5101:1-5-70 Disability financial assistance (DFA): interim assistance.

 

 

 

5101:1-5-70                 DADFA: interim assistance.

 

 

 

(A)  General principles

 

(1)   Section 1631 of the Social Security Act, as amended by Section 5 of Public Law 93-368, Section 1 of Public Law 94-365, and Section 204 of Public Law 104-193, provides for the reimbursement to states which have furnished assistance (cash or vendor payments) to an individual for meeting basic needs during:

 

(a)    The interim period for initial SSI claims, as set forth in paragraph (B) of this rule; or

 

(b)    The interim period for initial posteligibility SSI claims as set forth in paragraph (E) of this rule.

 

(2)   "Interim assistance" (IA), as defined by the social security administration (SSA) means assistance furnished to an individual or on behalf of the individual, financed totally from state and/or local funds, for meeting basic needs and furnished:

 

(a)   During the period beginning with the first day of the month following the later of:

 

(i)     The  month  in  which  the  individual  filed  an  application  for  SSI benefits; or

 

(ii)    The month for which the individual was found eligible to receive SSI benefits; and

 

Ending with (and including) the month the individual's SSI benefits began; or

 

(b)    During the period beginning with the day the individual's SSI benefits were reinstated after a period of suspense or termination, and ending with (and including) the month the individual's SSI benefits were resumed.

 

(3)   IA for initial claims, or initial posteligibility claims, does not include:

 

(a)  Payment for medical assistance; or

 

(b)   Assistance that is financed in whole or in part from federal funds; or

 

 

 

(c)      Assistance financed totally from state and/or local funds which is authorized for individuals for whom an SSI application is not pending, or for whom SSI benefits have not been terminated or suspended.

(4)     The terms "initial claims" and "initial posteligibility claims" mean the first payment with respect to the IA, as defined in paragraph (A)(2) of this rule, but do not include:

(a)         Any emergency advance payments authorized under section 1631(a)(4)(A) of the Social Security Act; or

(b)   Any presumptive disability or presumptive blindness payment authorized under section 1631(a)(4)(B) of the Social Security Act. Payments to individuals based on presumptive disability or blindness are made by the SSA and are issued directly to the individual without regard for IA involvement. Any retroactive payment due the individual after a final determination has been made will automatically be made to the ODJFS through the CDJFS; or,

(c)     Any immediate payments authorized under section 1631(a)(1) of the Social Security Act.

(B)  Interim period for initial claims

(1)    The interim period for initial claims begins with the first day of the month following the later of:

(a)   The month in which an individual filed an application for SSI benefits; or

(b)   The month that the individual is found eligible for SSI benefits; and ends with (and includes) the month that SSI benefit payments are made.

(2)    The interim period includes the last IA payment which is authorized and for which delivery cannot be stopped, following the CDJFS receipt of the individual's retroactive SSI benefit payment from the SSA.

(3)    The interim period may be extended when the initial claim is denied and a timely appeal is filed. In this situation, the interim period shall be extended pending SSA's decision on the appeal, which is the final determination. The interim period may be prolonged by reconsideration and other appeals of the initial SSI eligibility determination.

(4)    If a new initial claim is filed, rather than an appeal, the interim period shall begin with the date of the new initial claim, and a new ODJFS 7319JFS 07319 "Repayment Authorization for Interim Assistance Paid During Initial Eligibility Payment Period" shall be required.

(5)   The CDJFS shall not retain reimbursement for IA paid by ODJFS for the month in which the application for SSI is filed if the individual is not eligible for SSI in that month.

(6)    The CDJFS shall not recoup IA issued by ODJFS to an individual during the interim period for any month in which the individual was not eligible for an SSI payment.

(C)  Written authorization for repayment of IA during initial claim period

(1)    For each individual who applies for DADFA for whom an SSI application is pending, an ODJFS 7319a JFS 07319 must be completed.

(2)   If the individual refuses to sign the repayment authorization, the application for DADFA shall be denied.

(3)   An ODJFS 7319A JFS 07319 must be completed for each individual in receipt of ongoing DA cashDFA who applies for SSI. Following completion of the ODJFS 7319JFS 07319, the individual shall be considered to be receiving IA.

