Sections 56-202, 56-203, 56-209, 56-239, 56-250, 56-253, 56-255, 56-256 and 56-257, Idaho Code, authorize the Department to adopt and enforce rules for the administration of Title XIX of the Social Security Act (Medicaid), and Title XXI of the Social Security Act. (7-1-24)

The Department has written statements that pertain to the interpretation of, or documentation of compliance with, these rules. The documents are available for public inspection and copying at cost at the Department or at any of its Regional Offices. (7-1-24)

01. Advanced Payment of Premium Tax Credit. Payment of federal tax credits specified in 26 USC Part 36B (as added by Section 1401 of the Affordable Care Act) which are provided on an advance basis to an eligible individual enrolled in a Qualified Health Plan (QHP) through an exchange under Sections 1402 and 1412 of the Affordable Care Act. (7-1-24) 02. Adult. Any individual who has passed the month of their nineteenth birthday. (7-1-24) 03. Affordable Care Act. The Patient Protection and Affordable Care Act of 2010 (Pub. L. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (P L 111-152). (7-1-24) 04. Applicant. A person applying for public assistance from the Department, including individuals referred to the Department from a Health Insurance Exchange or Marketplace. (7-1-24) 05. Application. An application for benefits including an Application for Assistance (AFA) or other application recognized by the Department, including referrals from a Health Insurance Exchange or Marketplace. (7-1-24) 06. Application Date. The date the Application for Assistance (AFA) is received by the Department or by the Health Insurance Exchange or Marketplace electronically, telephonically, in person, or the date the application is postmarked, if mailed. (7-1-24) 07. Caretaker Relative. A relative of a child by full- or half-blood, adoption, or marriage with whom the child is living and who assumes primary responsibility for the child's care. A caretaker relative includes a child’s natural, adoptive, or step-parents, grandparents, siblings, aunt, uncle, niece, nephew, or cousin. (7-1-24) 08. Child. Any individual from birth through the end of the month of their nineteenth birthday. (7-1-24) 09. Citizen. A person having status as a “national of the United States” defined in 8 USC 1101(a)(22)that includes both citizens of the United States and non-citizen nationals of the United States. (7-1-24) 10. Cost-Sharing. A participant payment for a portion of Medicaid service costs such as deductibles, co-insurance, or co-payment amounts. (7-1-24) 11. Creditable Health Insurance. Coverage that provides benefits for inpatient and outpatient hospital services and physicians' medical and surgical services. Creditable coverage excludes liability, limited scope dental, vision, specified disease, or other supplemental-type benefits. (7-1-24) 12. Department. The Idaho Department of Health and Welfare or its designee. (7-1-24) 13. Federal Poverty Guidelines (FPG). Issued annually by the Department of Health and Human Services (HHS).TheFPG are available on the U.S. Health and Human Services website at http://aspe.hhs.gov/poverty. (7-1-24) 14. Health Assessment. An examination performed by a primary care provider in order to determine the appropriate health plan for a Medicaid-eligible individual. (7-1-24) Department of Health and Welfare Assistance for Families & Children 15. Health Care Assistance (HCA). Health coverage that includes Medicaid coverage under Title XIX or Title XXI and private health insurance plans purchased with a Premium Tax Credit described in Subsection 010.01 of this rule granted by the Department for persons or families within Idaho. (7-1-24) 16. Health Insurance Premium Program (HIPP). The Premium Assistance program in which Title XIX and Title XXI participants may participate. (7-1-24) 17. Health Plan. A set of health services paid for by Idaho Medicaid, or health insurance coverage obtained through the Health Insurance Exchange or Marketplace. (7-1-24) 18. Health Questionnaire. A tool used to assist Department staff in determining the correct Health Plan for the Medicaid applicant. (7-1-24) 19. Internal Revenue Code. The federal tax law used to determine eligibility under Title 26 USC for individual income and self-employment income. (7-1-24) 20. Internal Revenue Service (IRS). The US government agency in charge of tax laws. These laws are used to determine income eligibility. The IRS website is at http://www.irs.gov. (7-1-24) 21. Insurance Affordability Programs. Include Title XIX, Title XXI, and all insurance programs available in the Health Insurance Exchange or Marketplace. (7-1-24) 22. Lawfully Present. An individual who is a qualified non-citizen under Section 221 of these rules. (7-1-24)

01. MAGI-Based Income. Income calculated using the same financial methodologies used by the IRS to determine modified adjusted gross income (MAGI) for federal tax filers, with the following exceptions: (7-1-24) a. Educational income under Section 382 of these rules; (7-1-24) b. Indian monies excluded by federal law are not included in MAGI-based income; (7-1-24) c. Lump sum income is counted only in the month received under Section 384 of these rules; and (7-1-24) d. For Medicaid applicants, MAGI-based income is calculated based on income received in the month of application. (7-1-24) 02. Medicaid. Idaho’s Medical Assistance Program administered by the Department and funded with federal and state funds under Title XIX of the Social Security Act that provides medical care for eligible individuals. (7-1-24) 03. Modified Adjusted Gross Income (MAGI). Adjusted Gross Income as defined by the IRS, plus certain tax-exempt income. (7-1-24) 04. Newborn Deemed Eligible. A child born to a woman who is eligible for and receiving medical assistance on the date of the child’s birth, including during a month of retroactive eligibility for the mother. A child born under these conditions is eligible for Medicaid for the first year of their life. (7-1-24) 05. Non-Citizen. Same as “alien” under Section 101(a)(3) of the Immigration and Nationality Act (INA) (8 USC 1101 (a)(3)), and includes any individual who is not a citizen or national of the United States. (7-1-24) 06. Parent. For a household with a MAGI-based eligibility determination a parent can be: (7-1-24) a. Natural; (7-1-24) Department of Health and Welfare Assistance for Families & Children b. Biological; (7-1-24) c. Adoptive; or (7-1-24) d. Stepparent. (7-1-24) 07. Participant. An individual who is eligible for, and enrolled in, a Health Care Assistance program. (7-1-24) 08. Qualified Hospital. Has a Memorandum of Understanding (MOU) with the Department, participates as a provider under the Medicaid State Plan, may assist individuals in completing and submitting applications for health coverage, and has not been disqualified from doing presumptive eligibility determinations. (7-1-24) 09. Qualified Non-Citizen. Same as “qualified alien” under 8 USC164(b) and (c). (7-1-24) 10. Reasonable Opportunity Period. A period allowed for an individual to provide requested proof of citizenship or identity. A reasonable opportunity period extends for ninety (90) days beginning on the 5th day after the notice requesting the proof has been mailed to the applicant. This period may be extended if the Department determines that the individual is making a good faith effort to obtain necessary documentation. (7-1-24) 11. Sibling. For household with MAGI-based eligibility determination, a natural or biological, adopted, half- or stepsibling. (7-1-24) 12. Tax Dependent. A person, who is a related child, or other qualifying relative or person, under federal IRS standards for whom another individual can claim a deduction for a personal exemption when filing a federal income tax for a taxable year. (7-1-24) 13. Third-Party. Includes a person, institution, corporation, public or private agency that is liable to pay all or part of the medical cost of injury, disease, or disability of a medical assistance participant. (7-1-24) 14. Title XIX of the Social Security Act. Also known as Medicaid, is a medical benefits program jointly financed by the federal and state governments and administered by the States. This program pays for medical assistance for certain individuals and families with low income, and for some program types, limited resources. (7-1-24) 15. Title XXI of the Social Security Act. Also known as the Children's Health Insurance Program (CHIP), is a federal and state partnership similar to Medicaid that expands health insurance to targeted, low-income children. (7-1-24)

(Sections 100-199)

The participant has rights protected by federal and state laws and Department rules. The Department will inform participants of the following rights during the application process and eligibility reviews. (7-1-24) 01. Right to Apply. Any person has the right to apply for any Health Care Assistance program. Applications may be submitted by paper, electronically, fax, or telephonically. Application information must be in a form or format provided by the Department. (7-1-24) 02. Right to Hearing. Any participant can request a hearing to contest a Department decision under IDAPA 62.01.01, “Idaho Rules of Administrative Procedure,” and Office of Administrative Hearings General Order No. 1. (7-1-24) Department of Health and Welfare Assistance for Families & Children 03. Right to Request Reinstatement of Benefits. Any participant has the right to request reinstatement of benefits until a hearing decision is made if the request for the reinstatement is made before the effective date of the action taken on the notice of decision. Reinstatement pending a hearing decision is not provided if an application is denied because an individual did not provide citizenship or identity documentation during a reasonable opportunity period allowed by the Department. (7-1-24)

An individual who is applying for benefits, receiving benefits, or providing additional information as required by these rules, may do so with the depiction of the individual's name either handwritten, electronic, or recorded telephonically. Such signature serves as intention to execute or adopt the sound, symbol, or process for the purpose of signing the related record. (7-1-24)

Each application will be processed as close to real time as practicable, but not longer than forty-five (45) days, from the date of application, unless prevented by events beyond the Department’s control. (7-1-24)

Title XIX and Title XXI coverage begins the first day of the application month. Coverage for a newborn is effective the date of birth. (7-1-24)

Title XIX and Title XXI can begin up to three (3) calendar months before the application month if the participant is eligible during the prior period. Coverage is provided if services that can be paid by Medicaid were received in the prior period. (7-1-24)

(Sections 200-299)

Non-financial criteria are conditions of eligibility, other than income, that must be met before Health Care Assistance can be authorized. (7-1-24)

The participant must live in Idaho and have no immediate intention of leaving, including an individual who has entered the state to look for work, or who has no permanent, fixed address. (7-1-24)

01. Citizenship Verified. Citizenship must be verified through electronic means when available. If an electronic verification is not immediately obtainable, the Department may request documentation from the applicant. The Department will not deny the application for health coverage until the applicant has had a reasonable opportunity period to obtain and provide the necessary proof of US citizenship. (7-1-24) Department of Health and Welfare Assistance for Families & Children 02. Benefits During Reasonable Opportunity Period. Benefits are provided during the reasonable opportunity period that is provided to allow the applicant time to obtain and provide documentation to verify U.S. citizenship. No overpayment exists for the reasonable opportunity period if the applicant does not provide necessary documentation during the reasonable opportunity period so that the application results in denial. (7-1-24)

Any individual who participates in Medicaid benefits must provide proof of US citizenship unless they have otherwise met the requirements under 42 CFR 435.406 Citizenship and Non-Citizen Eligibility. (7-1-24)

An individual who meets eligibility criteria for a category of assistance but does not meet US citizenship requirements or eligible non-citizen requirements may receive medical assistance under a Title XIX or Title XXI coverage group as follows: (7-1-24) 01. Emergency Medical Conditions. An individual not meeting the US citizenship requirement may receive medical services necessary to treat an emergency medical condition, including labor and delivery. Emergency medical conditions have acute symptoms of severity, including severe pain. (7-1-24) 02. Determination of Emergency Medical Conditions. The Department determines if a condition meets criteria of an emergency medical condition. (7-1-24) 03. Limitation on Medical Assistance. Medical assistance is limited to the period established for the emergency medical condition. (7-1-24) 04. Documentation Waived. For undocumented individuals with emergency medical conditions, the Social Security Number (SSN) requirement is waived because an SSN cannot be issued. Individuals must be otherwise eligible for Title XIX or XXI. (7-1-24)

Income of a legal non-citizen’s sponsor and the sponsor’s spouse are counted in determining eligibility. (7-1-24)

Section 213 of the Immigration and Naturalization Act requires that a sponsor signing Form I-864, Affidavit of Support, reimburse the Department for Health Care Assistance benefits paid for a sponsored, qualified non-citizen. (7-1-24)

01. SSN Required. An applicant must provide their SSN, or proof they have applied for an SSN, to the Department before approval of eligibility. If the applicant has more than one (1) SSN, all numbers must be provided. (7-1-24) a. The SSN must be verified by the Social Security Administration (SSA) electronically. When an SSN is unverified, the applicant is not eligible for Health Care Assistance. (7-1-24) b. The Department will notify the applicant in writing if eligibility is being denied or lost for failure to meet the SSN requirement. (7-1-24) 02. Application for SSN. The applicant must apply for an SSN, or a duplicate SSN when they cannot provide their SSN to the Department. If the SSN has been applied for, but not issued by the SSA, the Department cannot deny, delay, or stop benefits. The Department will help an applicant with required documentation when the applicant applies for an SSN. (7-1-24) Department of Health and Welfare Assistance for Families & Children 03. Failure to Apply for SSN. The applicant may be granted good cause for failure to apply for an SSN if they have a well-established religious objection to applying for an SSN. A well-established religious objection means the applicant: (7-1-24) a. Is a member of a recognized religious sect or division of the sect; and (7-1-24) b. Adheres to the tenets or teachings of the sect, or division of the sect, and for that reason is conscientiously opposed to applying for or using a national identification number. (7-1-24) 04. SSN Requirement Waived. An applicant may have the SSN requirement waived when they are: (7-1-24) a. Only eligible for emergency medical services under Section 250 of these rules; or (7-1-24) b. A newborn deemed eligible child under Section 530 of these rules. (7-1-24)

Title XIX and Title XXI participants must apply for and enroll in a cost-effective group health plan if one is available. A cost-effective health plan is one which has premiums and co-payments at a lower cost than Medicaid would pay for full medical services. Medicaid will pay premiums and other co-payments for plans the Department finds cost- effective. (7-1-24)

An inmate can receive Medicaid while they are an inpatient in a medical facility, and must meet all Medicaid eligibility requirements. (7-1-24)

Under Sections 56-203B and 56-209b(3), Idaho Code, medical support rights are assigned to the Department by signature on the application for assistance. The participant must cooperate to secure medical support from any liable third-party. The cooperation requirement may be waived if the participant has good cause for not cooperating. (7-1-24)

A Medicaid participant responsible for assigning their rights to medical support must cooperate to identify and locate the noncustodial parent, establish paternity, and establish, modify, and enforce a medical support order. (7-1-24) 01. Cooperation Defined. Cooperation includes providing all information to identify and locate the non-custodial parent and identify other liable third party-payers. The participant must provide the first and last name of the non-custodial parent, and at least two (2) of the following pieces of information about the non-custodial parent: (7-1-24) a. Birth-date; (7-1-24) b. SSN; (7-1-24) c. Current address; (7-1-24) d. Current phone number; (7-1-24) e. Current employer; (7-1-24) f. Make, model, and license number of any motor vehicle owned by the non-custodial parent; or Department of Health and Welfare Assistance for Families & Children (7-1-24) g. Names, phone numbers, and addresses of the parents of the non-custodial parent. (7-1-24) 02. Good Cause Defined. The participant may claim good cause for failure to cooperate in securing medical support for a minor child. Good cause is limited to the following: (7-1-24) a. Proof the child was conceived because of incest or rape; (7-1-24) b. Proof the child’s non-custodial parent may inflict physical or emotional harm to the participant, the child, the custodial parent, or the caretaker relative; (7-1-24) c. A credible explanation is provided showing the participant cannot provide the minimum information regarding the non-custodial parent; or (7-1-24) d. A participant who has good cause for not cooperating under Subsection 291.03.b of this rule. (7-1-24) 03. Conditions for Non-Denial of Medicaid. Medicaid cannot be denied for individuals who meet one (1) of the following conditions: (7-1-24) a. A child or unmarried minor child who cannot legally assign their rights to medical support; or (7-1-24) b. A pregnant woman whose income is at or below the FPG, and who does not cooperate in establishing paternity and obtaining medical support from, or derived from, the father of the unborn child. (7-1-24)

When the Department or federal government selects a case for review in the quality control process, the participant must cooperate in the review of the case. (7-1-24)

(Sections 300-344)

Household composition and financial responsibility are divided into two (2) categories: tax-filing and non-tax filing households. (7-1-24)

01. Taxpayers. For an individual filing a federal tax return for the taxable year in which an initial determination or redetermination of eligibility is made, and who is not claimed as a tax dependent by another taxpayer, the tax filing household consists of the taxpayer, the taxpayer’s spouse, and the taxpayer’s tax dependents. (7-1-24) 02. Individuals Claimed as a Tax-Dependent. For an individual who is claimed as a tax dependent by another taxpayer, the tax filing household is the household of the taxpayer claiming such individual as a tax dependent, except when tax dependents meeting any of the following criteria will be treated as non-filers under Section 302 of these rules. Individuals: (7-1-24) a. Claimed as a tax dependent by an individual other than a spouse or custodial parent; (7-1-24) b. Under age nineteen (19) living with both parents, if the parents are not married, or married filing Department of Health and Welfare Assistance for Families & Children separately; and (7-1-24) c. Under age nineteen (19) claimed as a tax dependent by a parent residing outside of the applicant household. (7-1-24) 03. Married Couples. For married couples living together, each spouse is included in the household of the other spouse, regardless of whether a joint federal tax return is filed, if one (1) spouse is claimed as a tax dependent by the other spouse, or if each filed separately. (7-1-24)

01. Individuals Not Filing a Tax Return and Not Claimed as a Tax Dependent. For an individual who does not expect to file a federal tax return and is not claimed as a tax dependent by a tax filer, or meets one (1) of the exceptions in this rule, the household consists of the individual and, if living with the individual the following: (7-1-24) a. The individual’s spouse; (7-1-24) b. The individual’s natural, adopted, and stepchildren under age nineteen (19); or (7-1-24) c. If individuals are under age nineteen (19), the individual’s natural, adopted, and step parents and natural, adoptive, and step siblings under age nineteen (19). (7-1-24) 02. Married Couples. Married couples living together will be included in the household of the other spouse. (7-1-24)

(Sections 345-394)

The sum of calculated MAGI-based income of every individual whose income must be included in the household budget minus a standard disregard in the amount of five percent (5%) of federal poverty guidelines by family size, if the disregard is used to establish eligibility. (7-1-24)

Financial eligibility for Medicaid applicants will be based on calculated monthly household income and household size. Eligibility for Health Care Assistance is determined by comparing the individual's calculated income against the income limit. (7-1-24)

Earned income is derived from labor or active participation in a business. Earned income includes taxable wages, tips, salary, commissions, bonuses, self-employment, and any other type of income defined as earnings by the Internal Revenue Service (IRS). Earned income is counted as income when it is received, or would have been received, except for the decision of the participant to postpone receipt. Earnings over a period of time and paid at one (1) time, such as the sale of farm crops, livestock, or poultry are annualized, and IRS-allowable self-employment expenses deducted. (7-1-24)

A dependent child’s earned income is excluded, unless the child is required to file a tax return based on his own income. (7-1-24)

An individual who receives a service, benefit, or durable goods instead of wages is earning in-kind income. In-kind Department of Health and Welfare Assistance for Families & Children income is excluded. (7-1-24)

Income from self-employment is treated as earned income. Calculated self-employment income is the taxable self- employment income after gross receipts and the IRS allowable costs of producing the self-employment income, when the self-employment is expected to continue under Title 26, U.S.C. (7-1-24)

Unearned income is any income the individual receives that is not gained through employment. Unearned income is not excluded income if it is taxable. (7-1-24)

A non-recurring lump sum payment is income in the month the lump sum is received. Lump sum income is a retroactive monthly benefit or a windfall payment. The lump sum may be earned or unearned income that is paid in a single sum. Lump sum income includes retirement, survivors, and disability insurance (RSDI), severance pay, disability insurance, and lottery winnings. (7-1-24)

A child's unearned income is countable towards their household’s eligibility, only when the child must file a tax return based on their own income. (7-1-24)

(Section 395-399)

A standard disregard in the amount of five percent (5%) of federal poverty guidelines by family size is applied to the calculated income of an individual in those situations where the application of the disregard is necessary in order for the individual to be eligible for the highest income limit health care coverage for which they may be eligible. (7-1-24)

(Sections 400-499)

Medicaid is available for the following adults: (7-1-24) 01. Parent, Caretaker Relative, or a Pregnant Woman. The individual who: (7-1-24) a. Is a parent, caretaker relative, or a pregnant woman in the household budget unit. (7-1-24) b. Is responsible for an eligible dependent child, which includes the unborn child of a pregnant woman. (7-1-24) c. Lives in the same household with the eligible dependent child. (7-1-24) 02. Adults Under Age 65. The individual must: (7-1-24) Department of Health and Welfare Assistance for Families & Children a. Be age nineteen (19) or older and under age sixty-five (65); (7-1-24) b. Not entitled to or enrolled in Medicare Part A or Part B; and (7-1-24) c. Not otherwise eligible for any other coverage under the State Plan. (7-1-24) 03. MAGI Income Eligibility. For any of the eligibility groups under Subsections 400.01 and 02, the individual must meet all income requirements of the Medicaid program for eligibility determined under MAGI methodologies identified in Sections 300 through 303, and 411 of these rules. Eligibility is based on: (7-1-24) a. The number of members included in the household budget unit; (7-1-24) b. All countable income for the household budget unit; and (7-1-24) c. Eligible individuals will have income calculated using their MAGI. Individuals with MAGI not greater than one hundred thirty-three per cent (133%) after applying a five per cent (5%) disregard to income are eligible to receive Medicaid in this rule. (7-1-24) 04. Member of More Than One Budget Unit. No person may receive benefits in more than one (1) budget unit during the same month. (7-1-24) 05. More Than One Medicaid Budget Unit in Home. If there is more than one (1) Medicaid budget unit in a home, each budget unit is considered a separate unit. (7-1-24)

The income limits are based on the number of household budget unit members. Parents and caretaker relatives, whose MAGI-based income does not exceed the guidelines listed in the table below for their household size, meet the income limit for parent and caretaker relative Medicaid. TABLE 411 INCOME LIMITS Number of Household Members Income Limit 1 $233 2 $289 3 $365 4 $439 5 $515 6 $590 7 $666 8 $741 9 $816 10 $982 Over 10 Persons Add $75 Each (7-1-24)

Department of Health and Welfare Assistance for Families & Children

Participants who no longer qualify for Medicaid due to an increase in earned income or working hours are eligible for an additional twelve (12) months of Medicaid. Participants must have been eligible for Medicaid during at least three (3) of the six (6) months immediately preceding the month in which the participant became ineligible. (7-1-24)

Participants are eligible for four (4) calendar months of Extended Medicaid if an increase in the participant’s spousal support causes them to exceed the income limit for their household budget unit size. The participant must have received Medicaid in Idaho in at least three (3) of the six (6) months before the month the participant became income ineligible. (7-1-24)

A pregnant woman who receives Health Care Assistance and becomes ineligible because of an increase in income will continue to receive coverage through the end of the month in which the sixtieth day of her postpartum period falls. (7-1-24)

(Sections 520-529)

Children are eligible for Health Care Assistance when the household's total MAGI-based income minus a standard disregard in the amount of five percent (5%) of FPG by family size is less than or equal to the applicable income limit for the age of the child. (7-1-24) 01. Title XIX Income Limit. For children age zero (0) to six (6), Title XIX income limit is one hundred forty-two percent (142%) of the FPG for the household size. For children age six (6) through age eighteen (18) the income limit is one hundred thirty three percent (133%) of the FPG for the household size. (7-1-24) 02. Title XXI Income Limit. For children age zero (0) to six (6), Title XXI income limit is between one hundred forty-two percent (142%) and one hundred eighty-five percent (185%) of the FPG for the household size. For children ages six (6) through eighteen (18) the income limit is between one hundred thirty-three percent (133%) and one hundred eighty five percent (185%) of the FPG for the household size. (7-1-24) 03. Disregard Applied. A standard disregard in the amount of five percent (5%) of FPG by family size is applied to the calculated income used to establish the child’s eligibility when applying the disregard is necessary for the child to be financially eligible. (7-1-24)

Household size and financial responsibility for health coverage for children is determined using the methodology under Section 300 of these rules. (7-1-24)

A child is ineligible for coverage under the CHIP plan if they have access to or are enrolled in other health coverage plans as described below: (7-1-24) 01. Covered by Creditable Health Insurance. The child is covered by creditable health insurance at the time of application. (7-1-24) 02. Child is Eligible under Idaho’s Title XIX State Plan. (7-1-24) 03. Idaho State Employee Benefit Plan. The child is eligible to receive health insurance benefits under Idaho’s State employee benefit plan. (7-1-24) Department of Health and Welfare Assistance for Families & Children

Children under age nineteen (19), who are found eligible for health coverage in an initial determination or at renewal, remain eligible for a period of twelve (12) months. The twelve (12) month continuous eligibility period does not apply if, for any reason, eligibility was determined incorrectly. (7-1-24) 01. Reasons Continuous Eligibility Ends. (7-1-24) a. The child is no longer an Idaho resident; (7-1-24) b. The child dies; (7-1-24) c. The participant requests closure; or (7-1-24) d. The child turns nineteen (19) years old under Subsection 010.05 of these rules. (7-1-24) 02. Reasons Children are not Eligible for Continuous Eligibility. (7-1-24) a. A child is approved for emergency medical services; or (7-1-24) b. A child is approved for pregnancy-related services. (7-1-24)

An individual who is between the age of eighteen (18) and twenty-six (26), who was in foster care and became ineligible for Medicaid as a foster child due to age, may receive Medicaid coverage until their twenty-sixth birthday. There are no financial eligibility criteria. The only non-financial criteria are the receipt of foster care services and age. (7-1-24)

(Sections 530-549)

A child is deemed eligible for Medicaid for their first year of life when the following exists. (7-1-24) 01. Mother Filing an Application. The child is born to a mother who files an application for medical assistance. (7-1-24) 02. Mother Is Eligible for Medicaid. The mother is eligible for Medicaid in the newborn’s birth month, including a month of retroactive coverage. This includes a mother who qualifies for coverage only for the delivery because of her alien status. (7-1-24)

A minor parent is a child under the age of eighteen (18) who is pregnant or has a child. Minor parents who live with their parents may be eligible for Health Care Assistance for themselves and their children. The minor parent’s eligibility is determined under Section 300 of these rules related to tax filing households. (7-1-24)

A resident of an eligible institution must meet all non-financial and financial criteria of Title XIX, Title XXI, or any other applicable program. (7-1-24)

Children who receive foster care or are in adoptive placements are eligible for Medicaid. The children must meet non-financial criteria and the financial requirements described for the children's coverage group. (7-1-24) Department of Health and Welfare Assistance for Families & Children

A child may be eligible for Medicaid under the Title IV-E foster care program if they meet the eligibility requirements in IDAPA 16.06.01, “Child and Family Services,” Section 425. (7-1-24)

01. Payments for Children Under Eighteen (18) Years Old with SED. Under Section 56-254(2), Idaho Code, the Department will make payments for medical assistance for a child under eighteen (18) years old with serious emotional disturbance (SED), as defined in Section 16-2403, Idaho Code, and verified by an independent assessment: (7-1-24) a. Whose family income does not exceed three hundred percent (300%) of the FPG as determined using MAGI-based eligibility standards; or (7-1-24) b. Who meets other Title XIX Medicaid eligibility standards under the rules of the Department. (7-1-24) 02. Youth Empowerment Services (YES) Benefits. Applicants whose family income is equal to or less than three hundred percent (300%) of the FPG for children zero (0) to eighteen (18) years old and who meet the non-financial eligibility criteria in Sections 200 through 299 of these rules may receive the following benefits: (7-1-24) a. YES State Plan option services and supports under IDAPA 16.03.26, “Medicaid Plan Benefits,” Sections 640 through 649; and (7-1-24) b. Additional covered services under IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24) 03. Additional Eligibility Criteria and Program Requirements for YES. Additional eligibility criteria and program requirements applicable to the YES State Plan option are under IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24)

