5101:4-8-17. Food assistance: calculating the overpayment claim amount

The county agency shall calculate claims, make collections, and disqualify assistance group members based on the date of overpayment, date of discovery, and the food assistance regulations in effect at the time of the overpayment.

(A) How is the claim amount calculated for non-trafficking claims?

(1) A county agency shall calculate a claim back to at least twelve months prior to when it became aware of the overpayment. For all claims, the county agency cannot include any amounts occurring more than six years before it became aware of the overpayment. For an intentional program violation claim, the claim shall be calculated back to the month the act of the intentional program violation first occurred.

(2) To calculate a claim, the county agency shall:

(a) Determine the correct amount of benefits the applicant should have received for each month . Do not apply the earned income deduction to any earned income the assistance group failed to report in a timely manner. When the agency failed to act on reported earned income apply the earned income deduction.

(b) Subtract the amount of the benefit the applicant should have received from the benefit amount actually received. This is the amount of the overpayment. When the overpayment equals zero or is negative dispose of the claim referral.

(c) Reduce the overpayment amount when there are any expunged benefits from the assistance group's electronic benefit transfer account . The county agency shall document any reduction of an overpayment claim by use of expunged benefits via the statewide automated eligibility system . The difference from the amount of the expunged benefits and the overpayment amount is the amount of the claim.

(B) How is the amount of an intentional program violation claim calculated?

When an assistance group member is found to have committed an intentional program violation, the county agency shall disqualify that individual and initiate collection action against the remaining adult assistance group members.

For intentional program violation claims, the amount of food assistance benefits collected shall be the greater of twenty per cent or twenty dollars per month of the assistance group's monthly entitlement, before disqualification of the assistance group member found to have committed the intentional program violation.

When the assistance group member is determined to have committed the intentional program violation by intentionally failing to report a change in the assistance group's circumstances, the first month affected by the assistance group's failure to report shall be the first month in which the change would have been effective had it been reported timely. When calculating the claim amount, the county agency shall allow the maximum reporting allowance of ten days from the date of change plus the maximum allowance for notice of adverse action of fifteen days. Therefore, for the purposes of claim calculation, a change cannot be effective sooner than twenty-five days from the date the change occurred.

Prior to the determination of an intentional program violation or the signing of either a waiver of right to a disqualification hearing or a disqualification consent agreement in cases of deferred adjudication, the claim against the assistance group shall be handled as an inadvertent household error claim.

(C) How is the amount of an inadvertent household error claim calculated?

When due to a misunderstanding or inadvertent error on the part of the assistance group, the assistance group failed to report a change in its circumstances within ten days of the date the change became known to the assistance group, the first month affected by the assistance group's failure to report shall be the first month in which the change would have been effective had it been reported timely. When calculating the claim amount, the county agency shall allow the maximum reporting allowance of ten days from the date of change plus the maximum allowance for notice of adverse action of fifteen days. Therefore, for the purposes of claim calculation, a change cannot be effective sooner than twenty-five days from the date the change occurred.

(D) How is the amount of an agency error claim calculated?

When the assistance group timely reported a change, but the county agency did not timely act on the change, the first month affected by the county's failure to act shall be the first month the county agency should have made the change effective. Therefore, when a notice of adverse action was required but was not provided, the county agency shall assume that the maximum advance notice period of fifteen days would have expired without the assistance group requesting a fair hearing.

(E) How are trafficking claims calculated?

Claims arising from trafficking-related offenses shall be the value of the trafficked benefits as determined by:

(1) The individual's admission;

(2) Adjudication; or

(3) The documentation that forms the basis for the trafficking determination.

(F) Claim offset

After calculating the amount of the claim, the county agency shall offset the amount of the claim (even when the claim is one hundred twenty-five dollars or less) against any amount of lost benefits which have not yet been restored to the assistance group. The county agency shall not offset against retroactive or initial benefits in accordance with paragraph (G) of rule 5101:4-8-03 of the Administrative Code. The county agency shall then initiate collection action for the remaining balance. When the county agency did not complete a JFS 07424, "Report of Claim Determination/Lost Benefits" (rev. 8/2001) because the claim was one hundred twenty- five dollars or less, at the time the offset action is taken, the county agency shall complete the JFS 07424 so documentation exists as to why the lost benefit amount was reduced.