(4)     The interim period as set forth in paragraph (B) of this rule, applies to individuals in receipt of ongoing DADFA benefits who apply for SSI. Refusal of the individual to sign the ODJFS 7319JFS 07319 renders the individual ineligible for DADFA while the SSI application is pending.

(5)    The repayment authorization remains in effect until a final determination has been made by the SSA. If the claim is denied and a timely appeal is filed, the decision from the appeal is the final determination. If a new claim is filed rather than an appeal, a new ODJFS 7319JFS 07319 is required:

(6)   Once the authorization is executed, the individual cannot withdraw or cancel it, unless both the individual and the CDJFS agree in writing to the withdrawal. In this situation, the individual is not eligible for DADFA once the authorization is withdrawn.

(7)   If at a later date the ODJFS 7319JFS 07319 is withdrawn at the agreement of

both the individual and the CDJFS, the revocation of the authorization form is effective the date of the joint agreement between the individual and the CDJFS. It is not retroactive to the date the authorization was signed.

(D)  CDJFS responsibility when eligibility for IA for initial claims period is determined.

When an individual's eligibility for IA for an initial claim, as defined in paragraphs (A)(4) and (B) of this rule, is being determined, the CDJFS shall:

(1)   Secure a signature on the ODJFS 7319JFS 07319 for each individual for whom an SSI application is pending.

(2)   Register a medicaid application for the individual.

(3)   Complete a disability determination referral to ODJFS county medical services (CMS).

(4)    Send the repayment authorization to the local social security office within ten working days of obtaining the individual's signature on the ODJFS 7319JFS 07319. The CDJFS shall keep a copy in the assistance group record. If the individual is determined not eligible for DADFA, the ODJFS 7319JFS 07319 shall be rescinded within one working day of the determination of ineligibility. It is necessary to keep the ten working days requirement as no retroactive SSI payment will be received if the local social security office has processed the SSI application before the repayment authorization is received.

(5)   Issue IA if all DADFA eligibility requirements are met.

(6)     Upon receipt of the retroactive SSI benefits, the CDJFS shall compute the amount of IA issued as follows:

(a)    When a married couple is receiving IA, and only one spouse is found eligible for SSI benefits, the IA amount to be reimbursed shall be the difference between the DADFA payment for one person and the DADFA payment for two. When both of the individuals are found eligible for SSI benefits, and both were receiving DADFA, the IA amount to be reimbursed for each individual shall be one-half of the total monthly payment.

(b)   In situations when a family is receiving DADFA, and at least one of the assistance group members is receiving IA, that portion of the monthly DADFA  payment  that  represents  the  IA  individual's  needs  is  the

amount to be reimbursed as IA, if the individual is subsequently found eligible for SSI. Specifically, the amount to be reimbursed is the difference between the DADFA payment standard including the SSI eligible individual(s), and the DADFA payment standard excluding the individual(s).

(7)   Any amount that represents the difference between the amount of the retroactive SSI payment and the amount of IA issued shall be paid to the individual by county warrant. The warrant shall be issued within ten working days of the receipt of the individual's retroactive SSI check by the CDJFS.

(8)    If the SSA has selected a representative payee for the individual, the CDJFS shall pay the balance of the retroactive SSI benefits due the individual to the payee. The name and address of the payee are shown on the SSA-8125 "Notice of Interim Assistance Reimbursement Eligibility and Accountability Report".

(9)   If the law requires the commissioner of SSA to restrict the manner in which the residual amount of a retroactive SSI payment may be paid to an individual, such as installment and/or dedicated account cases, SSA will ask the CDJFS to determine the amount of IA it is entitled to be reimbursed and SSA will then release that amount to the CDJFS.

(10)    Within ten working days of the CDJFS receipt of the individual's retroactive SSI check, an ODJFS 7107a JFS 07107 "Notice of Interim Assistance Reimbursement" shall be sent to the individual explaining the apportionment of the retroactive SSI check. If no payment is being made to the individual, the CDJFS shall enter "no warrant" in the blocks designated for "date of warrant" and "amount of warrant" on the ODJFS 7107JFS 07107.

