2003 Establishing an Overpayment
A. Establish an overpayment when payment was made for a benefit month in which the assistance unit or a provider was paid incorrectly or was ineligible whether it was a client error or an agency error.
1. Determine the months the assistance unit/provider was paid incorrectly;
2. Recalculate the correct benefit amount(s) using the actual case circumstances, such as actual income, assets, persons or shelter costs, and policy in effect at the time of the occurrence;
3. Determine the overpayment amount(s).
B. Determine the person(s) the claim is to be established against and recover overpayments from any adult member of an assistance unit at the time the overpayment occurred regardless of whether or not s/he is:
1. Currently receiving benefits; or
2. No longer receiving benefits; or
3. A member of another assistance unit.
NOTE: All responsible adult members who received benefits during a month an overpayment occurred are held jointly and severally liable for the full amount owed.
C. Inquire to see if there are outstanding overpayments against the applicant or other adult assistance unit members when processing applications:
1. Open the case in the name of the adult listed as having an overpayment so the existing recoupment will be made;
2. DO NOT assign a different case number.
D. Set a “$$” alert on the Program and Person Alerts (PRAP) screen for a case with outstanding overpayments to alert others if the case closes and reapplication is made.
E. Establish an overpayment within the allowed time frames as follows:
1. Request the necessary verification to validate the allegations within ten days once a potential overpayment is discovered;
2. Establish and submit the claim within 30 calendar days once the verification is received and the overpayment is verified;
3. Use each month in error not to exceed six years from the date of discovery of the overpayment for SNAP;
4. Use all months in error for all other programs.
F. Realize PRICE and field audits (Management Evaluations) will review cases to assure federal compliance for establishing overpayments within 30 days of the date the overpayment is verified.
G. Take the following actions when trafficking (buying, theft or selling) of SNAP benefits occurs, excluding vendor violations:
1. Process the case on EPICS when a trafficking overpayment occurs and the individual is currently receiving benefits;
2. Complete and submit a DFS 760 with the appropriate evidence when the individual is NOT currently receiving benefits;
3. Understand ALL trafficking cases must be referred for disqualification.
NOTE: The amount of the overpayment is the amount of benefits bought, stolen or sold.
H. Determine a claim against the child care provider for the amount of the overpayment when:
1. The provider overcharged the agency;
2. The provider misrepresented or gave false information on the Bill for Child Care Services, DFS 201;
3. The provider misrepresented or gave false information on the provider registration form, DFS 203a/b, and would not have been eligible as a child care provider;
4. The provider hired a person as a substitute provider who did not meet the definition of a substitute;
5. The provider bills the agency for hours the client was not participating in an approved child care activity and the provider was fully aware the client was not participating during the hours billed.
I. Determine a claim against the provider or assistance unit when it is discovered the agency created the overpayment.
1. Use the month DFS-FO would have made the change effective had the DFS-FO acted timely and correctly; and
2. Make the claim against the provider when the child still attends care with the provider;
3. Make the claim against the assistance unit when the child no longer attends that child care facility.
J. Require EPICS to recalculate the benefit for SNAP and/or AFDC/POWER using the new information for each month benefits were incorrectly issued:
1. The AFDC/POWER overpayment is shown on AFPD;
2. The SNAP overpayment is shown on FSAD;
3. The message “Overpayment Has Occurred” will be displayed;
4. The amount of the overpayment will be shown and transferred to the OVCA screen;
K. Enter “NCR” (new case referral) in the “status code” field on OVCA screen as all other status codes are used by the PRICE staff only.
L. Disallow the 20% earned income deduction on all unreported earned income when establishing an overpayment for SNAP client errors:
1. Enter the “DE” code on the EAIN or SEEI screen in the Type field to disallow the 20% earned income deduction;
2. Enter the “RE” code on the EAIN or SEEI screen to allow the 20% earned income deduction when the earned income was reported timely.
M. Disallow the POWER earned income disregards when establishing an overpayment due to an earned income client error or an IPV which occurred prior to 8/1/97.
1. Enter the “LM” code on the EAIN or SEEI screen in the Denial Code field;
2. Understand POWER overpayments after 8/1/97 are considered noncompliance and the $1 nonpayment status penalty is to be applied.
N. Enter the “CH” code on UNIN for unreported/retained child support.
1. Check the CSCR screen for amounts the non-custodial parent paid and was retained by the state for each month of any possible overpayment for other support retained by the client;
2. Document on the screen print to be sent to PRICE and in the case record the amount of child support retained by the state and to be credited to the overpayment(s).
O. Understand EPICS will create a separate overpayment claim for each federal fiscal year based on the month the overpayment occurred for POWER:
1. Establish separate overpayments and recoupments for each different program;
2. Understand EPICS automatically numbers the overpayments for each program in the order the overpayments are established;
3. Establish a separate overpayment claim for each cause if an overpayment covers two or more months and if different months have different causes;
Example: The first month was a client error (CL) but the second month was an agency error (AG).
4. DO NOT establish separate claims when the overpayment months are within the same federal fiscal year and due to the same cause.
P. Complete and submit a DFS 760 a/b to recalculate the benefit manually and as documentation for the case record for individuals not on EPICS or for the following programs not on EPICS:
1. Supportive services for work programs;
2. Child care payments to recipients or providers;;
3. Burial.
Q. Generate the appropriate overpayment notice(s) (see Tables).
R. Allow the assistance unit or provider to request an administrative hearing to dispute the application of policy which led to the amount of the overpayment unless an administrative hearing has already been held.
1. Stop all collection activities and billing notices by placing a “y” in the “term indicator” on the OVCA screen;
2. Remove the “y” and resend the overpayment notice once the hearing is held and when the State’s decision is upheld.