(G) Processing intentional program violations

Individuals found to have committed an intentional program violation either through an administrative disqualification hearing, a federal, state, or local court, or who have signed either a waiver of right to an administrative disqualification hearing, or a disqualification consent agreement in cases referred for prosecution, shall be ineligible to participate in the program for a period of twelve months for the first offense, except as provided in paragraphs (H) to (K) of this rule, for a period of twenty- four months upon the second occasion of any intentional program violation, except as provided in paragraphs (H) to (K) of this rule, and permanently for a third occasion of any intentional program violation.

The disqualification period for non-participants at the time of the administrative disqualification or court decision shall take precedence in accordance with division 5101:6 of the Administrative Code.

(H) Controlled substance violation

Individuals found by a federal, state, or local court to have used or received food assistance benefits in a transaction involving the sale of a controlled substance (as defined in section 102 of the Controlled Substances Act ( 21 U.S.C. 802 )), ( 12/2014) shall be ineligible to participate in the program for a period of twenty-four months upon the first occasion of such a violation and permanently upon the second occasion of such a violation.

(I) Firearms, ammunition, or explosives violation

Individuals found by a federal, state, or local court to have used or received food assistance benefits in a transaction involving the sale of firearms, ammunition, or explosives shall be permanently ineligible to participate in the program upon the first occasion of such violation.

(J) Trafficking food assistance benefits of five hundred dollars or more

An individual shall be permanently disqualified when convicted by a federal, state, or local court of trafficking food assistance benefits for an aggregate amount of five hundred dollars or more.

For purposes of this rule, "trafficking" is defined as fraudulently using, transferring, altering, acquiring or possessing food assistance benefits or presenting food assistance benefits for payment or redemption knowing the same to have been fraudulently obtained or transferred for cash or consideration other than eligible food. "Acquiring food assistance benefits" does not include providing false information as part of the certification, reapplication, or reporting changes processes.

(K) Receipt of multiple benefits simultaneously

An individual shall be ineligible to participate in the food assistance program for a ten-year period when the individual is found, through an administrative disqualification hearing, a federal, state, or local court, or who has signed either a waiver of right to administrative disqualification hearing or a disqualification consent agreement in cases referred for prosecution, of having made a fraudulent statement or representation with respect to the identity or place of residence of the individual in order to receive multiple benefits simultaneously under the food assistance program.

Effective: 8/1/2015
Five Year Review (FYR) Dates: 04/17/2015 and 08/01/2020
Promulgated Under: 111.15
Statutory Authority: 5101.54
Rule Amplifies: 329.04, 329.042, 5101.54
Prior Effective Dates: 6/2/80, 6/20/80, 10/1/81, 6/2/82, 8/15/82, 9/27/82, 1/1/83, 6/10/83, 8/1/83, 9/24/83 (TEMP.), 11/11/83, 4/1/84 (TEMP.), 6/1/84, 8/1/84 (EMER.), 10/20/84, 12/31/84 (EMER.), 4/1/85, 5/3/85 (EMER.), 8/1/85, 8/20/86 (EMER.), 11/15/86, 3/24/88 (EMER.), 6/18/88, 10/1/88 (EMER.), 11/18/88, 4/1/89, 5/1/89 (EMER.), 7/11/89 (EMER.), 7/17/89, 9/17/89, 1/5/90 (EMER.), 5/22/90, 10/1/90, 10/1/91, 2/3/92, 8/1/92 (EMER.), 10/30/92, 6/1/94, 7/1/94, 9/1/94, 7/1/95, 8/1/95, 12/1/95, 5/1/96, 9/22/96 (EMER.), 10/1/96 (EMER.), 11/22/96, 11/22/96 12/1/95, 5/1/96, 9/22/96 (EMER.), 10/1/96 (EMER.), 11/22/96, 11/22/96 (EMER.), 1/1/97 (EMER.), 2/7/97, 3/1/97, 3/23/97, 10/1/97, 2/1/98 (EMER.), 2/23/98, 8/1/98, 5/1/99, 7/15/99, 8/1/01 (Emer.), 8/11/01, 9/1/04, 12/01/09