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

 

 

 

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

 

 

 

(A)  What is interim assistance?

 

(1)   "Interim assistance" 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 provided:

 

(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 supplemental security income (SSI) benefits and ending with (and including) the month the individual's SSI benefits began; 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.

 

(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.

 

(2)    Interim assistance for initial claims, or initial posteligibility claims does not include:

 

(a)   Payment for medical assistance;

 

(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.

 

(B)  What is an initial claim and initial posteligibility claim?

 

The terms "initial claim" and "initial posteligibility claim" mean the first payment of interim assistance. The terms do not include:

 

(1)    Any emergency advance payments authorized under section 1631(a)(4)(A) of the Social Security Act (01/06/2006);

 

 

 

(2)   Any presumptive disability or presumptive blindness payment authorized under section 1631(a)(4)(B) of the Social Security Act (01/06/2006). Payments to individuals based on presumptive disability or blindness are made by the social security administration (SSA) and are issued directly to the individual without regard for interim assistance involvement. Any retroactive payment due the individual after a final determination has been made will automatically be made to the Ohio department of job and family services (ODJFS) through the county agency;

(3)    Any immediate payments authorized under section 1631(a)(1) of the Social Security Act (01/06/2006);

(4)   Interim payments authorized under section 1631(a)(8) of the Social Security Act (01/06/2006); or

(5)   Provisional payments authorized under section 1631(p)(7) of the Social Security Act (01/06/2006).

(C)  What is the 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 interim assistance payment which is authorized and for which delivery cannot be stopped, following the county agency 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.

(4)    If a new initial claim rather than an appeal was filed, the interim period shall begin with the date of the new initial claim, and a new JFS 07319 "Authorization for Reimbursement of Interim Assistance Initial Claim or Posteligibility Case" (rev. 12/2013)(rev. 4/2014) shall be required.

(5)   The county agency shall not retain reimbursement for interim assistance 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 county agency shall not recoup interim assistance issued by ODJFS to an individual during the interim period for any month in which the individual was not eligible for an SSI payment.

(D)  What is the interim period for inital 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 interim assistance payment which is authorized and for which delivery cannot be stopped, following the county agency receipt of the individual's retroactive reinstated SSI benefit payment from the SSA.

(3)   The county agency shall not recoup interim assistance issued by 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)    SSA releases a retroactive SSI 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. The county agency must secure the individual's signature on a new JFS 07319.

(E)    What are the county agency responsibilities when eligibility for interim assistance during an initial claim period is determined?

When an individual's eligibility for interim assistance during an initial claim period is being determined, the county agency shall:

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

(2)   Register an application for medicaid for the disabled on behalf of the individual.

(3)   Complete a disability determination in accordance with rule 5101:1-5-20 of the Administrative Codereferral to the Ohio department of medicaid (ODM).

(4)   Submit the repayment authorization to the local SSA office within ten working days of obtaining the individual's signature on the JFS 07319. The county agency shall keep a copy in the assistance group record. If the individual is determined not eligible for DFA, the JFS 07319 shall be rescinded within one working day of the determination of ineligibility.

(5)   Issue interim assistance if all DFA eligibility requirements are met.

(6)    Upon notification from SSA that retroactive SSI benefits have been approved, the county agency shall determine the amount of interim assistance provided to the individual.

When a married couple is receiving interim assistance:

(a)   If only one spouse is found eligible for SSI benefits, the interim assistance amount to be reimbursed shall be the difference between the DFA payment for one person and the DFA payment for two people.

(b)   If both of the married individuals are found eligible for SSI benefits, and both were receiving DFA, the interim assistance amount to be reimbursed for each individual shall be one-half of the total monthly DFA payment.

(7)   Within ten working days of receiving the individual's retroactive SSI payment, the county agency shall issue a JFS 07107 "Notice of Interim Assistance Reimbursement" (rev. 4/2001) to the individual. If no payment is being made to the individual, the county agency shall enter "no warrant" in the blocks designated for "date of warrant" and "amount of warrant" on the JFS 07107.

(8)   If an individual dies or disappears before the individual has received all the SSI benefits to which the individual is entitled, ODJFS retains the right to receive benefits due for the retroactive period.

(F)    What are the county agency responsibilities when eligibility for interim assistance during an inital posteligibility payment period is determined?

When an individual whose SSI benefits have been suspended or terminated applies for DFA, the county agency shall:

(1)   Secure a signature on the JFS 07319 for each individual who applies for DFA and whose SSI benefits have been terminated or suspended.