(11)   If an individual dies or disappears before he has received all the SSI benefits to which he is entitled, ODJFS retains the right to receive benefits due for the retroactive period. In this situation, the SSA will forward a one-time payment to the CDJFS for ODJFS. Any excess benefits received must be returned to the SSA on an individual case basis showing the individual's name and social security number. The CDJFS shall send the excess funds to the SSA district office which services the CDJFS or to the district office which services the individual's last address.

(12)   If required, the CDJFS shall complete part IV of the SSA-8125 as set forth in the instructions for completion of the SSA-8125 in paragraph (I) of this rule, and return it to the SSA. The CDJFS shall report the receipt and distribution of retroactive SSI benefits retained by the CDJFS as reimbursement for IA on

the ODJFS 2827JFS 02827 "Monthly Financial Statement." The CDJFS shall determine the amount of retroactive SSI benefits to be retained as reimbursement by including all DADFA benefits paid by ODJFS that meet the definition of IA as set forth in paragraph (A) of this rule, irrespective of the number of Ohio counties in which the individual resided during the interim period.

(13)    The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DADFS funds paid by ODJFS on the SSA-8125. If the individual's claim for SSI is denied or no retroactive payments are due, the CDJFS is not required to complete part IV of the SSA-8125 but shall retain the original in the assistance group record.

(E)  Interim period for initial posteligibility claims

(1)   The interim period for initial posteligibility claims begins with the first day that the individual's SSI benefits were suspended or terminated, if the individual is subsequently found eligible for SSI benefits, and ends with, and includes, the month that the SSI benefit payment is made.

(2)   The interim period for initial posteligibility claims includes the last IA payment which is authorized and for which delivery cannot be stopped, following the CDJFS receipt of the individual's retroactive reinstated SSI benefit payment from the SSA.

(3)     The CDJFS shall not recoup IA issued by the ODJFS during the initial posteligibility claim period for any month in which the individual was not eligible for a retroactive reinstatement of SSI benefits.

(4)   The interim period for initial posteligibility claims continues until:

(a)   The period of time has elapsed that the individual has to file an appeal if the suspension or termination requires an appeal for reinstatement; or

(b)     SSI releases a retroactive payment after a period of suspension or termination; or

(c)   SSA makes a final determination on the claim and the individual does not file a timely request for review. If a timely request for review is filed, the decision from the review is the final determination; or

(d)   One year has elapsed from the date that the SSI benefits were suspended

or terminated, if the SSA has not reopened the individual's claim to explore the individual's eligibility for reinstated SSI benefits.

(5)   Under no circumstances shall the interim period for initial posteligibility claims exceed one year unless the SSA has reopened the individual's claim and is in the process of exploring the individual's eligibility for reinstated SSI benefits.

(6)   The initial posteligibility claim period shall expire twelve months following the suspension or termination of the individual's SSI benefits if the SSI payments are not reinstated by the twelfth month, and if the SSA has not reopened the individual's claim and is not in the process of exploring the individual's eligibility for reinstated SSI benefits.

(7)   If the individual's SSI benefits are not reinstated within the twelve-month initial posteligibility claim period, and no SSA decision is pending, the individual must reapply for SSI benefits.

(8)    In addition, the CDJFS must secure the individual's signature on an ODJFS 7319a JFS 07319, as the ODJFS 7233JFS 07233 will cease to be effective following the expiration of the twelve-month initial posteligibility interim period.

(F)   Written authorization for IA during initial posteligibility claim period

(1)   For each individual who applies for DADFS and whose SSI benefits have been terminated or suspended, an ODJFS 7233a JFS 07233 must be completed.

(2)   If the individual refuses to sign the repayment authorization, the application for DADFA during the initial posteligibility period shall be denied.

(3)      An individual who applies for DADFA whose SSI benefits have been terminated or suspended shall be referred to the local SSA office for verification of the status of the individual's termination or suspension of SSI benefits, prior to authorizing DADFA.