Presumptive eligibility determination for qualifying medical coverage groups can only be provided by a qualified hospital defined in Section 011 of these rules. (7-1-24) 01. Presumptive Eligibility Decisions. Decisions of presumptive eligibility can be made for individuals who meet program requirements for MAGI-based Medicaid coverage. (7-1-24) 02. Presumptive Eligibility Determination. Presumptive eligibility determinations are made by a qualified hospital when an individual receiving medical services is not covered by health care insurance and the financial assessment by hospital staff indicates the individual is eligible for Medicaid coverage in Idaho. This determination is made by hospital staff through an online presumptive application process: (7-1-24) a. Prior to completion of a full Medicaid application; and (7-1-24) b. Prior to a determination being made by the Department on the full application. (7-1-24) 03. Presumptive Eligibility Period. The presumptive eligibility period begins on the date the presumptive application is filed online and ends with the earlier of the following: (7-1-24) a. The date the full eligibility determination is completed by the Department; or (7-1-24) Department of Health and Welfare Assistance for Families & Children b. The end of the month after the month the qualified hospital completed the presumptive eligibility determination. (7-1-24)

A qualified hospital must have a Memorandum of Understanding (MOU) with the Department and follow all standards and processes agreed to in the MOU. (7-1-24) 01. Acceptance of Application. The qualified hospital accepts the request for services in the same manner as all applications for assistance are accepted. (7-1-24) 02. Standards and Processes. The presumptive eligibility determination must be based on standards and processes provided by the Department. (7-1-24) 03. Assistance to Applicant. The qualified hospital must assist the applicant in completing the Department's application process. (7-1-24) 04. Qualified Hospital Staff. Only qualified hospital staff who are trained in presumptive eligibility standards can make a presumptive eligibility determination. (7-1-24) 05. Notice to Applicant. The qualified hospital or the Department will provide notice to the applicant within two (2) business days on the presumptive eligibility determination. (7-1-24) 06. Notice and Hearing Rights. Presumptive eligibility decisions are not appealable and do not have hearing rights under the Title XIX Medicaid program. (7-1-24) 07. Number of Presumptive Eligibility Periods Allowed. Only one (1) presumptive eligibility period is allowed per applicant in any twelve (12) month period. (7-1-24)

(Sections 600-701)

Participants must have an annual eligibility review of all eligibility factors. Exceptions to the annual eligibility renewal are listed in Section 601 of these rules. (7-1-24) 01. Continuing Eligibility. Is determined using available electronic verification sources without participant contact, unless information: (7-1-24) a. Is not available; (7-1-24) b. Sources provide conflicting information; or (7-1-24) c. Is inconsistent with information provided by the participant. (7-1-24) 02. Inconsistency Impacts Eligibility. When inconsistency exists from electronic verification sources that impact participant eligibility, information must be verified by the participant. The Department provides the participant a document that displays household information currently being used to establish eligibility and asks the participant to verify correctness, and if not correct to provide updated information. (7-1-24)

A participant who receives Title XIX or Title XXI through time-limited coverage does not require an annual renewal when the following exists. (7-1-24) 01. Extended Medicaid. A participant who receives extended Medicaid is eligible under Section 420 Department of Health and Welfare Assistance for Families & Children of these rules. (7-1-24) 02. Pregnant Woman. A pregnant woman of any age is eligible for the Pregnant Woman coverage if she meets all the non-financial and financial criteria of the coverage group. Coverage includes services as described in IDAPA 16.03.26, “Medicaid Plan Benefits.” The Pregnant Woman medical assistance coverage extends through the sixty (60) day postpartum period if she applied for medical assistance while pregnant and was receiving medical assistance when the child was born. An individual who applies for Pregnant Woman medical assistance after the child is born is not eligible for the sixty-day (60) postpartum period. (7-1-24) 03. Newborn Child of Medicaid-Eligible Mother. A participant receiving Medicaid as the newborn child of a Medicaid-eligible mother is eligible under Section 530 of these rules. (7-1-24)

Changes in family circumstances must be reported to the Department by the tenth of the month following the month in which the change occurred. Report of changes may be made verbally, in writing, through personal contact, telephone, fax, electronic mail, or mail. (7-1-24)

Changes in circumstances the participant must report are the following: (7-1-24) 01. Name or Address. A name change for any participant or a change of address or location. (7-1-24) 02. Household Composition. Changes in family composition if a parent or relative caretaker receives Medicaid. (7-1-24) 03. Marital Status. Marriages or divorces of any family member if a parent or relative caretaker receives Medicaid. (7-1-24) 04. New SSN. SSN is newly assigned to a Medicaid Health Care Assistance program participant. (7-1-24) 05. Health Insurance Coverage. Enrollment or disenrollment of a participant in a health insurance plan. (7-1-24) 06. End of Pregnancy. Pregnant participants must report when pregnancy ends. (7-1-24) 07. Earned Income. Changes in the amount or source of earned income if a parent or relative caretaker receives Title XIX benefits. (7-1-24) 08. Unearned Income. Changes in the amount or source of unearned income if a parent or relative caretaker receives Title XIX benefits. (7-1-24) 09. Support Income. Changes in the amount of spousal support received by an adult household member. (7-1-24) 10. Disability. A family member who becomes disabled or is no longer disabled if a parent or relative caretaker receives Title XIX benefits. (7-1-24)

The Department will notify the participant of changes in their Health Care Assistance. The notice must give the effective date, the reason for the action, the rule that supports the action, and appeal rights. (7-1-24)

Department of Health and Welfare Assistance for Families & Children The Department can switch a participant from the Medicaid Basic Plan to the Medicaid Enhanced Plan within the same month. Advance notice must be given to the participant when there is a decrease in their benefits and they will be switched from the Enhanced Plan to the Basic Plan. (7-1-24)

The Department must notify the participant at least ten (10) calendar days before the effective date when a reported change results in Health Care Assistance closure. (7-1-24)

Advance notice is not required when a condition under this rule exists. The participant will be notified no later than the date of the action. (7-1-24) 01. The Department has Proof of the Participant’s Death. (7-1-24) 02. The Participant Requests Closure in Writing. (7-1-24) 03. Participant in Institution. The participant is admitted or committed to an institution. Further payments to the participant do not qualify for federal financial participation under the State Plan. (7-1-24) 04. Nursing Care. The participant is placed in a nursing facility or Intermediate Care Facility for Persons with Intellectual Disabilities (ICF/IID). (7-1-24) 05. The Participant’s Address is Unknown. (7-1-24) 06. The Participant is Approved for Medical Assistance in Another State. (7-1-24) 07. Eligible One Month. The participant is eligible for aid only during the calendar month of their application for aid. (7-1-24) 08. Retroactive Medicaid. The participant’s Title XIX or Title XXI eligibility is for a prior period. (7-1-24)

Health Care Assistance overpayments occur when a participant receives benefits during a month they were not eligible. (7-1-24)

All Health Care Assistance overpayments are subject to recovery. Overpayments are recovered by direct payment from the participant. (7-1-24) 01. Notice of Overpayment. The participant must be informed of the Health Care Assistance overpayment and appeal rights. (7-1-24) 02. Notice of Recovery. The participant must be informed when their Health Care Assistance overpayment is fully recovered. (7-1-24)

Zero-Based Regulation Review – 2023 for Rulemaking and 2024 Legislative Review IDAPA 16 – IDAHO DEPARTMENT OF HEALTH AND WELFARE Division of Welfare 16.03.04 – Idaho Food Stamp Program Who does this rule apply to? For those seeking nutrition assistance under the Idaho Food Stamp Program (also known as the Supplemental Nutrition Assistance Program - SNAP). What is the purpose of this rule? The purpose of these rules is to raise the nutritional level among low-income households whose limited food purchasing power contributes to hunger and malnutrition among members of such households. These rules contain the eligibility criteria for those seeking to receive benefits under the Idaho Food Stamp Program administered by the Department of Health and Welfare for the United States Department of Agriculture. What is the legal authority for the agency to promulgate this rule? This rule implements the following statute passed by the Idaho Legislature: Public Assistance and Welfare - Public Assistance Law: • Section 56-203, Idaho Code – Powers of State Department Where can I find information on Administrative Appeals? Administrative appeals and contested cases are governed by the provisions of IDAPA 16.05.03, “Contested Case Proceedings and Declaratory Rulings.” How do I request public records? Unless exempted, all public records are subject to disclosure by the Department that will comply with Title 74, Chapter 1, Idaho Code, upon requests. Confidential information may be restricted by state or federal law, federal regulation, and IDAPA 16.05.01, “Use and Disclosure of Department Records.” Who do I contact for more information on this rule? Idaho Department of Health and Welfare Division of Welfare – Idaho Food Stamp Program 450 West State Street Boise, ID 83702 P.O. Box 83720 Boise, ID 83720-0036 Phone: (208) 334-5815 or Toll-Free (877) 456-1233 Fax: (208) 334-5817 Email: SRProgramRules@dhw.idaho.gov Webpage: https://healthandwelfare.idaho.gov/services-programs/food-assistance/about-snap

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Table of Contents 16.03.04 – Idaho Food Stamp Program 000. Legal Authority. .................................................................................................... 10 001. -- 007. (Reserved) ................................................................................................. 10 008. Audit, Investigation And Enforcement. ................................................................. 10 009. (Reserved) ............................................................................................................ 10 010. Definitions A Through D. ...................................................................................... 10 011. Definitions E Through L. ....................................................................................... 11 012. Definitions M Through Z. ...................................................................................... 12 013. Abbreviations A Through G. ................................................................................. 14 014. Abbreviations I Through Z. ................................................................................... 14 015. -- 098. (Reserved) ................................................................................................. 15 099. Signatures. ........................................................................................................... 15 100. Application. ........................................................................................................... 15 101. Application Forms. ................................................................................................ 15 102. (Reserved) ............................................................................................................ 15 103. Filing An Application. ............................................................................................ 15 104. -- 105. (Reserved) ................................................................................................. 16 106. Determination Of When A New Application For Assistance (AFA) Is Required. .. 16 107. -- 112. (Reserved) ................................................................................................. 16 113. Household Cooperation. ....................................................................................... 16 114. Application Withdrawal. ........................................................................................ 16 115. Authorized Representative. .................................................................................. 16 116. -- 119. (Reserved) ................................................................................................. 17 120. Household Interviews. .......................................................................................... 17 121. -- 132. (Reserved) ................................................................................................. 17 133. Verification. ........................................................................................................... 17 134. (Reserved) ............................................................................................................ 17 135. Sources Of Verification. ........................................................................................ 17 136. (Reserved) ............................................................................................................ 17 137. Proof For Questionable Information. .................................................................... 18 138. Providing Proof To Support Application Statements. ........................................... 18 139. -- 141. (Reserved) ................................................................................................. 18 142. Processing Standards. ......................................................................................... 18 143. -- 145. (Reserved) ................................................................................................. 18 146. Denial Of Food Stamp Application. ...................................................................... 18 147. Delays In Processing. ........................................................................................... 18 148. -- 154. (Reserved) ................................................................................................. 18 155. Expedited Service Eligibility. ................................................................................ 18 156. Time Limits For Expedited Food Stamps. ............................................................ 19 157. Expedited Food Stamp Work Registration. .......................................................... 19 158. Expedited Verification. .......................................................................................... 19 159. (Reserved) ............................................................................................................ 19 160. Expedited Certification. ........................................................................................ 19

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161. No Limit To Expedited Certifications. ................................................................... 21 162. Expedited Services For Destitute Households. .................................................... 21 163. Special Consideration Of Income For Destitute Households. .............................. 21 164. Denial Of Expedited Service. ............................................................................... 21 165. Contesting Denied Expedited Service. ................................................................. 21 166. -- 177. (Reserved) ................................................................................................. 22 178. Categorically Eligible Households. ....................................................................... 22 179. Households Not Categorically Eligible. ................................................................ 22 180. Categorical Eligibility Ends. .................................................................................. 22 181. Broad -Based Categorically Eligible Household Exceptions. ............................... 22 182. Verification For TAFI Or AABD Households. ........................................................ 23 183. Time Limits For Categorically Eligible Households. ............................................. 23 184. -- 194. (Reserved) ................................................................................................. 23 195. Disaster Certification. ........................................................................................... 23 196. -- 199. (Reserved) ................................................................................................. 23 200. Nonfinancial Criteria. ............................................................................................ 23 201. Identification. ........................................................................................................ 23 202. Residency. ............................................................................................................ 23 203. Social Security Number (SSN) Requirement. ...................................................... 23 204. Citizenship And Qualified Non-Citizen Requirements. ......................................... 23 205. Written Declaration Of Citizenship Or Immigration Status. .................................. 24 206. Proof Of Proper Immigration Status. .................................................................... 24 207. Non-Citizen Eligibility Pending Verification. .......................................................... 24 208. -- 211. (Reserved) ................................................................................................. 24 212. Food Stamp Households. ..................................................................................... 24 213. Separate Food Stamp Household Composition For Related Members. .............. 24 214. Child Custody. ...................................................................................................... 25 215. Persons Not Eligible For Separate Food Stamp Household Status. .................... 25 216. Elderly Or Disabled Food Stamp Household Members. ....................................... 25 217. Nonhousehold Members. ..................................................................................... 26 218. Persons Disqualified As Food Stamp Household Members. ................................ 26 219. Circumstances Under Which Food Stamp Participation Is Prohibited. ................ 26 220. -- 225. (Reserved) ................................................................................................. 27 226. Job Search Assistance Program (JSAP). ............................................................. 27 227. Exemptions From JSAP. ...................................................................................... 27 228. Deferrals From JSAP For Household Members Participating In TAFI. ................ 28 229. Participants Losing JSAP Exempt Status. ............................................................ 28 230. -- 235. (Reserved) ................................................................................................. 28 236. Good Cause. ........................................................................................................ 28 237. Sanctions For Failure To Comply With JSAP Work Program Requirements. ...... 28 238. Notice Of Sanctions For Failure To Comply With JSAP. ...................................... 29 239. Right To Appeal Sanction. .................................................................................... 29 240. JSAP Sanction Begins. ........................................................................................ 29 241. Ending Sanctions For Failure To Comply With JSAP. ......................................... 29

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242. Corrective Action For Work Programs. ................................................................. 29 243. -- 250. (Reserved) ................................................................................................. 30 251. Able-Bodied Adults Without Dependents (ABAWD) Work Requirement. ............. 30 252. Proof Required For ABAWDs. .............................................................................. 30 253. ABAWD Good Cause. .......................................................................................... 30 254. Reporting ABAWD Changes. ............................................................................... 30 255. Regaining Eligibility. ............................................................................................. 30 256. Three Additional Months Of Food Stamps After Regaining Eligibility. ................. 31 257. Persons Not Considered ABAWD. ....................................................................... 31 258. Food Stamps Issued To Ineligible ABAWD. ......................................................... 31 259. Strikes. ................................................................................................................. 31 260. Government Employees Dismissed For Strike. .................................................... 31 261. Voluntary Job Quit. ............................................................................................... 31 262. Voluntary Reduction In Work Hours. .................................................................... 32 263. -- 264. (Reserved) ................................................................................................. 32 265. Situations Not Considered Voluntary Job Quit Or Reduction Of Work. ................ 32 266. Household Member Leaves During A Penalty Period. ......................................... 33 267. Good Cause For Voluntarily Quitting A Job Or Reducing Work Hours. ............... 33 268. Proof Of Job Quit Or Reduction Of Work Hours. .................................................. 33 269. (Reserved) ............................................................................................................ 33 270. Penalty For Applicant Quitting A Job Or Reducing Work Hours. ......................... 33 271. Penalty For Recipient Quitting A Job Or Reducing Work Hours. ......................... 33 272. Participant Voluntary Quit Or Reduction Of Work Hours. ..................................... 34 273. – 274. (Reserved) ................................................................................................. 34 275. Ending Voluntary Quit Work Program Penalties. ................................................. 34 276. Failure To Comply With A Requirement Of Another Means - Tested Program. ... 35 277. Penalty For Failure To Comply With A Requirement Of Another Means - Tested Program. ............................................................................................................ 35 278. Cooperation In Establishment Of Paternity And Obtaining Support. .................... 35 279. Failure To Cooperate. .......................................................................................... 35 280. Exemptions From The Cooperation Requirement. ............................................... 35 281. – 282. (Reserved) ................................................................................................. 35 283. Student Enrollment. .............................................................................................. 35 284. Determining Student Eligibility. ............................................................................. 36 285. Ineligibility Of Fugitive Felons And Probation And Parole Violators. .................... 36 286. Effective Date Of Ineligibility. ................................................................................ 36 287. Ineligibility For A Felony Conviction For Possession, Use, Or Distribution Of A Controlled Substance. ....................................................................................... 36 288. -- 299. (Reserved) ................................................................................................. 36 300. Resources Defined. .............................................................................................. 37 301. Determining Resources. ....................................................................................... 37 302. -- 304. (Reserved) ................................................................................................. 37 305. Resource Limit. .................................................................................................... 37 306. -- 307. (Reserved) ................................................................................................. 37

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308. Equity Value Of Resources. ................................................................................. 37 309. Liquid Resources. ................................................................................................. 37 310. Nonliquid Resources. ........................................................................................... 37 311. Factors Making Property A Resource. ................................................................. 38 312. -- 313. (Reserved) ................................................................................................. 38 314. Jointly Owned Resources. .................................................................................... 38 315. Jointly Owned Resources Excluded. .................................................................... 38 316. -- 322. (Reserved) ................................................................................................. 38 323. Lump Sum Resources. ......................................................................................... 38 324. -- 333. (Reserved) ................................................................................................. 39 334. Vehicles. ............................................................................................................... 39 335. -- 350. (Reserved) ................................................................................................. 39 351. Excluded Resources. ........................................................................................... 39 352. Household Goods Excluded. ................................................................................ 39 353. Personal Effects Excluded. .................................................................................. 39 354. Home And Lot Excluded. ...................................................................................... 39 355. Life Insurance Excluded As A Resource. ............................................................. 40 356. Burial Space Or Plot And Funeral Agreement Exclusions. .................................. 40 357. Pension Plans Or Funds Excluded As A Resource. ............................................. 40 358. Income-Producing Property Excluded. ................................................................. 40 359. Livestock Excluded. .............................................................................................. 40 360. Property Used For Self-Support Excluded. .......................................................... 40 361. Property Used With Excluded Vehicle. ................................................................. 40 362. Salable Item Without Significant Return Excluded. .............................................. 40 363. HUD Family Self-Sufficiency (FSS) Escrow Account. .......................................... 40 364. Educational Accounts Excluded As A Resource. ................................................. 41 365. Individual Development Account Excluded As A Resource. ................................ 41 366. -- 372. (Reserved) ................................................................................................. 41 373. Government Payments Excluded. ........................................................................ 41 374. Excluded Inaccessible Resources. ....................................................................... 41 375. Frozen Or Secured Accounts Excluded. .............................................................. 41 376. Real Property Excluded If Attempt To Sell. .......................................................... 41 377. Trust Funds Excluded. ......................................................................................... 41 378. Installment Contracts Excluded. ........................................................................... 41 379. Treatment Of Excluded Resources. ..................................................................... 42 380. (Reserved) ............................................................................................................ 42 381. Nonliquid Resources With Liens Excluded. .......................................................... 42 382. (Reserved) ............................................................................................................ 42 383. Excluded Resource Changes To Counted Resource. .......................................... 42 384. -- 385. (Reserved) ................................................................................................. 42 386. Transfer Of Resources. ........................................................................................ 42 387. Transfer Of Resource Not Counted For Disqualification. ..................................... 42 388. Disqualification For Transferring Resources. ....................................................... 42 389. -- 399. (Reserved) ................................................................................................. 43

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400. Income. ................................................................................................................. 43 401. Earned Income. .................................................................................................... 43 402. Unearned Income. ................................................................................................ 43 403. -- 404. (Reserved) ................................................................................................. 44 405. Excluded Income. ................................................................................................. 44 406. (Reserved) ............................................................................................................ 46 407. Income And Eligibility Verification System (IEVS). ............................................... 46 408. (Reserved) ............................................................................................................ 46 409. Use Of IEVS Information For Applicant Households. ........................................... 46 410. (Reserved) ............................................................................................................ 46 411. Verified Upon Receipt IEVS Data. ........................................................................ 46 412. Unverified IEVS Data. .......................................................................................... 46 413. -- 427. (Reserved) ................................................................................................. 46 428. Calculation Of Self-Employment Income. ............................................................. 46 429. Self-Employed Farmer. ....................................................................................... 47 430. -- 500. (Reserved) ................................................................................................. 47 501. Initial Changes In Food Stamp Case. ................................................................... 47 502. Earned Income When A Household Member Turns Age Eighteen. ..................... 47 503. -- 507. (Reserved) ................................................................................................. 47 508. Projecting Monthly Income. .................................................................................. 47 509. Types Of Income To Be Averaged. ...................................................................... 48 510. -- 511. (Reserved) ................................................................................................. 48 512. Special Cases For Counting Income. ................................................................... 48 513. -- 531. (Reserved) ................................................................................................. 48 532. Gross Income Limit. ............................................................................................. 48 533. Household Eligibility And Benefit Level. ............................................................... 49 534. Averaging Infrequent, Fluctuating, Or One-Time Only Expenses. ....................... 49 535. Medical Expenses. ............................................................................................... 49 536. Dependent Care Expenses. ................................................................................. 49 537. Dependent Care Restrictions. .............................................................................. 49 538. Child Support Expenses. ...................................................................................... 50 539. -- 541. (Reserved) ................................................................................................. 50 542. Costs Allowed For Shelter Deduction. .................................................................. 50 543. Utility Allowances. ................................................................................................ 50 544. -- 546. (Reserved) ................................................................................................. 50 547. Costs Not Allowed For The Shelter Deduction. .................................................... 50 548. Computing The Shelter Deduction. ...................................................................... 51 549. Net Income Limit Test. ......................................................................................... 51 550. Determination Of Food Stamp Benefit. ................................................................ 51 551. Rounding Food Stamp Payment. ......................................................................... 51 552. -- 561. (Reserved) ................................................................................................. 51 562. Prorating Initial Month's Benefits. ......................................................................... 51 563. Food Stamp Prorating Formula. ........................................................................... 51 564. Benefits After The Initial Month. ........................................................................... 51

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565. -- 572. (Reserved) ................................................................................................. 51 573. Acting On Household Composition Changes. ...................................................... 51 574. (Reserved) ............................................................................................................ 51 575. Household Composition Changes For Student. ................................................... 51 576. -- 587. (Reserved) ................................................................................................. 52 588. Notice Of Decision To Households. ..................................................................... 52 589. -- 600. (Reserved) ................................................................................................. 52 601. Reporting Requirements And Responsibilities. .................................................... 52 602. (Reserved) ............................................................................................................ 52 603. Person Outside Household Fails To Provide Proof -- Changes. .......................... 52 604. -- 610. (Reserved) ................................................................................................. 52 611. Time Frames For Reporting Changes In Household Circumstances. .................. 52 612. (Reserved) ............................................................................................................ 52 613. Changes On Which The Department Must Act. ................................................... 52 614 -- 616. (Reserved) .................................................................................................. 52 617. Increases In Food Stamp Benefits. ...................................................................... 52 618. Decreases In Food Stamp Benefits. ..................................................................... 53 619 -- 620. (Reserved) .................................................................................................. 53 621. TAFI Or AABD Household Reporting Changes. ................................................... 53 622. Change Ends TAFI Or AABD Income. ................................................................. 53 623. Failure To Take Required Action. ......................................................................... 53 624. -- 628. (Reserved) ................................................................................................. 53 629. Notice Of Lowering Or Ending Benefits. ............................................................... 53 630. Adequate Notice. .................................................................................................. 53 631. Timely Notice. ....................................................................................................... 53 632. Timely Notice Not Required. ................................................................................ 53 633. Notice Of Changes Not Required. ........................................................................ 54 634. Verbal Request For End Of Food Stamps. ........................................................... 55 635. -- 638. (Reserved) ................................................................................................. 55 639. Continuation Of Benefits Pending A Hearing. ...................................................... 55 640. (Reserved) ............................................................................................................ 55 641. Reducing Or Ending Benefits Before Hearing Decision. ...................................... 55 642. -- 643. (Reserved) ................................................................................................. 55 644. Expiration Of Certification Period. ........................................................................ 56 645. Recertification Process. ........................................................................................ 56 646. Notice Of Decision For Timely Recertification. ..................................................... 56 647. -- 649. (Reserved) ................................................................................................. 56 650. Restoration Of Lost Benefits. ............................................................................... 56 651. Time Frames For Restoration Of Benefits. ........................................................... 56 652. -- 655. (Reserved) ................................................................................................. 56 656. Replacing Food Destroyed By A Disaster. ........................................................... 56 657. -- 674. (Reserved) ................................................................................................. 57 675. IPV, IHE, And AE Food Stamp Claims. ................................................................ 57 676. Persons Liable For Food Stamp Claims. .............................................................. 57

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677. Computing Food Stamp Claims. .......................................................................... 57 678. -- 691. (Reserved) ................................................................................................. 58 692. Determining Delinquent Claims. ........................................................................... 58 693. (Reserved) ............................................................................................................ 58 694. Collecting Claims. ................................................................................................. 58 695. Top Notices. ......................................................................................................... 58 696. Effects Of Top On The Food Stamp Household. .................................................. 59 697. Removing A Claim From Top. .............................................................................. 59 698. Intentional Program Violation (IPV). ..................................................................... 59 699. Establishing An Intentional Program Violation (IPV). ........................................... 60 700. Administrative Responsibility For Establishing IPV. ............................................. 60 701. Penalties For An IPV. ........................................................................................... 60 702. Penalties For IPV Trafficking. ............................................................................... 61 703. Penalties For IPV Receipt Of Multiple Benefits. ................................................... 61 704. -- 714. (Reserved) ................................................................................................. 61 715. Waived Hearings. ................................................................................................. 61 716. Disqualification After Waived Hearing. ................................................................. 61 717. Court Referrals. .................................................................................................... 61 718. Deferred Adjudication. .......................................................................................... 61 719. (Reserved) ............................................................................................................ 62 720. Claims Discharged By Bankruptcy. ...................................................................... 62 721. (Reserved) ............................................................................................................ 62 722. Interstate Claims Collection. ................................................................................. 62 723. -- 727. (Reserved) ................................................................................................. 62 728. Food Stamp Reduction, Suspension, Or Cancellation. ........................................ 62 729. -- 750. (Reserved) ................................................................................................. 62 751. Boarders. .............................................................................................................. 62 752. Strikers. ................................................................................................................ 63 753. Sponsored Legal Non-Citizens. ............................................................................ 63 754. Deeming Income And Resources To Sponsored Legal Non-Citizen. .................. 63 755. – 756. (Reserved) ................................................................................................. 64 757. Sponsored Legal Non-Citizen's Responsibility. .................................................... 64 758. – 760. (Reserved) ................................................................................................. 64 761. Collecting Claims Against Sponsors Who Signed An I-864 Affidavit Of Support On Or After December 19, 1997. ...................................................................... 64 762. Collecting Claims Against Sponsored Legal Non-Citizens. .................................. 64 763. Reimbursement For Benefits Received. ............................................................... 64 764. -- 790. (Reserved) ................................................................................................. 64 791. Resident Of An Institution. .................................................................................... 64 792. Prerelease Applicants From Public Institutions. ................................................... 65 793. Substance Use Disorder Treatment Centers. ...................................................... 65 794. Treatment Center Responsibilities. ...................................................................... 65 795. Residents Of Group Living Arrangements. ........................................................... 66 796. Shelters For Battered Women And Children. ....................................................... 66

