCR) and Eligibility Review (ER) periods. See the CSD Procedures Manual section Working Family Support for WFS recertification procedures at Basic Food MCR and ER.