(4)   The repayment authorization remains in effect until one of the following events occurs:

(a)     SSI  releases  a  retroactive  payment  after  the  period  of  suspension  or termination; or

(b)    SSA makes a final determination on the issue and no timely request for review is filed; or

(c)   The period of time has elapsed that the individual has to file an appeal if the reason for the suspension or termination requires an appeal for reinstatement; or

(d)      The CDJFS and the individual agree in writing to terminate the authorization, which shall result in the individual's ineligibility for DADFA; or

(e)   One year has elapsed from the date that the individual's SSI benefits were terminated or suspended, unless the SSA has reopened the individual's claim and is in the process of exploring the individual's eligibility for reinstated SSI benefits. The repayment authorization for the interim period of the initial posteligibility claim shall not exceed one year, unless the SSA has reopened the individual's claim and is in the process of exploring the individual's eligibility for reinstated SSI benefits; or

(f)     SSI benefits are not reinstated within one year from termination or suspension, and the SSA has not reopened the individual's claim, the ODJFS 7233JFS 07233 is no longer in effect as the individual must reapply for SSI benefits which requires that an ODJFS 7319a  JFS 07319 must be completed, because reinstatement of SSI benefits will not occur. Therefore, the initial posteligibility claim period ends, and an initial claim period begins with the individual's reapplication for SSI benefits.

(G)   CDJFS responsibility when eligibility for IA for initial posteligibility payment period is determined.

When an individual whose SSI benefits have been suspended or terminated applies for DADFA, the CDJFS shall:

(1)     Secure a signature on the ODJFS 7233JFS 07233 for each individual who applies for DADFA and whose SSI benefits have been terminated or suspended.

(2)    Send the repayment authorization to the local SSA office within one working day of obtaining the individual's signature on the ODJFS 7233JFS 07233. The CDJFS shall keep a copy in the assistance group record. If the individual is subsequently determined to be ineligible for DADFA, the ODJFS 7233JFS

07233 shall be rescinded within one working day of the determination of ineligibility. It is necessary to keep the one working day requirement as the CDJFS will not receive the individual's retroactive reinstated SSI check if the SSA office processes the individual's reinstatement of SSI benefits prior to receipt of the ODJFS 7233JFS 07233 from the CDJFS.

(3)    Prior to approving DADFA for an individual whose SSI benefits have been suspended or terminated, the CDJFS shall refer the individual to the local SSA office to secure verification of the status of the individual's termination or suspension of SSI benefits.

(4)    Issue IA if all DADFA requirements are met including verification from the SSA office that the individual's SSI benefits will not be immediately reinstated.

(5)    Once the individual's SSI benefits are reinstated, the retroactive reinstatement SSI award will be sent to the CDJFS that forwarded the ODJFS 7233JFS 07233 to the SSA. If the SSA denies the individual's request for reinstatement, and the individual does not timely request a review of the determination, the SSA-8125 will be sent to notify the CDJFS of the denial of reinstatement.

(6)    Upon receipt of the individual's retroactive reinstated SSI benefits, the CDJFS shall compute the amount of IA issued as follows:

(a)     When a married couple is receiving IA, (DADFA) during the initial posteligibility payment period, and only one of the individuals receives reinstated SSI benefits, the amount of the IA to be reimbursed shall be the difference between the DADFA payment for one and the DADFA payment for two. When both of the individuals are found eligible for SSI during initial posteligibility payment period, the IA amount to be reimbursed for each individual shall be one-half of the total monthly payment.

(b)    Additionally, if the SSA prorates the individual's SSI payment for any month, the initial posteligibility IA amount for that month (remainder of difference between payment for one and two) must be prorated as set forth in paragraph (H) of this rule.

(c)   In situations when a family is receiving DADFA, and at least one of the assistance group members is receiving IA, that portion of the monthly DADFA payment that represents the IA individual's needs is the amount to be reimbursed as IA, if the individual is subsequently found

eligible for SSI. Specifically, the amount to be reimbursed is the difference between the DADFA payment standard including the SSI eligible individual(s), and the DADFA payment standard excluding the individual(s).

(7)   Any amount that represents the difference between the amount of the retroactive reinstated SSI payment and the amount of IA issued shall be paid to the individual by county warrant. The warrant shall be issued within ten working days of the CDJFS receipt of the individual's retroactive reinstated SSI check.