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797. -- 815. (Reserved) ................................................................................................. 67 816. Purchase Of Prepared Meals. .............................................................................. 67 817. -- 849. (Reserved) ................................................................................................. 67 850. Food Stamp Household Rights. ........................................................................... 67 851. (Reserved) ............................................................................................................ 68 852. Food Stamp Household Responsibilities. ............................................................. 68 853. Department Informing Responsibilities. ................................................................ 68 854. Department Will Document Eligibility Decisions. .................................................. 68 855. -- 860. (Reserved) ................................................................................................. 68 861. No Discrimination In Food Stamp Program. ......................................................... 68 862. Public Notice For No Discrimination. .................................................................... 69 863. (Reserved) ............................................................................................................ 69 864. Discrimination Complaint Procedure. ................................................................... 69 865. Disclosure Of Information. .................................................................................... 69 866. Availability Of Public Information. ......................................................................... 69 867. Food Stamp Information Requirements. .............................................................. 69 868. -- 871. (Reserved) ................................................................................................. 69 872. Program Transfer During Certification Period. ..................................................... 69 873. -- 878. (Reserved) ................................................................................................. 69 879. Review Of Case File. ............................................................................................ 69 880. -- 882. (Reserved) ................................................................................................. 69 883. Refusal To Cooperate With Quality Control Reviews. .......................................... 69 884. -- 999. (Reserved) ................................................................................................. 70

Section 000 Page 10

16.03.04 – IDAHO FOOD STAMP PROGRAM 000. LEGAL AUTHORITY. Sections 56-202, 56-203, and 56-209, Idaho Code, authorizes the Department to enter into contracts and agreements with the federal government and to engage in rulemaking for the administration and management of public assistance or welfare services. (7-1-24) 001. -- 007. (RESERVED) 008. AUDIT, INVESTIGATION AND ENFORCEMENT. The Department may audit, investigate and take enforcement action under these rules and the provisions of IDAPA 16.05.07, “Investigation and Enforcement of Fraud, Abuse or Misconduct.” (7-1-24) 009. (RESERVED) 010. DEFINITIONS A THROUGH D. 01. Adequate Notice. Notice a household must receive on or before the first day of the month an action by the Department is effective. (7-1-24) 02. Administrative Error Claim. A claim resulting from an overissuance caused by the Department’s action or failure to act. (7-1-24) 03. Aid to the Aged, Blind and Disabled (AABD). Cash, excluding in-kind assistance, financed by federal, state, or local government and provided to cover living expenses or other basic needs. (7-1-24) 04. Application for Participation. The application form filed by the head of the household or authorized representative. (7-1-24) 05. Authorized Representative. A person designated by the household to act on behalf of the household to apply for, or receive and use Food Stamps. (7-1-24) 06. Battered Women and Children's Shelter. A shelter for battered women and children which is a public or private nonprofit residential facility. (7-1-24) 07. Boarder. An individual paying a reasonable amount for meals and lodging. (7-1-24) 08. Boarding House. A licensed commercial enterprise offering meals and lodging for payment to make a profit. (7-1-24) 09. Broad-Based Categorical Eligibility. If a participant meets the eligibility requirements found in 7 CFR Section 273.2(j)(2) and also all other Food Stamp eligibility criteria, then the participant is eligible for Food Stamps. Participants who are eligible under this definition are also subject to resource, gross, and net income eligibility standards. (7-1-24) 10. Categorical Eligibility. If all household members receive or are authorized to receive monthly cash payment through TAFI, AABD, or SSI, the household is categorically eligible. Categorically eligible households are exempt from resource, gross, and net income eligibility standards. (7-1-24) 11. Certification Period. The period for which a household is certified to receive Food Stamp benefits. The month of application counts as the first month of certification. (7-1-24) 12. Contact (Six-Month). A recertification that waives the interview requirement, allowing for written contact and verification of the participant’s circumstances in lieu of the interview. (7-1-24) 13. Claim Determination. The action taken by the Department establishing the household’s liability for repayment when an overissuance of Food Stamps occurs. (7-1-24) 14. Department. The Idaho Department of Health and Welfare. (7-1-24) 15. Disqualified Household Members. Individuals required to be excluded from participation in the Food Stamp Program are Disqualified Household Members. (7-1-24)

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011. DEFINITIONS E THROUGH L. 01. Electronic Benefit Transfer (EBT). A method of issuing Food Stamps to an eligible household. (7-1-24) 02. Eligible Foods. Any food or food product for human consumption excluding alcohol, tobacco, and hot food products ready for immediate consumption. Eligible foods also include garden seeds and plants to grow food for human consumption. (7-1-24) 03. Eligible Household. A household living in Idaho and meeting the eligibility criteria in these rules. (7-1-24) 04. Exempt. A household member who is not required to register for, or participate in, the JSAP program is exempt. A household member who is not required to register for work is exempt. (7-1-24) 05. Extended Certification Household (EC). A household in which all members are elderly or disabled, and no one has earned income. (7-1-24) 06. Fair Hearing. A fair hearing in an appeal of a Department decision. (7-1-24) 07. Federal Fiscal Year (FFY). The period from October 1 to September 30. (7-1-24) 08. Field Office. A Department service delivery site. (7-1-24) 09. Food and Nutrition Service (FNS). The federal entity under the US Department of Agriculture (USDA) that administers the Food Stamp program. (7-1-24) 10. Group Living Arrangement. A public or private nonprofit residential setting serving no more than sixteen (16) residents. The residents are blind or disabled and receiving benefits under Title II or XVI of the Social Security Act, certified by the Department under Section 1616(e) of the Social Security Act, or under standards determined by the Secretary of USDA to be comparable to Section 1616(e) of the Social Security Act. (7-1-24) 11. Homeless Person. A person: (7-1-24) a. Who has no fixed or regular nighttime residence. (7-1-24) b. Whose primary nighttime residence is a temporary accommodation for not more than ninety (90) days in the home of another individual or household. (7-1-24) c. Whose primary nighttime residence is a temporary residence in a supervised public or private shelter providing temporary residence for homeless persons. (7-1-24) d. Whose primary nighttime residence is a temporary residence in an institution which provides temporary residence for people who are being transferred to another institution. (7-1-24) e. Whose primary nighttime residence is a temporary residence in a public or private place which is not designed or customarily used as sleeping quarters for people. (7-1-24) 12. Homeless Meal Provider. A public or private nonprofit establishment or a profit-making restaurant that provides meals to homeless people. The establishment or restaurant must be approved by the Department and authorized as a retail food store by FNS. (7-1-24) 13. Identification Card. The card identifying the bearer as eligible to receive and use Food Stamps. (7-1-24) 14. Inadvertent Household Error Claim (IHE). A claim resulting from an overissuance, caused by the household’s misunderstanding or unintended error. (7-1-24)

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15. Income and Eligibility Verification System (IEVS). A system of information acquisition and exchange for income and eligibility verification which meets Section 1137 of the Social Security Act requirements. (7-1-24) 16. Institution of Higher Education. Any institution that normally requires a high school diploma or equivalency certificate for enrollment. These institutions include colleges, universities, and business, vocational, technical, or trade schools at the post-secondary level. (7-1-24) 17. Institution of Post-Secondary Education. Educational institutions normally requiring a high school diploma or equivalency certificate for enrollment or admits persons beyond the age of compulsory school attendance. The institution must be legally authorized by the state and provide a program of training to prepare students for gainful employment. (7-1-24) 18. Legal Noncitizen. A qualified alien under 8 USC Section 1641(b). (7-1-24) 19. Limited Utility Allowance (LUA). Utility deduction given to a food stamp household that has a cost for more than one (1) utility. This includes electricity and fuel for purposes other than heating or cooling, water, sewage, well and septic tank installation and maintenance, telephone, and garbage or trash collection. (7-1-24) 012. DEFINITIONS M THROUGH Z. 01. Migrant Farmworker Household. Has a member who travels from community to community to do agricultural work. (7-1-24) 02. Minimum Utility Allowance (MUA). Utility deduction given to a food stamp household that has a cost for one (1) utility that is not heating, cooling, or telephone. (7-1-24) 03. Nonexempt. A household member who must register for work and participate in the JSAP program. (7-1-24) 04. Nonprofit Meal Delivery Service. A political subdivision or a private nonprofit organization that prepares and delivers meals and is authorized to accept Food Stamps. (7-1-24) 05. Overissuance. The amount Food Stamps issued exceeds the Food Stamps a household was eligible to receive. (7-1-24) 06. Parental Control. Means that an adult household member has a minor in the household who is dependent financially or otherwise on the adult. Minors living with children of their own are not under parental control. (7-1-24) 07. Participant. A person who receives Food Stamp benefits. (7-1-24) 08. Program. The Food Stamp Program created under the Food Stamp Act and administered in Idaho by the Department. (7-1-24) 09. Recertification. A recertification is a process for determining ongoing eligibility for Food Stamps. (7-1-24) 10. Retail Food Store. For Food Stamp purposes means: (7-1-24) a. An establishment, or recognized department of an establishment, or a house-to-house food trade route, whose food sales volume is more than fifty percent (50%) staple food items for home preparation and consumption. (7-1-24) b. Public or private communal dining facilities and meal delivery services. (7-1-24)

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c. Private nonprofit drug addict or alcohol treatment and rehabilitation programs. (7-1-24) d. Public or private nonprofit group living arrangements. (7-1-24) e. Public or private nonprofit shelters for battered women and children. (7-1-24) f. Private nonprofit cooperative food purchasing ventures, including those whose members pay for food prior to the receipt of the food. (7-1-24) g. A farmers’ market. (7-1-24) h. An approved public or private nonprofit establishment that feeds homeless persons. The establishment must be approved by FNS. (7-1-24) 11. Sanction. A penalty period when an individual is ineligible for Food Stamps. (7-1-24) 12. Seasonal Farmworker Household. Has a member who does agricultural work of a seasonal or other temporary nature. (7-1-24) 13. Self-Employment. The process of actively earning income directly from one's own business, trade, or profession. To be considered self-employed, a person is responsible for obtaining or providing a service or product that generates, or is expected to generate, income. (7-1-24) 14. Spouse. Persons who are legally married under Idaho law. (7-1-24) 15. Standard Utility Allowance (SUA). Utility deduction given to a food stamp household that has a cost for heating or cooling. (7-1-24) 16. State. Any of the fifty (50) States, the District of Columbia, Puerto Rico, Guam, Northern Mariana Islands, and Virgin Islands of the United States. (7-1-24) 17. Student. An individual between the ages of eighteen (18) and fifty (50), physically and intellectually fit, and enrolled at least half-time in an institution of higher education. An institution of higher education usually requires a high school or general equivalency diploma for enrollment. This includes colleges, universities, and vocational or technical schools at the post-secondary school level. (7-1-24) 18. Substance Use Disorder Treatment Program. Any drug or alcohol rehabilitation program conducted by a private nonprofit organization or institution or a publicly operated community mental health center under Part B of Title XIX of the Public Health Service Act (42 USC 300x, et seq.). Indian reservation-based centers may qualify if FNS requirements are met and the program is funded by the National Institute on Alcohol Abuse under Public Law 91-616 or was transferred to Indian Health Service funding. (7-1-24) 19. Supplemental Security Income (SSI). Monthly cash payments under Title XVI of the Social Security Act. Payments include state or federally administered supplements. (7-1-24) 20. Systematic Alien Verification for Entitlements (SAVE). The federal automated system that provides immigration status needed to determine an applicant's eligibility for many public benefits, including Food Stamps. (7-1-24) 21. Telephone Utility Allowance (TUA). Utility deduction given to a Food Stamp household that has a cost for telephone services and no other utilities. (7-1-24) 22. Timely Notice. Notice that is mailed electronically, at least ten (10) days before the effective date of an action taken by the Department. (7-1-24) 23. Tribal General Assistance. Cash, excluding in-kind assistance, financed by federal, state, or local government and provided to cover living expenses or other basic needs. (7-1-24)

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24. Verification. Third party data or documents used to prove the accuracy of information used to make an eligibility determination. (7-1-24) 25. Verified Upon Receipt. Information received from certain authorized automated system matches that are considered automatically verified unless questionable. (7-1-24) 26. Written Notice. Correspondence that is generated by any method including handwritten, typed, or electronic, delivered to the customer by hand, U.S. Mail, professional delivery service, or by any electronic means. The terms “notice” and “written notice” are used interchangeably. (7-1-24) 013. ABBREVIATIONS A THROUGH G. 01. AABD. Aid to the Aged, Blind, and Disabled. (7-1-24) 02. ABAWD. Able-bodied adults without dependents. (7-1-24) 03. AE. Administrative Error. (7-1-24) 04. AFA. Application for Assistance. (7-1-24) 05. CSS. Bureau of Child Support Services. (7-1-24) 06. DHW. Department of Health and Welfare in Idaho. (7-1-24) 07. EBT. Electronic Benefit Transfer. (7-1-24) 08. EWS. Enhanced Work Services. (7-1-24) 09. FNS. Food and Nutrition Service of the USDA. (7-1-24) 10. FFY. Federal fiscal year. (7-1-24) 11. FPG. Federal Poverty Guideline(s). (7-1-24) 12. FQC. Federal Quality Control. (7-1-24) 13. HUD. US Department of Housing and Urban Development. (7-1-24) 014. ABBREVIATIONS I THROUGH Z. 01. IHE. Inadvertent household error. (7-1-24) 02. IPV. Intentional program violation. (7-1-24) 03. IRS. Internal Revenue Service. (7-1-24) 04. JSAP. Job Search Assistance Program. (7-1-24) 05. LUA. Limited utility allowance. (7-1-24) 06. MUA. Minimum utility allowance. (7-1-24) 07. PA. Public Assistance. (7-1-24) 08. RSDI. Retirement, Survivors, Disability Insurance received from SSA. (7-1-24)

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09. SAVE. Systematic Alien Verification for Entitlements. (7-1-24) 10. SDX. State Data Exchange. (7-1-24) 11. SQC. State Quality Control. (7-1-24) 12. SUA. Standard utility allowance. (7-1-24) 13. SSA. Social Security Administration. (7-1-24) 14. SSI. Federal Supplemental Security Income Program for the aged, blind, or disabled. (7-1-24) 15. SSN. Social Security Number. (7-1-24) 16. TAFI. Temporary Assistance for Families in Idaho. (7-1-24) 17. TOP. Treasury Offset Program. (7-1-24) 18. TUA. Telephone Utility Allowance. (7-1-24) 19. UI. Unemployment Insurance. (7-1-24) 20. USDA. U S Department of Agriculture. (7-1-24) 21. VA. Veterans Administration. (7-1-24) 22. WIOA. Workforce Innovation and Opportunity Act. (7-1-24) 015. -- 098. (RESERVED) 099. SIGNATURES. An individual who is applying for benefits, receiving benefits, or providing additional information as required in these rules, may do so with the representation of the individual's name either handwritten, electronic, or recorded telephonically. Such signature serves as intention to execute or adopt the sound, symbol, or process for the purpose of signing the related record. (7-1-24) 100. APPLICATION. To apply for Food Stamps, the household or an authorized representative must complete and file an application with the Department, complete an interview, and verify information. There is no age requirement for applicants. Applicants may bring anyone to the interview. The Department will act on all applications and will grant Food Stamps to eligible households back to the date of application. (7-1-24) 101. APPLICATION FORMS. Households can file an application the first day they contact the Department. The Department will have AFA forms readily available to households and will provide an AFA to any person making a request. Requests for the application can be made by telephone, in person, or by another person. The Department will mail or give the AFA to the person on the day requested. (7-1-24) 102. (RESERVED) 103. FILING AN APPLICATION. The AFA must contain the applicant’s name, address, signature, and application date. A household can file for Food Stamps by turning in page one of the AFA to the Food Stamp office. This protects the application date. If the household is eligible, Food Stamps for the first month will be prorated from the application date. The AFA can be submitted at the field office by the household or authorized representative. The AFA can be submitted by mail, fax, or email. (7-1-24)

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104. -- 105. (RESERVED) 106. DETERMINATION OF WHEN A NEW APPLICATION FOR ASSISTANCE (AFA) IS REQUIRED. The Department must follow the procedure outlined in 7 CFR 273.2(g) and (h) in determining when a food stamp household is required to fill out a new AFA. (7-1-24) 107. -- 112. (RESERVED) 113. HOUSEHOLD COOPERATION. The household must cooperate with the Department. The application must be denied if the household refuses to cooperate. Refusal to cooperate includes failing to act without a sound and timely excuse. Giving false information on purpose is failure to cooperate. If an application is denied or Food Stamps are stopped for refusal to cooperate, the household may reapply. The household is not eligible until it cooperates with the Department. (7-1-24) 114. APPLICATION WITHDRAWAL. Households can withdraw their application any time before the eligibility decision. The Department will document the case record with the withdrawal reason. The Department will tell the household of the right to reapply. (7-1-24) 115. AUTHORIZED REPRESENTATIVE. The household can choose a nonhousehold member to act as an authorized representative. The household can designate in writing another responsible household member or a responsible adult outside the household as an authorized representative. An adult employee of an authorized substance use disorder treatment and rehabilitation center, or an authorized group living arrangement center, may act as an authorized representative for the household. Conditions for an authorized representative are: (7-1-24) 01. Designating Authorized Representative. Households may designate an authorized representative to act on behalf of a household to apply for, receive, or use food stamps. The authorized representative should be aware of household circumstances. (7-1-24) 02. Persons Who Cannot Be an Authorized Representative. Persons with a conflict of interest may not act as an authorized representative without the Department’s written approval. The field office supervisor must determine if no one else is available and give written approval. Persons with a conflict of interest are listed below: (7-1-24) a. Retailers allowed to accept Food Stamps. (7-1-24) b. Department employees involved in the certification or issuance process. (7-1-24) c. A person disqualified for IPV during the penalty period, unless they are the only adult household member and no one else is available. (7-1-24) d. Homeless meal providers. (7-1-24) 03. Department Responsibilities. The Department will: (7-1-24) a. Make sure authorized representatives are properly selected. (7-1-24) b. Record the representative’s name in the case record. (7-1-24) c. Inform the household it will be liable for any overissuance resulting from wrong information given by the representative. (7-1-24) d. Make sure the household freely requested the representative. (7-1-24) 04. Authorized Representative Removed. The Department may remove an authorized representative for up to one (1) year if the person knowingly gives false information, or improperly uses the Food Stamps. This

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provision does not apply to substance use disorder centers and group homes. Written notice must be sent to the household and the authorized representative thirty (30) days before the penalty begins. The notice must list: (7-1-24) a. The proposed action. (7-1-24) b. The reason for the action. (7-1-24) c. The right to a fair hearing. (7-1-24) d. The name and telephone number to contact for more information. (7-1-24) 05. Authorized Representatives for Substance Use Disorder Treatment Centers and Group Homes. Substance use disorder treatment centers and the heads of group living arrangements that act as authorized representatives for their residents, and which intentionally misrepresent households’ circumstances, may be prosecuted under applicable federal and state statutes for their acts. (7-1-24) 116. -- 119. (RESERVED) 120. HOUSEHOLD INTERVIEWS. The Department must conduct an interview with the applicant, a member of the household, or the authorized representative. Interviews must be conducted either face-to-face or via telephone The frequency of the interview must be as follows: (7-1-24) 01. Twenty-Four Months. At least once every twenty-four (24) months for households certified for twenty-four (24) months. (7-1-24) 02. Twelve Months. Every twelve (12) months for all other households. (7-1-24) 121. -- 132. (RESERVED) 133. VERIFICATION. The Department must have verification to support the benefit determination. The Department must give the applicant household a clear written statement of the proof to bring to the interview. The statement will indicate the Department will help the household get proof, if needed. The Department must give the household ten (10) calendar days from the request date to provide proof. Proof can be provided in person, by mail, or by electronic interfaces. If the proof supplied is questionable, the Department can require further proof. The Department will notify the household of any other steps necessary to complete the application process. (7-1-24) 134. (RESERVED) 135. SOURCES OF VERIFICATION. The following sources of verification must be considered: (7-1-24) 01. Written Confirmation. A primary source of proof is written confirmation of circumstances. Written proof includes driver’s licenses, work or school identification, birth certificates, wage stubs, award letters, court orders, divorce decrees, separation agreements, insurance policies, rent receipts, and utility bills. Acceptable proof is not limited to a single document. Proof can be obtained from the household or other sources. Secondary sources of proof must be used to verify a household’s circumstances if the primary source cannot be obtained or does not prove eligibility or benefit level. (7-1-24) 02. Collateral Contact. An oral confirmation of a household’s circumstances by a person outside of the household. The collateral contact may be made either in-person or over the telephone. (7-1-24) 03. Automated System Data. Information that is obtained through interfacing with other government agency computer systems or authorized systems. (7-1-24) 136. (RESERVED)

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137. PROOF FOR QUESTIONABLE INFORMATION. Prior to the certification, a six-month or twelve-month contact, or recertification of the household, the Department must verify all questionable information regarding eligibility and benefit level. Proof is required when details are not consistent with information received by the Department. Proof may be obtained either verbally or in writing.(7-1-24) 138. PROVIDING PROOF TO SUPPORT APPLICATION STATEMENTS. The household has primary responsibility to provide proof supporting its statements on the application and to resolve any questionable information. The Department must assist the household in obtaining proof. Households may supply proof in person, or by mail, facsimile, or other electronic interfaces. The Department will not require the household to present proof in person. (7-1-24) 139. -- 141. (RESERVED) 142. PROCESSING STANDARDS. The Department will determine Food Stamp eligibility within thirty (30) days of the application date. The application date is the day the AFA is received and date stamped by the field office. The application date for a person released from a public institution is the release date if the person applied for Food Stamps before their release. The AFA must contain at least the applicant’s name and address and be signed by a responsible household member or representative. (7-1-24) 143. -- 145. (RESERVED) 146. DENIAL OF FOOD STAMP APPLICATION. The Department will deny the Food Stamp application under conditions listed below and send the household notice of denial. (7-1-24) 01. Household Ineligible. The Department will deny the application for ineligible households as soon as possible, but not later than thirty (30) calendar days following the application date. (7-1-24) 02. Household Fails to Appear for Interview. If the household fails to appear for an interview, and fails to contact the Department, the application will be denied thirty (30) calendar days after the application date. (7-1-24) 03. Household Does Not Provide Proof After Interview. If the household did not provide requested proof after an interview or later request, the Department will deny the application ten (10) calendar days after the request for proof. (7-1-24) 147. DELAYS IN PROCESSING. The Department must follow the procedure outlined in 7 CFR 273.2(h) in determining the appropriate action to take on food stamp benefits when there are delays in completing the application process. (7-1-24) 148. -- 154. (RESERVED) 155. EXPEDITED SERVICE ELIGIBILITY. Applicants must be screened to determine if the household is entitled to expedited service. The household must meet one (1) of the expedited service criteria below. The household must have provided proof postponed by the last expedited service or have been certified under the normal standards since the last expedited service. (7-1-24) 01. Low Income and Resources. To receive expedited services, the household’s monthly countable gross income must be less than one hundred fifty dollars ($150) and the household’s liquid resources must not exceed one hundred dollars ($100). (7-1-24) 02. Destitute. To receive destitute expedited services, the household must be a destitute migrant or seasonal farmworker household. The household’s liquid resources must not exceed one hundred dollars ($100). (7-1-24)

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03. Income Less Than Rent and Utilities. The household’s combined monthly gross income and liquid resources are less than their monthly rent or mortgage, and utilities cost. (7-1-24) 156. TIME LIMITS FOR EXPEDITED FOOD STAMPS. Time limits for acting on expedited Food Stamp applications are listed below: (7-1-24) 01. Seven Day Limit for Food Stamps. For households entitled to expedited service, the Department will provide Food Stamps to the household within seven (7) days of the application date. (7-1-24) 02. Seven Days After Discovery. If not discovered at initial screening, the Department will provide expedited services to an expedite-eligible household within seven (7) days, which begins the day after the Department finds the household is entitled to expedited service. (7-1-24) 03. Seven Days for Waived Interview. The Department will provide expedited services within seven (7) days of the application date for households entitled to an office interview waiver. Seven (7) days is counted from the application date. (7-1-24) 157. EXPEDITED FOOD STAMP WORK REGISTRATION. The applicant must complete work registration unless they are exempt or have a representative register them. Other non- exempt household members must register if the registration can be done in seven (7) days. (7-1-24) 158. EXPEDITED VERIFICATION. The Department will verify the applicant’s identity through readily available proof or a collateral contact. Proof may include identification such as a driver’s license, birth certificate, or voter registration card. The Department will try to get proof so that benefits can be issued within seven (7) days of the application date. Expedited Food Stamps must not be delayed beyond seven (7) days for proof other than identity. Other proof can be postponed to issue expedited Food Stamps. (7-1-24) 159. (RESERVED) 160. EXPEDITED CERTIFICATION. If all required proof is provided for expedited certification, a normal certification period is assigned. Certification based on application date, household type, and proof is listed below: (7-1-24) 01. Non-migrant Household Applying from the First Through the Fifteenth of the Month. (7-1-24) a. For a non-migrant household applying from the first through the fifteenth of the month, if proof of eligibility factors is postponed, assign a normal certification period; the Department will issue the first month’s benefits. The Department will not issue the second month’s benefits until the postponed proof is received. (7-1-24) b. When proof is postponed, the household has thirty (30) days from the application date to provide the proof. The household must be given timely and adequate notice that no further benefits will be issued until proof is completed. If the proof results in changes in the household’s Food Stamps, the Department will act on the changes without advance notice. (7-1-24) c. If postponed proof is provided before the second month, the Department will process an issuance for the first working day of the second month. If proof is provided in the second month, the Department will issue benefits within seven (7) calendar days from the date the proof is received. If postponed proof is not provided within thirty (30) days from the application date, the Department will close the case. (7-1-24) 02. Non-migrant Household Applying from the Sixteenth Through the End of the Month. (7-1-24) a. For a non-migrant household applying from the sixteenth to the end of the month, if proof of eligibility factors is postponed, the Department will assign a normal certification period, and issue the first- and second-month’s benefits within the expedited time frame. (7-1-24)

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b. When proof is postponed, the household has thirty (30) days from the application date to complete the proof. The household must be given timely and adequate notice that no further benefits will be issued until proof is completed. If the proof results in changes in the household’s Food Stamps, the Department will act on the changes without advance notice. (7-1-24) c. If postponed proof is provided within thirty (30) days, the Department will process an issuance for the first working day of the third month. If postponed proof is not provided within thirty (30) days from the application date, the Department will close the case. (7-1-24) 03. Migrant Household Applying from the First Through the Fifteenth of the Month. (7-1-24) a. For a migrant household applying from the first (1st) through the fifteenth (15th) of the month, if proof of eligibility factors is postponed, the Department will assign a normal certification period, and issue the first month’s benefits. (7-1-24) b. When proof is postponed, the household has thirty (30) days from the application date to complete in-state proof. The household has sixty (60) days from the application date to complete out-of-state proof. The household must be given adequate and timely notice no further benefits will be issued until the postponed proof is completed. Before the second month’s benefits are issued, the household must provide all in-state postponed proofs. Before the third month’s benefits are issued, the household must provide all out-of-state postponed proof. If the proofs result in changes in the household’s Food Stamps, the Department will act on these changes, without providing advance notice. (7-1-24) c. Migrants are entitled to postponed out-of-state proof only once each season. If postponed in-state proof is provided before the second month, the Department will process an issuance for the first working day of the second month. If postponed out-of-state proof is provided before the third month, the Department will process a regular issuance for the third month. If postponed out-of-state proof is provided in the third month, the Department will issue benefits within seven (7) calendar days from the date proof is received. If postponed in-state proof is not provided within thirty (30) days from the application date, the Department will close the case. If postponed out-of- state proof is not provided within sixty (60) days from the application date, the Department will close the case. (7-1-24) 04. Migrant Household Applying from the Sixteenth Through the End of the Month. (7-1-24) a. For a migrant household applying from the Sixteenth to the end of the month, if proof of eligibility factors is postponed, the Department will assign a normal certification period, and issue the first- and second-months’ benefits within the expedited time frame. (7-1-24) b. When proof is postponed, the household has thirty (30) days from the application date to provide in-state proof. The household has sixty (60) days from the application date to provide out-of-state proof. The household must be given adequate and timely notice no further benefits will be issued until the postponed proof is completed. Before the third month’s benefits are issued, the household must provide all in-state and out-of-state postponed proofs. If the proofs result in changes in the household’s Food Stamps, the Department will act on these changes without providing advance notice. (7-1-24) c. Migrants are entitled to postponed out-of-state proof only once each season. If postponed proof is provided before the third month, the Department will process a regular issuance for the third month. If postponed out- of-state proof is provided in the third month, the Department will issue benefits within seven (7) calendar days from the date proof is received. If postponed in-state proof is not provided within thirty (30) days from the application date, the Department will close the case. If postponed out-of-state proof is not provided within sixty (60) days from the application date, the Department will close the case. (7-1-24) 05. Reapplying Household. When a household granted postponed proof at the last expedited certification reapplies, it must provide the postponed proof before it is again eligible for expedited certification. The Department does not require postponed proof if the household was certified under normal standards since the last expedited certification. (7-1-24)

