The CAO must make a decision on eligibility within 30 calendar days of the application filing date. If there is enough information to determine eligibility for Medical Assistance, the CAO must not delay authorization of Medical Assistance while waiting for verification of Cash Assistance eligibility.
If the applicant has cooperated in trying to get verification and the CAO is waiting for the needed verification from a third party or a domestic relations section, the initial authorization of assistance must not be delayed beyond 30 days after application. See Chapter 178.
NOTE: If documentation of an abusive living situation is not readily available and it appears that third-party verification cannot be gotten within the application processing period, the CAO may authorize assistance on the basis of the person’s statement.
NOTE: The CAO must use the "Comments" section of the record to provide a continuous record of supporting information that is not specifically recorded in the case record.
At application, the CAO must record the following information:
The reason for the application denial if a full application interview is not scheduled.
NOTE: This may be recorded during the screening interview.
Any pertinent information that is not on the PA 600.
The date and place of the interview.
If needed, an additional explanation of reasons for or circumstances of the application that are not already listed on the PA 600 (for example, past management).
Any plans established with the applicant in addition to those recorded.
An explanation of major differences between the information on the PA 600 and the information in the case record.
The application process ends when one of the following takes place:
The applicant does not go on with the application or withdraws.
NOTE: The CAO must discuss any misunderstanding of agency requirements or methods to prevent an applicant from withdrawing when it is not wise or necessary to do so.
The applicant is found ineligible for Cash Assistance, and the CAO determines eligibility for Medical Assistance and SNAP benefits.
The applicant is found eligible and assistance is authorized.
The CAO must send a Notice to Applicant when the eligibility decision is made.
An applicant may voluntarily withdraw his or her application at any time before the eligibility determination.
55 Pa. Code § 125.24(c)(7)(vii)(B)
If the applicant withdraws the application, the CAO must take the following actions:
Fill out the affidavit section of the PA 600.
List the program from which the applicant is withdrawing.
Get the applicant’s signature and record the date.
Record in the "Comments" section the reason for withdrawal, if the applicant gave a reason.
Send a Notice to Applicant to notify the applicant that the application was denied because of the withdrawal request.
Complete the “Not Authorized” area on page 1 of the PA 600.
If the applicant is found ineligible, the CAO must do the following:
Record the appropriate information in the case record.
Send a Notice to Applicant as soon as possible. See Chapter 177.
Complete the "Not Authorized" area of Section A on page 1 of the PA 600.
Review the case for Medical Assistance eligibility.
Review the case for SNAP eligibility.
The applicant is responsible for providing, to the extent that he or she is able, verification required for establishing eligibility.
The CAO must help the applicant, if necessary, to get the required verification or establish a reasonable plan with the applicant for getting the verification on his or her own.
If the applicant fails to cooperate in providing the necessary verification, the CAO must do the following:
55 Pa. Code § 125.21 55 Pa. Code § 133.23 55 Pa. Code § 201.3
Deny assistance.
Use reason code 042 for the denial.
Send a Notice to Applicant that includes:
What information was not provided or what action was not taken;
The regulation requiring this information or action; and
What action the CAO took to help the applicant get this information.
Complete the "Not Authorized" area of Section A on page 1 of the PA 600.
NOTE: Review and authorize Medical Assistance if necessary verification is available. See Medical Assistance Eligibility Handbook Chapter 378.
The applicant is responsible for providing verification that he or she has met the Job Search requirements of applying for at least three jobs per week while the application is pending, unless the applicant verifies that he or she is exempt or has good cause. If the applicant fails to meet this requirement, the CAO must do the following:
Deny assistance
Issue a Notice to the applicant; use Reason Code 974 - Failure to meet work search requirements.
Complete the "Not Authorized" area of Section A on page 1 of the PA 600.
NOTE: Review and authorize Medical Assistance if necessary verification is available. See Medical Assistance Handbook Chapter 378.
62 P.S. 405.1(a.2)(3) 55 Pa. Code § 165.1 55 Pa. Code § 165.52
Do not require a new application or renewal form (paper or electronic) when an application is denied or when ongoing benefits are discontinued for reasons other than income, resources or failure to meet Job Search requirements and the person reapplies within 60 days of the application denial date or closing date.
Require a new application if the denial is due to excess income, resources or failure to meet Job Search requirements. See Appendix D.
The CAO worker may determine that a new application form is required after considering the following:
The changes in an applicant’s or recipient’s circumstances since the denial of benefits or closure.
The length of time that has passed since the last interview.
Whether required forms have been signed or updated.
A review of criminal history status including fines, costs, restitution, probation, or parole may also be required if there is a change in information or circumstances.
The CAO may have the person complete a new application when it would expedite benefit delivery.
