Combination Cases 430-05-67-15-15

(Revised 12/01/08 ML3164)

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Combination Medicaid Cases

The worker must determine if a change reported for Medicaid results in an increase or decrease in food stamp benefits using the following procedures:

 

  1. Enter the verified changes on the benefit calculator or do a hand budget.
  2. If the changes result in an increase in benefits, the changes must be made to the case in TECS.

Exception:

In combination FS/MA cases when processing the cost of living adjustment changes in December of each year, if the recipient liability is being averaged, do not change the amount allowed as a medical expense deduction for food stamp purposes. The change is not acted on until recertification.

  1. If the changes results in a decrease in benefits, the changes are not acted on until the six month report or recertification, whichever occurs first, and benefits continue as previously authorized.  A copy of the benefit calculator or hand budget must be retained in the casefile.

Exception:

If the change meets the criteria to decrease benefits, the change must be acted on within 10 days from the date the change was reported and a 10 day advance notice must be sent.  If the change is reported in writing and signed by the household, a 10 day advance notice is not required.  Adequate notice is required.

 

Examples:

  1. In a combination FS/MA case if the entire recipient liability is being allowed as a medical expense deduction and it changes as a result of a change in income reported by the household, change the amount of income being used and allow the new recipient liability if it results in an increase in benefits.  

If the change in income reported by the household and resulting change in recipient liability results in a decrease in benefits, the change is not acted on until the six month report or recertification, whichever occurs first.

If MA closes for RL not being met, and this results in a decrease in benefits, do not remove the RL amount until recertification.    

  1. Ongoing FS/MA case.  Client is paid weekly and provides four of the five pay stubs from the base month.  The fifth pay stub is not required by Medicaid.  The worker must use the four pay stubs to convert the income.  If the change results in an increase in benefits, the change must be acted on.  

If the change results in a decrease in benefits, the change is not acted on and the benefits stays the same.  

  1. Ongoing FS/MA case.  Client resides in a group home and each month the case manager provides a listing of earnings for individuals in the group home to the county office.  If the change results in an increase in benefits, the change must be acted on.

If the change results in a decrease in benefits the change is not acted on until six month report or recertification, whichever occurs first.  

  1. Ongoing  FS/MA case.  Household provides base month and all of the processing month pay stubs. The processing month pay stubs must be used to determine the effect on the benefit, as it is the most current information.
  2. Ongoing FS/MA case.  Household provides pay stubs for Medicaid.  Actual income on the pay stubs is not over the gross income limit.  Worker converts the income as the individual is paid biweekly which results in the converted income exceeding the gross income limit.  

If the household is eligible for a benefit, no change is made, as it would result in a decrease in benefit.  The worker must send the F741 to the household.   

 

If the household is not eligible for a benefit, the worker must send the F419 to determine if the income will continue.  

  1. If the household responds and indicates the income will continue or the household does not respond, the case must be closed for excess income.
  2. If the household responds and states they do not know if the income will continue to exceed the gross income limit for the household size, the case must be closed.  

If the household verifies by the last working day of the processing month that gross income is below the gross income limit for the household size, the worker must revert the case to open and determine eligibility and level of benefits based on the newly verified income.

  1. If the household responds and states they do not expect the income to continue, the household must provide verification other than client statement that their income will not continue to exceed the gross income limit for their household size.  If the household does not provide the verification, the last reported converted income is used to close the case.

If the household provides the verification and the newly verified income results in an increase in benefits, the change must be acted on

 

If the household provides the verification and the newly verified income results in a decrease in benefits, the change must not be acted on until six month report or recertification, whichever occurs first.

 

Combination TANF Cases

When changes are reported for TANF that result in a change in the TANF grant, the changes along with the change in the TANF grant must be acted on regardless of the effect on the benefit.

 

Whenever a change results in the reduction or termination of a household’s TANF benefits within the household’s food stamp certification period, the worker must make a separate determination for food stamp eligibility.  A worker must not terminate a household’s food stamp benefits solely because the TANF case has closed.

 

When a household has not submitted a TANF monthly report by the third to the last working day of the month, the TANF grant must not be counted prospectively to determine food stamp benefits.

 

Exception:

If there is a two immediate prior consecutive month history, which could include the processing month, of late reporting for TANF, the TANF grant must be counted prospectively to determine food stamp benefits.  Monthly reports for TANF are due on the fifth of the month or the first working day after the fifth of the month if the fifth falls on a weekend or holiday.  A TANF monthly report received after the due date is considered a late report.

Example:

TANF/FS household files a monthly report for TANF on August 10 and September 20.  As of October 29, no monthly report has been filed.  On October 29 the worker is working November Food Stamp benefits.  The TANF grant must be anticipated for November.  