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161. NO LIMIT TO EXPEDITED CERTIFICATIONS. There is no limit to the number of times a household can receive expedited certification. (7-1-24) 162. EXPEDITED SERVICES FOR DESTITUTE HOUSEHOLDS. Migrant or seasonal farmworker households meeting destitute conditions below can get expedited services. The rules for destitute households apply at initial application, the six-month or twelve-month contact, and recertification, but only for the first month of each contact or certification period. (7-1-24) 01. Terminated Source of Income. When the household’s only income for the application month was received before the application date and was from a terminated source the Department will consider the household destitute. Terminated income is income received monthly or more often, no longer received from the same source the rest of the application month, or the next month or income received less often than monthly and not expected in the month the next regular payment is normally due. (7-1-24) 02. New Income in Application Month. When only new income is expected in the application month, the household is considered destitute. Only twenty-five dollars ($25), or less, of new income can be received in the ten (10) days after the application date. Income is new if twenty-five dollars ($25), or less, is received during the thirty (30) days before the application date. New income was received less often than monthly, was not received in the last normal payment interval, or was twenty-five dollars ($25) or less. (7-1-24) 03. Terminated Income and New Income in Application Month. Destitute households can get terminated income before the application date and new income before and after the application date. New income must not be received for ten (10) days after application and not exceed twenty-five dollars ($25). The household must get no other income in the application month. (7-1-24) 04. Application Month. For the application month, the Department will count only income received between the first day of the month and the application date, and will not count income from a new source expected after the application date. (7-1-24) 163. SPECIAL CONSIDERATION OF INCOME FOR DESTITUTE HOUSEHOLDS. Special consideration of income for destitute households is listed below. The rules for destitute households apply at initial application, a six-month or twelve-month contact, and recertification, but only for the first month of each contact or certification period. (7-1-24) 01. Travel Advances. For destitute eligibility and benefit level, travel advances: (7-1-24) a. Rom employers for travel costs to a new employment location are excluded. (7-1-24) b. Against future wages are counted as income, but not a new source of income. (7-1-24) 02. Household Member Changes Job. A person changing jobs with the same employer is still getting income from the same source. A migrant’s income source is the grower, not the crew chief. When a migrant moves with a crew chief from one (1) grower to another, the income from the first grower is ended. The income from the next grower is new income. (7-1-24) 03. Recertification or Six-Month or Twelve-Month Contact. The Department will disregard income from the new source for the first month of the new certification period if more than twenty-five dollars ($25) will not be received by the tenth calendar day after the normal issuance. (7-1-24) 164. DENIAL OF EXPEDITED SERVICE. The Department will deny expedited service if the household does not meet expedite criteria or fails to cooperate in the application process. Failure to cooperate includes missing a scheduled expedited service appointment. The Department will still process the application under standard methods. (7-1-24) 165. CONTESTING DENIED EXPEDITED SERVICE. The Department will offer an agency conference to a household contesting denial of expedited services. The

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Department will tell households they can request an agency conference; the conference will not delay or replace a fair hearing. Migrant farmworker households and households planning to move are entitled to expedited fair hearings. (7-1-24) 166. -- 177. (RESERVED) 178. CATEGORICALLY ELIGIBLE HOUSEHOLDS. Households with all members meeting one (1) of the criteria below are categorically eligible for Food Stamps. The Department will not compute resource eligibility, gross or net income limits, social security number information, sponsored alien information, and residency. Categorically eligible households must meet all other Food Stamp eligibility criteria, and have the same rights as other households. (7-1-24) 01. Cash Benefits. All household members are approved for or already receive TAFI, AABD, or SSI cash benefits. (7-1-24) 02. Benefits Recouped. All household members have AABD or SSI benefits being recouped. (7-1-24) 03. Grant Less Than Ten Dollars. All household members not receiving TAFI, AABD, or SSI because their grant is less than ten dollars ($10). (7-1-24) 179. HOUSEHOLDS NOT CATEGORICALLY ELIGIBLE. The households listed below are not categorically eligible for Food Stamps. (7-1-24) 01. IPV. Households are not categorically eligible, if any household member is disqualified for a Food Stamp IPV. (7-1-24) 02. Work Requirements. Households are not categorically eligible, if any household member fails to comply with the Food Stamp work requirements. (7-1-24) 03. Ineligible Legal Non-Citizen or Student. Households are not categorically eligible if any member is an ineligible legal non-citizen or ineligible student. (7-1-24) 04. Nonexempt Institution. Households are not categorically eligible if any member is a person living in a nonexempt institution. (7-1-24) 180. CATEGORICAL ELIGIBILITY ENDS. Categorical eligibility ends when the household member is no longer eligible for TAFI, AABD, or SSI. If the household is still eligible under Food Stamp rules, the household will continue to receive Food Stamps. If categorical eligibility ends and household income or resources exceed the Food Stamp limits, the household is no longer eligible for Food Stamps. Food Stamps will stop after timely advance notice. (7-1-24) 181. BROAD -BASED CATEGORICALLY ELIGIBLE HOUSEHOLD EXCEPTIONS. If a household contains any of the following members, the household is not eligible under Broad-Based Categorical Eligibility. (7-1-24) 01. IPV. Any household member is disqualified for an IPV. (7-1-24) 02. Drug-Related Felony. Any household member is ineligible because of a drug-related felony. (7-1-24) 03. Strike. Any household member is on strike. (7-1-24) 04. Transferred Resources. Any household member transferred resources to qualify for benefits. (7-1-24) 05. Refusal to Cooperate. Any household member refused to cooperate in providing information that is needed to determine initial or ongoing eligibility. (7-1-24)

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182. VERIFICATION FOR TAFI OR AABD HOUSEHOLDS. To determine eligibility for Food Stamps in TAFI or AABD households, the Department will use TAFI or AABD proof. (7-1-24) 183. TIME LIMITS FOR CATEGORICALLY ELIGIBLE HOUSEHOLDS. The Food Stamp application must not be delayed or denied because of a delayed public assistance decision. (7-1-24) 184. -- 194. (RESERVED) 195. DISASTER CERTIFICATION. When allowed by FNS, under Section 302(a) of the Disaster Relief Act of 1974, the Department can certify households affected by a natural disaster. If the Secretary of USDA declares a disaster area, the Department will follow disaster instructions issued by the USDA. (7-1-24) 196. -- 199. (RESERVED) 200. NONFINANCIAL CRITERIA. Nonfinancial criteria are identification, residency, Social Security Number, citizenship, and work requirements. Households must meet these nonfinancial criteria to be eligible for Food Stamps. (7-1-24) 201. IDENTIFICATION. The person making application for Food Stamps, including an authorized representative, must prove identity. Proof includes a driver’s license, school identification, wage stubs, and birth certificates. The Department will accept other reasonable proof of identity. (7-1-24) 202. RESIDENCY. A household must live in Idaho when applying for Food Stamps. A person can get Food Stamps as a member of only one (1) household a month. (7-1-24) 01. Place of Residency. An eligible Food Stamp household is not required to live in a permanent dwelling or have a fixed mailing address. There is no residence duration requirement. (7-1-24) 02. Vacationing Persons Not Residents. Persons in Idaho for vacation only are not residents for Food Stamp eligibility. Vacation is the period a household spends away from their usual activity, work, or home for travel, rest, or recreation. (7-1-24) 03. Different Physical and Mailing Addresses. The physical and mailing addresses of a Food Stamp household can be different. If the mailing address is not the household’s physical address, the household must provide proof of the physical address. (7-1-24) 203. SOCIAL SECURITY NUMBER (SSN) REQUIREMENT. 01. Expectations. Before certification, households must provide the Department the SSN, or proof of application for SSN, for each household member. If a household member has more than one (1) SSN, they must provide all SSNs. Each SSN must be verified by the SSA. A household member with an unverified SSN is not eligible for Food Stamp benefits. The ineligible person’s income and resources must be counted in the Food Stamp budget. If benefits are reduced or ended, because one (1) or more persons fail to meet the SSN requirement, the household must be notified in writing. (7-1-24) 02. Good Cause for Not Applying for SSN. If a household member can show good cause why an SSN application was not completed in a timely manner, an extension must be granted to allow them to receive Food Stamp benefits for one (1) month in addition to the month of application. Good cause for failure to apply must be shown monthly for such a household member to continue to participate. (7-1-24) 204. CITIZENSHIP AND QUALIFIED NON-CITIZEN REQUIREMENTS. To be eligible for Food Stamps, an individual must meet the requirements under 7 CFR 273.4, “Citizenship and alien

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status.” (7-1-24) 205. WRITTEN DECLARATION OF CITIZENSHIP OR IMMIGRATION STATUS. To get Food Stamps, one (1) adult household member must certify by signing a statement, under penalty of perjury, regarding the citizenship and immigration status of household members applying for benefits. (7-1-24) 206. PROOF OF PROPER IMMIGRATION STATUS. 01. Expectations. Households are required to submit documents to verify the immigration status of the legal non-citizen applicants. (7-1-24) 02. Failure to Provide Legal Non-Citizen Documents. If a household says it is unable or unwilling to provide legal non-citizen status documents for a legal non-citizen household member, the legal non-citizen member must be classified as an ineligible legal non-citizen. (7-1-24) 207. NON-CITIZEN ELIGIBILITY PENDING VERIFICATION. When an application is delayed after the Department has submitted a request to a federal agency for proof of eligible alien status, the Department must certify the person applying as eligible for Food Stamps pending the results of the investigation. The certification can last up to six (6) months from the date of the original request for proof. (7-1-24) 208. -- 211. (RESERVED) 212. FOOD STAMP HOUSEHOLDS. A Food Stamp household is composed of a person, or group of persons, applying for or getting Food Stamps. The composition of Food Stamp households is listed below: (7-1-24) 01. A Person Living Alone. (7-1-24) 02. Living with Others Preparing Separate Meals. Person(s) living with others, but customarily purchasing food and preparing meals separately from the others. (7-1-24) 03. Living with Others with Furnished Meals. Person(s) living with others and being furnished both meals and lodging. The person(s) pays less than the thrifty food plan. (7-1-24) 04. Living Together Preparing Common Meals. A group of persons who live, purchase food, and customarily prepare meals together for home consumption. (7-1-24) 05. Women Living in Shelter. Women, or women with their children, temporarily residing in a shelter for battered women and children. (7-1-24) 06. Living in Substance Use Disorder Treatment Center. Person living in a publicly operated community health center or in a private nonprofit center for substance use disorder treatment and rehabilitation. (7-1-24) 07. Resident of Group Living Center. Person residing in a group living arrangement center certified by the Department. (7-1-24) 213. SEPARATE FOOD STAMP HOUSEHOLD COMPOSITION FOR RELATED MEMBERS. One (1) of the conditions below must be met for related persons living together to be separate Food Stamp households. (7-1-24) 01. Children Age Twenty-Two and Older Living With Parents. Can be separate Food Stamp households. The households must purchase and prepare their food separately. (7-1-24) 02. Households Must Prepare Food Together Because of Age and Disability. Households that must purchase and prepare food together because one (1) household contains a person sixty (60) years old or older unable to purchase and prepare meals because of a disability, can be separate Food Stamp households. The spouse of the

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disabled person must be considered a member of that person’s household. These households must meet the following conditions: (7-1-24) a. The disability must be permanent under the Social Security Act or a nondisease-related, severe permanent disability. (7-1-24) b. The income of the household, which does not contain the person unable to purchase and prepare meals separately, must not exceed one hundred sixty-five percent (165%) of the net monthly income limit for the household size. To count income for the one hundred sixty-five percent (165%) net monthly income standard, exclude the income of the disabled person and their spouse. (7-1-24) c. Count all available income to the household not containing the disabled person. Compare the net monthly income eligibility standard for that size household. (7-1-24) 214. CHILD CUSTODY. For a child under eighteen (18) years old, the parent with primary physical custody is eligible to receive Food Stamp benefits for that child. If both parents request food stamp benefits for the child, primary custody is determined by where the child is expected to spend fifty-one percent (51%) or more of the nights during a certification period. When only one (1) parent applies for food stamp benefits, the child may be included in that parent's household even though they do not have primary physical custody of the child. (7-1-24) 215. PERSONS NOT ELIGIBLE FOR SEPARATE FOOD STAMP HOUSEHOLD STATUS. Persons listed below cannot be separate Food Stamp households. For Food Stamps, they are part of the household where they live. (7-1-24) 01. Spouses. (7-1-24) 02. Parents and Children Together. Children under age twenty-two (22), living together with their parents. Parents and children living together include natural, adopted, or stepchildren. (7-1-24) 03. Child Under Age Eighteen Under Parental Control. A child under age eighteen (18) and under parental control of an adult household member, unless the child is a foster child. (7-1-24) 216. ELDERLY OR DISABLED FOOD STAMP HOUSEHOLD MEMBERS. To be counted as an elderly or disabled Food Stamp household member, the person must meet one (1) of the following: (7-1-24) 01. Age Sixty or Older. (7-1-24) 02. Entitled to SSI Benefits. This includes SSI presumptive disability payments, SSI emergency advance payments, or special SSI status. (7-1-24) 03. Entitled to Social Security Payments Based on Disability or Blindness (RSDI). (7-1-24) 04. State Supplement. Entitled to state or federally funded State supplement payments to the SSI program such as AABD. (7-1-24) 05. Entitled to Medicaid Based on SSI-Related Disability or Blindness. (7-1-24) 06. Disability Retirement. Entitled to federal or state funded-disability retirement benefits because of a disability considered permanent by SSA. (7-1-24) 07. Disabled Veteran. A veteran with a service- or nonservice-connected disability rated or paid as total. (7-1-24) 08. Veteran Needing Aid and Attendance. A veteran considered in need of regular aid and attendance or permanently housebound under USC Title 38. (7-1-24)

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09. Veteran's Surviving Spouse. In need of aid and attendance or permanently housebound. (7-1-24) 10. Veteran's Surviving Child. Permanently incapable of self-support under USC Title 38. (7-1-24) 11. Veteran's Survivor Entitled. A veteran’s surviving spouse or child entitled to receive payment for a service-connected death under USC Title 38. The veteran’s surviving spouse or child must be permanently disabled under Section 221(i) of the Social Security Act. A veteran’s surviving spouse or child entitled to pension benefits for a nonservice death under USC Title 38. The veteran’s surviving spouse or child must be permanently disabled under Section 221(i) of the Social Security Act. “Entitled” refers to veterans, surviving spouses, and children receiving pay or benefits, or who have been approved for payments, but are not yet receiving them. (7-1-24) 12. Railroad Retirement and Medicare. Entitled to an annuity payment under Section 2(a)(1)(iv) of the Railroad Retirement Act of 1974 and determined eligible for Medicare by the Railroad Retirement Board. (7-1-24) 13. Railroad Retirement and Disability. Entitled to an annuity payment under Section 2(a)(1)(v) of the Railroad Retirement Act of 1974 and is determined disabled by the Board under SSI criteria. (7-1-24) 217. NONHOUSEHOLD MEMBERS. Nonhousehold members are persons not counted in determining Food Stamp household size. Their income and resources do not count toward the Food Stamp household. Nonhousehold members may be eligible as a separate household and are listed below: (7-1-24) 01. Roomers. A person who pays for lodging, but not meals. (7-1-24) 02. Live-In Attendants. A person living with a household to provide medical, housekeeping, child care, or other similar services. (7-1-24) 03. Ineligible Students. A person between the ages of eighteen (18) and fifty (50), physically and intellectually fit, enrolled at least half-time in an institution of higher education, and not meeting Food Stamp eligibility requirements for students. (7-1-24) 04. Residents of Institutions. A resident of an institution is an ineligible household member because the institution provides the resident over fifty percent (50%) of three (3) meals daily, as part of the normal services. The institution is not allowed to accept Food Stamps. (7-1-24) 218. PERSONS DISQUALIFIED AS FOOD STAMP HOUSEHOLD MEMBERS. Persons disqualified as Food Stamp household members must not participate in the Food Stamp program. Disqualified household members include, but are not limited to, sanctioned individuals, fleeing felons, and ineligible non-citizens. Treatment of disqualified household members is described under 7 CFR 273.11(c). (7-1-24) 219. CIRCUMSTANCES UNDER WHICH FOOD STAMP PARTICIPATION IS PROHIBITED. 01. Prohibition from Receiving Food Stamp Benefits. An individual is prohibited from receiving Food Stamp benefits at the time of application if they: (7-1-24) a. Receive tribal commodities; (7-1-24) b. Are incarcerated; (7-1-24) c. Are in an institution; (7-1-24) d. Are in foster care and the foster parents are receiving a cash benefit for providing care and maintenance for the child; (7-1-24) e. Receive Food Stamp benefits in another household; (7-1-24)

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f. Are deceased; or (7-1-24) g. Receive cash benefits in a TAFI Caretaker Relative household. (7-1-24) 02. Prohibited Participation During the Certification Period. If the Department learns of prohibited participation during the certification period, it will act to end benefits for that individual. (7-1-24) 220. -- 225. (RESERVED) 226. JOB SEARCH ASSISTANCE PROGRAM (JSAP). 01. JSAP Status. All household members, unless exempt, must participate in JSAP, including members who are on strike and members who are not migrants in the job stream. The Department determines the JSAP status of a participant at certification, a six-month or twelve-month contact, recertification, and when household changes occur. (7-1-24) 02. JSAP Information. The Department will explain the JSAP requirement, rights, responsibilities, and the result of failure to comply. (7-1-24) 227. EXEMPTIONS FROM JSAP. 01. Parents or Caretakers Responsible for the Care of a Child Under Six Years Old. If the child becomes six (6) during the certification period, the parent or caretaker must register for JSAP at the next scheduled six-month or twelve-month contact or recertification, unless exempt for another reason. (7-1-24) 02. Parents and Caretakers of an Incapacitated Person. A parent or caretaker responsible for the care of a person incapacitated due to illness or disability is exempt from JSAP. (7-1-24) 03. Persons Who Are Incapacitated. A person physically or intellectually unfit for employment is exempt from JSAP. (7-1-24) 04. Students Enrolled Half-Time. A student eighteen (18) years or older is exempt from JSAP if they: (7-1-24) a. Are enrolled at least half-time in any institution of higher learning and if they meet the definition of an eligible student in Section 282 of these rules; or (7-1-24) b. Are enrolled at least half-time in any other recognized school or training program. (7-1-24) c. Remain enrolled during normal periods of class attendance, vacation, and recess. If they graduate, enroll less than half-time, are suspended or expelled, drop out, or do not intend to register for the next normal school term (excluding summer), they must register for work at the next scheduled six-month or twelve-month contact or recertification. (7-1-24) 05. SSI Applicants. Are exempt from JSAP until SSI eligibility is determined. (7-1-24) 06. Persons Who Are Employed or Self-Employed. Are exempt from JSAP if they are: (7-1-24) a. Working at least thirty (30) hours per week; (7-1-24) b. Receiving earnings equal to the federal minimum wage multiplied by thirty (30) hours; or (7-1-24) c. A migrant or seasonal farm worker under contract or agreement to begin employment within thirty (30) days. (7-1-24) 07. Persons in Treatment for a Substance Use Disorder. A regular participant in a substance use

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disorder treatment and rehabilitation program is exempt from JSAP. (7-1-24) 08. Unemployment Insurance (UI) Applicant/Recipient. A person receiving UI is exempt from JSAP. A person applying for, but not receiving UI, is exempt from JSAP if they are required to register for work with the Department of Commerce and Labor as part of the UI application process. (7-1-24) 09. Children Under Age Sixteen. Are exempt from JSAP. A child who turns sixteen (16) within a certification period must register for JSAP at the six-month or twelve-month contact or recertification, unless exempt for another reason. (7-1-24) 10. Persons Age Sixteen or Seventeen. Are exempt from JSAP if they are attending school at least half-time, or are enrolled in an employment and training program, including GED, at least half-time. (7-1-24) 11. Participants Age Sixty or Older. Are exempt from JSAP. (7-1-24) 12. Pregnant Women. In their third trimester are exempt from JSAP. (7-1-24) 228. DEFERRALS FROM JSAP FOR HOUSEHOLD MEMBERS PARTICIPATING IN TAFI. Deferrals from JSAP for household members participating in the TAFI program are listed below. (7-1-24) 01. Reasonable Distance. Appropriate child care is not available within a reasonable distance from the participant’s home or work site. (7-1-24) 02. Relative Child Care. Informal child care by relatives or others is not available or is unsuitable. (7-1-24) 03. Child Care Not Available. Appropriate and affordable child care is not available. (7-1-24) 229. PARTICIPANTS LOSING JSAP EXEMPT STATUS. If an exempt household member becomes mandatory, the Department must notify the participant of JSAP requirements. (7-1-24) 230. -- 235. (RESERVED) 236. GOOD CAUSE. A mandatory participant may get a deferral from JSAP requirements, if the Department determines a valid reason exists. (7-1-24) 237. SANCTIONS FOR FAILURE TO COMPLY WITH JSAP WORK PROGRAM REQUIREMENTS. When a JSAP participant fails or refuses to comply with work program requirements without good cause, sanctions listed below must be applied. In determining which sanction to impose, sanctions previously imposed for voluntary quit or reduction in work hours under Section 271 of these rules must be considered. (7-1-24) 01. Noncomplying Household Member. The participant who commits the work program violation is excluded as a household member when determining the Food Stamp allotment. The person cannot receive Food Stamps, but their income and resources are counted in the Food Stamp computation for the household. The person must serve a minimum sanction period plus take corrective action to become eligible for Food Stamps again. If the sanctioned household member becomes exempt from JSAP requirements, the Department will end the sanction. (7-1-24) a. First work program violation. A minimum sanction period of one (1) month is imposed. (7-1-24) b. Second work program violation. A minimum sanction period of three (3) months is imposed. (7-1-24) c. Third and subsequent work program violations. A minimum sanction period of six (6) months is imposed. (7-1-24)

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02. Joins Another Household. If a sanctioned household member leaves the original household and joins another Food Stamp household, treat the sanctioned member as an excluded household member. The person cannot receive Food Stamps, but their income and resources are counted in the Food Stamp computation for the household. The person is excluded for the rest of the sanction period and until corrective actions are taken. (7-1-24) 03. Closure Reason. The household must be informed of the reason for the closure. (7-1-24) 04. Sanction Notice. The household must be informed of the proposed sanction period. (7-1-24) 05. Sanction Start. The household must be informed the sanction will begin the first month after timely notice. (7-1-24) 06. Actions to End Sanction. The household must be informed of the actions the household can take to end the sanction. (7-1-24) 07. Fair Hearing. The household must be informed of the right to a fair hearing. (7-1-24) 238. NOTICE OF SANCTIONS FOR FAILURE TO COMPLY WITH JSAP. A Notice of Decision is sent when a participant fails to comply with JSAP requirements. The Notice of Decision must contain data listed below. If the member complies before the effective date of the action, the sanction does not take effect. The Notice of Decision must: (7-1-24) 01. Include the Proposed Sanction Period. (7-1-24) 02. Include the Reason for Sanction. (7-1-24) 03. Include the Actions the Sanctioned Person Takes to End Sanction. (7-1-24) 04. Tell the Household of its Right to Fair Hearing. (7-1-24) 239. RIGHT TO APPEAL SANCTION. The participant has the right to appeal the decision to sanction. The participant may contest a decision of mandatory status or a denial, reduction, or termination of benefits, due to failure to comply with JSAP. Appeals are conducted under IDAPA 16.05.03, Section 350, “Contested Case Proceedings and Declaratory Rulings.” The Department will notify JSAP of the fair hearing. (7-1-24) 240. JSAP SANCTION BEGINS. The sanction period begins the first month after the Notice of Decision unless a fair hearing is requested. (7-1-24) 241. ENDING SANCTIONS FOR FAILURE TO COMPLY WITH JSAP. Household members sanctioned for not complying with JSAP are ineligible until a condition listed below is met. (7-1-24) 01. Fair Hearing Reversal. Sanction ends if a fair hearing reverses the sanction. (7-1-24) 02. Sanctioned Member Becomes Exempt. Sanction ends if the sanctioned member becomes exempt from JSAP. (7-1-24) 03. Member Complies With JSAP. Sanction ends if the member, who refused to comply with a JSAP requirement, complies. The member must complete corrective action and serve the minimum sanction period. (7-1-24) 242. CORRECTIVE ACTION FOR WORK PROGRAMS. A mandatory participant can requalify for Food Stamps after a sanction by becoming exempt from work requirements, or serving the sanction period and correcting noncompliance with JSAP. (7-1-24)

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243. -- 250. (RESERVED) 251. ABLE-BODIED ADULTS WITHOUT DEPENDENTS (ABAWD) WORK REQUIREMENT. To participate in the Food Stamp program, a person must meet one (1) of the following. A person who does not meet one (1) of these conditions may not participate in the Food Stamp program as a member of any household for more than three (3) full months (consecutive or otherwise) in a fixed thirty-six (36) month period. (7-1-24) 01. Work at Least Eighty Hours per Month. The person must work at least eighty (80) hours per month. The definition of work is any combination of: (7-1-24) a. Work in exchange for money. (7-1-24) b. Work in exchange for goods or services, known as “in-kind” work. (7-1-24) c. Unpaid work, with a public or private non-profit agency. (7-1-24) 02. Participate in JSAP or Another Work Program. The person must participate in and comply with the requirements of the JSAP program (other than job search or job readiness activities), the WIOA program, a program under Section 236 of the Trade Act of 1974, or another work program recognized by the Department. The person must participate for at least eighty (80) hours per month. (7-1-24) 03. Combination of Work and Work Programs. The person must work and participate in a work program. Participation in work and work programs must total at least eighty (80) hours per month. (7-1-24) 04. Participate in Work Opportunities. The person must participate in and comply with the requirements of a Work Opportunities program. (7-1-24) 05. Residents of High Unemployment Areas. ABAWDs residing in a county identified by the Department as having high unemployment or lack of jobs may not be subject to the three (3) month limitation of benefits. ABAWDs residing in these counties are subject to JSAP work requirement. (7-1-24) 252. PROOF REQUIRED FOR ABAWDS. The Department requires proof of compliance with the ABAWD requirements. If there is evidence the ABAWD got Food Stamps in another state, the Department will get proof of the number of countable months from that state, before certification. A written or verbal statement from the other state agency of countable months is acceptable proof. (7-1-24) 253. ABAWD GOOD CAUSE. The work requirement is met if an ABAWD would have worked at least eighty (80) hours per month but missed work for good cause. The absence from work must be temporary. The ABAWD must keep the job. Circumstances beyond control of the ABAWD are the basis of good cause. These include illness, illness of a household member requiring the presence of the ABAWD, household emergency, and lack of transportation. (7-1-24) 254. REPORTING ABAWD CHANGES. ABAWDs must report within the first ten (10) days of the month following the date of change if total work or work program hours drop below eighty (80) hours per month. (7-1-24) 255. REGAINING ELIGIBILITY. ABAWDs whose three (3) month eligibility expires may regain eligibility for Food Stamps. During any thirty (30) consecutive days, the person must meet one (1) of the work requirements below. The Department will prorate Food Stamp benefits from the date the person regains eligibility. ABAWDs must continue to meet the work requirement to get Food Stamps or meet conditions for the three (3) additional months. There is no limit on the number of times an ABAWD may regain and maintain eligibility by meeting the work requirement. (7-1-24) 01. Work Eighty Hours. The person must work eighty (80) or more hours per month. (7-1-24) 02. Participate in JSAP. The person must participate in and comply with the requirements of the JSAP

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program (other than job search or job search training), the WIOA program, or a program under Section 236 of the Trade Act of 1974 for eighty (80) or more hours per month. (7-1-24) 256. THREE ADDITIONAL MONTHS OF FOOD STAMPS AFTER REGAINING ELIGIBILITY. A person who regained eligibility under Section 255 of these rules, but is no longer fulfilling the ABAWD work requirements in Section 251 of these rules through no fault of their own, may get Food Stamps for an additional three (3) consecutive months. For an applicant, the three (3) consecutive months begin the first full month of benefits. For a participant, the three (3) consecutive months begin the month following the month the participant no longer meets the work requirements. A person is eligible for the additional three (3) consecutive months only once in a thirty-six (36) month period. (7-1-24) 257. PERSONS NOT CONSIDERED ABAWD. Persons meeting any of the following are not considered ABAWD. (7-1-24) 01. Age. Persons under eighteen (18) and fifty-three (53) years old or older. Beginning October 1, 2024, the age limit increases to fifty-five (55). (7-1-24) 02. Disability. Persons medically certified as physically or intellectually unfit for employment. A person is medically certified as physically or intellectually unfit for employment if: (7-1-24) a. Receiving temporary or permanent disability benefits issued by a government or private source. (7-1-24) b. Obviously intellectually or physically unfit for employment, as determined by the Department. (7-1-24) c. The person has a statement from a physician, physician's assistant, nurse, nurse practitioner, designated representative of the physician's office, licensed or certified psychologist, a social worker, or any other medical personnel the Department determines appropriate, verifying physical or intellectual unfitness for employment. (7-1-24) 03. All Persons Residing in a Household Where a Household Member Is Under Age Eighteen. (7-1-24) 04. Pregnant Persons. (7-1-24) 05. A homeless individual, as defined under 7 CFR 271.2. (7-1-24) 06. A veteran who served in the US Armed Forces and was discharged or released from service, regardless of the reason for discharge or release. (7-1-24) 07. An individual who was eighteen (18) years old or older (at a state agency’s option), who at the time aged out of foster care program and who is under twenty-five (25) years old. (7-1-24) 258. FOOD STAMPS ISSUED TO INELIGIBLE ABAWD. If benefits are paid to an ABAWD in error, the months count against the three- (3) month time limit until repaid. (7-1-24) 259. STRIKES. Households must be denied Food Stamps if a member is unemployed because of a strike, unless the household was eligible for or getting Food Stamps the day before the strike. (7-1-24) 260. GOVERNMENT EMPLOYEES DISMISSED FOR STRIKE. State, federal, and local government employees dismissed because of joining in a strike against the governmental entity have voluntarily quit a job without good cause. (7-1-24) 261. VOLUNTARY JOB QUIT.