Example: Getting a new application may benefit the person if there are delays in locating or transferring previously completed documents from district to district or from county to county.
NOTE: If a new application form is submitted, process the application as a new application.
A new application form is not required when a person or family reapplies for Cash Assistance benefits within 60 days of the date of the application that was denied because the person or family failed to do any of the following:
Provide required information (Code 042).
Sign required forms, including employability and medical assessment forms (Code 043).
Apply for federal benefits (Code 044).
Reimburse a federal benefit (Code 045).
Supply proof of a Social Security number (Code 046).
Keep an appointment (Code 047).
Let the CAO know where they are living (Code 062).
A new application form is required if the application was denied because of excess income, resources or failure to meet Job Search requirements.
NOTE: A new application is required if the applicant group includes a person who was not part of the original budget group at the time of closing. See Section 104.15.
When determining whether another face-to-face interview is needed, the CAO must use discretion and consider the following:
The reasons for denial.
The period of time that has elapsed since the original interview.
Whether required forms have been signed or need to be updated.
NOTE: Cash assistance is authorized from the date eligibility is established (for example, when all eligibility factors are reviewed, required verification is provided; and rights and responsibilities are explained).
A new application form is not required when all of the following conditions are met:
The recipient has completed the required renewal form but has not completed the renewal process because he or she is waiting for information or verification.
Benefits were discontinued for reasons unrelated to income, resources or failure to meet Job Search requirements.
The recipients completed the renewal process by providing pending information or verification within 60 days of discontinuance.
NOTE: Completing the process means that the person provides all items needed to reestablish eligibility.
For renewals, the CAO must determine whether another face-to-face interview is needed by consider the following:
The reasons for closing
The period of time that has gone by since the renewal interview
Whether required forms have been signed or need to be updated
Review the person’s most recent AMR and update as necessary or complete a new AMR if there are significant changes.
Narrate the circumstances of case authorization by incorporating specific dates, delays, and receipt of information.
The CAO may require a person to complete a new application when information appears questionable, when the person reports numerous changes, or when the CAO otherwise determines that a new application is reasonable and necessary.
NOTE: Cash Assistance is authorized from the date eligibility is established (for example, when all eligibility factors have been reviewed, all required verification is provided, and the CAO has explained rights and responsibilities). The CAO must open the budget on the date that all eligibility factors are verified.
NOTE: When a cash budget is reopened, the CAO will evaluate whether it must authorize a retroactive period of Medical Assistance to cover medical services gotten since the date of cash discontinuance.
An application form is not required if the person or family reapplies within 60 days from the date of closing and cash benefits were discontinued for reasons unrelated to income, resources or failure to meet Job Search requirements. Reasons for discontinuing benefits may include closings due to returned mail (see Section 123.8) or failure to provide verification. Additional reasons may include, but are not limited to, failure to do the following:
Provide required information (Code 042).
Sign required forms, including employability or medical assessment forms (Code 043).
Apply for federal benefits (Code 044).
Reimburse a federal benefit (Code 045).
Supply proof of a Social Security number (Code 046).
Keep an appointment (Code 047).
NOTE: Reopening the case is basically a continuation of eligibility and not an application. The person is not required to appear for a face-to-face interview or sign forms that are generally required in an application interview.
The CAO should use discretion when determining whether a face-to-face interview is needed and consider the following:
The reason(s) for closing.
Changes that occurred since the case was closed.
The period of time that has gone by since the closing.
Whether required forms have been signed or need to be updated.
The CAO must review all eligibility factors, including the AMR, and update or complete a new AMR as necessary. The CAO should explain the person's rights and responsibilities and authorize Cash Assistance effective the date eligibility is established.
NOTE: An automated support referral to DRS must be completed as part of the reopening process if support action is required for benefits to continue. Any prior referral would have been terminated when the Cash Assistance benefits closed.
When reopening Cash Assistance benefits, the renewal date should stay the same as previously established in eCIS.
Example: Mrs. B.’s Cash Assistance renewal date was December 1, 2010. In September, mail sent to Mrs. B. was returned to the CAO. An Advance Notice was sent because Mrs. B.'s whereabouts were unknown, and her case was closed effective the day before the second payment date for October—October 15, 2010. Mrs. B. contacts the CAO on October 16 to report that mail was not received because her name was not properly listed on the apartment building mail box. There are no other changes reported. Mrs. B. requests that her case be reopened. She will provide the necessary verification by October 19. She provides proof of address on October 19. The CAO reopens the case effective that date. Since the system has set the renewal date to October 19, 2011, the caseworker must manually reset the date back to the original December 1, 2010, renewal date. Batch processing requires a specific number of days to post future renewal dates. The worker needs to set a system or calendar alert as a reminder to send out a renewal packet to complete the December 1, 2010, renewal.
