County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Definitions Number Page 44350B 1 of 4 Revision Date April 20 2020 BackgroundAn overpayment is any amount of any aid payment received by an Assistance Unit AU that they were not entitled to receive An overpayment may be all or a portion of the payment This includes payments issued for regular aid payment Immediate Need Homeless Assistance Aid Paid Pending APP for a state hearing or Employment Services ES PurposeThe purpose of this material revision is to add clarification to the Supplemental Payment definition PolicyAction for Civil Judgment The action taken by a county official to take the customer or former customer to court Administrative Agency Error Overpayment An overpayment caused by error on the part of the county when all information necessary to a correct determination of the grant was in the possession of the county Aid The amount of assistance issued to a customer Balancing A method for the recovery of all or a portion of an overpayment by applying it against an underpayment Claim ID When a claim overunder payment is determined and authorized in CalWIN it is assigned an unique ID number Claim ID that is linked to the Eligibility Determination and Benefits Calculation EDBC run and historical data that resulted in the claims creation Client Error Overpayment Other Overpayment An overpayment which does not meet the criteria to be considered an administrative overpayment a fraudulent overpayment or an Intentional Program Violation IPV Collect To recover CalWORKs funds which are overpaid to a person by using methods other than grant adjustment Corrective Payment A payment made to an AU when it is determined that the AU has been underpaid This usually occurs as the result of a retroactive court order delayed implementation of regulations or the correction of a misinterpretation of regulations Demand for Repayment The notification to a customer or former customer that an overpayment occurred for which there is a right for judicial restitution Where demand for repayment is appropriate it may be used concurrently with other methods of adjustment County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Definitions Number Page 44350B 2 of 4 Discharge An expungement process for nonfraudulent overpayments when the CalWORKs case has been closed and the liable individuals has not received CalWORKs for 36 consecutive months or longer This also includes mass overpayments resulting from negligence or major systematic error as defined by the California Department of Social Services CDSS The discharge process does not apply to Aid to Families with Dependent Children AFDC overpayments established prior to December 1 1996 Extended Filing Date The date the SAR 7 must be received in order for the customer to have continued CalWORKs eligibility The SAR 7 must be received by the end of the business day on the first working day of the payment period in order for the customer to continue eligibility without a break in aid Fraud Fraud exists when a person has Knowingly and with the intent to deceive or defraud made a false statement or representation to obtain benefits obtain a continuance or increase of benefits or avoid a reduction of benefits Knowingly and with intent to defraud failed to disclose a fact which if disclosed could have resulted in denial reduction or discontinuance of benefits Accepted benefits knowing that there was no eligibility for those benefits or accepted any amount of benefits knowing that this was greater than the amount to which they were entitled Made statements which that individual did not know to be true for the purpose of obtaining benefits continuing receiving benefits or avoiding a reduction or denial of benefits Grant Adjustment Recovery of an overpayment by reducing the grant of a customer or AU Intentional Program Violation IPV A determination made by a state or federal court or pursuant to an Administrative Disqualification Hearing ADH that an individual has intentionally Made a false or misleading statement or misrepresented concealed or withheld facts or Committed any act intended to mislead misrepresent conceal or withhold facts or propound a falsity and Committed these acts to establish or maintain CalWORKs eligibility or to increase or prevent a reduction in the amount of the CalWORKs grant Liable Individual The person who is determined to be accountable for the claim overpayment This person will be responsible for payment on the claim via methods such as monthly grant recoupment cash payments or tax intercepts Mass Overpayment An overpayment caused by the same action or inaction that impacts either eight percent of the county caseload or more than 1000 AUs within the county whichever is greater Month of Discovery The month in which the county obtained or could have obtained by taking prompt action information sufficient to support a determination both that an overpayment occurred and the amount of such overpayment Nonfraudulent Overpayment An overpayment which is not determined to be fraudulent County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Definitions Number Page 44350B 3 of 4 Overpayment Any amount of aid an AU has received to which it is not eligible This may be all or a portion of the aid payment It includes but is not limited to an Immediate Need payment a Special Need payment ES Supportive Services or APP for a state hearing Recoupment Recoupment is the method of recovering an overpayment by grant adjustments or voluntary grant offset from individuals or the AU Recovery A method of getting back CalWORKs funds which were overpaid Methods of recovery include grant adjustment recoupment voluntary grant offset voluntary cash recovery demand for repayment action for civil judgment and balancing Regrouping When the data ie discovery date error type or claim amount in a claim is changed in CalWIN and EDBC is run again a new EDBC number is assigned and the recalculated claim is assigned a new number based on the new EDBC run The old claim number does not disappear within the system but is closed out as recalculated This allows historical data to remain available for tracking purposes and to create an audit trail Supplemental Payment A payment issued to an eligible AU when the budget for the current month is recomputed as a result of a change in anticipated income and determined that the customer is due a larger aid payment in order to receive the correct amount of CalWORKs for the month Technical Overpayment This overpayment occurs when all four of the following requirements apply The customer fails to meet a condition of eligibility for CalWORKs Examples include but are not limited to failing to o Secure a Social Security Number o Assign support rights o Meet the Sponsored NonCitizen requirements o Apply for potentially available income o Apply for Unemployment Insurance Benefits The customers failure to meet the condition of eligibility is caused by the state county or Eligibility Worker error and not by the customers error The amount of aid paid would have been the same had the customer met the condition of eligibility This overpayment is discovered calculated or recouped after January 1 1985 Note Technical overpayments are not considered overpayments in the State of California Any technical overpayment which was discovered on or after January 1 1985 cannot be considered an overpayment Recoupment of any technical overpayments regardless of when they occurred or were discovered stopped effective January 1 1985 Underpayment An Underpayment occurs when the customer receives less than the amount to which the AU is entitled in a given month or months If an underpayment comes to the attention of the HSS reasonable steps to correct the underpayment must be taken County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Definitions Number Page 44350B 4 of 4 Note A payment due to a change in the current months budget is not an underpayment rather it is considered a supplement to the grant Unlocatable Means either of the following When the county is unable to determine the whereabouts of the caretaker relative When the county is able to locate the liable individual but unable to execute a legal process to collect Voluntary Cash Recovery Repayment made voluntarily to the county by a customer who has incurred an overpayment Voluntary Grant Offset Voluntary repayment made to the county by a customers foregoing all or a portion of a grant for which he or she is eligible Procedure None References EAS 443502 ACL No 19102 ACIN No I7219 Sunset Date This policy will be reviewed for continuance by April 30 2023 Approval for Release Rick Wanne Director Eligibility Operations