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63-287.1Establishment of CalFresh Overissuances under SAR |
Regulations governing the establishment of a CalFresh overissuance
under Semi-Annual Reporting (SAR) regulations will vary depending on the
eligibility factor in question, when the household is required to report, and
required worker action. An overissuance will be established as applicable based on: ·
The household’s failure to report accurately, completely or
timely; and/or ·
County error. When assessing whether an overissuance should be
established based on the mandatory reporting of mid-period changes, the worker must determine if the household reported
the change in a timely manner (i.e., within 10 days). If a household makes a mandatory report of a mid-period
change timely (within 10 days), the worker will not establish an overissuance
if the correct allotment cannot be issued due to timely notice requirements. ·
An overissuance will
not be assessed based on a timely, accurate and complete
report where timely (10-day) notice alone delayed issuance of the correct
allotment. ·
An overissuance will
be assessed when late
reporting alone or together with timely notice requirement delayed issuance
of the correct allotment. Refer to 63-287.2
Examples 2 and 3 and 63-451. NOTE: Due to CalWORKs and CalFresh having different mid-period reporting requirements, there will be times when failure to report something (such as income over the CalWORKs IRT) will result in an overpayment in CalWORKs but will not result in an overissuance in CalFresh. This is the case even though CalFresh would have taken mid-period action to decrease the allotment amount based on a mandated CalWORKs report had it been made timely. Refer to 63-283.8. |
63-287.3Examples: Failure to Report Income |
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63-287.4Late or Incomplete SAR 7 |
A. LATE OR INCOMPLETE SAR
7 An overissuance will be assessed when a household submits a
late or incomplete SAR 7 and the worker is unable to decrease benefits or
discontinue the case due to timely notice requirements. Refer to 63-274.5.
B. UNVERIFIED
CHANGE REPORTED MID-PERIOD If the household voluntarily reported an unverified change
mid-period and that change is not included on the SAR
7, the worker will call the client to attempt to resolve the discrepancy. ·
If the worker cannot resolve the discrepancy, the SAR 7
will be considered incomplete. ·
If the discrepancy is resolved late in the Submit Month and
the worker does not have timely notice to decrease benefits, the worker will release
the benefits at the prior (higher) level and an IHE overissuance will be established
for the amount the household was not entitled to receive.
SAR
households that have been discontinued for failing to submit a timely or a
complete SAR 7 must be evaluated for good cause when the household submits a
complete SAR 7 or reapplies in the calendar month following the
discontinuance. Once
good cause has been determined and the discontinuance rescinded, benefits
must be released to the household at the previous level until timely notice
can be sent to decrease benefits. An
overissuance will be established when benefits are released at a previous
higher level as a result of the worker's inability to decrease benefits
without timely notice. Refer
to 63-274.6 and 7. |
63-287.5Aid Paid Pending |
Each individual or household has the right to request a
fair hearing to appeal a denial, reduction, or termination of benefits. An IHE overissuance will be established if
the household received more benefits than it was entitled to receive pending
a state hearing decision because the household requested a continuation of
benefits (Aid Paid Pending (APP)) based on the mistaken belief that it was
entitled to such benefit. Refer to 63-451.9. When APP is granted for a CalWORKs case, the PACF allotment
will be determined by using the actual CalWORKs grant paid to the household,
which will be the higher APP level. Since
this would result in a decrease of CalFresh benefits, the worker must give
the household timely notice prior to decreasing their benefits. If there is no timely notice, CalFresh benefits will not be
reduced until the month for which timely notice can be provided. The APP amount can be included in the computation of the
CalFresh allotment because the APP is “Known-to-County” information and can be
reasonably anticipated. However, once
the APP stops, the CalFresh benefits will be recalculated mid-period.