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An employed household member who voluntarily quits a job without good cause is not eligible for Food Stamps. The Department is required to make a voluntary job quit determination when it learns that any employed household member has quit their job and any of the following circumstances apply. (7-1-24) 01. Voluntary Job Quit Timeframes. The Department must make a voluntary job quit determination: (7-1-24) a. For any applicant who quits their job within sixty (60) days of the application date. (7-1-24) b. For any new household member who quits their job within the sixty (60) days prior to entering the household. (7-1-24) c. For any recipient who quits their job at any time during the certification period. (7-1-24) 02. Job Definition for Voluntary Job Quit. The Department must make a voluntary job quit determination for any household member who is not exempt from work registration for any reason other than employment if: (7-1-24) a. They quit a job of at least thirty (30) hours a week; or (7-1-24) b. Their weekly earnings from the job they quit are equivalent to the federal minimum wage multiplied by thirty (30) hours. (7-1-24) 262. VOLUNTARY REDUCTION IN WORK HOURS. An employed household member who voluntarily reduces hours of work without good cause is not eligible for Food Stamps. The Department is required to make a reduction in work hours determination when it learns that any employed household member has voluntarily reduced their work hours and any of the following circumstances apply. (7-1-24) 01. Voluntary Work Reduction Timeframe. The Department must make a reduction in work hours determination if the hours of work were voluntarily reduced by a(n): (7-1-24) a. Applicant, within sixty (60) days of the application date. (7-1-24) b. New household member, within the sixty (60) days prior to entering the household. (7-1-24) c. Recipient, at any time during the certification period. (7-1-24) 02. What Counts as a Significant Voluntary Work Reduction. For any household member's eligibility for Food Stamps to be affected, the Department must determine that: (7-1-24) a. Prior to the voluntary reduction in hours, the job was at least thirty (30) hours a week; and (7-1-24) b. The hours of work have been voluntarily reduced to less than thirty (30) hours per week without good cause. (7-1-24) 263. -- 264. (RESERVED) 265. SITUATIONS NOT CONSIDERED VOLUNTARY JOB QUIT OR REDUCTION OF WORK. Situations not counted as a voluntary job quit or reduction of work hours are listed below: (7-1-24) 01. The Person Ends Self-Employment. (7-1-24) 02. Employer Demands Resignation and Person Resigns. (7-1-24) 03. Laid Off From New Job. A person quits a job, secures new employment at comparable salary or hours, and then is laid off or loses the new job through no fault of their own. (7-1-24)

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266. HOUSEHOLD MEMBER LEAVES DURING A PENALTY PERIOD. When the household member who committed a voluntary quit or reduction in hours penalty leaves the household, the penalty follows the household member who caused it. If the household member who committed the penalty joins another household, they are ineligible for the balance of the penalty period unless they meet the conditions stated in Subsection 275.01 of these rules. (7-1-24) 267. GOOD CAUSE FOR VOLUNTARILY QUITTING A JOB OR REDUCING WORK HOURS. If a household member voluntarily quits a job, the Department will determine if the quit was for good cause. All facts and circumstances submitted by the household and the employer must be considered. Good cause reasons are listed in 7 CFR 273.7(i)(3). (7-1-24) 268. PROOF OF JOB QUIT OR REDUCTION OF WORK HOURS. Verification from the household is required if the household’s job quit or reduction of work hours is questionable. When proof of the voluntary quit cannot be obtained, the household must not be denied Food Stamps. If a household member refuses, without good cause, to provide enough information to determine voluntary quit or work reduction, a penalty must be imposed. (7-1-24) 269. (RESERVED) 270. PENALTY FOR APPLICANT QUITTING A JOB OR REDUCING WORK HOURS. If the Department determines a voluntary quit or reduction of work hours was not for good cause, the member who quit is not eligible for a ninety (90) day penalty period. The penalty period begins the date the household member quit. The applicant household must be told the job quit and work reduction penalty information listed below: (7-1-24) 01. Denial Reason. The household must be informed of the reason for the Food Stamp denial for the member. (7-1-24) 02. Sanction Period. The household must be informed of the proposed voluntary quit or work reduction sanction period. (7-1-24) 03. Fair Hearing. The household must be informed of the right to a fair hearing. (7-1-24) 04. Right to Reapply. The household must be informed of the right to reapply after the ninety (90) day penalty period. (7-1-24) 271. PENALTY FOR RECIPIENT QUITTING A JOB OR REDUCING WORK HOURS. If the Department determines a member of the household voluntarily quit a job or reduced work hours, the penalty listed in Subsection 271.01 of this rule must be imposed. Food Stamps must be reduced, beginning the first month after timely notice. The household must be told the information listed in this rule within ten (10) calendar days of the voluntary quit or reduction in work ruling. When determining the sanction to impose, previous sanctions for noncompliance with JSAP and work registration requirements as described in Section 237 of these rules must be considered. Previous sanctions for recipient voluntary quit or work reduction must also be considered. If the sanctioned household member becomes exempt from JSAP requirements, the Department will end the sanction. The voluntary quit sanction does not end if the sanctioned household member becomes exempt due to application or receipt of Unemployment Insurance. (7-1-24) 01. Non-Complying Household Member. The participant who commits the work program violation is excluded as a household member when determining the Food Stamp allotment. The person cannot receive Food Stamps, but their income and resources are counted in the Food Stamp computation for the household. The person must serve a minimum sanction period plus take corrective action to become eligible for Food Stamps again. Corrective action includes: returning to work, increasing work hours to meet the work exemption, or completing required activities with JSAP. (7-1-24) a. First work program violation. A minimum sanction period of one (1) month is imposed. (7-1-24)

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b. Second work program violation. A minimum sanction period of three (3) months is imposed. (7-1-24) c. Third and subsequent work program violation. A minimum sanction period of six (6) months is imposed. (7-1-24) 02. Joins Another Household. If a sanctioned household member leaves the original household and joins another Food Stamp household, the Department will treat the sanctioned member as an excluded household member. The person cannot receive Food Stamps, but their income and resources are counted in the Food Stamp computation for the other household. The person is excluded for the rest of the sanction and until corrective actions are taken. (7-1-24) 03. Closure Reason. The household must be informed of the reason for the closure. (7-1-24) 04. Sanction Notice. The household must be informed of the proposed sanction period. (7-1-24) 05. Sanction Start. The household must be informed the sanction will begin the first month after timely notice. (7-1-24) 06. Actions to End Sanction. The household must be informed of the actions the household can take to end the sanction. (7-1-24) 07. Fair Hearing. The household must be informed of the right to a fair hearing. (7-1-24) 272. PARTICIPANT VOLUNTARY QUIT OR REDUCTION OF WORK HOURS. If it is discovered a household member voluntarily quit a job or reduced work hours without good cause during the certification period the Department must provide the individual with a notice of adverse action within ten (10) days after the determination of a quit or reduction in work effort. The individual will be disqualified according to the minimum mandatory sanction schedule under Subsection 271.01 of these rules. (7-1-24) 273. – 274. (RESERVED) 275. ENDING VOLUNTARY QUIT WORK PROGRAM PENALTIES. Eligibility may be reestablished before the end of the penalty period for an otherwise eligible household member when they meet the conditions in Subsection 275.01 of this rule. Eligibility may be reestablished after a voluntary quit or work reduction penalty period has elapsed for an otherwise eligible household member when they meet a condition in Subsection 275.02 of this rule. (7-1-24) 01. Ending Voluntary Quit or Reduction Penalty Before the End of the Penalty Period. If the sanctioned household member becomes exempt from JSAP requirements, their eligibility for Food Stamps may be reestablished. The voluntary quit penalty does not end if the sanctioned household member becomes exempt due to application or receipt of Unemployment Insurance. (7-1-24) 02. Ending Voluntary Quit or Reduction Penalty After Penalty Period. (7-1-24) a. If the sanctioned household member gets a new job comparable in salary or hours to the job they quit, their eligibility for Food Stamps may be reestablished. A comparable job may entail fewer hours or a lower net salary than the job which was quit. To be comparable, the hours for the new job cannot be less than thirty (30) hours per week and the salary or earnings for the new job cannot be less than federal minimum wage multiplied by thirty (30) hours per week. (7-1-24) b. If the sanctioned household member’s hours of work are restored to more than thirty (30) hours per week before reduction, their eligibility for Food Stamps may be reestablished. (7-1-24) c. A sanctioned household member can requalify for Food Stamps after serving the minimum sanction period and completing corrective action. The participant must contact the Department and request an opportunity to correct the sanction. (7-1-24)

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276. FAILURE TO COMPLY WITH A REQUIREMENT OF ANOTHER MEANS - TESTED PROGRAM. Food Stamps must not increase when a failure to comply causes other means-tested benefits to decrease. Benefits from means-tested programs like TAFI may decrease due to failure to comply with a program requirement. Food Stamp benefits must not increase because of this income loss. If a reduction in benefits from another means-tested program occurs, the Department will verify the reason for the reduction. If the reason for the reduction cannot be verified, the Department will document the case record to reflect the good faith effort to verify the information. (7-1-24) 277. PENALTY FOR FAILURE TO COMPLY WITH A REQUIREMENT OF ANOTHER MEANS - TESTED PROGRAM. To prevent an increase in Food Stamp benefits, penalties will be applied to a Food Stamp case for failure to comply with a requirement of another means-tested program such as TAFI. When a Food Stamp recipient fails to comply with a requirement of the TAFI program, the Department will count that portion of the benefit decrease attributed to the TAFI penalty. Conditions for ending the penalty are listed below. (7-1-24) 01. Time-Limited TAFI Penalty. If the TAFI penalty is time-limited, the Department will end the Food Stamp penalty when the TAFI penalty is ended. (7-1-24) 02. Lifetime TAFI Penalty. If the TAFI penalty is a lifetime penalty, apply the Food Stamp penalty for a length of time to match the remaining months of TAFI eligibility for the household. The Department will end the Food Stamp penalty if the household subsequently reapplies for TAFI and is denied for a reason other than the noncompliance that caused the TAFI penalty. (7-1-24) 03. Member Who Caused the TAFI Penalty Leaves the Household. The Department will end the Food Stamp penalty when the member who caused the TAFI penalty leaves the household. (7-1-24) 278. COOPERATION IN ESTABLISHMENT OF PATERNITY AND OBTAINING SUPPORT. A natural or adoptive parent or other individual living with and exercising parental control over a minor child who has an absent parent must cooperate in establishing paternity for the child and obtaining support for the child. (7-1-24) 279. FAILURE TO COOPERATE. When a parent or individual fails to cooperate in establishing paternity and obtaining support, they are not eligible to participate in the Food Stamp Program. (7-1-24) 280. EXEMPTIONS FROM THE COOPERATION REQUIREMENT. The parent or individual will not be required to provide information about the absent or alleged parent or otherwise cooperate in establishing paternity or obtaining support if good cause for not cooperating exists. Good cause for failure to cooperate in obtaining support is listed below: (7-1-24) 01. Rape or Incest. Proof the child was conceived because of incest or forcible rape. (7-1-24) 02. Physical or Emotional Harm. Proof the absent parent may inflict physical or emotional harm to the children, the participant, or individual exercising parental control. This must be supported by medical evidence, police reports, or as a last resort, an affidavit from a knowledgeable source. (7-1-24) 03. Minimum Information Cannot be Provided. Substantial and credible proof is provided indicating the participant cannot provide the minimum information regarding the non-custodial parent. (7-1-24) 281. – 282. (RESERVED) 283. STUDENT ENROLLMENT. A student is considered enrolled in an institution of higher education if participating in a regular curriculum there. Enrollment status of a student begins the first day of the school term for the institution of higher education. The enrollment continues through normal periods of class attendance, vacation, and recess. Enrollment stops if the student

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graduates, is suspended or expelled, drops out, or does not intend to register for the next normal school term. Summer school terms are not normal school terms. (7-1-24) 284. DETERMINING STUDENT ELIGIBILITY. To be eligible for Food Stamps, a student must meet at least one (1) of the following: (7-1-24) 01. Employment. The student: (7-1-24) a. Is employed a minimum of eighty (80) hours per month and is paid for such employment; or (7-1-24) b. Is self-employed a minimum of eighty (80) hours per month; and (7-1-24) c. Must earn at least the federal minimum wage times eighty (80) hours. (7-1-24) 02. Work Study Program. The student is in a state or federally financed work study program during the regular school year. The student exemption begins the month the school term begins, or the month the work study is approved, whichever is later. The exemption continues until the end of the month the school term ends, or it becomes known the student has refused an assignment. The student work study exemption stops when there are breaks of a full calendar month or longer between terms, without approved work study. The exemption only applies to months the student is approved for work study. (7-1-24) 03. Caring for Dependent Child. The student is: (7-1-24) a. Responsible for the care of a dependent household member under the age of six (6). (7-1-24) b. Responsible for the care of a dependent household member who has reached the age of six (6), but is under age twelve (12) when the state agency has determined that adequate child care is not available to enable the student to attend class and comply with the eighty (80) hour work requirement. (7-1-24) c. A single parent enrolled in an institution of higher education on a full-time basis, as determined by the institution, and be responsible for the care of a dependent child under age twelve (12). (7-1-24) 04. TAFI Participant. The student gets cash benefits from the TAFI program. (7-1-24) 05. Training. The student is assigned to or placed in an institution of higher education through, or complying with, the following programs: WIOA, JOBS, JSAP, a program under Section 236 of the Trade Act of 1974, or a program for employment and training operated by a state or local government. (7-1-24) 285. INELIGIBILITY OF FUGITIVE FELONS AND PROBATION AND PAROLE VIOLATORS. Individuals who are fleeing to avoid prosecution or custody for a crime, or an attempt to commit a crime, classified as a felony (or in the state of New Jersey, a high misdemeanor), or who are violating a condition of probation or parole under a federal or state law, cannot be considered eligible household members. (7-1-24) 286. EFFECTIVE DATE OF INELIGIBILITY. The effective date of disqualification for Food Stamps is the month following the date the Department has documented evidence the individual is fleeing or violating parole/probation. (7-1-24) 287. INELIGIBILITY FOR A FELONY CONVICTION FOR POSSESSION, USE, OR DISTRIBUTION OF A CONTROLLED SUBSTANCE. Individuals convicted under federal or state law of a felony involving the possession, use, or distribution of a controlled substance can receive Food Stamps when they comply with the terms of a withheld judgment, probation, or parole. Controlled substance felons who are not complying with the terms of a withheld judgment, probation, or parole are not eligible for Food Stamps. (7-1-24) 288. -- 299. (RESERVED)

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300. RESOURCES DEFINED. Resources include, but are not limited to, cash, bank accounts, stocks, bonds, personal property, and real property. A household must have the right, authority, or power to change the resource to cash for the resource to be counted. The household must have the legal right to use the resource for support and maintenance for the resource to be counted. (7-1-24) 301. DETERMINING RESOURCES. The resources of all household members are counted unless the resource is excluded. (7-1-24) 302. -- 304. (RESERVED) 305. RESOURCE LIMIT. The Food Stamp resource limit is five thousand dollars ($5,000) for Broad-Based Categorically Eligible households. Households that do not meet the requirements for Broad-Based Categorical Eligibility are subject to resource limits published by the FNS. (7-1-24) 306. -- 307. (RESERVED) 308. EQUITY VALUE OF RESOURCES. Equity value is the current market value of a resource, minus any encumbrance. The current market value is the price the resource is expected to sell for, on the open market, in the geographic area involved. An encumbrance is a legally binding debt against property. The encumbrance on the property does not prevent the property owner from selling to a third party. (7-1-24) 309. LIQUID RESOURCES. All liquid resources are counted, unless excluded. Liquid resources are listed below and can be easily converted to cash. (7-1-24) 01. Cash on Hand. (7-1-24) 02. All Bank and Credit Union Accounts. (7-1-24) 03. Lump Sum Payments. Such as insurance, SSI, retirement, and income tax refund. (7-1-24) 04. Trusts. Unrestricted trust accounts and any available amounts from restricted trust accounts. (7-1-24) 05. Stocks, less Fees for Transfer and Penalty for Early Sale. (7-1-24) 06. Savings Bonds, Treasury Bonds, Commercial Bonds at Current Market Value. (7-1-24) 07. Savings Certificates or Certificates of Deposit. Issued by banks, credit unions, or other financial concerns, less the penalty for early withdrawal. (7-1-24) 310. NONLIQUID RESOURCES. Countable nonliquid resources are resources not easily converted to cash and are listed below. (7-1-24) 01. Real Property. Equity value of real property (land and buildings, including mobile homes) unless specifically excluded. Property may be excluded if the property is: (7-1-24) a. Used as a home. (7-1-24) b. Income-producing, and the income is consistent with the property’s fair market value. (7-1-24) c. Essential to employment or self-employment. (7-1-24) d. Used in connection with an excluded vehicle. (7-1-24)

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02. Vehicles. Licensed and unlicensed automobiles, trucks, vans, motorcycles, self-propelled motor homes, snowmobiles, boats, aircraft, all-terrain vehicles, and mopeds. (7-1-24) 03. Personal Property. Personal property not otherwise excluded. Personal property includes trailers pulled by another means or campers placed on the bed of a truck or pickup. (7-1-24) 311. FACTORS MAKING PROPERTY A RESOURCE. Property of any kind, including cash, can be a resource and must meet all criteria listed below: (7-1-24) 01. Ownership Interest. A participant must have ownership interest in property for it to be counted as a resource. Property is not a resource if the participant does not own all or part of the property. (7-1-24) 02. Legal Right to Spend or Convert Property. A participant must have a legal right to spend or convert property to cash. Physical possession of property is not needed if the owner has the legal ability to spend or convert the property to cash. (7-1-24) 03. Legal Ability to Use for Support and Maintenance. Property is not a resource if it cannot legally be used for the owner’s support and maintenance. (7-1-24) 312. -- 313. (RESERVED) 314. JOINTLY OWNED RESOURCES. A resource owned jointly by members of two (2) or more households is counted in its entirety for each household, unless the household proves the resource is not available. If the household shows it has access to only a portion of a resource, that portion of the resource is counted. (7-1-24) 315. JOINTLY OWNED RESOURCES EXCLUDED. A jointly owned resource is excluded, if the household shows it cannot sell or divide the resource without consent of the other owner, and the other owner will not sell or divide the resource. A jointly owned resource is excluded, if owned by a resident in a shelter for battered women and children and access to the resource requires agreement of a joint owner living in the former household. A vehicle, jointly owned by a household member and a person not living in the household, may be excluded. The household member must not have possession of the vehicle. The household member must not be able to sell the vehicle. (7-1-24) 316. -- 322. (RESERVED) 323. LUMP SUM RESOURCES. Nonrecurring lump sum payments are considered a resource in the month received, unless excluded under these rules. A household is not required to report changes in resources during a certification period. Some lump sum payments are listed below: (7-1-24) 01. Retroactive Payments. (7-1-24) a. Social Security. (7-1-24) b. SSI. (7-1-24) c. Public Assistance. (7-1-24) d. Railroad Retirement Benefits. (7-1-24) e. Unemployment Compensation Benefits. (7-1-24) f. Child Support. (7-1-24) 02. Insurance Settlements. (7-1-24)

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03. Income Tax Refunds, Rebates, or Credits. (7-1-24) 04. Property Payments. Lump sum payments and contract payments from sale of property are counted as income. (7-1-24) 05. Security Deposits. Refunds of security deposits on rental property or utilities. (7-1-24) 06. Disability Pension. Annual adjustment payments in VA disability pensions. (7-1-24) 07. Vacation Pay. Vacation pay, withdrawn in one (1) lump sum by a terminated employee. (7-1-24) 08. Military Reenlistment Bonuses. (7-1-24) 09. Job Corps Readjustment Pay. (7-1-24) 10. Severance Pay. Paid in one (1) lump sum to a former employee. (7-1-24) 11. TAFI One-Time Cash Diversion Payment. (7-1-24) 324. -- 333. (RESERVED) 334. VEHICLES. The value of any vehicle that is primarily for recreational use counts toward the household’s resource limit. All other vehicles in the household will have their values counted as provided in 7 CFR 273. (7-1-24) 335. -- 350. (RESERVED) 351. EXCLUDED RESOURCES. Some resources do not count against the limit because they are excluded. Resources excluded by federal law are also excluded for Food Stamps. Exclusions from resources are under Sections 352 through 382 of these rules. (7-1-24) 352. HOUSEHOLD GOODS EXCLUDED. Household goods are items of personal property normally found in the home. The items must be used for maintenance, use, and occupancy of the home. Household goods include, but are not limited to, furniture, appliances, television sets, carpets, and utensils for cooking and eating. (7-1-24) 353. PERSONAL EFFECTS EXCLUDED. Personal effects are items worn or carried by a participant, or items having an intimate relation to the participant. They include, but are not limited to, clothing, jewelry, personal care items, and prosthetic devices. Personal effects include items for education or recreation, such as books, musical instruments, or hobby materials. (7-1-24) 354. HOME AND LOT EXCLUDED. The home and surrounding land and buildings not separated by property owned by others, are excluded as a resource. A public road or right of way that separates any plot from the home will not affect the exclusion. The home may be a house, trailer, or vehicle. (7-1-24) 01. Unoccupied Home Exclusion. A temporarily unoccupied home is excluded if the household members intend to return. The household members must be absent because of employment, training for future employment, illness, or the home must be temporarily uninhabitable from casualty or natural disaster. (7-1-24) 02. Building Lot Exclusion. The following are excluded as a resource: (7-1-24) a. A lot where a household is building a permanent home (7-1-24) b. A lot where a household intends to build a permanent home; and (7-1-24)

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c. A lot and partly completed home (7-1-24) d. The household can only have one (1) home and lot excluded. The household cannot own a home and lot and have a building lot exclusion for another property. (7-1-24) 355. LIFE INSURANCE EXCLUDED AS A RESOURCE. The cash surrender value of life insurance policies is excluded as a resource. (7-1-24) 356. BURIAL SPACE OR PLOT AND FUNERAL AGREEMENT EXCLUSIONS. Burial spaces or plots and funeral agreements are excluded from resources as listed below. (7-1-24) 01. Burial Space or Plot Exclusion. One (1) burial space or plot, for each household member, from resources. The value of the burial space or plot does not affect this exclusion. (7-1-24) 02. Funeral Agreement Exclusion. Up to the equity value of one (1) bona fide funeral agreement, for each household member, from resources. (7-1-24) 357. PENSION PLANS OR FUNDS EXCLUDED AS A RESOURCE. The cash value of any funds in a plan, contract, or account, under Sections 401(a), 403(a), 403(b), 408, 408A, 457(b), and 501(c) of the Internal Revenue Code of 1986. and the value of funds in a Federal Thrift Savings Plan Account under 5 U.S.C. 8439 are excluded as a resource. This exclusion includes any current or future tax preferred retirement accounts approved under federal or state law. (7-1-24) 358. INCOME-PRODUCING PROPERTY EXCLUDED. Property that annually produces income consistent with its fair market value is excluded as a resource. Real property, not used as a home, is excluded as a resource if it produces income consistent with its fair market value. This exclusion includes land and buildings. Annual income is consistent with the property’s fair market value when consistent with area market trends. (7-1-24) 359. LIVESTOCK EXCLUDED. Livestock includes cows, pigs, sheep, llamas, and horses. Farm animals kept for food are excluded. (7-1-24) 360. PROPERTY USED FOR SELF-SUPPORT EXCLUDED. Property essential to the employment or self-employment of a household member, such as tools of a trade or the farm land and machinery of a farmer, is excluded as a resource. Essential work-related equipment of an ineligible legal non-citizen or disqualified person is excluded as a resource. Self-support property is excluded during employment and temporary periods of unemployment. For a household member engaged in farming, property essential to self- employment continues to be excluded for one (1) year from the date the household member ends self-employment from farming. (7-1-24) 361. PROPERTY USED WITH EXCLUDED VEHICLE. Portions of real or personal property are excluded as a resource if used in connection with an excluded vehicle. The vehicle must be used to produce income or be necessary for transporting a physically disabled household member. (7-1-24) 362. SALABLE ITEM WITHOUT SIGNIFICANT RETURN EXCLUDED. Resources that cannot be sold for a significant return are excluded. “Significant return” means any return, after estimating costs of sale or disposition, and taking into account the ownership interest of the household, is more than one thousand five hundred dollars ($1,500). (7-1-24) 363. HUD FAMILY SELF-SUFFICIENCY (FSS) ESCROW ACCOUNT. Escrow accounts and the interest earned on an escrow account established by HUD for families participating in the FSS Program under Section 544 of the National Affordable Housing Act, are excluded as a resource when determining eligibility for food stamps. The federal exclusion for the funds in this program and other similar type escrow funds are only excluded while the funds are still in the escrow account or being used for a HUD approved purpose. Participants in the FSS program may withdraw funds from the escrow account before completing the program, with permission from the public housing authority, but only for purposes related to the goal of the FSS

