5101:4-8-03 Food assistance: restoration and entitlement of lost benefits.

 

 

 

5101:4-8-03                 Food stamps: Restoration restoration and entitlement of lost benefits.

 

 

 

(A)   Each county agency shall be responsible for maintaining an accounting system for documenting an AG's entitlement to restoration of lost benefits and for recording the balance of lost benefits that must be restored to the AG. Each county shall, at a minimum, document in the case file using the JFS 07424, "Report of Claim Determination/Lost Benefits," "Report of Claim Determination/Lost Benefits" (rev. 8/01), how the amount to be restored was calculated and the reason lost benefits must be restored. The accounting system shall be designed to readily identify those situations where a claim against an AG can be used to offset the amount of the to be restored benefits. Thus prior to restoring lost benefits, the county agency shall complete the JFS 07424 and offset any restoration amount by any outstanding claims.

 

(B)  Entitlement

 

The county agency shall restore to AGs benefits which were lost whenever the loss was caused by an error by the county agency or by an administrative disqualification for intentional program violation which was subsequently reversed, or as otherwise specifically provided for in Chapter division-level designation 5101:6 of the Administrative Code and paragraphs (G) to (J) of this rule entitling AGs to restoration of lost benefits. Furthermore, unless there is a statement elsewhere in the regulations that an AG is entitled to lost benefits for a longer period, benefits shall be restored even if the AG is currently ineligible. Benefits shall be restored for not more than twelve months prior to whichever of the following occurred first.

 

(1)  The date the county agency receives a request for restoration from an AG; or;

 

(2)   The date the county agency is notified or otherwise discovers that a loss to an AG has occurred. Benefits shall be restored even if an AG is currently ineligible.

 

(C)  Entitlement as a result of judicial action

 

The county agency shall restore to AGs benefits which were found by any judicial action to have been wrongfully withheld. If the judicial action is the first action the recipient has taken to obtain restoration of lost benefits, the benefits shall be restored for a period of not more than twelve months from the date the court action was initiated. When the judicial action is a review of a county agency action, the benefits shall be restored for a period of not more than twelve months from the first of the following dates.

 

(1)  The date the county agency receives a request for restoration; or;

 

 

(2)    If no request for restoration is received, the date the fair hearing action was initiated; but never more than one year from when the county agency is notified of, or discovers, the loss.

(D)  Restoration of benefits due to gaining categorical eligibility

AGs who gain categorical eligibility are entitled to restored benefits back to the date of the original food stamp application, the date it gained categorical eligibility, or the date categorical eligibility for the specific type of AG was created, whichever is later. To determine the prior months of eligibility and the date when restored benefits should begin, consult rule 5101:4-4-27 of the Administrative Code.

(E)  Errors discovered by the county agency

If the county agency determines that a loss of benefits has occurred, and the AG is entitled to restoration of those benefits, the county agency shall automatically take action to restore any benefits that were lost. No action by the AG is necessary. However, benefits shall not be restored if the benefits were lost more than twelve months prior to the month the loss was discovered by the county agency in the normal course of business, or were lost more than twelve months prior to the month the county agency was notified in writing or orally of a possible loss to a specific AG. The AG shall be provided notice of entitlement in accordance with Chapter 5101:6-2 of the Administrative Code. The county agency shall notify the AG of its entitlement, the amount of benefits to be restored, any offsetting that was done, the method of restoration, and the right to appeal through the fair hearing process, if the AG disagrees with any aspect of the proposed lost benefit restoration.

(F)   Disputed benefits

If the AG does not agree with the amount of lost benefits computed by the county agency or the county agency's determination that the AG is not entitled to restoration of lost benefits, the following procedures apply.

(1)   AG does not agree with amount of lost benefits restored

If the county agency determines that an AG is entitled to restoration of lost benefits, but the AG does not agree with the amount to be restored as calculated by the county agency or any other action taken by the county agency to restore lost benefits, the AG may request a fair hearing.  The hearing request must be received by the state or county agency within ninety days of the date of the AG is notified notice of its entitlement to restoration of lost benefits. If a fair hearing request is received requested prior to or during the time lost benefits are being restored, the AG shall receive the lost benefits

as determined by the county agency pending the results of the fair hearing. If the fair hearing decision is favorable to the AG, the county agency shall restore the lost benefits in accordance with that decision.

(2)   AG does not agree with denial of restoration of lost benefits

If an AG believes it is entitled to restoration of lost benefits, but the county agency, after reviewing the case file, does not agree, the county agency shall notify the AG that the request for restoration of lost benefits is denied, in accordance with Chapter 5101:6-2 of the Administrative Code. The hearing request must be received by the state or county agency within ninety days from the date the notice was issued AG has ninety days from the date of the county agency determination to request a fair hearing. The county agency shall restore lost benefits to the AG only if the fair hearing decision is favorable to the AG. Benefits lost more than twelve months prior to the date the county agency was initially informed of the AG's possible entitlement to lost benefits shall not be restored.

(G)  Computing the amount to be restored

After correcting the loss for future months and excluding those months for which benefits may have been lost prior to the twelve-month time limit limits described in paragraphs (E) and (F) of this rule, the county agency shall calculate the amount to be restored as follows.:

(1)   Incorrect allotment

If the AG was eligible but received an incorrect allotment, the loss of benefits shall be calculated only for those months the AG participated.

