Adding or deleting a budget group member may increase the assistance payment, decrease the assistance payment, cause a month of zero cash payment, or ineligibility.
When the budget group asks to add a person or when the CAO requires that a mandatory member be added, the CAO will:
1. Ask the budget group to submit a PA 600 asking to add the person, except for a newborn child.
NOTE: The CAO will process the request within the time limits for applicants. See Chapter 104, Application.
NOTE: If the additional person is a newborn child, see Section 168.812 before following step 2 below.
2. Complete a prospective determination of need by combining the best estimate of the budget group’s income and circumstances for the application month and the following month with the additional person added.
3. If adding the member results in ineligibility, determine if the additional person must be included in the budget group.
IF THE ADDITIONAL PERSON IS A MANDATORY MEMBER, the CAO will:
Discontinue the cash payment effective the next payment day that can be met with proper notice;
Provide an Advance Notice unless one of the exceptions in Chapter 177, Notices applies; and
Do not complete an overpayment referral for any assistance received, if the client reported the change timely.
IF THE ADDITIONAL PERSON IS NOT A MANDATORY MEMBER, the CAO will:
Deny assistance to the applicant only;
Provide a Notice to Applicant; and
Determine if the person’s income should be deemed to the budget group.
4. If the budget group remains eligible with the person added, calculate the monthly payment amount. Budget the additional member’s income.
5. If the addition of the person causes an increase in monthly assistance payment:
Add the person effective the next payment date for which the deadline can be met;
Authorize a supplemental payment reflecting the additional person’s needs from the date eligibility is established to the effective date of the increase; and
Provide a Confirming Notice.
6. If the addition of the person causes a decrease in the monthly assistance payment:
Provide an Advance Notice; and
Add the person and decrease the payment for the first payment day that can be met with timely notice.
Example 1: Mrs. Lewis and three children receive TANF with January payment dates of Jan. 3 and 8. The family has been eligible for TANF because of the absence of Mr. Lewis. On Jan. 15, Mrs. Lewis reports that Mr. Lewis returned to the home. She completes a PA 600. The CAO determines Mr. Lewis eligible effective Jan. 15. He has no income. The budget group remains eligible for TANF. The CAO authorizes an increase in the monthly assistance payment effective with the Jan. 18 benefit and a supplemental OTI to cover the payment difference for Jan. 15-17.
Example 2: The Lewis example above, except Mr. Lewis works part-time and earns $70 per week. Mr. Lewis’s earnings are budgeted prospectively. The budget remains eligible for TANF with a new income adjustment of $140.
Assistance payment without Mr. L = $514
FSA with Mr. L = $607
Income adjustment - $140
Assistance payment with Mr. L = $467
The addition of Mr. Lewis decreased the monthly assistance payment. The CAO gives the budget group an Advance Notice. The addition of Mr. Lewis and the decrease are effective the first payment day following timely notice. There is no overpayment for the period January 15 until Mr. Lewis is added to the budget group.
If the CAO discovers that a budget group has not reported the presence of a person required to be in the budget group, it will re-determine the budget group’s eligibility by including the income and resources of the person who moved to the common residence. Re-determine eligibility and re-calculate payment amount back to the date the change would have been made if the information had been reported timely.
There is an overpayment if that person's income and resources would have reduced the monthly assistance payment. Do not allow income deductions when the information is not reported timely.
There is an overpayment if that person did not meet an eligibility requirement that would have affected the whole budget group. This includes such things as a TANF parent participating in a strike or the principal wage earner not cooperating with employment and training requirements.
The CAO will complete an overpayment referral if there has been an overpayment.
The CAO will not authorize a corrective payment if the budget group has been underpaid unless the CAO did not act timely.
Example: In August the CAO discovers that a mandatory member has been living with the budget group since April. The CAO determines that, if the change had been reported timely, the person should have been added effective the first payment day in May. The new member’s income would have decreased the monthly payment. The CAO adds the mandatory member and decreases the payment amount effective the second benefit in August. The CAO completes an overpayment referral for May, June, July and the first payment day in August.