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contract, such as completion of higher education, job training, or to meet start-up expenses involved in creation of a small business. (7-1-24) 364. EDUCATIONAL ACCOUNTS EXCLUDED AS A RESOURCE. The cash value of any funds in a qualified tuition program under Section 529 of the Internal Revenue Code of 1986, or in a Coverdell education savings account under Section 530 of the Internal Revenue Code, are excluded as resources. (7-1-24) 365. INDIVIDUAL DEVELOPMENT ACCOUNT EXCLUDED AS A RESOURCE. The cash value of an Individual Development Account (IDA) under Section 56-1101(5), Idaho Code, is excluded as a resource. (7-1-24) 366. -- 372. (RESERVED) 373. GOVERNMENT PAYMENTS EXCLUDED. Government payments for the restoration of a home damaged in a disaster are excluded as a resource. The household must be subject to legal sanction if the funds are not used as intended. (7-1-24) 374. EXCLUDED INACCESSIBLE RESOURCES. The cash value of resources not legally available to the household is excluded as a resource. The household must provide proof resources are not available. (7-1-24) 375. FROZEN OR SECURED ACCOUNTS EXCLUDED. Frozen bank accounts used as security for a loan or due to bankruptcy proceedings are excluded as resources. (7-1-24) 376. REAL PROPERTY EXCLUDED IF ATTEMPT TO SELL. Real property is excluded as a resource if the household is making a good faith effort to sell it at a reasonable price. The Department will verify the property is for sale and the household has not refused a reasonable offer. (7-1-24) 377. TRUST FUNDS EXCLUDED. Trust funds are excluded if all conditions listed below are met: (7-1-24) 01. Trust Irrevocable or Not Changeable by Household. The household must be unable to revoke the trust agreement or change the name of the beneficiary during the certification period. (7-1-24) 02. Trust Unlikely to End During Certification. The trust arrangement must be unlikely to end during the certification period. (7-1-24) 03. Trustee Independent from Household Control. The trustee of the fund is either a court, institution, corporation, or organization not under the direction or ownership of a household member, or a court- appointed person who has court-imposed limits placed on the use of funds. (7-1-24) 04. Trust Not Under Control of Household-Directed Business. The trust investments do not directly involve or help any business or corporation under the control, direction, or influence of a household member. (7-1-24) 05. Origin and Use of Trust. The funds held in an irrevocable trust are: (7-1-24) a. Set up from the household’s own funds. The trustee uses the funds only to make investments for the trust, or to pay education or medical expenses of the beneficiary; or (7-1-24) b. Set up from nonhousehold funds by a nonhousehold member. (7-1-24) 378. INSTALLMENT CONTRACTS EXCLUDED. An installment contract for the sale of land and buildings is excluded as a resource. The purchase price must be consistent with the property’s fair market value. The contract or agreement must produce income consistent with the

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property’s fair market value. Income is consistent with the property’s fair market value when consistent with area market trends. The actual property sold under an excluded installment contract is excluded as a resource. Property held as security for the fulfillment of an excluded installment contract is excluded as a resource. (7-1-24) 379. TREATMENT OF EXCLUDED RESOURCES. An excluded resource kept in a separate account is excluded for an unlimited period. If an excluded resource is combined with countable resources, the resource is not counted for six (6) months from the date the funds are combined. After six (6) months, the total combined resources are counted. (7-1-24) 380. (RESERVED) 381. NONLIQUID RESOURCES WITH LIENS EXCLUDED. A nonliquid resource, with a lien placed against it, is excluded. The lien must result from a business loan. The lien agreement must forbid the household to sell the resource. (7-1-24) 382. (RESERVED) 383. EXCLUDED RESOURCE CHANGES TO COUNTED RESOURCE. Resource value increases when a participant replaces an excluded resource with a counted resource. (7-1-24) 384. -- 385. (RESERVED) 386. TRANSFER OF RESOURCES. Households that knowingly transfer resources for the purpose of qualifying or attempting to qualify for Food Stamps benefits are disqualified from participation in the program for up to one (1) year from the date of the discovery of the transfer. (7-1-24) 387. TRANSFER OF RESOURCE NOT COUNTED FOR DISQUALIFICATION. A transferred resource is not counted for disqualification, under the conditions below: (7-1-24) 01. Three Months Before Application. The transfer of a resource was more than three (3) months before the date of Food Stamp application. (7-1-24) 02. Resources Less Than Limit. The transfer, when added to the other countable resources, does not exceed the resource limit. (7-1-24) 03. Transfer at Fair Market Value. The sale or trade of a resource, made at or near the fair market value, is not counted. (7-1-24) 04. Transfer Between Household Members. A resource transferred between members of the same household, including ineligible legal non-citizens or disqualified persons whose resources are considered available to the household, is not counted. (7-1-24) 05. Transfer for Reasons Other Than Food Stamps. A resource transferred for reasons other than trying to qualify for Food Stamps is not counted. (7-1-24) 388. DISQUALIFICATION FOR TRANSFERRING RESOURCES. The Department will base the disqualification period on the amount the transferred resource exceeds the resource limit, when added to other countable resources. Disqualification periods are listed in Table 388. The disqualification period begins in the first month of application or recertification. Amount in Excess of the Resource Limit Months of Disqualification $0 - 249.99 1 $250 - 999.99 3

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(7-1-24) 389. -- 399. (RESERVED) 400. INCOME. All household income is counted in the Food Stamp budget unless excluded under these rules. Income can be earned or unearned. (7-1-24) 401. EARNED INCOME. Earned income includes, but is not limited to the following. (7-1-24) 01. Wages or Salary. Wages and salaries of an employee, advances, tips, commissions, meals, and military pay are earned income. Garnishments from wages are earned income. (7-1-24) 02. Self-Employment Income. Income from self-employment, including capital gains, is earned income. Rental property is self-employment income if a household member manages the property an average of twenty (20) or more hours per week. Payment from a roomer or boarder is self-employment income. (7-1-24) 03. Training Allowances. From programs such as Vocational Rehabilitation. (7-1-24) 04. Payments Under Title I. Such as VISTA and University Year for Action under P.L. 93-113. (7-1-24) 05. On-the-Job Training Programs. WIOA income includes monies paid by WIOA or the employer. Income from WIOA on-the-job training programs is earned income, unless paid to a household member under age nineteen (19). The household member under age nineteen (19) must be under the control of another household member. (7-1-24) 06. Basic Allowance for Housing (BAH). An Armed Services housing allowance. (7-1-24) 402. UNEARNED INCOME. Unearned income includes, but is not limited to the following: (7-1-24) 01. Public Assistance (PA). Payments from SSI, TAFI, AABD, GA, or other Public programs. (7-1-24) 02. Retirement Income. Payments from annuities, pensions, and retirement. (7-1-24) 03. Strike Benefits. (7-1-24) 04. Veteran's Benefits. (7-1-24) 05. Disability Income. (7-1-24) 06. Workers' Compensation. (7-1-24) 07. Unemployment Insurance. (7-1-24) 08. Contributions. (7-1-24) $1,000 - 2999.99 6 $3,000 - 4,999.99 9 $5,000 or more 12 Amount in Excess of the Resource Limit Months of Disqualification

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09. Rental Property Income. Minus the cost of doing business, if a household member is not managing the property at least twenty (20) hours per week. (7-1-24) 10. Support Payments. Includes child support payments. (7-1-24) 11. Alimony. (7-1-24) 12. Educational Benefits Unless Excluded. (7-1-24) 13. Regular Payments from a Government Source. Payments or allowances a household receives that are funded from a government source. (7-1-24) 14. Dividends, Interest, and Royalties. (7-1-24) 15. Contract Income From the Sale of Property. (7-1-24) 16. Funds From Trusts. Monies withdrawn from trusts exempt as a resource. Dividends paid or dividends that could be paid from trusts exempt as a resource. (7-1-24) 17. Recurring Lump Sum Payments. (7-1-24) 18. Cash Prizes, Gifts, and Lottery Winnings. (7-1-24) 19. Diverted Support or Alimony. Child support or alimony payments diverted by the provider to a third party to pay a household expense. (7-1-24) 20. Agent Orange Payments. Payments made under the Agent Orange Act of 1991 and disbursed by the US Treasury. (7-1-24) 21. Garnishments. (7-1-24) 22. Tribal Gaming Income. The participant can choose to count the income in the month received, or prorate the income over the period it is intended to cover. (7-1-24) 23. Other Monetary Benefits Not Otherwise Counted or Excluded. (7-1-24) 403. -- 404. (RESERVED) 405. EXCLUDED INCOME. Income excluded when computing Food Stamp eligibility is listed below: (7-1-24) 01. Money Withheld. Money withheld voluntarily or involuntarily, from an assistance payment, earned income, or other income source, to repay an overpayment from that income source. (7-1-24) 02. Child Support Payments. Child support payments received by TAFI recipients that are withheld by the state. (7-1-24) 03. Earnings of Household Member Under Age Eighteen Attending School. The member must be under parental control of another household member and attending elementary or secondary school. In this rule, a student is someone who attends elementary or secondary school, or who attends GED or home-school classes that are recognized, operated, or supervised by the school district. This exclusion applies during semester and summer vacations if enrollment will resume after the break. If the earnings of the child and other household members cannot be differentiated, the Department will prorate equally among the working members and exclude the child’s share. (7-1-24) 04. Educational Income. Includes grants, scholarships, fellowships, work study, educational loans on which payment is deferred, and veterans’ educational benefits. To be excluded, education benefits must meet

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requirements under 7 CFR 273.9(c)(3). (7-1-24) 05. Infrequent or Irregular Income. If it does not exceed thirty dollars ($30) total in a three (3) month period. (7-1-24) 06. Cash Donations. Based on need and received from one (1) or more private nonprofit charitable organizations. The donations must not exceed three hundred dollars ($300) in a calendar quarter of an FFY. (7-1-24) 07. Income in Kind. Any gain or benefit, such as meals, garden produce, clothing, or shelter, not paid in money. (7-1-24) 08. Vendor Payments. Payment made on behalf of a household by a person or organization outside of the household directly to either the household’s creditors or to a person or organization providing a service to the household. (7-1-24) 09. Third Party Payments. Payment by a third party on behalf of a household using funds that are not owed to the household. (7-1-24) 10. Loans. Money received that is to be repaid (7-1-24) 11. Money for Third Party Care. Money received and used for the care and maintenance of a third party who is not in the household. If a single payment is for both household members and nonhousehold members, the identifiable portion of the payment for nonhousehold members is excluded. If a single payment is for both household members and nonhousehold members, the Department will exclude the lesser of: (7-1-24) a. The prorated share of the nonhousehold members if the portion cannot be identified. (7-1-24) b. The amount used for the care and maintenance of the nonhousehold members. (7-1-24) 12. Reimbursements. For past or future expenses not exceeding actual costs. Payments must not represent a gain or benefit, be used for the purpose intended, and be for other than normal living expenses. Excluded reimbursements are not limited to: (7-1-24) a. Travel, per diem, and uniforms for job or training. (7-1-24) b. Out-of-pocket expenses of volunteer workers. (7-1-24) c. Medical and dependent care expenses. (7-1-24) d. Pay for services provided by Title XX of the Social Security Act. (7-1-24) e. Repayment of loans made by the household from their personal property limit. The repayment must not exceed the amount of the loan. (7-1-24) f. Work-related and dependent care expenses paid by the JSAP program. (7-1-24) g. Transitional child care payments. (7-1-24) h. Child care payments under the Child Care and Dependent Block Grant Act of 1990. (7-1-24) 13. Federal Earned Income Tax Credit (EITC). (7-1-24) 14. Work Study. Work Study income received while attending post-secondary school. (7-1-24) 15. HUD FSS Escrow Account. The federal exclusion for these funds is only excluded while the funds are in the escrow account or being used for a HUD-approved purpose. See Section 363 of these rules for further clarification. (7-1-24)

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16. Temporary Census Earnings. Wages earned for temporary employment related to US Census activities during the regularly scheduled ten (10) year US Census. (7-1-24) 17. Income Excluded by Federal Law. (7-1-24) 406. (RESERVED) 407. INCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS). Income must be verified with the IEVS system for all households applying for or getting Food Stamps and for disqualified members with income counted toward the household Food Stamp benefits. (7-1-24) 408. (RESERVED) 409. USE OF IEVS INFORMATION FOR APPLICANT HOUSEHOLDS. IEVS data must be used to compute eligibility and benefits if IEVS data is received before the application is processed. IEVS data on applicant households must be used as soon as possible, even if the applicant household was approved before the IEVS data was received. Action on applications must not be delayed pending receipt of IEVS data. If IEVS data requiring further proof is received before application approval the proof must be obtained and resolved before approving the application. If an applicant household cannot provide an SSN at application, IEVS data must be used as soon as possible after the SSN is known. IEVS data must be used for all household members, eligible, excluded or disqualified. (7-1-24) 410. (RESERVED) 411. VERIFIED UPON RECEIPT IEVS DATA. The IEVS data listed below is considered verified upon receipt, unless it is questionable: (7-1-24) 01. Benefit Data Exchange (BENDEX). BENDEX Social Security retirement and disability income data. (7-1-24) 02. State Data Exchange (SDX). Benefit and eligibility data from SSA under Titles II and XVI of the Social Security Act accessed through the SDX. (7-1-24) 03. TAFI. (7-1-24) 04. AABD. (7-1-24) 05. Medicaid. The Federally aided program for medical care (Title XIX, Social Security Act). (7-1-24) 412. UNVERIFIED IEVS DATA. The IEVS data listed below is considered unverified: (7-1-24) 01. IRS Reported Unearned Income. Data from IRS, including any unreported assets producing income. (7-1-24) 02. Wage File. Data from Department of Commerce and Labor or its counterpart in another state. Wage data from Beneficiary Earning Exchange Record (BEER). (7-1-24) 03. Self-Employment Earnings. Data from BEER. (7-1-24) 04. Income Information the Department Deems Questionable. (7-1-24) 413. -- 427. (RESERVED) 428. CALCULATION OF SELF-EMPLOYMENT INCOME. Self-employment is generally considered annual or seasonal. The Department will add all gross self-employment

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income, either actual or anticipated, and capital gains and exclude the costs of producing the self-employment income and divide the remaining amount of self-employment income by the number of months over which the income will be averaged. This amount is the monthly self-employment income. (7-1-24) 01. Self-Employment Expense Deduction.The Department will use a standard fifty percent (50%) self-employment deduction unless the applicant claims the actual allowable expenses exceed the standard deduction and provides proof of the expenses. (7-1-24) 02. Allowable Costs of Producing Self-Employment Income. Costs of labor, stock, raw material, seed and fertilizer, payments on the principal of the purchase price of income-producing real estate and capital assets, equipment, machinery, and other durable goods, interest paid to purchase income-producing property, insurance premium, and taxes paid on income-producing property. (7-1-24) 03. Costs Not Allowable. Net losses from previous periods, federal, state, and local income taxes, money set aside for retirement, work-related personal expenses (such as transportation to and from work), depreciation, amount that exceeds the payment a household receives from a boarder for lodging and meals, net losses from previous periods, and federal, state, and local income taxes. (7-1-24) 429. SELF-EMPLOYED FARMER. To be considered a self-employed farmer, a person must receive, or expect to receive, an annual gross income of one thousand dollars ($1,000) or more earned from farming activities. If a farmer’s cost of producing self-employment income results in a loss, the Department subtracts the loss from other countable income in the household under 7 CFR 273.11(a)(2)(ii)(A) and (B). (7-1-24) 430. -- 500. (RESERVED) 501. INITIAL CHANGES IN FOOD STAMP CASE. The Department will act on changes in household circumstances found during the application or the initial interview. (7-1-24) 01. Food Stamp Issuance Changes. The Department will make changes to the household’s Food Stamp issuance when it is required to act on a change. (7-1-24) 02. Change Before Certification. If a household reports a change in household circumstances before certification, the Department will include the reported information in determining Food Stamp eligibility and amount. (7-1-24) 03. Change After Certification. If a household reports a change after the initial Food Stamp benefit has been paid, the Department must act on the change as required by policy for acting on changes within a certification period. Notice of the change must be given to the Food Stamp household. (7-1-24) 502. EARNED INCOME WHEN A HOUSEHOLD MEMBER TURNS AGE EIGHTEEN. When a child attending elementary or secondary school turns age eighteen (18), the Department will not count earned income received or expected by that person until the next six-month or twelve-month contact, or recertification. (7-1-24) 503. -- 507. (RESERVED) 508. PROJECTING MONTHLY INCOME. Income is projected for each month. Past income may be used to project future income. Changes expected during the certification period must be considered. Criteria for projecting monthly income is listed below: (7-1-24) 01. Income Already Received. The Department will count income already received by the household during the month. If the actual amount of income from any pay period is known, use the actual pay period amounts to determine the total month’s income. The Department will convert the actual income to a monthly amount if a full month’s income has been received or is expected to be received. (7-1-24)

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02. Anticipated Income. The Department will count income that the household and the Department anticipate the household will get during the remainder of the certification period. If the exact income amount is uncertain or unknown, that portion must not be counted. If the date of receipt of income cannot be anticipated for the month of the eligibility determination, that portion must not be counted. If the income has not changed and no changes are anticipated, the Department will use the income received in the past thirty (30) days as one (1) indicator of anticipated income. If changes in income have occurred or are anticipated, past income cannot be used as an indicator of anticipated income. If income changes and income received in the past thirty (30) days do not reflect anticipated income, the Department can use the household income received over a longer period to anticipate income. If income changes seasonally, the Department can use the household income from the last season, comparable to the certification period, to anticipate income. (7-1-24) 509. TYPES OF INCOME TO BE AVERAGED. Types of income to be averaged are listed below. Income for a destitute migrant or seasonal farm worker household is not averaged. (7-1-24) 01. Self-Employment Income. (7-1-24) 02. Contract Income. Income over the period of the contract, if not received on an hourly or piecework basis. Households with averaged contract income include school employees, share croppers, and farmers. These households do not include migrants or seasonal farm workers. (7-1-24) 03. Income Received Less Often Than Monthly. When receipt of income is less often than monthly, the anticipated income can be averaged over the period intended to cover to determine the average monthly income. (7-1-24) 04. Child Support Income. Can be averaged to make a valid projection for ongoing income. (7-1-24) 510. -- 511. (RESERVED) 512. SPECIAL CASES FOR COUNTING INCOME. Special cases for counting income are listed below: (7-1-24) 01. Wages Held at the Request of Employee. Income in the month the wages would have been paid by the employer. (7-1-24) 02. Garnishments Held by Employer. Income in the month the wages would have been paid. (7-1-24) 03. Wages Held by Employer, Other Than Garnishment and Employee Request. Even if in violation of law, are not counted as income. (7-1-24) 04. Advances on Wages. Count as income if the household reasonably expects the advance to be paid. (7-1-24) 05. Varying Payment Cycles. Households getting unearned or earned income on a recurring monthly or semi-monthly basis do not have varying income merely because mailing or payment cycles cause additional payments to be received in a month. The income is counted for the month it is intended. (7-1-24) 06. Nonrecurring Lump Sum Payments and Capital Gains. Nonrecurring lump sum payments must not be counted as income, but are counted as a resource starting in the month received. Nonrecurring lump sum payments include capital gains from the sale or transfer of securities, real estate, or other real property held as an investment for a set period. The capital gains are income only if the assets were used in self-employment. (7-1-24) 513. -- 531. (RESERVED) 532. GROSS INCOME LIMIT. Households exceeding the gross income limit for the household size are not eligible unless they are categorically

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eligible or have an elderly or disabled member. A household with an elderly or disabled household member is exempt from the gross income limit. (7-1-24) 533. HOUSEHOLD ELIGIBILITY AND BENEFIT LEVEL. A household’s eligibility and benefit level is calculated under 7 CFR 273.10, except as indicated below. The deductions in this rule are subtracted from non-excluded income. (7-1-24) 01. Standard Deductions. Are determined by federal law. (7-1-24) 02. Earned Income Deduction. Is twenty percent (20%) of gross earned income. (7-1-24) 03. Homeless Shelter Deduction. Is established by FNS. (7-1-24) 04. Excess Medical Deduction. Excess medical expense is nonreimbursed medical expense of more than thirty-five dollars ($35) per household per month. The household member must be either age sixty (60) or older or disabled to get this expense deduction. Special diets are not deductible. For allowable medical expenses, see Section 535 of these rules. (7-1-24) 05. Dependent Care Expense Deduction. Is for monthly dependent care expenses. The dependent care may be needed for children or adults. (7-1-24) 06. Child Support Expense Deduction. Is the legally obligated child support and arrearage the household pays, or expects to pay, to or for a non-household member. (7-1-24) 07. Excess Shelter Expense Deduction. Excess shelter expense is the monthly shelter cost over fifty percent (50%) of the household’s income after all other deductions, and is not deducted if the household has received the homeless shelter deduction. For allowable shelter expenses, see Section 542 of these rules. (7-1-24) 534. AVERAGING INFREQUENT, FLUCTUATING, OR ONE-TIME ONLY EXPENSES. Infrequent, fluctuating, or one-time only expenses for medical, child support, shelter, or child care may be averaged. (7-1-24) 535. MEDICAL EXPENSES. Elderly or disabled household members that incur medical expenses over thirty-five dollars ($35) per month are allowed a Standard Medical Expense (SME) deduction. Eligible households must verify monthly medical expenses of more than thirty-five dollars ($35) at initial application. Households with medical expenses that exceed the monthly SME may either verify the minimum amount to receive the SME or request and verify excess costs to receive an actual expense deduction at application and recertification. The household must provide proof of the incurred or anticipated cost before a deduction is allowed. (7-1-24) 536. DEPENDENT CARE EXPENSES. The care of a dependent must be necessary to maintain employment, conduct job search, or attend school or training. The dependent care expenses must be deducted from income. (7-1-24) 537. DEPENDENT CARE RESTRICTIONS. The following types of dependent care cannot be deducted: (7-1-24) 01. Care by Household Member. If the care is provided by another household member. (7-1-24) 02. In-Kind Payment. Such as food or exchanges for shelter. (7-1-24) 03. Vendor Payment. (7-1-24) 04. Spouse Can Give Care. If the spouse in the home is physically capable of the dependent care and is not working, seeking work, or registered for work. (7-1-24) 05. Dependent Care. If paid or reimbursed under a federal child care program. (7-1-24)

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538. CHILD SUPPORT EXPENSES. Child support expense may be deducted for a household paying or expecting to pay legally obligated child support to or for a person living outside the household. The child support expense deducted must reflect the child support the household pays or expects to pay during the certification period, rather than the obligated amount. (7-1-24) 539. -- 541. (RESERVED) 542. COSTS ALLOWED FOR SHELTER DEDUCTION. Shelter costs are current charges for the shelter occupied by the household and include costs for the home temporarily not occupied because of employment or training away from home or illness. (7-1-24) 543. UTILITY ALLOWANCES. The shelter deduction is computed using one (1) of four (4) utility allowances: SUA, LUA, MUA, or TUA. Utility allowances are not prorated. (7-1-24) 01. Standard Utility Allowance (SUA). (7-1-24) a. The household must have a primary heating or cooling cost to qualify for SUA. The heating or cooling costs must be separate from rent or mortgage payments. (7-1-24) b. Households are limited to one (1) SUA. (7-1-24) 02. Limited Utility Allowance (LUA). The household must be billed for more than one (1) utility that is not for heating or cooling. (7-1-24) 03. Minimum Utility Allowance (MUA). The household must be billed for one (1) utility that is not for heating, cooling, or telephone service. (7-1-24) 04. Telephone Utility Allowance (TUA). The household must be billed for telephone service and have no other verified utility expenses. (7-1-24) 544. -- 546. (RESERVED) 547. COSTS NOT ALLOWED FOR THE SHELTER DEDUCTION. The costs listed below are not allowed in computing the shelter deduction. (7-1-24) 01. Fees for a One-Time Utility Deposit. (7-1-24) 02. Damage or Advance Deposits on Rentals. (7-1-24) 03. Payments Made to Pay Past Due Rent. (7-1-24) 04. Cost to Cut the Household’s Own Wood for Heating. (7-1-24) 05. Furniture Rental Fees. (7-1-24) 06. Insurance on Furniture or Personal Belongings. (7-1-24) 07. Vehicle Not Used as Residence. Payments or gasoline costs on vehicles used only for recreation. (7-1-24) 08. Repairs Not Paid by Household. Costs for repairing or replacing shelter paid by private or public agencies, insurance companies, or any other source. (7-1-24) 09. Shelter Not Paid by Household but Paid by a Vendor or Employer. (7-1-24)

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10. Utility Costs Paid by HUD or FmHA Negative Utility Payment. (7-1-24) 548. COMPUTING THE SHELTER DEDUCTION. The shelter deduction is computed as listed below: (7-1-24) 01. If Household has Elderly or Disabled Member. The Department will deduct the monthly shelter cost exceeding fifty percent (50%) of the household’s income after all other deductions. (7-1-24) 02. If Household has No Elderly or Disabled Member. The Department will deduct the excess of fifty percent (50%) of the household’s income, after all other deductions, up to the maximum limit under Title 7 USC Section 2014. (7-1-24) 549. NET INCOME LIMIT TEST. Categorically eligible households do not have to meet the net income limit. All other households, including those with an elderly or disabled household member, must not exceed the net income limit to be eligible for Food Stamps. (7-1-24) 550. DETERMINATION OF FOOD STAMP BENEFIT. The Food Stamp benefit is computed under 7 CFR 273.9 and 273.10. (7-1-24) 551. ROUNDING FOOD STAMP PAYMENT. Income and deductions are not rounded in determining gross or net income. Only the final Food Stamp amount is rounded. (7-1-24) 552. -- 561. (RESERVED) 562. PRORATING INITIAL MONTH'S BENEFITS. Prorating is based on a thirty (30) day calendar month. Benefits are prorated from the application date to the end of the month. (7-1-24) 563. FOOD STAMP PRORATING FORMULA. The prorated Food Stamp amount is determined under 7 CFR 273.10(a)(1)(iii)(B). If the amount for the initial month is less than ten dollars ($10), benefits must not be issued. (7-1-24) 564. BENEFITS AFTER THE INITIAL MONTH. After the initial month, benefits must be issued as described below. (7-1-24) 01. All Eligible One and Two Person Households. Receive a minimum allotment equal to eight percent (8%) of the maximum one (1) person allotment. (7-1-24) 02. All Eligible Three or More Person Households. When the calculation of benefits would yield a zero benefit, the Department will deny the household’s application on the grounds that its net income exceeds the level at which benefits are issued. (7-1-24) 03. Not Categorically Eligible. All households, except categorically eligible households, must be denied if the household’s net income exceeds the level at which benefits are issued. (7-1-24) 565. -- 572. (RESERVED) 573. ACTING ON HOUSEHOLD COMPOSITION CHANGES. Changes in household composition are not required to be reported. If a household does report a change in household composition, the Department will act on the change using options under 7 CFR 273.12(c). (7-1-24) 574. (RESERVED) 575. HOUSEHOLD COMPOSITION CHANGES FOR STUDENT. Ineligible students are defined as nonhousehold members. When a student’s status changes, the change is treated as a