(2)   Delay, denial, or termination

If the loss was caused by an incorrect delay, denial, or termination of benefits, the months affected by the loss shall be calculated as follows. After computing the date the loss initially occurred, the loss shall be calculated for each month subsequent to that date until either the first month the error is corrected or the first month the AG is found ineligible.

(a)   Erroneous denial

If an eligible AG's application was erroneously denied, the month the loss initially occurred shall be the month of application, or for an eligible AG filing a timely reapplication, the month following the expiration of its certification period.

(b)   Erroneous delay

If an eligible AG's application was delayed, the months for which benefits are may be lost shall be calculated in accordance with procedures for determining whether the delay was caused by the AG or by the county agency in rule 5101:4-2-01 of the Administrative Code.

(c)   Erroneous termination

If an AG's benefits were erroneously terminated, the month the loss initially occurred shall be the first month benefits were not received as a result of the erroneous action.

(H)  Determination of eligibility

For each month affected by the loss, the county agency shall determine if the AG was actually eligible. In cases where there is no information in the AG's case file to document that the AG was actually eligible, the county agency shall advise the AG of what information must be provided to demonstrate eligibility for these months. For each month the AG cannot provide the necessary information to demonstrate its eligibility, the AG shall be considered ineligible.

(I)  Calculation of benefits

For the months the AG was eligible, the county agency shall calculate the allotment the AG should have received. If the AG received a smaller allotment than it was eligible to receive, the difference between the actual and correct allotments equals the amount to be restored.

(J)   Offsetting claims

If a claim against an AG is unpaid or terminated as provided in rule 5101:4-8-19 of the Administrative Code, the amount to be restored shall be offset against the amount due on the claim before the balance, if any, is restored to the AG. At the point in time when the AG is certified and receives an initial allotment, the initial allotment shall not be reduced to offset claims, even if the initial allotment is paid retroactively.

(K)  Lost benefits to individuals disqualified for intentional program violation

Individuals disqualified for intentional program violation are entitled to restoration of any benefits lost during the months that they were disqualified, not to exceed twelve months prior to the date of county agency notification, only if the decision

which resulted in disqualification is subsequently reversed. For example, an individual would not be entitled to restoration of lost benefits for the period of disqualification based solely on the fact that a criminal conviction could not be obtained, unless the individual successfully challenged the disqualification period imposed by an administrative disqualification in a separate court action. Participation in an administrative disqualification hearing in which the AG contests the county agency assertion of intentional program violation shall be considered notification that the AG is requesting restored benefits.

(L)  Calculating amount of lost benefits due

For each month the individual was disqualified, not to exceed twelve months prior to county agency notification, the amount to be restored, if any, shall be determined By by comparing the allotment the AG received with the allotment the AG would have received had the disqualified member been allowed to participate. If the AG received a smaller allotment than it should have received, the difference equals the amount to be restored.

(M)   Method of restoration: lump-sum

The county agency shall use the following methods to restore lost benefits to AGs. Regardless of whether an AG is currently eligible or ineligible, the county agency shall restore lost benefits to an AG by issuing an allotment equal to the amount of benefits that were lost. The amount restored shall be issued in addition to the allotment currently eligible AGs are entitled to receive.

(N)  Method of restoration: monthly installment

The county agency shall honor reasonable requests by AGs to restore lost benefits in monthly installments if, for example, the AG fears the excess coupons benefits may be lost or stolen or that the amount to be restored is more than it can be used use in a reasonable period of time.

(O)  Procedure to restore lost benefits

The county agency shall authorize a separate, nonroutine issuance for the amount of the lost benefits or add the restored amount to a routine issuance. The former method is preferred as it provides a better audit trail and is simpler for the AG to understand.

(P)   Time limit for restoring lost benefits

The county agency shall issue restored benefits within thirty days from the date the lost  benefits  were  discovered.  Exceptions:  federal  regulations  require  restored

benefits due under rule 5101:4-2-02 of the Administrative Code be issued within ten days after the date the lost benefits were discovered. When restored benefits are ordered by a fair hearing decision, the issuance must take place in accordance with division-level 5101:6 of the Administrative Code.

(Q)  Beneficiary of restoration

Whenever lost benefits are due an AG and the AG's membership has changed, the county agency shall restore the lost benefits to the AG containing a majority of the individuals who were AG members at the time the loss occurred. If the county agency cannot locate or determine the AG which contains a majority of the AG members, the county agency shall restore the lost benefits to the AG containing the individual who was head of the AG at the time the error occurred.

Effective:                                                     12/01/2005

R.C. 119.032 review dates:                         09/15/2005 and 12/01/2010

CERTIFIED ELECTRONICALLY

Certification

11/21/2005

Date

Promulgated Under:                           111.15

Statutory Authority:                           5101.54

Rule Amplifies:                                  329.04, 329.042, 5101.54

Prior Effective Dates:                         6/2/80, 1/22/82, 3/20/83, 7/1/83 (Temp.), 8/19/83,

9/24/83 (Temp.), 11/11/83, 4/10/84 (Emer.), 8/1/84 (Emer.), 10/20/84, 1/16/87 (Emer.), 4/6/87, 6/22/87,

4/1/89, 1/5/90 (Emer.), 3/22/90, 10/1/90, 8/1/92 (Emer.), 10/30/92, 8/1/95, 10/1/96, 5/1/99, 10/1/01

(Emer.), 10/11/01