(2)   Submit repayment authorization to the local SSA office within one working day of obtaining the individual's signature on the JFS 07319. The county agency shall keep a copy in the assistance group record. If the individual is subsequently determined to be ineligible for DFA, the JFS 07319 shall be rescinded within one working day of the determination of ineligibility.

(3)     Prior to approving DFA for an individual whose SSI benefits have been suspended or terminated, the county agency 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 interim assistance if all DFA requirements are met including verification

from  the  local  SSA  office  that  the  individual's  SSI  benefits  will  not  be immediately reinstated.

(5)   Upon notification from SSA that retroactive SSI benefits have been reinstated, the county agency shall determine the amount of interim assistance provided to the individual.

(a)    When a married couple is receiving interim assistance during the initial posteligibility payment period:

(i)    If only one of the individuals receives reinstated SSI benefits, the amount of the interim assistance to be reimbursed shall be the difference between the DFA payment for one and the DFA payment for two.

(ii)    If both of the individuals are found eligible for SSI during initial posteligibility payment period, the interim assistance amount to be reimbursed for each individual shall be one-half of the total monthly payment.

(b)   If the SSA prorates the individual's SSI payment for any month, the initial posteligibility interim assistance amount for that month must be prorated.

(6)   Within ten working days of receiving the individual's retroactive reinstated SSI payment, the county agency shall issue a JFS 07107 to the individual. If no payment is being made to the individual, the county agency shall enter "no warrant" in the blocks designated for "date of warrant" and "amount of warrant" on the JFS 07107.

(7)   If an individual dies or disappears before the individual has received all the SSI benefits to which the individual is entitled, ODJFS retains the right to receive benefits due for the retroactive period.

(G)    When is written authorization for reimbursement of interim assistance during an inital posteligibility claim period required?

(1)     Each individual who applies for DFA and whose SSI benefits have been terminated or suspended must complete a JFS 07319. If the individual refuses to sign the repayment authorization, the application for DFA during the initial posteligibility period shall be denied.

(2)    Prior to authorizing DFA benefits, an individual who applies for DFA 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 SSI benefits.

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

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

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

(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;

(d)   The county agency and the individual agree in writing to terminate the authorization, which shall result in the individual's ineligibility for DFA;

(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.

(H)    When is written authorization for reimbursement of interim assistance during an initial claim period required?

(1)   Each individual who applies for disability financial assistance (DFA) and who has an application for SSI pending with the SSA must complete a JFS 07319. If the individual refuses to sign the JFS 7319, the application for DFA shall be denied.

(2)   Each individual in receipt of ongoing DFA who applies for SSI must complete a

JFS 07319. Following completion of the JFS 07319, the individual shall be considered to be receiving interim assistance.

(3)    The interim period applies to individuals in receipt of ongoing DFA benefits who apply for SSI. Refusal of the individual to sign the JFS 07319 renders the individual ineligible for DFA while the SSI application is pending.

(4)    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 JFS 07319 is required.

(5)    Once the JFS 07319 is executed, the individual cannot withdraw or cancel it, unless both the individual and the county agency agree in writing to the withdrawal.

(6)    If at a later date the JFS 07319 is withdrawn at the agreement of both the individual and the county agency, the revocation of the authorization form is effective the date of the joint agreement between the individual and  the county agency.

(I)  How is the amount of interim assistance calculated?

(1)   In determining the amount of interim assistance to be retained as reimbursement for initial posteligibility claims, the county agency shall prorate the amount it recoups for any month that SSA prorates the retroactive SSI payment.

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

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

(4)    The county agency shall not recoup DFA 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.

(J)   How does the county agency process interim assistance reimbursement from the SSA?

(1)      The county agency shall comply with the electronic interim assistance reimbursement process described in the "Interim Assistance Reimbursement (IAR) State Handbook" (SSA Publication No. 17-007 (rev. 09/29/2012). This handbook can be found at on the SSA website, http://www.ssa.gov/gso/eiar/eIAR_InternetHandbook.pdf.

(2)   When an individual has received interim assistance in more than one county, the county agency where the individual resides in last is responsible for processing the request for the total reimbursement for all interim assistance paid.

Effective:                                                             10/01/2016

Five Year Review (FYR) Dates:                         05/01/2019

CERTIFIED ELECTRONICALLY

Certification

09/19/2016

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, 7/1/01, 7/1/03 (Emer.), 9/30/03, 9/1/08, 5/1/14