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new person entering or leaving the Food Stamp household. (7-1-24) 576. -- 587. (RESERVED) 588. NOTICE OF DECISION TO HOUSEHOLDS. The Department must send the household a written notice as soon as Food Stamps are approved or denied. The household must get the notice no later than thirty (30) days after the application date. (7-1-24) 589. -- 600. (RESERVED) 601. REPORTING REQUIREMENTS AND RESPONSIBILITIES. Changes may be reported by phone, mail, other electronic interfaces, or in person to the Department. Households must report when: (7-1-24) 01. Household’s Total Gross Income Exceeds One Hundred Thirty Percent (130%) of FPG for the Household Size. (7-1-24) 02. There is a Decrease in the Household’s ABAWD Hours to Less Than Eighty (80) Hours Per Month. (7-1-24) 03. There are Substantial Lottery Winnings. Defined as equal to or greater than the financial resource limit for elderly or disabled households not subject to the Broad-Based Categorical Eligibility (BBCE) resource limit. (7-1-24) 602. (RESERVED) 603. PERSON OUTSIDE HOUSEHOLD FAILS TO PROVIDE PROOF -- CHANGES. Food Stamps cannot be closed solely because a person outside the household fails to provide requested proof. The Department will attempt to get another source of proof if a person outside the household does not provide requested proof. Disqualified household members are not persons outside the household. (7-1-24) 604. -- 610. (RESERVED) 611. TIME FRAMES FOR REPORTING CHANGES IN HOUSEHOLD CIRCUMSTANCES. Households reporting required changes to the Department must do so by the tenth day of the month following the month in which the change occurred. If Food Stamps are over-issued because a household fails to report required changes, a claim determination must be prepared. A person can be disqualified for failure to report a change if they commit an IPV. (7-1-24) 612. (RESERVED) 613. CHANGES ON WHICH THE DEPARTMENT MUST ACT. The Department must follow the procedures for acting on reported changes under 7 CFR 273.12. (7-1-24) 614 -- 616. (RESERVED) 617. INCREASES IN FOOD STAMP BENEFITS. 01. Household Reports a Change. If a household reports a change that results in an increase in Food Stamps and the proof cannot be obtained through interfaces or data brokers, the Department must allow the household ten (10) days to provide proof. (7-1-24) 02. Failure to Provide Proof of Change. If the household fails to provide proof of a change that would increase the benefit level, the Food Stamp benefit remains at the amount already established. (7-1-24) 03. Proof Provided Within Ten Days. If the household provides proof within ten (10) days of reporting the change, the Department will increase the Food Stamp benefits beginning the month immediately

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following the month in which the change was reported. For changes reported after the 20th of the month, a supplement is issued for the next month no later than the 10th of the next month. If the change is reported and verified after the final date to adjust Food Stamp benefits for the following month in the Department’s automated eligibility system, the change to the Food Stamp benefits must be made by the following month, even if a supplement must be issued. (7-1-24) 04. Proof Not Provided Within Ten Days. If the household fails to provide proof within ten (10) days of reporting the change, but provides proof later, benefits are increased the month after the proof of the change is provided. (7-1-24) 618. DECREASES IN FOOD STAMP BENEFITS. If the Department acts on a change that results in a decrease in Food Stamp benefits, the Department must give timely notice, if required. The notice must explain the reason for the action. (7-1-24) 619 -- 620. (RESERVED) 621. TAFI OR AABD HOUSEHOLD REPORTING CHANGES. If a change in the AABD or TAFI grant results in a change in the household's Food Stamp benefits, the Department must count the new grant amount, regardless of whether the Food Stamps increase or decrease. If a change requires a reduction or ending of TAFI or AABD and Food Stamp benefits, the Department will issue a Notice of Decision for both programs. If the household makes a timely request for a fair hearing and continued benefits, Food Stamp benefits continue pending the hearing. The household must reapply if certification expires before the hearing is complete. (7-1-24) 622. CHANGE ENDS TAFI OR AABD INCOME. Food Stamp benefits will be closed only if there is a change on which the Department is required to act. If TAFI or AABD ends and the household remains Food Stamp eligible, the Department must advise the household of any applicable work registration requirements. (7-1-24) 623. FAILURE TO TAKE REQUIRED ACTION. If the Department is unable to make a change in Food Stamp eligibility or issuance and an overissuance results, the Department will collect the overpayment. If the Department fails to act on a change that increases household benefits, the Department will restore lost benefits. (7-1-24) 624. -- 628. (RESERVED) 629. NOTICE OF LOWERING OR ENDING BENEFITS. Households must be sent a Notice of Decision when Food Stamps are ended or reduced unless notice is not required under these rules. (7-1-24) 630. ADEQUATE NOTICE. Adequate notice is a written statement telling the household the action the Department is taking. The notice must tell the reasons for the action and advise the household of the right to a hearing. All notices must be adequate. If Food Stamps are reduced, the household must receive the notice on or before the first day of the month the action is effective. (7-1-24) 631. TIMELY NOTICE. Timely notice must be mailed at least ten (10) days before the effective date of the action. (7-1-24) 632. TIMELY NOTICE NOT REQUIRED. Timely notice is not required when the conditions listed below are met. Adequate notice must be given. (7-1-24) 01. Statement of Household. The Department gets a clear, written, signed statement from the household. Food Stamps can be ended or reduced from the facts given in the household statement. (7-1-24) 02. Food Stamps Reduced After Closure Notice. The household is sent a notice of closure because it did not provide requested proof. The household provides the proof before the first day of the month of closure. If the

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proof results in reduced Food Stamps, the reduced benefits are issued. (7-1-24) 03. Food Stamps Closed or Reduced Because of IPV Penalty. The Department must impose the IPV penalty the first of the month after the month it gives written notice to the participant. (7-1-24) 633. NOTICE OF CHANGES NOT REQUIRED. Notice to individual Food Stamp households is not required when the conditions under Subsection 633.01 in this rule are met. Mass notice must be given in some situations under Subsection 633.02 in this rule: (7-1-24) 01. Waiver by the Household. A household member or authorized representative provides a written statement requesting closure. The person gives information causing reduction or an end to benefits and states, in writing, they know adverse action will be taken. The person acknowledges in writing continuation of benefits is waived if a fair hearing is requested. (7-1-24) 02. Mass Changes. Include changes: (7-1-24) a. In the income limit tables. (7-1-24) b. In the issuance tables. (7-1-24) c. In Social Security benefits. (7-1-24) d. In SSI payments. (7-1-24) e. In TAFI or AABD grants. (7-1-24) f. Caused by a reduction, suspension, or cancellation of Food Stamps ordered by the Secretary of USDA. (7-1-24) g. When the Department performs mass changes, it notifies Food Stamp households of the mass change by one (1) of the following methods: (7-1-24) i. Media notices. (7-1-24) ii. Posters in the Food Stamp offices and issuance locations. (7-1-24) iii. A general notice mailed to households. (7-1-24) 03. Mass Changes in TAFI or AABD. When a mass change to TAFI or AABD causes a Food Stamp change, the Department will use the following criteria: (7-1-24) a. If the Department has thirty (30) days advance notice of the TAFI or AABD mass change, Food Stamps must be adjusted the same month as the change. (7-1-24) b. If the Department does not have advance notice, Food Stamp benefits must be changed no later than the month after the TAFI or AABD mass change. (7-1-24) c. Ten (10) day advance notice to Food Stamp households is not required. Adequate notice must be sent to Food Stamp households. (7-1-24) d. If a household requests a fair hearing because of an issue other than mass change, the Department will continue Food Stamps. (7-1-24) 04. Notice of Death. Notice is not required when the Department learns of the death of all household members. (7-1-24) 05. Completion of Restored Benefits. Notice is not required when an increased allotment, due to

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restored benefits, ends. The household must have been notified in writing when the increase would end. (7-1-24) 06. Joint Public Assistance and Food Stamp Applications. Notice is not required if the household jointly applies for TAFI or AABD and Food Stamps and gets Food Stamps pending TAFI or AABD approval. The household must be notified at certification that Food Stamps will be reduced upon TAFI or AABD approval. (7-1-24) 07. Converting From Repayment to Benefit Reduction. Notice is not required if a household with an IHE or IPV claim fails to repay under the repayment schedule. An allotment reduction is enforced. (7-1-24) 08. Households Receiving Expedited Service. Notice is not required if all the following conditions are met: (7-1-24) a. The applicant received expedited services. (7-1-24) b. Proof was postponed. (7-1-24) c. A regular certification period was assigned. (7-1-24) d. Written notice, stating future Food Stamps depend on postponed proof, was given at approval. (7-1-24) 09. Residents of a Substance Use Disorder Treatment Center or a Group Living Arrangement Center. Notice is not required when the Department ends Food Stamps to residents of a substance use disorder treatment center or group living arrangement center if: (7-1-24) a. The Department revokes the center’s certification. (7-1-24) b. FNS disqualifies the center as a retailer. (7-1-24) 634. VERBAL REQUEST FOR END OF FOOD STAMPS. If a household makes a verbal request for closure, the Department will end the benefits, and notify the household with a ten (10) day advance Notice of Decision. (7-1-24) 635. -- 638. (RESERVED) 639. CONTINUATION OF BENEFITS PENDING A HEARING. The household retains the right to continued benefits when the household requests a fair hearing within the ten (10) day notice period. The household must request this continuation of Food Stamps. If certification has not expired, Food Stamps can continue at the former level. Benefits must be continued within five (5) working days of the household’s request for a fair hearing. (7-1-24) 640. (RESERVED) 641. REDUCING OR ENDING BENEFITS BEFORE HEARING DECISION. Benefits may be ended or reduced before the hearing decision, if any of the following is met: (7-1-24) 01. Appeal of Federal Law. The hearing official states, in writing, the sole issue being appealed is one of federal law, regulation, or policy. (7-1-24) 02. Food Stamp Issuance Changes. Food Stamp eligibility or benefit level changes occur before the hearing decision and a new hearing is not requested. (7-1-24) 03. Food Stamp Certification Period Expires. (7-1-24) 04. Mass Change Occurs Before the Hearing Decision. (7-1-24) 642. -- 643. (RESERVED)

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644. EXPIRATION OF CERTIFICATION PERIOD. Household eligibility ends when the certification period expires. (7-1-24) 645. RECERTIFICATION PROCESS. The Department must follow the recertification procedures under 7 CFR 273.14. (7-1-24) 646. NOTICE OF DECISION FOR TIMELY RECERTIFICATION. A Notice of Decision must be sent to households that reapply for Food Stamps. To receive Food Stamps with no break in issuance, households must complete a six-month or twelve-month contact or recertification before the fifteenth day of the last month of certification or six-month or twelve-month contact period. If the household applies before the fifteenth day of the month, the Department will notify the household of eligibility or denial by the end of the current certification period. (7-1-24) 647. -- 649. (RESERVED) 650. RESTORATION OF LOST BENEFITS. Lost benefits must be restored. The Department may find Food Stamps have been incorrectly denied, ended, or underissued to an eligible household. The Department may learn of lost benefits from case reviews, Quality Control reviews, or other sources. Benefits are restored when caused by a Department error, when a fair hearing is reversed, or an IPV disqualification is reversed. The Department will restore benefits to eligible and previously eligible households and to households who have moved out of state. The Department will restore benefits for SSA joint processing errors. (7-1-24) 651. TIME FRAMES FOR RESTORATION OF BENEFITS. Benefits must not be restored if lost more than twelve (12) months before notification or discovery. (7-1-24) 01. Lost Benefits Reported by Household. Are restored when the Department learns of lost benefits reported by the household, a person outside the household, or by another agency. Twelve (12) months are counted from the month the Department is notified of the lost benefits. (7-1-24) 02. Lost Benefits Discovered by Department. Are restored when the Department discovers lost benefits during the course of business. Twelve (12) months are counted from the month the Department discovers the benefits were lost. (7-1-24) 03. Lost Benefits From Fair Hearing. Are restored to a household that requests a fair hearing and the decision is in the household’s favor. Twelve (12) months are counted from the effective date of the adverse action causing the fair hearing. (7-1-24) 652. -- 655. (RESERVED) 656. REPLACING FOOD DESTROYED BY A DISASTER. Conditions and procedures for replacing food destroyed by a disaster are listed below. The food must have been purchased with Food Stamps. (7-1-24) 01. Food Destroyed in a Disaster. The actual value of loss, not to exceed one (1) month’s allotment, can be replaced. The food bought with Food Stamps must have been destroyed in a disaster. The disaster may involve only the household, such as a house fire, or a larger scope, such as a flood. There is no limit on the number of times food destroyed in a disaster may be replaced. (7-1-24) 02. Replacement Time Limit for Disaster Loss. The Department must provide either disaster Food Stamps or replacement Food Stamps, but not both, within ten (10) days of the reported loss, if: (7-1-24) a. The household reports the disaster within ten (10) days of the incident. (7-1-24) b. The disaster is verified by collateral contact, an organization such as the Fire Department or Red Cross, or by home visit. (7-1-24)

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657. -- 674. (RESERVED) 675. IPV, IHE, AND AE FOOD STAMP CLAIMS. An overissuance exists when the amount of Food Stamps issued exceeds the Food Stamps a household is eligible to receive. The Department must establish a claim against the household, to recover the value of Food Stamps overissued or misused. The types of Food Stamp claims are listed below. (7-1-24) 01. Intentional Program Violation (IPV) Claim. A overissuance caused by an intentional, knowing, and willful program violation. (7-1-24) 02. Inadvertent Household Error (IHE) Claims. An error, without intent to cause an overissuance, which results in a Food Stamp overissuance. Causes of IHE claims are: (7-1-24) a. Failure to give information. A household, without intent to cause an overissuance, fails to give correct or complete information. (7-1-24) b. Failure to report change that was required to be reported. A household, without intent to cause an overissuance, fails to report changes or to report at all. (7-1-24) c. Failure to comply. A household, without intent to cause an overissuance, fails to comply due to language barrier, educational level, or not understanding written or verbal instructions. (7-1-24) d. Pending IPV. An IHE claim occurs between the time of an IPV referral and the IPV decision. (7-1-24) 03. Agency Error Claim (AE). A claim that results from an overissuance caused by a Department action or a failure to act. (7-1-24) 676. PERSONS LIABLE FOR FOOD STAMP CLAIMS. The persons listed below are responsible for paying a claim. (7-1-24) 01. Adult Household Members. Adult members of the household at the time of the overissuance or trafficking are liable. They are individually and jointly liable, whether residing in the household where the claim arose, or in any other household. (7-1-24) 02. Sponsor of an Alien. The sponsor of an alien household member if the sponsor is at fault for the claim. (7-1-24) 03. Person Connected to the Household. A person connected to the household, such as an authorized representative, who trafficks or causes an overissuance or trafficking. (7-1-24) 677. COMPUTING FOOD STAMP CLAIMS. The Department computes Food Stamp claims as described below. (7-1-24) 01. Claims Not Related to Trafficking. The Department computes claims not related to trafficking back to a minimum of twelve (12) months before it became aware of the overissuance. The Department does not compute these claims back more than six (6) years. For an IPV claim, the Department computes back to the month the first IPV occurred. The Department continues to compute back a minimum of twelve (12) months before the first IPV. The Department does not compute IPV claims back more than six (6) years before the first IPV. (7-1-24) 02. Trafficking-Related Claims. Are the value of the trafficked Food Stamps as determined by: (7-1-24) a. The individual’s admission. (7-1-24) b. Adjudication. (7-1-24)

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c. The documentation forming the basis for the trafficking determination. (7-1-24) 678. -- 691. (RESERVED) 692. DETERMINING DELINQUENT CLAIMS. The Department determines if a claim is delinquent using the following. (7-1-24) 01. Claim Not Paid by Due Date. Is delinquent if there is not a satisfactory payment arrangement. The claim remains delinquent until paid in full, a satisfactory repayment agreement is negotiated, or allotment reduction is invoked. (7-1-24) 02. Payment Arrangement Not Followed. The claim is delinquent if a payment arrangement is established, but scheduled payment is not made by the due date. The claim remains delinquent until paid in full, allotment reduction is invoked, or the Department agrees to resume or renegotiate the repayment schedule. (7-1-24) 03. Previous Claim. A claim is not delinquent if another claim for the same household is being paid through an installment agreement or allotment reduction. The Department begins collection on the new claim after the first claim is settled. (7-1-24) 04. Collection Coordinated Through Court. A claim is not delinquent if the Department is unable to determine delinquency status because collection is coordinated through the court system. (7-1-24) 05. Claim Awaiting Hearing Decision. Is not delinquent. If later, the hearing officer affirms a claim does exist against the household, the Department notifies the household. (7-1-24) 693. (RESERVED) 694. COLLECTING CLAIMS. The Department collects payment for claims using the methods listed below. (7-1-24) 01. Allotment Reduction. The Department reduces the Food Stamp allotment to collect the claim. (7-1-24) a. For an IPV claim, the allotment reduction limit is the greater of twenty dollars ($20) per month or twenty percent (20%) of the household's monthly allotment. (7-1-24) b. For an IHE or AE claim, the allotment reduction limit is the greater of ten dollars ($10) per month or ten percent (10%) of the household's monthly allotment. The household can agree to a higher amount. (7-1-24) c. The Department does not reduce the initial month's Food Stamps unless the household agrees to this reduction. (7-1-24) 02. Household Repays the Claim from its EBT Account. (7-1-24) 03. Payment by Cash, Check, or Money Order. (7-1-24) 04. Household Performing Public Service. Payment by public service as ordered by a court, specifically as payment of a claim. (7-1-24) 05. Collection by Treasury Offset Program (TOP). The Department submits claims delinquent for one hundred and eighty (180) days, or more, for collection through TOP. (7-1-24) 695. TOP NOTICES. The Department will provide the household with a notice of intent to collect via Treasury offset. The notice must inform the household of the right to request a Department review of the intended collection action. The Department must receive the request for review within sixty (60) days of the notice of intent to collect. The notice of review

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determination must inform the household of the right to request that FNS review the Department’s decision. The notice must include instructions for requesting a review by FNS and the address of the FNS regional office. (7-1-24) 696. EFFECTS OF TOP ON THE FOOD STAMP HOUSEHOLD. When a claim is referred to TOP, any eligible federal payment owed to the household may be intercepted and applied to the claim to reduce the debt. The household may be required to pay collection or processing fees charged by the federal government to intercept the payment. (7-1-24) 697. REMOVING A CLAIM FROM TOP. The Department removes a claim from TOP under the conditions listed below. (7-1-24) 01. Instructed by FNS or Treasury. (7-1-24) 02. Household Undergoing Allotment Reduction. (7-1-24) 03. Claim Is Paid in Full. (7-1-24) 04. Claim Is Satisfied Through a Hearing, Termination, Compromise, or Other Means. (7-1-24) 05. Household Arranges to Resume Payments. (7-1-24) 698. INTENTIONAL PROGRAM VIOLATION (IPV). An IPV includes the actions listed below. The participant must intentionally, knowingly, and willfully commit a program violation. (7-1-24) 01. False Statement. A person makes a false statement to the Department, either orally or in writing, to get Food Stamps. (7-1-24) 02. Misleading Statement. A person makes a misleading statement to the Department, either orally or in writing, to get Food Stamps. (7-1-24) 03. Misrepresenting. A person misrepresents facts to the Department, either orally or in writing, to get Food Stamps. (7-1-24) 04. Concealing. A person conceals or withholds facts to get Food Stamps. (7-1-24) 05. Violation of Regulations. A person commits any act violating the Food Stamp Act, federal regulations, or state Food Stamp regulations. The violation may relate to use, presentation, transfer, acquisition, receipt, or possession of Food Stamps. (7-1-24) 06. Trafficking in Food Stamps. Means any of the following: (7-1-24) a. The buying, selling, stealing, or otherwise effecting an exchange of food stamp benefits issued and accessed via EBT cards, card numbers, and personal identification numbers (PINs), or by manual voucher and signature, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone; (7-1-24) b. Attempting to buy, sell, steal, or otherwise affect an exchange of food stamp benefits issued and accessed via EBT cards, card numbers, and PINs, or by manual voucher and signatures, for cash or consideration other than eligible food, either directly, indirectly, in complicity or collusion with others, or acting alone; (7-1-24) c. The exchange of firearms, ammunition, explosives, or controlled substances, defined under Section 802 of Title 21, USC, for food stamp benefits; (7-1-24) d. Purchasing a product with food stamp benefits that has a container requiring a return deposit with the intent of obtaining cash by discarding the product and returning the container for the deposit amount, intentionally discarding the product, and intentionally returning the container for the deposit amount; (7-1-24)

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e. Purchasing a product with food stamp benefits with the intent of obtaining cash or consideration other than eligible food by reselling the product, and subsequently intentionally reselling the product purchased with food stamp benefits in exchange for cash or consideration other than eligible food; or (7-1-24) f. Intentionally purchasing products originally purchased with food stamp benefits in exchange for cash or consideration other than eligible food. (7-1-24) 699. ESTABLISHING AN INTENTIONAL PROGRAM VIOLATION (IPV). The Department establishes an IPV by the actions listed below. (7-1-24) 01. Waiver. The participant signs a waiver to a disqualification hearing. (7-1-24) 02. Hearing. An administrative disqualification hearing determines an IPV. (7-1-24) 03. Judgment. A court judgment determines an IPV. (7-1-24) 700. ADMINISTRATIVE RESPONSIBILITY FOR ESTABLISHING IPV. The Department must investigate and refer cases for an IPV determination. If there is enough recorded evidence to establish an IPV, the Department must take the actions listed below: (7-1-24) 01. Act to Collect. The Department must act to collect overissuances. The Department must set up IHE overissuance claims when a suspected IPV claim is not pursued under administrative or prosecution procedures. (7-1-24) 02. Obtain Administrative Disqualification. The Department pursues administrative disqualification when: (7-1-24) a. The case facts do not warrant civil or criminal prosecution. (7-1-24) b. The case referred for prosecution was declined. (7-1-24) c. The case was referred for prosecution and no action was taken in a reasonable time. (7-1-24) d. The case was referred for prosecution, but the case was withdrawn by the Department. (7-1-24) 03. Do Not Obtain Administrative Disqualification. The Department must not pursue an administrative disqualification in cases: (7-1-24) a. Being referred for prosecution. (7-1-24) b. After any prosecutor action against the accused if the case issues are the same or related circumstances. (7-1-24) 701. PENALTIES FOR AN IPV. IPV persons are ineligible for Food Stamps for twelve (12) months for the first violation, for twenty-four (24) months for the second violation, and permanently for the third violation. The Department will disqualify only the person(s) who committed the IPV. The Department will notify the person in writing of the disqualification penalty. The penalty continues without interruption until completed, regardless of the eligibility of the disqualified person. An IPV penalty can be imposed even if no overissuance claim exists. (7-1-24) 01. Administrative Disqualification Hearings. The disqualification begins no later than the first day of the second month following the date the person gets written notice of the disqualification. (7-1-24) 02. Waivers. The disqualification begins the first day of the month following the date the person gets the written notice of disqualification. (7-1-24)

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03. Court Decisions. The disqualification begins on the date imposed by the court (to start the beginning of the following month) or, if no date is specified, within forty-five (45) days of the date the disqualification was ordered, beginning the first day of the month. (7-1-24) 702. PENALTIES FOR IPV TRAFFICKING. IPV persons are ineligible for Food Stamps for two (2) years for the first finding by a court the recipient purchased illegal drugs with Food Stamps, are permanently ineligible for Food Stamps for a second finding by the court the recipient purchased illegal drugs with Food Stamps, and are permanently ineligible for Food Stamps for a first finding by a court the recipient purchased firearms, ammunition, or explosives with Food Stamps. A person convicted of trafficking in Food Stamp benefits of five hundred dollars ($500) or more is permanently disqualified from the Food Stamp program. (7-1-24) 703. PENALTIES FOR IPV RECEIPT OF MULTIPLE BENEFITS. A person found making a fraudulent statement or representation about identity or residence to get multiple benefits is ineligible for Food Stamps for ten (10) years for the first and second offenses and permanently for the third offense. (7-1-24) 704. -- 714. (RESERVED) 715. WAIVED HEARINGS. Persons accused of an IPV may waive their right to an administrative disqualification hearing by completing and signing a Waiver of Disqualification Hearing. If the reviewers determine a waiver is proper, each household member suspected of IPV must be mailed or given a Waiver of Disqualification Hearing. (7-1-24) 716. DISQUALIFICATION AFTER WAIVED HEARING. Persons waiving their right to an IPV administrative disqualification hearing must have penalties imposed. (7-1-24) 717. COURT REFERRALS. Procedures for court referrals are listed below: (7-1-24) 01. Referred Cases. The Department may refer persons to law enforcement or county prosecutor who are suspected of getting or receiving Food Stamps by committing an IPV, or persons suspected of committing an IPV. (7-1-24) 02. Impose Court Penalties. The Department must disqualify a person found guilty of IPV by a court for the length of time specified by the court. The disqualified member’s household will remain responsible for the overissuance, resulting from the disqualified member’s IPV, regardless of the household’s eligibility. If the court fails to specify a period, the Department will use the IPV penalty periods under Section 701 of these rules unless they are contrary to the court order. (7-1-24) 718. DEFERRED ADJUDICATION. Deferred Adjudication is an out-of-court settlement between the accused IPV member and the prosecutor. Terms of the settlement are listed below: (7-1-24) 01. Deferred Judgment Conditions. Guilt is not decided by the court because the accused person has met the terms of a court order or an agreement with the prosecutor. (7-1-24) 02. Agreement with Prosecutor. If the Department has an agreement with the prosecutor, the prosecutor may defer adjudication. The prosecutor must agree to give advance written notice to the member stating the consequences of consenting to disqualification. (7-1-24) 03. Notice to Food Stamp Member. If the prosecutor decides deferred adjudication is fitting, the household member suspected of IPV must be mailed or presented with a Deferred Adjudication Disqualification Consent Agreement. (7-1-24) 04. Disqualification Period. The period of disqualification must begin within forty-five (45) days of the date the member signed the Deferred Adjudication Disqualification Consent Agreement. The period of

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disqualification must begin as agreed upon with the prosecutor. Once a disqualification penalty is imposed against a member, the period continues uninterrupted regardless of the household’s eligibility. The disqualified member’s household continues to be responsible for overissuance repayment resulting from the disqualified member’s IPV regardless of the household’s eligibility. (7-1-24) 05. Notice of Disqualification. The Department must provide a completed Notice of Disqualification before the disqualification to the disqualified member and remaining household members. The Department must provide a Demand Letter for Overissuance and Repayment Agreement. (7-1-24) 719. (RESERVED) 720. CLAIMS DISCHARGED BY BANKRUPTCY. The Department will act for FNS in bankruptcy proceedings against households owing claims. The Department may file proofs of claims, objections to discharge, exceptions, petitions, and any other documents, motions, or objectives FNS might have filed. (7-1-24) 721. (RESERVED) 722. INTERSTATE CLAIMS COLLECTION. Idaho is responsible for initiating and continuing collection action on any Food Stamp recipient claim regardless of whether the household remains in Idaho. (7-1-24) 723. -- 727. (RESERVED) 728. FOOD STAMP REDUCTION, SUSPENSION, OR CANCELLATION. Food Stamps for all Food Stamp households must be reduced suspended, or cancelled, if ordered by the USDA Secretary to comply with Section 18 of the Food Stamp Act of 1977. Reduced Food Stamps are computed using the thrifty food plan amounts and are reduced by a percentage defined by FNS. Food Stamp reduction, suspension, and cancellation rules are described below: (7-1-24) 01. Reducing Food Stamps. FNS will notify the Department of the effective date of reduction and of the thrifty food plan reduction percentage. The Department must: (7-1-24) a. Act immediately to carry out the reduction. (7-1-24) b. Guarantee one (1) and two (2) person households a minimum benefit of equal to eight percent (8%) of the maximum one (1) person allotment unless the reduction is ninety percent (90%) or more of total projected monthly benefits. (7-1-24) 02. Restoring Lost Benefits. Households whose Food Stamps are reduced or cancelled under this rule are not entitled to restoration of benefits. Reductions or cancellations of Food Stamps may be ordered restored by the USDA Secretary. (7-1-24) 03. Suspension or Cancellation. If a suspension or cancellation is in effect, no Food Stamps are to be issued to the applicant. (7-1-24) 04. Hearings. Any household whose allotment was reduced, suspended, or cancelled under this rule can request a fair hearing. (7-1-24) 729. -- 750. (RESERVED) 751. BOARDERS. Rules for Food Stamp boarders are listed below: (7-1-24) 01. Boarder Included with Food Stamp Household. Boarders may be included in the Food Stamp household providing board. The Food Stamp household must request the boarder be included. The household must be otherwise eligible. (7-1-24)