The CAO will waive certain cash assistance eligibility requirements during a grace period for a newborn child only. When notified of a child's birth, the CAO must:
1. Establish the grace period. The grace period begins with the newborn child’s birth date. It ends on the first day of the second month after the birth or on the mother’s release from the hospital, whichever is later.
2. If the CAO receives notification of the newborn child’s birth date before the end of the grace period, authorize cash assistance within 15 calendar days effective the newborn child’s date of birth. Authorize as soon as possible after receiving notification. Do not wait the full 15 calendar days to authorize.
NOTE: Do not authorize cash assistance for the newborn under the mother’s name if it is known that the mother will not have care and control of the newborn.
For example, do not add the newborn if the mother signed an adoption agreement giving the care and control of the newborn to someone else. In that instance, if the adoptive parents want to receive assistance for that child, an application for benefits must be completed on behalf of the newborn under the regular process.
NOTE: Notification may include contact by the birth mother, CAO liaison, birth center, midwife, neighbor or family member, facsimile from the hospital, newspaper birth announcement, system “Baby” alerts or a hospital MA 112. The contact may be in person, by phone or in writing.
NOTE: Although the MA 112 is an MA form, the CAO must authorize cash assistance for an eligible child based on MA 112 receipt if that is how the CAO is notified of the birth.
An eligible child is one born to a custodial mother with an active cash assistance budget in which she is receiving cash for herself and/or other children.
Example: Ms. Tate is receiving cash assistance as a pregnant woman with no children. When Baby Tate is born, he is added to the cash budget. If Ms. Tate was receiving SSI, Baby Tate would be authorized for Medicaid only unless Ms. Tate applies for cash assistance for the child.
3. There is a case alert system to notify of a newborn’s birth. It ensures a cash assistance/MA eligible newborn is authorized in the correct category. The CAO must act on this “Baby” alert, with at most three alerts allowed. The alert means that there is an invoice for the newborn’s medical services and the newborn was not added to eCIS. The CAO must authorize assistance effective the newborn’s date of birth as soon as it receives the first alert.
4. If the CAO receives notification after the end of the grace period, the caretaker/relative must apply before the CAO can authorize cash assistance for the newborn. They must verify eligibility requirements and cooperate with providing verification. In this case, cash assistance is authorized for an eligible newborn child effective the date the CAO determines eligibility rather than the newborn’s date of birth.
NOTE: Authorize MA effective the newborn’s date of birth even if cash assistance was not authorized because the CAO received notification after the end of the grace period.
5. After authorizing cash assistance for the newborn child, the worker will:
Complete the support referral process. See Chapter 131, Support; and
Mail to the client on the authorization date:
A completed Confirming Notice;
PA 600 asking the client for information on the newborn child only; and
A completed Adding Your Baby to the Assistance Grant (PA 1576) to schedule an interview so that eligibility can be determined before the end of the grace period.
6. During the eligibility interview scheduled for the caretaker/relative, use the PA 1576/1576S to review and verify enumeration, support, budget group and all other eligibility requirements to support continued eligibility. Then return to step 2 to continue the process using Section 168.81.
A member may be removed from the budget group:
Because he or she leaves the common residence;
Because he or she no longer meets eligibility requirements;
When removal of a non-mandatory member financially benefits the budget group; or
When the CAO is imposing a sanction.
When the CAO determines that a person should to be removed from the budget group, the CAO will:
1. Determine if the person is being removed because of a sanction
2. If the person is not being sanctioned:
Remove the person from the budget group for the first payment date that can be met with proper notice;
Provide an Advance Notice unless the payment name waives the right to advance notice; and
Do not process an overpayment referral or authorize a supplemental payment if the change was reported and acted upon timely.
3. If the person is being sanctioned:
Impose the appropriate sanction per CAH 135.7.
Complete the prospective determination of need by estimating budget group income for the payment month.
Deem the income of an LRR, parent of a TANF minor parent or stepparent who stays in the common residence.
