Connecticut Department of Social Services Uniform Policy Manual: 1500.01 Eligibility Process - Definitions

CONNECTICUT DEPARTMENT OF SOCIAL SERVICESPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1500.01 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________

1500.01 Adequate Notice

Adequate notice is a notice of denial, discontinuance, or reduction of assistance which includes a statement of the Department's intended action, the reasons for the intended action, the specific regulations supporting such action, an explanation of the assistance unit's right to request a Fair Hearing to contest the action, and the circumstances under which benefits are continued if the unit requests a Fair Hearing.

Allotment

An allotment is a dollar amount representing the total value of Food Stamp benefits an assistance unit is authorized to receive during a month or other specified period.

Applicant

Applicant means the individual or individuals for whom assistance is requested.

Application

Application is written indication on a form prescribed by the Department of the desire to obtain assistance.

Application Process

The application process is all activity related to the exploration, investigation and disposition of an application beginning with the filing of an assistance request and ending with disposition of the application.

Assessment of Spousal Assets

An Assessment of Spousal Assets is a determination of the total value of all non-excluded available assets owned by both MCCA spouses which is done upon the request of an institutionalized spouse or a community spouse or upon the filing of an application for medical assistance and is used to calculate the Community Spouse Protected Amount.

Authorized Representative

An authorized representative is an adult, over the age of eighteen, who has written authorization to act on the behalf of an assistance unit of which he or she is not currently a member, and who would otherwise not be eligible to act without such authorization.

PRIVATE tc \l 1 ""PRIVATE CONNECTICUT DEPARTMENT OF SOCIAL SERVICEStc \l 1 "CONNECTICUT DEPARTMENT OF SOCIAL SERVICES" UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-89-38 1500.01 page 2 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________

1500.01 Beginning Date of Assistance

Beginning Date of Assistance is the earliest date on which an assistance unit or a member of an assistance unit is entitled to the benefits of the program.

Certification of Eligibility

Certification is the formal authorization to participate in a particular assistance program.

Certification Period

A certification period is the interval of time within which an assistance unit is eligible to receive benefits from a particular assistance program.

Community Spouse

A community spouse is an individual who resides in the community, who does not receive home and community based services under a Medicaid waiver, who is married to an individual who resides in a medical facility or long term care facility or who receives home and community based services (CBS) under a Medicaid waiver.

Community Spouse Disregard (CSD)

A community spouse disregard is the amount of the institutionalized spouse's available non-excluded assets which is excluded in determining the institutionalized spouse's eligibility for Medicaid.

Community Spouse Protected Amount (CSPA)

A community spouse protected amount is the amount of the total available non-excluded assets owned by both MCCA spouses which is protected for the community spouse and is not counted in determining the institutionalized spouse's eligibility for Medicaid.

Continuous Period of Institutionalization

A continuous period of institutionalization is a period of 30 or more consecutive days of residence in a medical institution or long term care facility, or receipt of home and community based services (CBS) under a Medicaid waiver.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-06 Transmittal: UP 06-07 1500.01 page 3 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________

1500.01 Date of Application

The date of application is the date a formal written request for assistance is filed with the Department in accordance with the rules established for the program for which application is made.

Date of Authorization

The date of authorization is the date the Department makes a case action decision, as opposed to the effective date of the action.

Date of Issuance

The date of issuance is the actual mailing date of a benefit, notice or other item of correspondence, or the date the item becomes available for in-office pickup.

Documentation

Documentation is the act of recording a fact, circumstance or condition through the use of a supporting reference, annotation or the inclusion of documentary evidence.

Eligibility Process

The eligibility process is all activity related to the application process, interim activity, redetermination and Fair Hearings.

Ending Date of Assistance

Ending date of assistance is the last day on which the assistance unit or a member of an assistance unit is entitled to the benefits of the program.

Exceptional Circumstances

Exceptional circumstances are conditions that are unusual or extreme for a community spouse, and which either directly threaten the community spouse's ability to remain in the community, or pose some other type of unusual or extreme hardship for the community spouse, such as caring for a disabled child, sibling or other immediate relative.

Fraud Early Detection (FRED) System

The Fraud Early Detection System is used to identify, investigate and determine if an application under AABD, Medicaid or Food Stamps is fraudulent before granting assistance.

