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

Revised November 20, 2020

Purpose:

This section explains how often we review an Assistance Unit’s (AU) eligibility based on the type of benefits they receive, their circumstances, and when ACES sets 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 388-434-0010 How do I get Basic Food benefits after my certification period has ended?

WAC 388-434-0015  Extension of certification periods and waiver of eligibility reviews and mid-certification reviews during the COVID-19 pandemic.

WAC 388-493-0010 Working family support

NOTE: As noted in WAC 388-434-0015, certification periods were extended for the following periods: 

  • November 2020 is extended two months, to January 2021;
  • December 2020 is extended two months, to February 2021;
  • January 2021 is extended 4 months, to May 2021;
  • February 2021 is extended 4 months, to June 2021.

Mid-Certification Reviews for cash and food are waived that are due from November 2020 to June 2021. See Mid-Certification Reviews.


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

Our eligibility system 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

MN with Spend-down

 3-6

All other medical programs (other than AEM)

 12

Working Family Support

 6

When possible, the system automatically matches the cash review periods with Basic Food certification periods to minimize the number of reviews.

  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 food and cash 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 food, cash and medical programs:
    Someone can recertify benefits by:
    • Completing DSHS 14-001 (X) Application for Benefits;
    • Completing DSHS 14-078(X) Eligibility Review;
    • Completing an ACES Interactive Interview Declaration (IID); 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. Interview Requirements:
    We must interview a person at cash and food Eligibility Review or recertification if we have not interviewed them in the last twelve months. Exception to this is for the those in the Elderly Simplified Application Project (ESAP) Basic Food. See Clarifying Information #2 under WAC 388-452-0005.
     
  5. Notice of expiration:
    If we certified an AU for three or more months, we send them a letter to tell them that their food and cash benefits are ending by the first day of the last month of their certification period.
     
  6. 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.
    • If we initiate a review for Basic Food or Cash, and there is an initiated review, ACES also initiates a review for classic medical S02, S03, or S05.
       
  7. Verification at recertification:
    • If someone does not give us verification we ask for by the end of their certification period or within 10 days of the date we asked for it, we count the verification as late.
    • A person has until the end of the month after the month their certification ended to give us any late or missing verification without losing benefits.
    • If someone gives us an application or verification 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 verification of her circumstances by April 15th. Vicky does not give us the required verification timely, and her worker denies the application to recertify her food benefits. On May 4th, Vicky turns in the required verification. If Vicky is still eligible for benefits, her worker reinstates the benefits back to May 1st.
EXAMPLE:  Bill's certification period ends July 31st.  He turns in the ER form July 28th, but doesn’t contact the CSO for an interview.  His benefits terminate July 31st. 

On August 25th, 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 August 1. 

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

NOTE: People have 10 days to provide information or verification we need to determine if they are eligible. The denial letter we send if they do not give us the verification we ask for informs them what they must do to have us reconsider the denied recertification. 
  1. Letters:
    • See Letters for information on what to include in approval and denial letters.
    • See Limited English Proficiency (LEP) for information on what we must translate in letters.
  2. Primary source of information for medical:
    If the customer stated they’d like to continue to receive CN Medical, 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:
    • An application;
    • An eligibility review;
    • A Basic Food application or recertification;
    • An in-person or telephone interview.

Worker Responsibilities - WAC 388-434-0005 and WAC 388-434-0010

Acceptable forms and Interviews

  1. Electronic or Paper Application / Eligibility Review Form
    1. Ensure the household has completed and signed one of the following as part of the process if they aren’t completing a Telephonic Signature:
      1. Online application or eligibility review;
      2. Application for Benefits (DSHS 14-001);
      3. Eligibility Review (DSHS 14-078); or
      4. ACES IID after reviewing the information for accuracy.
    2. Accept any of the above forms to complete the recertification process if received after the ER notice was mailed to the customer, but prior to the system allowing initiation of the review.
  2. Rights and Responsibilities (14-113) and Your DSHS Cash or Food Assistance Benefits (14-520)
    1. Face to Face Interviews
      1. When conducting face-to-face interviews, explain and review forms: Your Cash and Food Assistance Rights and Responsibilities (DSHS 14-113) and Your DSHS Cash or Food Benefits (DSHS 14-520). Answer any questions about the forms and ask them to sign both forms to acknowledge their understanding. Send the forms as file only to scan into the Electronic Case Record (ECR).
      2. For mandatory Able Bodied Adults Without Dependents (ABAWDs) review Basic Food Eligibility Requirements: What You Need to Know to Keep Your Benefits (DSHS 11-034b).
    2. Phone Interviews
      1. When conducting a phone interview, explain the rights and responsibilities and the allowable use of benefits to the customer, send them a copy of the DSHS 14-113 and the DSHS 14-520 and request them to sign and return the documents..
      2. For mandatory Able Bodied Adults Without Dependents (ABAWDs) review Basic Food Eligibility Requirements: What You Need to Know to Keep Your Benefits (DSHS 11-034b).
  3. Recertification Interview
    1. If the customer calls before the end of the certification period to do an interview, but we have not received the review form, determine if the customer is eligible for a Telephonic Signature.
    2. Follow CSD Procedure Handbook – Accepting a Telephonic Signature for an Eligibility Review.

Completing the Review

  1. Review of current circumstances:
    1. As part of the review ensure that:
      1. The customer answered all questions clearly and completely; and
      2. For cash assistance, they signed and dated the application or ER. Both spouses, or both parents of a child in common must sign when the parents live together.
    2. Complete an Equal Access (EA) Screening.
      1. Guidance on completing an EA Screening can be found in the CSD Procedures Handbook.
    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. See EA-Z Manual – Verification for more information on living above means (LAM)
        2. For medical programs, we must get proof of income at each review.
      2. Resources: (Except for: 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 (COD).
        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. Do not asking for duplicate or unneeded proof.
        1. Document proof we received.
        2. Take action on any incorrect payments you discover. Send the person a letter about the actions you took.
      5. Work Registration:
        1. Check the work registration status of each customer to see if it matches their current circumstance. Take any action to update the status if there are changes.
  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 don’t complete a required interview, complete a review form (if asked to do so), or give us proof we ask for.
    1. See Equal Access (EA) for additional actions required when the household has an EA plan.
    2. If the person does not take the needed actions or give us the proof we need to decide if they are eligible for benefits by the end of the review month, cash assistance will auto close.
    3. If a review is initiated for CN medical, the system 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.
    4. If we asked for proof but the customer did not provide the proof we requested for:
      1. Both cash and medical assistance, cash will auto close. Medical assistance will need to close with advance and adequate notice
        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.
    5. For food and cash, if we received information to establish eligibility the month after the month the review was due, we will reopen the benefits effective the date you determined they were eligible.

Clarifying Information – WAC 388-493-0010

Working Family Support recertification occurs 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.