 

When a TANF household changes from TANF Diversion to TANF or from TANF to TANF Diversion, a TANF grant is anticipated as follows:

  1. A household received four months of TANF Diversion Assistance and a closing notice is sent in month four. The household submits a TANF monthly report in month four and a Request for Benefits.  A TANF grant must be anticipated and counted for month five.
  2. A household received four months of TANF Diversion Assistance and a closing notice is sent in month four. The household submits a TANF monthly report in month four but does not submit a Request for Benefits.  A TANF grant is not anticipated or counted for month five.
  3. A household received four months of TANF Diversion Assistance and a closing notice is sent in month four. The household does not submit a TANF monthly report in month four but does submit a Request for Benefits.  A TANF grant is not anticipated or counted for month five.
  4. A household received four months of TANF Diversion Assistance and a closing notice is sent in month four. The household does not submit a TANF monthly report or a Request for Benefits in month four.  A TANF grant is not anticipated or counted for month five.
  5. A household received two months of TANF.  The household submits a Request for Benefits and a TANF monthly report in month two to be changed to TANF Diversion.  A TANF grant must be anticipated and counted for month three.

 

If a change is made to the TANF case after authorizing food stamps and it results in the TANF case closing, the worker must revert TANF to close and reauthorize the food stamp case as the household is no longer considered categorically eligible.

 

If a change in household circumstances requires a reduction or termination in the TANF grant and the worker has sufficient information to determine how the change affects the household’s food stamp eligibility and benefit level, the worker must take the following actions:

  1. If the change requires a reduction or termination of food stamp benefits, the worker must issue adequate notice or advance notice for both the TANF and food stamp actions on the same day. If the household requests a fair hearing within the period provided by the notice, the worker must continue the household’s food stamp benefits on the basis authorized immediately prior to sending the adequate or advance notice.

 

If a fair hearing is requested for both programs, the hearing must be conducted according to TANF procedures and timeliness standards.

 

If the food stamp certification period expires before the fair hearing process is completed, the household must reapply for food stamp benefits.

  1. If the change will result in an increase in benefits as a result of the reduction or termination of the TANF grant, the worker must issue the TANF advance notice, but must not take any action to increase the household’s food stamp benefits until the household decides whether it will appeal the TANF advance notice.

If the household appeals and the TANF grant is continued, the household’s food stamp benefits must continue at the previous level.

 

If the household does not appeal, the worker must act on the changes along with the change in the TANF grant. The 10-days for the worker to act on the increase is calculated from the date the TANF advance notice period expires.

 

Examples:

  1. Ongoing TANF/FS case reports an increase in earned income on the TANF October 5 TANF monthly report.  The change results in a decrease in the TANF grant.  The increased earned income and the decreased TANF grant must be acted for November benefits allowing for adequate notice as the change meets the criteria to decrease benefits.  
  2. Ongoing TANF/FS case calls the worker to report a household member left the home on October 25.  Since the change will result in a decrease in TANF and requires advance notice for both TANF and Food Stamps, the household member must be removed and the decreased TANF grant must be anticipated for December benefits.  The TANF advance notice and the Food Stamp advance notice must be issued on the same day.

 

Whenever a change results in the reduction or termination of the TANF grant and the worker does not have sufficient information to determine how the change affects food stamp eligibility and benefit level (such as an absent parent returning to the household and the household asked to have its TANF case closed without providing any information on the income of the new household member), the worker must take the following action:

  1. If the situation requires a reduction or termination of the TANF grant and requires a TANF advance notice, the worker must issue F419 at the same time it sends a TANF advance notice giving the household 10 days from the mail date to provide the needed information. Before taking further action, the worker must wait until the TANF advance notice period expires, or until the household requests a fair hearing, whichever occurs first.
  1. If the household requests a fair hearing and elects to have the TANF grant continue pending the appeal, the worker must continue food stamp benefits at the same level.
  2. If the household does not request a fair hearing and provides the information requested, the worker has 10 days to act on the changes and the change in the TANF grant allowing for advance or adequate notice.  
  3. If the household does not request a fair hearing and fails to provide the information, only the change in the TANF grant is acted on allowing for advance or adequate notice.   
  1. If the situation does not require a TANF advance notice, the worker must send F419 giving the household 10 days from the mail date to provide the needed information. If the household provides the requested information within the 10 days, the worker has 10 days to act on the information allowing for advance or adequate notice.

If the household fails to provide the requested information, only the TANF grant is removed when determining food stamp benefits.

Example:

Ongoing TANF/FS case calls the worker on October 5 to report the absent parent returned to the household and asked to have their TANF case closed.  The worker must send the F419 – Request for Information on the same day the TANF advance notice to close is sent allowing the household 10 days to provide the information for the absent parent.  

 

The household provides the information on October 10.  The worker must not act on the changes until October 15.  If the household does not request a fair hearing for TANF, the change to add the absent parent and remove the TANF grant must be acted on.