4. If the budget group is ineligible with the person removed, close the cash budget effective the first payment date that can be met with proper notice.
5. If the budget group is eligible with the person removed, calculate the assistance payment amount. Determine if the deleted member’s income must still be counted:
If the person removed is a sponsor of an alien or stays in the common residence and is an LRR, stepparent, or parent of a TANF minor parent, budget any deemed income.
If the person removed is an LRR or putative father, but is no longer in the common residence, count only the income made available by the LRR when completing the net test. Do not count the support income when determining the payment amount as it must go to the Department. Apply the support requirements in Chapter 131, Support. The client must pay the entire amount.
NOTE: A putative father must acknowledge in writing that income made available to the budget group is support. Otherwise the income is considered a contribution.
If the person removed stays in the common residence and is not an LRR, stepparent, sponsor of an alien or parent of a TANF minor parent, count only the income made available by the person removed. Count the income for the prospective determination and when calculating the payment amount.
Example 1: Mr. and Mrs. Mertz and their three children receive TANF with payment days of Jan. 11 and Jan. 26. On Jan. 15, Mr. Mertz, who is employed, leaves the common residence. The family has no other income.
The CAO removes Mr. Mertz from the budget group and removes his income from the benefit calculation effective Jan. 26. The CAO completes a prospective determination of need for Mrs. Mertz and children. If Mr. Mertz contributes to the family, the support income counts for the net test. If the family is eligible, the CAO must collect the support.
NOTE: An increase or decrease to the second check in a payment month will not result in an underpayment or overpayment for the month.
Example 2: Mr. and Mrs. Wagner receive TANF for themselves and two children. In February Mr. Wagner is sanctioned for 60 days for failure to comply with employment requirements. He is employed part-time. The CAO removes Mr. Wagner effective the first payment day in March. The sanction period is March and April. The CAO will count Mr. Wagner’s expected income for March when completing the prospective determination of need. If eligible, Mr. Wagner’s income is deemed to determine the March payment amount. The CAO will calculate his income as though he were still part of the budget group.
Example 3: Mrs. Hershey and her sons, Mike and Joe, receive TANF. On Feb. 15, Joe, age 18, quits school and starts working part-time. He will earn $80 per week. Mrs. Hershey asks that he be removed from the budget. Joe states he will pay $20 per week room and board beginning Feb. 22. The budget group has no other income.
The CAO removes Joe from the budget group effective March 5, the first date that can be met with proper notice. The CAO expects $20 per week room and board income when completing the net test for March. The room and board income will be used to determine the monthly benefit amount.
If the caretaker/relative does not establish the newborn child’s eligibility by the end of the grace period, the CAO will reduce or stop cash benefits with the first payment date that can be met after the grace period. The CAO must send an Advance Notice to the caretaker/relative.
NOTE: Failure to establish eligibility applies to the newborn child only. If the newborn child is determined ineligible, the entire budget group does not necessarily become ineligible for TANF unless the newborn child is the only child in the budget group. See Chapter 110, Budget Groups.
Even if the newborn is removed from the grant, the caretaker/relative must still provide any information about the newborn child’s income and resources if the newborn is a mandatory budget group member. The CAO must include any newborn child’s income or resources when determining the budget group’s eligibility or benefit amount unless the newborn is not a mandatory budget group member.
The caretaker/relative must provide all information about the newborn child’s income or resources or risk ineligibility unless good cause is claimed and upheld or the newborn is not a mandatory budget group member.
If a newborn child is not included in the budget group, the caretaker/relative does not need to take support action for the newborn child.
The CAO must process a cash assistance overpayment for assistance received during the grace period if the caretaker/relative fails to establish the newborn child’s eligibility within the grace period.
The newborn child may be eligible for medical assistance even if found ineligible for cash assistance.
There are special procedures to transfer abandoned children from one budget group to another quickly. Use these procedures only when:
The children are current TANF cash assistance recipients;
NOTE: This applies if the abandoned child is receiving TANF benefits in another state. The CAO can authorize TANF before the date the other state removes the child from its program. The CAO should give the state both the date the child began living in Pennsylvania and the date of the new TANF authorization.
