Connecticut Department of Social Services Uniform Policy Manual: 1505.40 Application Process - Eligibility Determinations

CONNECTICUT DEPARTMENT OF SOCIAL SERVICESPRIVATE UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-06 Transmittal: UP-06-07 1505.40 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD ____________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 A. Processing Applications

1. Prior to making an eligibility determination the Department conducts a thorough investigation of all circumstances relating to eligibility and the amount of benefits.

2. A Fraud Early Detection (FRED) investigation is done on AABD, Medicaid and Food Stamps applications that meet an error prone profile. Conditions that would cause a case to meet this profile include, but are not limited to:

a. a previous fraud overpayment;

b. children under the age of six;

c. the household is suspected of living above its means;

d. the case was denied or closed within three months;

e. application is inconsistent with prior case history;

f. questionable absent parent information;

g. no income for two consecutive months;

h. questionable verification;

i. living in Connecticut for less than three months;

j. household composition appears different than reported;

k. assets appear to be greater than reported.

PRIVATE CONNECTICUT DEPARTMENT OF SOCIAL SERVICEStc \l 1 "CONNECTICUT DEPARTMENT OF SOCIAL SERVICES" UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 3-1-00 Transmittal: UP-00-2 1505.40 page 2 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD ____________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 A. Processing Applications (cont.)

3. The eligibility determination for an assistance program is not delayed pending a determination of eligibility for the same applicant in a different program category, unless participation in the MA or FS program as categorically needy is dependent upon eligibility for cash assistance.

4. The Department may complete the eligibility determination at any time during the application process when:

a. the applicant withdraws the application; or

b. all requirements for determining eligibility on a FS expedited service application are met; or

c. the application process is complete and all required verification has been obtained; or

d. adequate information exists to determine ineligibility because one or more eligibility requirements are not satisfied; or

e. the applicant refuses to cooperate in completing an eligibility requirement rendering the entire assistance unit ineligible.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-15-90 Transmittal: UP-00-2 1505.40 Page 3 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD ____________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 B. Incomplete Applications

1. Applicant Failure (All Programs)

The following provisions apply if the applicant failed to complete the application without good cause:

a. If eligibility has been established to the extent that assistance can be granted to all or a part of the assistance unit, the case is processed between:

(1) the day after the expiration of the applicants deadline for completing the required action; and

(2) the last day of the agency promptness standard for processing the application;

b. If assistance cannot be granted:

(1) AFDC, AABD and MA cases are denied between the thirtieth day and the last day of the appropriate promptness standard for processing the application;

(2) FS applications are denied on the thirtieth day following the date of application.

c. The applicant's failure to provide required verification by the processing date causes:

(1) one or more members of the assistance unit to be ineligible if the unverified circumstance is a condition of eligibility; or

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 12-1-91 Transmittal: UP-00-2 1505.40 Page 4 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD ____________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 B. 1. c. Applicant Failure (All Programs) (continued)

(2) the circumstance to be disregarded in the eligibility determination if consideration of the circumstance is contingent upon the applicant providing verification;

d. Verification received after the date that an incomplete application is processed:

(1) is used only with respect to future case actions; and

(2) is not used to retroactively determine a corrective payment.

2. Administrative Delays (All Programs)

a. The Department cannot postpone the eligibility determination beyond the standard thirty, forty-five or ninety day processing period if due to an administrative delay the only information needed is verification of non-citizen status.

b. If the eligibility determination is delayed, the Department continues to process the application until a decision can be made.

c. Delaying the FS eligibility determination beyond the thirtieth day causes the processing period to be extended by an additional thirty days.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 11-15-90 Transmittal: UP-00-2 1505.40 Page 5 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD ____________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 B. 3. Applicant Failure Subsequent to Administrative Delays

The following provisions apply if subsequent to an administrative delay the applicant becomes responsible for not completing the application process:

a. for AFDC, AABD and MA applications, the Department:

(1) determines eligibility without further delay; or

(2) continues to pend the application if good cause can be established or if a 10 day extension is granted.

b. for FS applications, the Department:

(1) determines eligibility without further delay if eligibility can be established; or

(2) denies assistance on the last day of the second thirty day period if eligibility cannot be established.

4. Delays Due to Good Cause (AFDC, AABD, MA Only)

a. The eligibility determination is delayed beyond the AFDC, AABD or MA processing standard if because of unusual circumstances beyond the applicant's control, the application process is incomplete and one of the following conditions exists:

(1) eligibility cannot be determined; or

(2) determining eligibility without the necessary information would cause the application to be denied.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 12-1-03 Transmittal: UP-03-34 1505.40 page 6 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: AFDC The Application Process AABD _______________________________________________________________ FS Subject: MA Eligibility Determinations ______________________________________________________________________________

1505.40 B. 4. b. Delays Due to Good Cause (AFDC, AABD ,MA only) (continued)

If the eligibility determination is delayed, the Department continues to process the application until:

(1) the application is complete; or

(2) good cause no longer exists.

5. Delays Due to Insufficient Verification (AFDC, AABD, MA Only)

a. Regardless of the standard of promptness, no eligibility determination is made when there is insufficient verification to determine eligibility when the following has occurred:

(1) the Department has requested verification; and

(2) at least one item of verification has been submitted by the assistance unit within a time period designated by the Department, but more is needed.

b. Additional 10 day extensions for submitting verification shall be granted, as long as after each subsequent request for verification at least one item of verification is submitted by the assistance unit within each extension period.

C. Determining Cause of Delay (FS Only)

1. The applicant is considered responsible for incomplete applications if the Department has taken the following actions:

a. offered assistance in completing application materials or procuring difficult to obtain verification; or

b. scheduled a second interview for applicants who failed to appear for the first scheduled interview but who contacted the Department to reschedule; or

c. with the exception of (3) below, has allowed at least ten days from the date it notifies the applicant of a required action for the applicant to complete the action, including requests to provide verification.

CONNECTICUT DEPARTMENT OF SOCIAL SERVICES UNIFORM POLICY MANUAL ______________________________________________________________________________ Date: 7-1-93 Transmittal: UP-01-04 1505.40 page 7 ______________________________________________________________________________ Section: Type: Eligibility Process POLICY ______________________________________________________________________________ Chapter: Program: FS The Application Process ______________________________________________________________ Subject: Eligibility Determinations ______________________________________________________________________________

1505.40 C. Determining Cause of Delay (FS Only) (continued)

2. The Department is responsible for incomplete applications if in the appropriate situation it has not:

offered assistance in completing application materials or obtaining verification where appropriate; or

b. scheduled a second interview; or

c. allowed the applicant 10 days to complete a required action.

The Department is considered responsible for delays in processing applications if it has agreed to accept responsibility for obtaining verification on behalf of the assistance unit, and the delay is due to a delay in getting that verification, provided that the assistance unit continues to cooperate in the verification process.

Applicants are not allowed 10 days to complete the application process, but instead must complete the process by the last day of the application processing standard if:

a. they failed to appear for both the initial and rescheduled office interview, but complete the interview prior to the last day of the standard processing period; and

b. the date the interview is conducted is after the twentieth day of the processing period; and

c. except for administrative delays, there is less than 10 days between the date the verification is requested and the standard of promptness.