PRIVATE tc \l 1 ""PRIVATE CONNECTICUT DEPARTMENT OF SOCIAL SERVICEStc \l 1 "CONNECTICUT DEPARTMENT OF SOCIAL SERVICES" UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 10-1-89 Transmittal: UP-01-04 1500.01 page 4 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________ 1500.01 Interim Activity

Interim activity is any action or activity other than application, redetermination or Fair Hearings.

Intervenor

An intervenor is person who participates in a Fair Hearing on a limited basis in the interest of justice.

Institutionalized Spouse

An institutionalized spouse is a spouse who resides in a medical facility or long term care facility, or who receives home and community based services (CBS) under a Medicaid waiver, and who is legally married to someone who does not reside in such facilities or who does not receive such services.

Joint Processing

Joint processing is the simultaneous processing of a PA and FS assistance request that has been filed concurrently.

Mass Change

A mass change is one which affects all or a portion of the caseload which shares similar circumstances.

MCCA Spouses

MCCA spouses are spouses who are members of a married couple one of whom becomes an institutionalized spouse on or after September 30, 1989, and the other spouse becomes a community spouse.

Migrant or Seasonal Farm Worker Assistance Unit

A migrant or seasonal farm worker assistance unit is an assistance unit whose primary livelihood is derived from farm labor.

Notice

A notice is a written statement which the Department mails to the assistance unit to inform the unit that the Department has taken or intends to take a specific action in the unit's case.

PRIVATE tc \l 1 ""PRIVATE CONNECTICUT DEPARTMENT OF SOCIAL SERVICEStc \l 1 "CONNECTICUT DEPARTMENT OF SOCIAL SERVICES" UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 12-1-91 Transmittal: UP-01-04 1500.01 page 5 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________

1500.01 Party to a Hearing Requested by Another

A party to a hearing requested by another is a person who is allowed to participate in a hearing requested by another person on an issue of mutual interest.

Prerelease Applicant

A prerelease applicant is an individual who is currently ineligible for Food Stamps due to institutional status, but who has applied jointly for Food Stamps and SSI in anticipation of being released from the institution.

Primary Verification

Primary verification is an inquiry to verify non-citizen status using direct access into the INS data base in accordance with the Immigration Reform and Control Act of 1986.

Public Assistance

Public Assistance (PA) means any of the following programs: Aid to Families with Dependent Children (AFDC), Aid to the Aged, Blind or Disabled (AABD), and Medical Assistance (MA).

Redetermination Process

The redetermination process is all activity related to the reevaluation of a recipient's eligibility, and the recertification of a food stamp assistance unit.

Request for a Fair Hearing

A request for a Fair Hearing is a clear statement by the assistance unit or the unit's authorized representative which indicates that the unit disagrees with a Departmental action or non-action, and wishes to have its case reviewed by an independent authority.

Secondary Verification

Secondary verification is a written request to verify non-citizen status with INS, in addition to or in lieu of primary verification, in accordance with the Immigration Reform and Control Act of 1986.

PRIVATE tc \l 1 ""PRIVATE CONNECTICUT DEPARTMENT OF SOCIAL SERVICEStc \l 1 "CONNECTICUT DEPARTMENT OF SOCIAL SERVICES" UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 02-13-01 Transmittal: UP-01-04 1500.01 page 6 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC AABD _______________________________________________________________ MA Subject: FS Definitions ______________________________________________________________________________

1500.01 Significant Financial Duress

Significant financial duress is a severe expense or set of expenses to be paid by the community spouse as a direct result of exceptional circumstances, and are those for which the community spouse could not reasonably be expected to pay from his or her monthly income or assets.

Spend-Down

Spend-down is the process by which income which exceeds an MA assistance unit's Medically Needy Income Limit (MNIL) is offset by incurred medical expenses.

Spousal Share

A spousal share is one-half of the total value of assets which result from the assessment of spousal assets.

SSI Assistance Unit

An SSI assistance unit is an assistance unit which is composed entirely of individuals who are either applicants or recipients of SSI.

Timely Notice

Timely notice is notice of discontinuance or reduction of assistance which the Department mails to the assistance unit at least 10 days before the Department's intended action becomes effective.

Verification

Verification is the act of confirming a fact, circumstance or condition through direct evidence or other reliable documentation or collateral contact.