The children are abandoned because the parents are substance abusers; and
Another caretaker is requesting cash assistance for the children.
The procedures are as follows:
1. The caretaker/relative tells the CAO that the children are now under her care and control. She asks that assistance be authorized in her name on behalf of the children. If the children are not currently receiving assistance, complete the application process as usual.
2. If the children currently receive assistance, the worker will immediately (on the same work day), send an Advance Notice to the losing parent. The Notice states that the monthly assistance payment will decrease because the children are being removed from the budget group.
3. Within the same day, the worker will complete the application or redetermination for the caretaker/relative and the children. This may include having the caretaker/relative complete the PA 600 and PA 601, obtain essential verification, and cooperate with child support requirements. Be as generous and open-minded as possible deciding what must be verified. For example, do not require verification again if the children’s original record verifies birth dates and social security numbers.
4. When eligibility is established, authorize assistance on behalf of the children in the caretaker/relative’s name. If the caretaker/relative meets the definition of a specified relative or if a temporary exception to living with a specified relative may be granted, authorize assistance in the TANF category. See Chapter 127, Specified Relatives.
NOTE: It is not necessary to establish legal guardianship for abandoned children of substance abusing parents when adding these children to another caretaker/relative budget group.
5. The CAO may authorize assistance before the effective date that the benefit amount decreases for the losing parent’s budget group.
6. These actions happen in the following order on the same day:
Using individual delete, remove the children from the parent’s budget group using reason code 065 effective with the first benefit reachable with advance notice.
Using case or budget open, authorize medical assistance under the “PC” category for the children using reason code 065. The “PC” authorization is effective on the transaction date. Issue a duplicate medical assistance card if a replacement card is needed to make sure the caretaker has a valid medical card.
Using a county OTI, issue benefits for the children based on the new FSA amount covering the period from the "PC" category authorization date to the day before the losing parent's budget closing date. Use supplemental reason code 227.
Depending on the payment day schedule, if the payment date for the newly authorized “PC” is different from the losing budget group’s payment date, you may need to issue two OTIs to cover the period to the losing budget group’s payment date.
Using case or budget close, close the "PC" category effective with the "through" date of the supplemental OTI.
NOTE: If a second OTI is needed, do not close the “PC” category until after completing the second OTI transaction.
On the deadline date, open the budget for the children in the “C” category using reason code 065 effective with the date after the “PC” closure.
If the children are being added to an existing open cash budget, use reason code 065 effective with the first payment date that can be met.
7. Process an overpayment referral against the losing parent for assistance received for the children beginning with the date the children were added to the new case or budget to the date they were deleted from the losing parent’s budget.
8. If the losing parent appeals the FSA reduction within the 10-day appeal period, the children will still be removed from the parent’s budget group. Authorize a recurring Special Need Allowance (SNA) using reason code 228 to make up for the reduction amount because of the children’s removal from the grant. The parent’s budget must also revert to TANF using a reason code other than 065.
Example: Ms. Harris appeals the removal of her two children from her TANF grant effective Jan. 8. Her assistance continues in the TANF category and the FSA continues to be based on a one-person FSA. However, authorize a recurring SNA to reflect the difference between a one-person and three-person FSA.
When the hearing decision is in favor of the CAO, the SNA is removed from the budget. Process an overpayment referral for the total amount of the TANF overpayment, including the SNA, against the losing parent’s TANF budget.
NOTE: Procedures for authorizing assistance in these unique cases have changed while requirements for assistance receipt have not changed. The caretaker/relative must establish eligibility for assistance using requirements in Chapter 104, Application, and Chapter 178, Verification. Those requirements are not changed or waived.
The special procedures below make the transfer faster from one budget group to another for abused persons and/or their children. Use them only when the abused persons in domestic violence situations are current cash assistance recipients.
