Case File Narrative 448-01-40-30

(Revised 3/1/12 ML #3304)  

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Narratives are used to document eligibility determinations. It is recommended that case file narratives be completed within the eligibility system. Narratives must include:

 

  1. The eligibility determination made at initial application or review including all financial and non-financial factors and verifications used in the determination.

 

  1. Use of prudent person concept and the decision arrived at when applying this concept.

 

  1. Any change in a recipient's circumstances resulting in a change in eligibility.

 

  1. Circumstances relating to overpayments, underpayments and questions of suspected fraud and abuse, actions taken, and how resolved.

 

  1. Any other information used in the eligibility determination.

 

  1. For Health Care Coverage, the completion of an ex parte review.

 

The information in the narrative is part of the case file and may be viewed by the applicant, recipient, authorized representative, legal representatives, administrative law judges and attorney generals. Based on this, narratives must not include:

 

  1. Personal opinions of applicant’s or recipient character or circumstances.

 

  1. When a case specific directive is received from the regional representative or policy administrator, documentation should not include “regional representative or state office said” but rather the policy reference or basis for the decision.

 

Following is a recommended format and example of information to include in the case file narrative. Additional information may need to be added based on the programs applied for and case circumstances.

 

   
NEW APPLICATION OR REVIEW Include case name, programs applied for and approval or denial.
DATE OF NARRATIVE  
ELIGIBILITY WORKER NAME  

PROGRAM INFORMATION

 

 

 List date application was requested, date application was returned, person interviewed and if expedited for SNAP processing timeframe.
EBT CARD ISSUED Date issued.
RESIDENCY Residential address including city and state.

HOUSEHOLD COMPOSITION

 

 

 

 List all household members including unborn, specifying relationship, ages, how they purchase and prepare meals and living arrangement. Include disqualified members and reason for disqualification.
CITIZENSHIP/IDENTITY For Health Care Coverage, list level verified and type of verification of each household member.

WORK REGISTRATION/BEST/

ABAWDS/JOBS

 

 

 

 

For SNAP, list household members required to work register, receiving ABAWDS months or required to participate in BEST. If exempt, document reason.

 

For TANF, list household members required to participate in JOBS or if exempt indicate reason.

ASSETS

 

 

 List liquid assets including bank and current value, vehicles including value and outstanding loan amount, if known, and other assets specifying asset and value.

INCOME

 

 

List all household members’ earned and unearned income. Document what income was used in application month and second or third beginning months, how often paid, employer, etc.

 

For SNAP and CCAP, indicate if income was converted.

EXPENSES

 

 

 

 

 

List all deductible expenses.

 

For SNAP, if household is in receipt of LIHEAP or responsible for utilities, specifying utility standard and why it was allowed or not allowed. Also, document request for expense the household failed to verify.
HEALTH INSURANCE List policies and who is covered.
PCP List household members and their PCP.

OTHER COMMENTS

 

 

 Any other information used in the eligibility determination such as pending disability, disqualifying transfers or TANF lifetime limits.

ACTION TAKEN

 

 

 

 

 

Program approval or denial including effective date of program eligibility, length of review period and household members covered.

 

For Medicaid, indicate if it is monthly reporting or continuous eligibility coverage period.