(8)    If the SSA has selected a representative payee for the individual, the CDJFS shall pay the balance of the retroactive reinstated SSI benefits due the individual to the payee. The name and address of the payee are shown on the SSA-8125.

(9)   If the law requires the commissioner of the SSA to restrict the manner in which the residual amount of a retroactive SSI payment may be paid to an individual such as installment and/or dedicated account cases, SSA will ask the CDJFS to determine the amount of IA it is entitled to be reimbursed and SSA will then release that amount to the CDJFS.

(10)    Within ten working days of the CDJFS receipt of the individual's retroactive reinstated SSI payment, an ODJFS 7107a JFS 07107 shall be sent to the individual explaining the apportionment of the retroactive reinstated SSI check. If no payment is being made to the individual, the CDJFS shall enter "no warrant" in the blocks designated for "date of warrant" and "amount of warrant" on the ODJFS 7107JFS 07107.

(11)   If an individual dies or disappears before he has received all the SSI benefits to which he is entitled, ODJFS retains the right to receive benefits due for the retroactive period. In this situation, the SSA will forward a one-time payment to the CDJFS for ODJFS. Any excess benefits received must be returned to SSA on an individual case basis showing the individual's name and social security number. The CDJFS shall send the excess funds to the SSA district office which services the CDJFS or to the district office which services the individual's last address.

(12)   If required, the CDJFS shall complete part IV of the SSA-8125 as set forth in the instructions for completion of the SSA-8125, and return it to the SSA. The CDJFS shall report the receipt and distribution of retroactive SSI benefits retained by the CDJFS as reimbursement for IA on the ODJFS 2827JFS 02827. The CDJFS shall determine the amount of retroactive SSI benefits to be  retained  as  reimbursement  by  including  all  DADFA  benefits  paid  by

ODJFS, that meet the definition of IA, irrespective of the number of Ohio counties in which the individual resided during the interim posteligibility period.

(13)    The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DADFA funds paid by ODJFS on the SSA-8125. If the individual's initial posteligibility claim for retroactive reinstated SSI benefits is denied or no retroactive reinstated benefits are due, the CDJFS is not required to complete part IV of the SSA-8125 but shall retain the original in the assistance group record.

(H)  Computation of IA reimbursement to be retained by the CDJFS

(1)    In determining the amount of IA to be retained as reimbursement for initial posteligibility claims, the CDJFS must prorate the amount it recoups for any month that SSA prorates the retroactive SSI payment.

(2)   The CDJFS must prorate the amount of DADFA issued beginning with the day from which the SSI payments are prorated and retain only that prorated amount of DADFA issued as reimbursement.

(3)     The CDJFS shall determine that a month's SSI payment was prorated by reviewing the "payment summary" of the SSA-8125. If the day shown under the "payment summary" of the SSA-8125 is other than the first day of the month, the CDJFS shall determine that the SSI payment was prorated and shall prorate the amount of DADFA to be applied as reimbursement.

(4)   The CDJFS shall not recover the difference paid for a prorated month from any other month in the interim period for initial posteligibility claims.

(5)   The CDJFS shall not recoup DADFA issued to the individual during the interim period, either the initial eligibility or the initial posteligibility interim period, for any month in which the individual was not eligible for an SSI payment.

(I)  Accounting for IA reimbursement

(1)    In every situation in which an individual has received IA, either during initial eligibility or initial posteligibility payment period, the SSA-8125 shall be forwarded by the SSA to the CDJFS.

(2)   The SSA-8125 will contain the following information:

(a)   Amount of retroactive payment being made;

(b)   The period of time covered by the retroactive payment;

(c)   The name of the county to which the check is being sent; and

(d)  The amount of the check.

(3)   In all cases, when the commissioner of SSA is not required by law to restrict the manner in which the retroactive SSI payment may be paid to an individual, the SSA will send the retroactive SSI payment to the CDJFS. When the CDJFS receives the first SSI payment due an individual, part IV of the SSA-8125 must be completed as set forth in paragraphs (I)(5)(a) to (I)(5)(h) of this rule. Within thirty working days of receipt of the IA reimbursement, the original copy of the SSA-8125 must be forwarded to the SSA.