NOTE: The person asking for cash assistance due to domestic violence cannot be the payment name for an existing case. A person claiming abuse who is the payment name is not eligible for an expedited authorization. Process these cases as an address change with the deletion of a budget group member(s) effective with the first benefit that can be reached.
The procedures are:
1. The person tells the CAO about the move from an abusive situation and asks for assistance to be authorized. If the person is not currently receiving assistance, complete the application process as usual.
2. If the person is currently receiving assistance and is not the payment name, the worker will immediately (within the same work day) send an Advance Notice to the losing budget group advising that the monthly assistance payment is decreasing or the case is being closed because of the removal of the person and/or children from the budget group.
3. Within the same day, the worker will complete the application for the person and/or the children. This requires the worker to have the person complete the PA 600, provide essential verification, and cooperate with child support requirements unless good cause prevents such cooperation.
NOTE: Transfer information needed for child support purposes from the other record.
Be as generous and open-minded as possible when deciding what must be verified before authorizing assistance. For example, do not require verification again if the original record verifies birth dates and Social Security numbers. A client’s statement is acceptable verification of flight from abuse.
4. When eligibility is established, authorize assistance on behalf of the person and/or child. If the person establishing the new budget group meets the definition of a specified relative for the child, authorize assistance in the TANF category. If the child is removed from a TANF budget group but does not now live with a specified relative, the CAO may grant a temporary exception to living with a specified relative and authorize assistance in the TANF category.
NOTE: Regulations allow for a TANF child to continue receiving benefits if that TANF child is placed under the care of a non-specified relative. See Chapter 127, Exception to Living With a Specified Relative.
5. Assistance may be authorized before the effective date of the losing group’s benefit reduction amount.
6. These actions happen in the following order on the same day:
Using individual delete, remove the person(s) from the losing budget group using reason code 065 effective with the first benefit that can be reached allowing for Advance Notice.
Using case or budget open, authorize medical assistance under the “PC/PD” category for the new budget group using reason code 065. The “PC/PD” authorization is effective as of the transaction date. Issue a duplicate medical assistance card when a replacement card is needed, making sure the caretaker has a valid medical card.
Using a county OTI, issue
benefits for the new budget group based on the new FSA amount
covering the period from the “PC/PD” category is authorized to
the day before the effective closing date for in the losing
budget. Use supplemental reason code 227.
NOTE: If the payment date for the newly authorized “PC/PD” is different from the payment date of the losing budget group, the CAO may need to issue two OTIs to cover the period to the losing budget group’s payment date.
Using case or budget close, close the “PC/PD” category effective as of the supplemental OTI “through” date.
NOTE: If a second OTI is needed, do not close the “PC/PD” category until after completing the second OTI transaction.
On the deadline date, open the budget for the person(s) in the new budget group in the “C/D” category using reason code 065 effective with the date following the “PC/PD” closure.
If the person(s) is being added to an existing open cash budget, use reason code 065 effective the first payment date that can be met.
7. Process an overpayment referral against the losing budget group for assistance received for person(s) in the new budget group beginning with the date of addition to the new case or budget to the date of deletion from the losing budget.
8. If a member of the losing budget group appeals the FSA reduction within the 10-day appeal period, the children in the new budget group will still be removed from the original budget group. Authorize a recurring Special Need Allowance (SNA) to the losing budget group to make up for the reduction amount. Authorize it using reason code 228. If TANF eligible children remain in the losing budget, it will stay as TANF.
When the hearing decision is in favor of the CAO, remove the SNA from the losing budget. Process an overpayment referral against the losing budget for the total overpayment amount, including the SNA and any money received during the appeal period.
NOTE: The procedure for authorizing assistance in these unique cases has changed. However, the standard eligibility requirements for the receipt of assistance have not changed. The victim(s) of domestic violence must establish eligibility for assistance under requirements in Chapter 104, Application, and Chapter 178, Verification. Those requirements are not changed or waived, except as specified in this section.
Below are special procedures to make the transfer faster for children being removed from one budget group and added to another due to a custody hearing determination or settlement. Use these procedures only when the children affected by custody hearing decisions are current cash assistance recipients.
