63-456  Restoration of Benefits

 

Table of Contents

 

Section

o  Entitlement to Restoration of Lost Benefits

456.1

o  Restoration of  Benefits due to Judicial Review

456.2

o  Restoration of  Benefits due to Reversal of an Intentional Program Violation (IPV) Disqualification

456.3

o  Lost Benefits Due to County Error

456.4

o  Calculation of Lost Months for Erroneous Delays, Denials or Termination

456.5

o  Computation of Lost Benefits

456.6

o  Offsetting Lost Benefits

456.7

o  Disputed Benefits

456.8

o  Household Composition Changes

456.9

o  Restoration to Households Leaving the County

456.10

o  Method of Restoration

456.11

 

 

 

63-456.1
Entitlement to Restoration of Lost Benefits

·      CalFresh benefits shall be restored to a CalFresh household whenever:

o  The loss of benefits was caused by administrative error;

o  An administrative disqualification for an Intentional Program Violation (IPV) is reversed by judicial action;

o  Regulations specifically state that the household is entitled to a restoration of lost benefits.

·      Unless a longer period of time is specified elsewhere in regulations, lost benefits shall be restored for not more than twelve (12)  months prior to the earlier of the following dates:

o  The date the worker receives a request for restoration from the household; or

o  The date the worker is notified or otherwise discovers that a loss of CalFresh benefits to the household has occurred.

·      Lost benefits shall be restored whether or not a household is currently eligible or ineligible.

Whenever it is discovered or the County is notified that a household may not have received CalFresh benefits to which they were entitled, the assigned worker shall:

o  Review the case record; and

o  Compute the household’s CalFresh benefits for the month(s) in question;

o  Issue lost benefits regardless of the household’s current eligibility status;

o  Issue lost benefits in addition to the allotment the household is currently eligible for.

 

63-456.2
Restoration of   Benefits due to Judicial Review

The worker shall restore lost benefits at the direction of any judicial action as the result of an administrative error or as directed by regulation.

When the judicial action is a review of a state hearing decision, benefits will not be restored for any month that is more than twelve (12) months prior to the date the state hearing was initiated or the dates specified in 63-456.1 above, whichever is earliest.

If the judicial action is the first action the recipient has taken to obtain restoration of lost benefits, then benefits shall be restored for a period of not more than twelve (12) months from the date the judicial action was initiated.

 

63-456.3
Restoration of   Benefits due to Reversal of an IPV Disqualification

If the decision that resulted in an IPV disqualification is subsequently reversed by a judicial action, that individual is entitled to a restoration of any benefits lost during the months that the individual was disqualified.

·      The restoration shall not exceed twelve (12) months prior to the date that worker is notified of the reversal.  However, if the individual was disqualified in an administrative disqualification hearing that preceded the judicial reversal, the worker shall restore benefits from the effective date of the notice of action informing the household of the administrative disqualification.

·      For each month the individual was disqualified, the amount to be restored, if any, will be determined by comparing the allotment the household received with the allotment household would have received had the disqualified member been allowed to participate.  If the household received a smaller allotment than it should have received, the difference is the amount that shall be restored.

 

63-456.4
Lost Benefits Due to County Error

A formal application for restoration of lost benefits is not required. 

·      If the County determines that a loss of benefits has occurred and the household is entitled to restoration of those benefits, the assigned worker shall automatically take action to restore any benefits that were lost.  

·      No action by the household is necessary.  However, benefits shall not be restored if the benefits were lost more than 12 months prior to the month the loss was discovered by the County in the normal course of business, or were lost more than 12 months prior to the month the County was notified in writing or orally of a possible loss to a specific household.

The County shall notify the household 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 state hearing process if the household disagrees with any aspect of the proposed lost benefit restoration.

Verbal requests must be documented in case comments and written requests shall be imaged in DoReS.

 

63-456.5

Calculation of Lost Months for Erroneous Delays, Denials or Termination

After determining the months in which the loss of benefits occurred and excluding the months for which benefits may have been lost prior to the 12-month time limit, the worker shall calculate the amount to be restored.

If the household was eligible but received an incorrect allotment, the loss of benefits shall be calculated only for those months the household participated. However, if a household did not have an opportunity to participate because of an incorrect delay, denial, or termination of benefits, the months affected by the loss shall be calculated as follows:

ERRONEOUS DELAY

If an eligible household's application was delayed (beyond the 30-day time limit), the months for which benefits may be lost shall be determined in accordance with regulations in Section 63-109.

ERRONEOUS DENIAL

When it is determined that an eligible household's application has been erroneously denied, the month the loss initially occurred shall be the month of application, or for an eligible household filing a timely recertification, the month following the expiration of the certification period.

ERRONEOUS TERMINATION

If the household'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.

 

63-456.6
Computation of Lost Benefits

The worker shall determine if the household was actually eligible for each month affected by the loss.

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

·      For the months the household was eligible, the worker shall calculate the allotment the household should have received.  If the household received a smaller allotment than it was eligible to receive, the difference between the actual and correct allotments is the amount that shall be restored

·      If an Inadvertent Household Error (IHE) or IPV claim is unpaid, suspended or terminated, the amount to be restored shall be offset against the amount due on the claim before the balance, if any, is restored to the household.  Refer to Section 63-456.7 below.

 

63-456.7
Offsetting Lost Benefits

When a budget re-computation from prior months results in lost benefits and there is also an uncollected IHE or IPV overpayment, the lost benefits must be used to offset the overpayment.

Exception:  When a household is certified and receives an initial allotment, this initial allotment is not considered lost benefits and shall not be reduced to offset claims, even if the allotment is paid retroactively.

NOTE: Lopez v. Glickman prohibits offsetting of Administrative Error (AE) claims against any amount of lost benefits which have not yet been restored to the household.

 

63-456.8
Disputed Benefits

If the household disagrees with the County’s determination and the dispute cannot be resolved, the household can request a state hearing.  The request for a state hearing must be made within 90 days of the date the household is notified of its entitlement or non-entitlement. If a state hearing is requested, benefits will be restored as determined by the HHSA Appeals Officer pending the results of the state hearing.  When the decision is received, the worker will take action in accordance with the state hearing instructions.

 

If a household believes it is entitled to restoration of lost benefits but the worker, after reviewing the case does not agree, the household has 90 days from the date of the worker’s determination to request a state hearing.  The worker shall restore lost benefits to the household only if the state hearing decision is favorable to the household. Benefits lost more than 12 months prior to the date the County was initially informed of the household's possible entitlement to lost benefits shall not be restored.

 

63-456.9
Household Composition Changes

Whenever lost benefits are due and the household's composition has changed, the worker shall restore the lost benefits to the household containing a majority of the individuals who were household members at the time the loss occurred.  If the worker cannot locate or determine the household containing a majority of household members, the worker shall restore the lost benefits to the household containing the head of the household at the time the loss occurred.

If a change in household composition occurs, the worker shall offset the amount of the IHE or IPV claim against restored benefits in accordance with Sections 63-454.7 and 63-456.6 above.  This action may be taken against any or all households which contain a member who was an adult member of the original household at the time the overissuance occurred (Section 63-451.2).

 

63-456.10
Restoration to Households Leaving the County

When the household entitled to restoration informs the County that they are moving out of the County, benefits shall be restored in a lump sum prior to the move whenever possible.

 

63-456.11
Method of Restoration

Although the normal method of restoration is a lump sum allotment, the worker will honor a reasonable request by the household to restore the lost benefits in monthly installments. The worker will determine whether or not a request is reasonable on a case-by-case basis.