(4)(a) When the commissioner of the SSA is required by law to restrict the manner in which the retroactive SSI payment may be paid to an individual, the CDJFS must forward the completed SSA-8125 to the designated SSA office within ten working days of the date SSA forwarded the form to the CDJFS. If the CDJFS does not complete and forward the SSA-8125 to the SSA office within ten working days of the date that it was forwarded to the CDJFS, SSA will forward a follow-up request to the CDJFS for the completion and return of that form. If the CDJFS fails to return the form to the designated SSA office within fifteen working days of the follow-up request, SSA will release the retroactive amount to the individual through its applicable processing procedures to protect the individual from hardship that may arise from the failure of the CDJFS to comply with SSA's interim assistance processing requirements. In these situations, the CDJFS may pursue recovery from the individual for any IA that the CDJFS may be due. However, the commissioner of the SSA will not be a party to or responsible for participating in the recovery effort under these circumstances.

(4)     The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DADFA funds paid by ODJFS on the SSA-8125. If the individual's claim for SSI is denied or no retroactive payments are due, the CDJFS is not required to complete part IV of the SSA-8125, but shall retain the original in the assistance group record.

(5)   In all cases, the CDJFS shall complete part IV of form SSA-8125 within thirty

working days after an IA reimbursement payment for either an initial SSI benefit claim or an initial posteligibility benefit claim is received from the SSA by the CDJFS.

(a)   "Item 1" - amount of the reimbursement check the CDJFS received from the SSA. Enter the total dollar amount of the payment received from SSA for the individual.

(b)   "Item 2" - amount of IA paid to the individual by ODJFS (using definition of IA printed on form SSA-8125). Enter the total dollar amount representing IA payment made by the CDJFS to the individual.

(c)   "Item 3" - amount of the reimbursement check retained by the CDJFS for ODJFS. Enter the total dollar amount of reimbursement retained by the CDJFS as reimbursement.

(d)     "Item 4" - amount of the reimbursement check forwarded to the individual. Enter the dollar amount of the reimbursement which exceeds the IA benefits paid by ODJFS and which excess was actually paid to the individual or his representative payee. "date sent": enter the date the excess was actually sent to the individual or representative payee.

(e)   "Item 5" - amount of the reimbursement check returned to the SSA. Enter the total dollar amount of reimbursement returned to the SSA for any reason.

(f)  Generally, the "remarks" section of the form is to be used by the CDJFS to indicate any other pertinent information relating to the applicable IA reimbursement payment involved which should be explained.

(g)   Some specific items which should be explained in the "remarks" section are as follows:

(i)   Enter the reason for the return of any portion of the reimbursement check to the SSA.

(ii)   If for any reason the total of the amounts shown in items 3, 4, and 5 of the report does not equal the amount shown in item 1, enter the reason for the discrepancy and outline what has been done to resolve the situation.

(iii)    If the CDJFS is unable to submit the SSA-8125 to the SSA within thirty working days from the receipt of the reimbursement check, explain the reason for the delay in reporting.

(iv)   Nonreceipt of the IA reimbursement check.

(h)   "Signature, title, agency, and date" - the date the IA report is forwarded to the SSA should be entered in the appropriate space. In the signature space, the name of the authorized individual who will sign the report should be typed or printed as well as signed. The title of the individual signing the report and his agency should also be typed or printed.

Effective:                                07/01/2003

CERTIFIED ELECTRONICALLY

Certification

06/27/2003

Date

Promulgated Under:   111.15

Statutory Authority:   5115.03

Rule Amplifies:           5115.03

Prior Effective Dates: 7-1-84, 8-1-85 (Emer.),

10-17-85, 4-9-87, 7-1-88

(Emer.), 9-15-88, 5-1-89

(Emer.), 7-1-89 (Emer.),

9-23-89, 8-1-90 (Emer.),

10-25-90, 10-1-91 (Emer.),

12-20-91, 2-1-95, 5-1-95,

8-1-95 (Emer.), 10-30-95,

7-1-98, 7-1-2001