The procedures are as follows:
1. The person gaining custody tells the CAO that custody of the children has been obtained, the children are under the care and control of the person who gained custody, and that person asks that assistance be authorized. If the children are not receiving assistance at this time, then complete the application process as usual.
NOTE: The guardian must provide acceptable legal verification of the custody change. Acceptable legal verification may include:
Court approved settlement of a custody petition;
Custody order;
Divorce settlement documenting that custody has been agreed on.
Authorization of assistance cannot take place without presentation of a legal document verifying the custody change.
2. For children who are receiving assistance at this time, the worker will immediately (within the same work day) send an Advance Notice to the losing budget group advising that the monthly assistance payment is being reduced or the case is being closed because of the removal of the person and/or children from the budget group.
3. Within the same day, the worker will complete the application for the person and/or the children. This requires the worker to have the person complete the PA 600, provide essential verification, and cooperate with child support requirements unless good cause prevents such cooperation.
NOTE: Transfer information needed for child support purposes from the other record. An Automated Support Referral (PA 643) is generated on the losing parent.
Be as generous and open-minded as possible when deciding what must be verified before authorizing assistance. For example, do not require verification again if the children’s original record verifies birth dates and social security numbers. The caretaker/relative must provide a copy of the court order verifying custody.
4. When eligibility is established, authorize assistance on behalf of the person and/or child. If the person establishing the new budget group meets the definition of a specified relative for the child, authorize assistance in the TANF category.
NOTE: Regulations allow for a TANF child to continue receiving benefits if that TANF child is placed under the care of a non-specified relative while the courts make a custody decision. See Chapter 127, Exception to Living with a Specified Relative.
5. Assistance may be authorized before the effective date of the losing group’s benefit reduction amount.
6. These actions happen in the following order on the same day:
Using individual delete, remove the person(s) from the losing budget group using reason code 065 effective with the first benefit that can be reached allowing for Advance Notice.
Using case or budget open, authorize medical assistance under the “PC/PD” category for the new budget group using reason code 065. The “PC/PD” authorization is effective as of the transaction date. Issue a duplicate emergency MA card if required.
Using a county OTI, issue benefits for the new budget group based on the new FSA amount covering the period from the date the “PC/PD” category is authorized to the day before the effective closing date in the losing budget. Use supplemental reason code 227.
NOTE: If the payment date for the newly authorized “PC/PD” is different from the payment date of the losing budget group, the CAO may need to issue two OTIs to cover the period to the losing budget group’s payment date.
Using case or budget close, close the “PC/PD” category effective as of the supplemental OTI “through” date.
NOTE: If a second OTI is needed, do not close the “PC/PD” category until after completing the second OTI transaction.
On the deadline date, open the budget for the person(s) in the new budget group in the “C/D” category using reason code 065 effective with the date following the “PC/PD” closure.
If the person(s) is being added to an existing open cash budget, use reason code 065 effective the first payment date that can be met.
7. Process an overpayment referral against the losing budget group for assistance received for person(s) in the new budget group beginning with the date of addition to the new case or budget to the date of deletion from the losing budget.
8. If a member of the losing budget group appeals the FSA reduction within the 13-day appeal period, the children in the new budget group will still be removed from the original budget group. Authorize a recurring Special Need Allowance (SNA) to the losing budget group to make up for the reduction amount. Authorize it using reason code 228. If TANF-eligible children remain in the losing budget, it will remain TANF.
When the hearing decision is in favor of the CAO, remove the SNA from the losing budget. Process an overpayment referral against the losing budget for the total overpayment amount, including the SNA and any money received during the appeal period.
NOTE: The procedure for authorizing assistance in these special cases has changed. However, the standard eligibility requirements for the receipt of assistance have not changed. The caretaker/relative of the children must establish eligibility for assistance using requirements in Chapter 104, Application, and Chapter 178, Verification. Those requirements are not changed or waived, except as specified in this section.
Reissued February 7, 2013, replacing January 31, 2012