The CAO must not perform the AP/CI function on a rejected application, a closed renewal budget, or a closed case until the applicant or recipient provides all items needed to establish or reestablish eligibility.
Examples:
Mrs. G. applies for Cash Assistance on May 2. She was given 10 days to provide required proof of the family’s Social Security numbers, residence, and identity. As of May 12, she has not provided the requested information. The CAO rejects her application and sends a Notice of Ineligibility, which includes a list of the items she needs to provide if she wishes to reapply. On May 21, the CAO receives the requested information from Mrs. G. The CAO must AP/CI her case, authorize benefits effective as of May 21, and send a Notice of Eligibility.
Ms. R. applies for Cash Assistance for herself and three children on May 18. She does not have proof of age or Social Security numbers for anyone. She is asked to provide this information by May 28. She fails to do so, and her application is rejected on May 29. The CAO sends a Notice of Ineligibility that includes the information she needs to provide to establish eligibility. On June 4, the CAO receives proof of her Social Security number and a birth certificate for one of the children. Ms. R. has not provided all the pending items needed to establish eligibility for Cash Assistance. The CAO files this information in the case file and does not AP/CI the case or send a Notice of Ineligibility.
NOTE: If the person provides some but not all of the pending information, the CAO should work with the person in an effort to get the required information.
Authorization is the process of completing and processing all of the data necessary to issue an assistance benefit.
If the applicant is eligible for a monthly assistance payment, the CAO must do the following:
55 Pa. Code § 125.24(c)(7)(vi)
Explain the amount of the monthly assistance payment and how it was computed.
Explain that the monthly assistance payment is a money payment that the recipient may use in any way he or she chooses.
Explain that a change in Cash Assistance eligibility may not result in a change of Medical Assistance eligibility.
Explain the medical, dental, pharmaceutical, optometric, and burial services.
Explain that the ACCESS card will be mailed by the contractor. Tell the client when to expect it and how it is to be used.
Provide an interim Medical Assistance card to anyone who needs a medical service before an ACCESS card will be received from the contractor. See the Medical Assistance Eligibility Handbook, Section 380.4.
Explain that any third-party medical coverage is to be used before Medical Assistance coverage
Upon request, help the person find medical care by accessing MA CARES and giving the person a list of providers who participate in the Medical Assistance program. See the Medical Assistance Eligibility Handbook, Section 338.51.
Explain the SNAP program
Complete a referral to EPSDT, DAP, LIHEAP, or WIC, if applicable.
Explain the availability of other social services.
Discuss the responsibility for reporting changes by the tenth of the month following the month in which the change occurs. 62 P.S .§ 432.19
Explain the purpose of semiannual reporting (SAR) if the applicant is required to submit semiannual reports.
Explain why the applicant must semiannually report.
Give a copy of the Semiannual Reporting form (SAR form, PA 564) with instructions for completing the form.
Explain how to complete and submit the SAR form.
Explain what needs to be verified and how the information must be verified.
Explain to applicants and recipients the benefits (for example, the EIC) of filing a tax return, and encourage applicants and recipients to file
Explain the distribution of assistance benefits through mail delivery or electronic benefit transfer (EBT).
NOTE: Explain to applicants and recipients that they may not use TANF funds issued through their PA ACCESS card to make electronic benefit transfer (EBT) transactions in liquor stores, casinos (gambling casinos, gaming establishments), or places for adult entertainment. [Title IV of the Middle Class Tax Relief and Job Creation Act of 2012 (P. L. 112-96)]
Provide the appropriate identification card to the recipient to use when getting his or her assistance payment. See Chapter 180, Appendix B.
Explain payment schedules and the meaning of payment day numbers.
Explain special allowances and benefits. See Chapter 138.
Complete the authorization process.
Complete and send a Notice of Eligibility.
If a check is issued, the CAO must read the following certification to the person. Tell the person that every time he or she endorses an assistance check, he or she is signing the certification statement that is on all assistance checks.
55 Pa. Code § 125.24(d)(2) 55 Pa. Code § 125.24(d)(3)
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READ BEFORE CASHING Caution – Know your endorser. Ink or indelible pencil should be used for endorsement. If endorsement is by mark (X), two witnesses and their addresses are required. By endorsing this check I certify that I have notified my county board of assistance of all changes in the facts as stated in my application for assistance and that neither I nor any member of my family has any earnings from employment or other resources which would affect the eligibility of myself or my family which I have not reported to said board. I know that I can be penalized by fine or imprisonment, or both, for any false statement. |
Reissued June 16, 2014, replacing January 3, 2013