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63-287.6County Error |
Overissuances related to county error will be determined
based on the worker failing to act correctly on a mandatory household report. ·
If the worker fails to act correctly on a mandatory
recipient report, the worker will re-determine the benefits the household
would have received based on an accurate report and correct County action. ·
If the worker’s recalculation results in an overissuance,
the date that the overissuance begins is the first month that the change
would have been made had timely and correct action been taken based on a
timely household report.
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63-287.7Voluntary Reports |
Changes that are not required to be reported, but that may
be voluntarily reported, should not be considered when determining an
overissuance. Unverified voluntary mid-period changes must be reported on
the SAR 7 or recertification that follows the change. Refer to 63-287.5(B). Verified mid-period reports are considered part of the case
record and will be entered into CalWIN at the time they were verified. The household is not required to report a
verified change again on the SAR 7 or recertification. Failure to act on a reported change that was
verified mid-period would be considered a County error. A CalFresh household is not required to report a new household member mid-period unless the new household member’s income together with the ongoing household’s income is over the IRT. |
63-287.8Changes After Income Has Been Reasonably Anticipated Based on Available Information |
The worker will not assess an overissuance when the actual
income received during the certification period differs from the amount of
income that was reasonably anticipated at initial application or when
processing the SAR 7 or recertification, as long as the household has reported
accurately and timely to the best of its ability and the worker has acted
correctly on all available information to reasonably anticipate income and
household circumstances. In other words, no reconciling based on actual income is ever
done so long as the requirement to report completely and accurately is met
and the worker determined and issued the benefits
correctly based on reasonably anticipated income. For example, if a worker receives an IEVS match that shows
a discrepancy between the actual and reported earnings, the worker will
determine if the household was mandated to report that income mid-period. An overissuance would only be assessed if
the income was over the IRT and the household failed to make the mandatory
report of income over the IRT within 10 days of receipt. A mid-period income discrepancy would not
result in an overissuance unless the household has failed to meet their mandatory
reporting requirements under SAR rules. Refer to 63-282.6 for additional
information. NOTE: Due to CalWORKs and CalFresh having different IRT reporting requirements, there will be times when failure to report income over the IRT will result in an overpayment for CalWORKs, but will not result in an overissuance for CalFresh. This is the case even though CalFresh would have taken mid-period action to decrease the allotment amount based on the report of income over the CalWORKs IRT when reported mid-period. |
63-287.9Budget Re-computation to Determine an Overissuance |
When re-computing benefits to determine an overissuance,
the worker will recreate case circumstances to determine what income should have
been reasonably anticipated at the time the change shall have been reported
using the correct processing timeframes. The worker will not use actual verified income (actual income determined after the fact) to reconcile against prospectively budgeted income that was used in the original allotment calculation. |
63-287.10Claim Recoupment by Allotment Reduction |
Recoupment by allotment reduction will be initiated only at
the beginning of a semi-annual period, the beginning of a certification
period or the month after the SAR 7 Submit Month, unless the recoupment does
not result in a decrease in benefits.
An allotment reduction to recover an overissuance is not a “County-Initiated” change. However: ·
A recoupment can be discontinued mid-period as appropriate
when the overissuance has been recouped. ·
When a recoupment of one overissuance is completed
mid-period, CalWIN may begin recoupment of the next overissuance mid-period
as long as the amount that is going to be recouped does not result in a
decrease of benefits.
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63-287.11Underissuances |
When a household receives fewer benefits than it was
entitled to receive, they are considered to have lost benefits, which the
worker is required to provide (restore) to the household (an underissuance). If the worker determines that an underissuance has occurred
due to an administrative error, and the recipient is entitled to restoration
of those benefits, the worker must immediately take action to restore the benefits
that were lost. ·
Restoration of benefits under these circumstances would be based
on SAR rules. ·
The worker will not use actual verified income to reconcile
against prospectively budgeted income that was used in the original allotment
calculation. The worker can only use income
that could have been “reasonably anticipated” at the time benefits were
initially calculated. Refer to 63-456. |