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02. Foster Children and Foster Adults. Foster children and foster adults are boarders. Foster care payments and guardianship payments are not income for Food Stamps if the foster child and adult do not get Food Stamps as part of the household. If the household requests the foster child and adult be included in the Food Stamp household, foster care payments and guardianship payments are counted. (7-1-24) 03. Certified Family Home (CFH). CFH residents are considered boarders and may be included in the CFH providers household. (7-1-24) 04. Meal Compensation. Boarder status must be given to persons paying a reasonable monthly amount for meals. (7-1-24) a. Payments for more than two (2) meals a day must equal or exceed the thrifty food plan for the boarder household size. (7-1-24) b. Payments for two (2) meals or less per day must equal or exceed two-thirds (2/3) of the thrifty food plan for the boarder household size. (7-1-24) 05. Nonboarder Status. A person paying less than a reasonable amount for meals is a member of the household providing board. (7-1-24) 06. Income from Boarders. If the boarder is not a Food Stamp household member: (7-1-24) a. The meals and lodging payment is self-employment income for the Food Stamp household. (7-1-24) b. The boarder’s income and resources are not counted for the Food Stamp household. (7-1-24) 752. STRIKERS. Households with strikers are not eligible to get Food Stamps unless the household was eligible the day before the strike. (7-1-24) 753. SPONSORED LEGAL NON-CITIZENS. Sponsored legal non-citizens are lawfully admitted for permanent United States residence. A sponsor executes an I- 864 affidavit of support on behalf of legal non-citizen. The income and resources of the sponsor will be deemed until the legal non-citizen becomes a naturalized citizen or until they have worked forty (40) qualifying quarters of coverage under Title II of the Social Security Act, or the sponsor dies. A qualifying quarter includes a quarter worked by the legal non-citizen’s parent while the legal non-citizen was under eighteen (18) and a quarter worked by the legal non-citizen’s spouse during marriage if the legal non-citizen remains married to the spouse or the spouse is deceased. Any quarter after January 1, 1997, in which a legal non-citizen received any federal means-tested benefit is not counted as a qualifying quarter. (7-1-24) 754. DEEMING INCOME AND RESOURCES TO SPONSORED LEGAL NON-CITIZEN. Income and resources of the sponsor are deemed available to the legal non-citizen. If the sponsor lives with their spouse, the spouse’s income and resources are also deemed available to the legal non-citizen. The income and resources are deemed, even if the sponsor and spouse were married after the sponsor signed the sponsorship agreement. The Department counts income and resources deemed to the legal non-citizen toward Food Stamp eligibility and issuance level of the legal non-citizen’s household. (7-1-24) 01. Battered Legal Non-Citizen Whose Sponsor Signed an Affidavit of Support. For sponsor deeming, a battered legal non-citizen includes the non-citizen and the child of the non-citizen. The non-citizen or child must be battered in the US by a spouse, parent, or member of the family in the same household. The non-citizen must not participate in, or acquiesce to, the battering of the child. (7-1-24) a. A battered legal non-citizen whose sponsor signed an affidavit of support is exempt from the sponsor deeming requirement for one (1) year if the need for Food Stamps is connected to the battery and the legal non-citizen no longer lives with the batterer. (7-1-24)

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b. The exemption from the sponsor deeming requirement can exceed more than one (1) year if the legal non-citizen demonstrates the battery has been recognized in an order of a judge or by the INS and the need for Food Stamps is connected to the battery. (7-1-24) 02. Indigent Legal Non-Citizen Whose Sponsor Signed an Affidavit of Support. A non-citizen is indigent if the household income does not exceed one-hundred thirty percent (130%) of the poverty income guideline (gross income limit) for the household size. (7-1-24) a. For an indigent non-citizen, the Department counts the non-citizen’s own income and the cash or in-kind income and resources provided by the sponsor and spouse who signed an affidavit of support. (7-1-24) b. A legal non-citizen that satisfies the indigent exemption criteria is exempt from deeming for twelve (12) months. The exemption can be renewed for additional twelve-month periods. (7-1-24) c. If a legal non-citizen is granted an indigence exemption, the Department must provide written notification to the Statistics Branch of the INS on an annual basis. Required information includes written notice of the determination, the sponsored legal non-citizen’s name, and the sponsor’s name. (7-1-24) d. A legal non-citizen can elect to decline the indigent exemption to avoid sponsor liability and notification to the INS. (7-1-24) e. If the legal non-citizen declines the indigent exemption, the household is subject to sponsored deeming. (7-1-24) 755. – 756. (RESERVED) 757. SPONSORED LEGAL NON-CITIZEN'S RESPONSIBILITY. The legal non-citizen and their spouse are responsible for getting the sponsor to cooperate with the Department in determining Food Stamp eligibility. The legal non-citizen and their spouse are responsible for providing the information and proof to determine the income and resources of the sponsor and sponsor’s spouse. The legal non- citizen and their spouse are responsible for providing information and proof to determine if the sponsor sponsors other legal non-citizens and how many. (7-1-24) 758. – 760. (RESERVED) 761. COLLECTING CLAIMS AGAINST SPONSORS WHO SIGNED AN I-864 AFFIDAVIT OF SUPPORT ON OR AFTER DECEMBER 19, 1997. Claims may be collected against a sponsor who signed an I-864 affidavit of support on or after December 19, 1997, and is found to have provided false statements or withheld information. (7-1-24) 762. COLLECTING CLAIMS AGAINST SPONSORED LEGAL NON-CITIZENS. Claims may be collected against sponsored legal non-citizens with a sponsor who signed an I-864 affidavit of support on or after December 19, 1997. Action may be taken to collect by submitting an IHE or IPV. (7-1-24) 763. REIMBURSEMENT FOR BENEFITS RECEIVED. A sponsor who signed an affidavit on or after December 19, 1997, must reimburse the Department for the amount of Food Stamps received by the sponsored legal non-citizen if false information is provided or information is withheld. At the time of application for a sponsored legal non-citizen, the legal non-citizen’s sponsor must be notified that he will be required to reimburse the Department for the entire amount of Food Stamps received by the sponsored legal non-citizen. (7-1-24) 764. -- 790. (RESERVED) 791. RESIDENT OF AN INSTITUTION. A resident of an institution is not eligible for Food Stamps unless the resident meets one (1) of the requirements listed below. A person is a resident of an institution if the institution provides over fifty percent (50%) of the person’s meals

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as a part of normal services. Residents must be otherwise Food Stamp eligible. (7-1-24) 01. Resident Under Housing Act. The resident is in federally subsidized housing for the elderly, under Section 202 of the Housing Act or 236 of the National Housing Act. (7-1-24) 02. Person with Substance Use Disorder. The resident is a person with a substance use disorder living and taking part in a treatment and rehabilitation program. (7-1-24) 03. Blind or Disabled. The person is a disabled or blind resident of a group living arrangement. (7-1-24) 04. Battered Woman and Child(ren). The resident is a woman or a woman and her child(ren), temporarily living in a shelter for battered women and children. (7-1-24) a. The woman is a separate household from other shelter residents for Food Stamps. (7-1-24) b. The woman and her children are a separate household from other shelter residents for Food Stamps. (7-1-24) 05. Homeless Person. The resident is a person living in a public or private nonprofit shelter for homeless persons. (7-1-24) 792. PRERELEASE APPLICANTS FROM PUBLIC INSTITUTIONS. Residents of public institutions who apply for prerelease program SSI may apply for Food Stamps before their release from public institutions. The application date is the date the person is released from the institution. Eligibility is based on the best estimate of a household’s circumstances for the release month and the month after. Eligibility and Food Stamp amount are based on income and resources. Food Stamps for the initial month are prorated from the date the person is released from the institution to the end of the calendar month. (7-1-24) 793. SUBSTANCE USE DISORDER TREATMENT CENTERS. 01. Center Provides Certification List. Each month, each center must give the field office a list of current participant residents. The list’s accuracy must be certified in writing by the center manager or designee. The Department must conduct random on-site visits to assure list accuracy. If the list is not accurate, or the Department fails to act on the change, the Department may transfer the Food Stamp amount from the center’s account to the household’s Food Stamp account, for the months the household was not living in the center. (7-1-24) 02. Center Misusing Food Stamps. The Department must promptly notify FNS if it believes a center is misusing Food Stamps. The Department must not act before FNS takes action against the center. (7-1-24) 794. TREATMENT CENTER RESPONSIBILITIES. Each treatment center must follow Food Stamp application standards, except for: (7-1-24) 01. Return Food Stamps. (7-1-24) a. The center must return to the Department all issue documents and Food Stamps not given to a departing resident. (7-1-24) b. Food Stamps must be returned to the Department if the participant left before the sixteenth of the month and the center was unable to give them the Food Stamps. (7-1-24) c. Food Stamps must be returned to the Department if they were left over for a resident who left on or after the sixteenth of the month. (7-1-24) 02. Give Food Stamps to Departing Participant. (7-1-24) a. The center must give the departing participant the ID card and any unredeemed Food Stamps.

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(7-1-24) b. The center must give the participant a full month’s Food Stamps if they have been issued, but none have been spent on behalf of the participant. (7-1-24) c. The center must give the departing participant one-half (1/2) of the monthly Food Stamps if the participant leaves before the sixteenth of the month and a portion of the Food Stamps have been spent on behalf of the participant. (7-1-24) d. If the participant leaves the center on or after the sixteenth, and Food Stamps were issued and used, the center is not required to give Food Stamps to the participant. (7-1-24) 03. Food Stamp Misuse. The center must be disqualified if it is administratively or judicially found the center misappropriated or used Food Stamps for purchases not contributing to a certified participant’s meals. (7-1-24) 04. FNS Disqualifies Center. If FNS disqualifies a center as a retailer, the Department must close residents’ cases. Individual notice of adverse action is not required. (7-1-24) 795. RESIDENTS OF GROUP LIVING ARRANGEMENTS. Disabled or blind residents of public or private non-profit group living arrangements, serving no more than sixteen (16) residents, may get Food Stamps. Residents get Food Stamps under the same standards as other households. Group living arrangements rules are listed below: (7-1-24) 01. FNS-Authorized Retailer or Department Certified. The center must be an FNS-authorized retailer or be certified by the Department as a non-profit group living center. Center status must comply with Section 1616(e) of the Social Security Act or comparable standards of the Secretary of USDA. (7-1-24) 02. Application Option. Residents may apply on their own, as a group, or through an authorized representative employed and designated by the center. Residents may apply through an authorized representative of the resident’s choice. (7-1-24) 03. Residents Apply on Their Own Behalf. A person or a group of residents making up a household can apply on their own behalf. The center must determine the resident is physically and intellectually capable of handling their own affairs. If the resident is eligible, the center does not act as the authorized representative. The resident or group is responsible for reporting any changes affecting eligibility or benefit level. The resident is responsible for overissuances. (7-1-24) 04. Certification. Residents of a center applying through the center’s authorized representative must be certified as a one (1) person household. Residents of a center applying on their own behalf must be certified according to household size. (7-1-24) 05. Residents Are Exempt From Work Registration. (7-1-24) 06. Residents Are Entitled to Notices of Adverse Action. If a group living arrangement center loses its authorization or certification, notice is not required. (7-1-24) 07. Using Food Stamps. The Food Stamps may be used by the resident, a group of residents, or by the center to purchase food for the resident. The center may accept Food Stamps as payment for meals. If residents purchase or prepare food for home consumption, the center must ensure each resident’s Food Stamps are used for meals intended for that resident. (7-1-24) 796. SHELTERS FOR BATTERED WOMEN AND CHILDREN. The Department must determine if the shelter for battered women and children is a public or private non-profit residential facility. The Department must determine if the shelter serves only battered women and their children. If the facility serves other persons, the Department must determine if a portion of the facility is set aside to serve only battered women and children. Shelters having FNS authorization to redeem Food Stamps on a wholesale basis meet

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the shelter definition. Battered women and children shelter rules are listed below: (7-1-24) 01. Food Stamp Eligibility. Women and children who recently left a household containing a person who abused them may get Food Stamps, even if the household they left was getting Food Stamps. Shelter residents may apply for and get separate Food Stamps only once in a month. The original Food Stamp certification must have included the person who subjected them to abuse. The resident household must meet eligibility criteria for income, resources, and expenses. (7-1-24) 02. Income, Resources, and Expenses of the Household Are Counted. Income, resources, and expenses of their former household, containing the person who subjected them to abuse, are not counted. Jointly held resources are inaccessible if the resources are jointly owned by the shelter resident and members of the abusive household. Jointly held resources are inaccessible if the shelter residents’ access to the resource is dependent on the agreement of the joint owner still living in the former household. Room payments to the shelter are shelter expenses. (7-1-24) 03. Food Stamps for Former Household. The Department must take prompt action to correct the former household’s eligibility and allotment. The Department must issue a ten (10) day advance notice of adverse action. (7-1-24) 797. -- 815. (RESERVED) 816. PURCHASE OF PREPARED MEALS. Persons listed below may purchase prepared meals with their Food Stamps at sites authorized to accept Food Stamps. (7-1-24) 01. Older Persons Eating at Communal Dining Facility. Persons sixty (60) or older and their spouses, or persons who receive SSI and their spouses, can use Food Stamps to buy meals made for them at communal dining facilities authorized to accept Food Stamps. (7-1-24) 02. Persons Unable to Prepare Meals Getting Meal Delivery Service. A person sixty (60) years of age or over, and a spouse, can elect to use Food Stamps to purchase meals from a nonprofit meal delivery service. A housebound, physically handicapped, or otherwise disabled person, unable to adequately prepare all meals, and a spouse, can elect to use Food Stamps to purchase meals from a nonprofit meal delivery service. (7-1-24) 03. Resident Center. A resident of a residential treatment center for substance use disorders can use Food Stamps at the center. The person must be enrolled in a treatment and rehabilitation program operated by a nonprofit organization or institution. (7-1-24) 04. Battered Women and Children. A resident of a shelter for battered women and children can use Food Stamps to purchase meals prepared by the shelter. (7-1-24) 05. Homeless. A homeless Food Stamp participant can use Food Stamps to buy meals prepared by a homeless meal provider. (7-1-24) 817. -- 849. (RESERVED) 850. FOOD STAMP HOUSEHOLD RIGHTS. The Food Stamp household has rights protected by federal and state laws and Department rules. The Department must inform participants of their rights during the application process and eligibility reviews. Food Stamp rights are listed below: (7-1-24) 01. Application. The right to get an application on the date requested. (7-1-24) 02. Application Registered. The right to have the signed application accepted right away. (7-1-24) 03. Representative. The right to have an authorized representative if the applicant cannot get to the Food Stamp office. The authorized representative must have knowledge of the applicant’s situation. (7-1-24)

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04. Thirty Day Processing. The right to have the application processed and Food Stamps issued within thirty (30) days. (7-1-24) 05. Notification. The right to be told in writing of: (7-1-24) a. The reasons for the Department’s action if the application is rejected. (7-1-24) b. The reasons for the Department’s action if Food Stamps are reduced or stopped. (7-1-24) 06. Fair Hearing. The right to request a fair hearing about the Department’s decision. The right to request a fair hearing if the household feels discrimination has taken place in any way. Food Stamp fair hearings must be requested within ninety (90) days from the day notice is mailed. In certain situations, Food Stamps may continue if a fair hearing is requested. (7-1-24) 851. (RESERVED) 852. FOOD STAMP HOUSEHOLD RESPONSIBILITIES. The Food Stamp household must provide correct and complete information so the Department can make accurate eligibility and benefit decisions. The responsibilities of the Food Stamp household are listed below: (7-1-24) 01. Provide Information. The Food Stamp household must provide information to determine Food stamp eligibility. This includes, but is not limited to, all information about household income, work, and housing cost. (7-1-24) 02. Quality Control. The Food Stamp household must cooperate with Quality Control if the case is selected for review. (7-1-24) 853. DEPARTMENT INFORMING RESPONSIBILITIES. The Department must inform the Food Stamp household of what is expected of the household in the eligibility determination process and advise the household of the information listed below: (7-1-24) 01. Households Rights and Responsibilities. (7-1-24) 02. Eligibility Factors That Must be Met and Proven. (7-1-24) 03. Consequences for Failure to Provide Proof of Eligibility Factors. (7-1-24) 04. Alternate Methods to Prove Eligibility When Household is Unable to Provide Proof. (7-1-24) 05. Methods the Department Uses to Prove Eligibility When Household is Unable to Provide Proof. (7-1-24) 06. Social Security Numbers the Department Will Use to Get Wage, Income, and Employment Information. (7-1-24) 854. DEPARTMENT WILL DOCUMENT ELIGIBILITY DECISIONS. The Department will document eligibility, ineligibility, and Food Stamp issuance in the case record. The Department must record enough detail to support the Food Stamp determination. (7-1-24) 855. -- 860. (RESERVED) 861. NO DISCRIMINATION IN FOOD STAMP PROGRAM. The Department must not allow human rights discrimination in the Food Stamp Program. The Department will administer the Food Stamp program so no applicant or recipient in Idaho is discriminated for or against due to race, color, gender, or age. The Department will administer the Food Stamp program so no applicant or recipient in Idaho is discriminated for or against, due to political or religious belief or affiliation, national origin, handicap, or disability.

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(7-1-24) 862. PUBLIC NOTICE FOR NO DISCRIMINATION. The Department will inform the public via the application form that the Food Stamp Program is conducted without discrimination. The Department must display the USDA poster “And Justice for All” in all field offices. The application form must inform the public the Food Stamp Program is conducted without discrimination. (7-1-24) 863. (RESERVED) 864. DISCRIMINATION COMPLAINT PROCEDURE. Any person can file a discrimination complaint. The person may use the Department’s complaint procedure. The person may file a complaint directly to FNS, to the Department, or both. The field office must explain both procedures orally or in writing. (7-1-24) 865. DISCLOSURE OF INFORMATION. The Department will make available to any federal, state, or local law enforcement officer the address, SSN, and (if available) photograph of a Food Stamp recipient. The officer must furnish the recipient’s name and provide the Department the federally required evidence the person is fleeing to avoid prosecution, custody, or confinement for a felony, violating a condition of parole or probation, or has information necessary for the officer to conduct an official duty related to a felony or parole violation. (7-1-24) 866. AVAILABILITY OF PUBLIC INFORMATION. Rules, state plans of operation, procedures, handbooks, manuals, and instructions used to certify households must be available to the public. These materials must be available for public examination during regular office hours and workdays. See 7 CFR 272.1(d). (7-1-24) 867. FOOD STAMP INFORMATION REQUIREMENTS. Federal regulations and procedures in FNS notices and policy memos must be available for examination by the public. State plans of operation must be available for examination by the public. Examination may take place during office hours at Department headquarters. Handbooks must be available for examination upon request at each field office. The Department must provide information about Food Stamps through mass media, posters, fliers, pamphlets, and face-to-face contacts. Minimum requirements are listed below: (7-1-24) 01. Rights and Responsibilities. Households must be informed of Food Stamp program rights and responsibilities. (7-1-24) 02. Bilingual Information. All program information must be available in Spanish. (7-1-24) 868. -- 871. (RESERVED) 872. PROGRAM TRANSFER DURING CERTIFICATION PERIOD. Households changing from Food Stamps to Food Distribution Program on Indian Reservations (FDPIR) must end their participation the last day of the month they choose to change programs. (7-1-24) 873. -- 878. (RESERVED) 879. REVIEW OF CASE FILE. The participant or their representative can review their case file under IDAPA 16.05.01, “Use and Disclosure of Department Records.” (7-1-24) 880. -- 882. (RESERVED) 883. REFUSAL TO COOPERATE WITH QUALITY CONTROL REVIEWS. The Department is required to conduct monthly random quality control reviews of food stamp cases, denials of food stamp applications, and issuance amounts. If a household is selected and refuses to cooperate in a quality control review, it is not eligible for food stamp benefits. (7-1-24)

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01. Advance Notice to End Food Stamps. The Department must send the household advance notice to end Food Stamps. The notice must list the reason for the proposed action, the right to a hearing, the right to schedule a conference or to continue the review. (7-1-24) 02. Food Stamp Eligibility During Quality Control Review Period, After Refusal to Cooperate. The household is not eligible for Food Stamps during the Quality Control review period until it cooperates with the review. (7-1-24) 884. -- 999. (RESERVED)

Section 56-202, Idaho Code, authorizes the Department to adopt rules for the administration of public assistance programs. (7-1-24)

The following are incorporated by reference (7-1-24) 01. “Medicare Modernization Act - Prescription Drug Program Guidance to States for the Low Income Subsidy (LIS),” dated May 25, 2005. The guidelines may be viewed at the main office of the Department. It is also available online at https://www.cms.gov/Medicare/Eligibility-and-Enrollment/ LowIncSubMedicarePresCov/Downloads/StateLISGuidance021009.pdf. (7-1-24) 02. Social Security Administration Program Operations Manual System (POMS) SI 01320.00, Deeming Resources, effective date: 10/17/2022. This Deeming of Income section is available at: https:// secure.ssa.gov/apps10/poms.nsf/lnx/0501320000. (7-1-24) 03. Social Security Administration Program Operations Manual System (POMS) SI 01330.00, Deeming Resources, effective date: 02/24/2010. This Deeming of Resources section is available at: https:// secure.ssa.gov/apps10/poms.nsf/lnx/0501330000. (7-1-24) 04. Social Security Administration Program Operations Manual System (POMS) SI 02302.200 Charted Threshold Amounts for Calendar Year 2023, effective date: 01/24/2023. This Charted Threshold Amounts table is available at: https://secure.ssa.gov/apps10/poms.nsf/lnx/0502302200. (7-1-24)

01. AABD Cash. An EBT payment to a participant, a participant’s guardian, or a holder of a limited power of attorney for EBT payments. AABD Cash is a payment of a supplemental cash amount to an individual who meets the program requirements. This payment may be made through direct deposit or an electronic benefits card. (7-1-24) 02. Applicant. A person applying for public assistance from the Department, including individuals referred to the Department from a health insurance exchange or marketplace. (7-1-24) 03. Annuity. A right to receive periodic payments, either for life, a term of years, or other interval of time, whether or not the initial payment or investment has been annuitized. It includes contracts for single payments where the single payment represents an initial payment or investment together with increases or deductions for interest or fees rather than an actuarially based payment from an insurance pool. (7-1-24) 04. Asset. Includes all income and resources of the individual and the individual’s spouse, including any income or resources that the individual or their spouse is entitled to, but does not receive because of action by: (7-1-24) a. The individual or their spouse; (7-1-24) b. A person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or their spouse; or (7-1-24) c. A person, including any court or administrative body, acting at the direction or upon the request of the individual or their spouse. (7-1-24) 05. Asset Transfer for Sole Benefit. An asset transfer is considered to be for the sole benefit of a spouse, blind or disabled child, or disabled individual if the transfer is arranged in such a way that no individual or entity except the spouse, blind or disabled child, or disabled individual can benefit from the assets transferred in any way, whether at the time of transfer or at any time in the future. (7-1-24) 06. Child. Any individual from birth through the end of the month of their nineteenth birthday. (7-1- 24) 07. Citizen. A person having status as a “national of the United States” defined in 8 USC 1101(a)(22) that includes both citizens of the United States and non-citizen nationals of the United States. (7-1-24) 08. Department. The Department of Health and Welfare. (7-1-24) 09. Direct Deposit. The electronic deposit of a participant’s AABD cash to the participant’s personal account with a financial institution. (7-1-24) 10. Electronic Benefits Transfer (EBT). A method of issuing AABD cash to a participant, a participant’s guardian, or a holder of a limited power of attorney for EBT payments for a participant. (7-1-24) 11. Essential Person. A person of the participant’s choice whose presence in the household is essential to the participant’s well-being. The essential person provides the services a participant needs to live at home. (7-1-24) 12. Fair Market Value. The price for which an asset can be reasonably expected to sell on the open market, in the geographic area involved. (7-1-24) 13. Long-Term Care. Services provided to an institutionalized individual as defined in 42 USC 1396p(c)(1)(C). (7-1-24) 14. Medicaid. Idaho’s Medical Assistance Program administered by the Department. See Title XIX. (7-1-24) 15. Needy. A person is considered needy for AABD cash payments if the person meets the non- financial requirements of Title XVI of the Social Security Act and the criteria in Section 514 of these rules. Title XVI of the Social Security Act, known as “Grants to States for Aid to the Aged, Blind, or Disabled,” is a program for financial assistance to needy individuals who are sixty-five (65) years of age or over, are blind, or are eighteen (18) years of age or over and permanently and totally disabled. (7-1-24) 16. Non-Citizen. Same as “alien” defined in Section 101(a)(3) of the Immigration and Nationality Act (INA) (8 USC 1101 (a)(3)), and includes any individual who is not a citizen or national of the United States. (7-1-24) 17. Participant. An individual who is eligible for, and enrolled in, a Health Care Assistance Program or Medicaid. (7-1-24) 18. Partnership Policy. A qualified long-term care insurance policy under Section 7702B(b) of the Internal Revenue Code of 1986, which meets the requirements of the long-term care insurance model regulation and Long-term Care Insurance Model Act promulgated by the National Association of Insurance Commissioners (NAIC), as incorporated in 42 USC 1396p(b)(5)(A). (7-1-24) 19. Premium. A regular, periodic charge or payment for health coverage. (7-1-24) 20. Reasonable Opportunity Period. A period allowed for an individual to provide requested proof of citizenship or identity. A reasonable opportunity period extends for ninety (90) days beginning on the 5th day after the notice requesting the proof has been mailed to the applicant. This period may be extended if the Department determines that the individual is making a good faith effort to obtain necessary documentation. (7-1-24) 21. Pension Funds. Retirement funds held in individual retirement accounts (IRAs), as described by the Internal Revenue Code, or in work-related pension plans, including plans for self-employed individuals sometimes referred to as Keogh plans. (7-1-24) 22. Sole Beneficiary. The only beneficiary of a trust, including a beneficiary during the grantor’s life, a beneficiary with a future interest, and a beneficiary by the grantor’s will. (7-1-24) 23. Title XIX. Of the Social Security Act, known as Medicaid, is a medical benefits program jointly financed by the federal and state governments and administered by the states that provides medical care for eligible individuals. Please see https://www.ssa.gov/OP_Home/ssact/title19/1900.htm. (7-1-24) 24. Title XXI. Of the Social Security Act, known as the Children's Health Insurance Program (CHIP), is a federal and state partnership that provides health insurance to targeted, low-income children. Please see https:// www.ssa.gov/OP_Home/ssact/title21/2100.htm. (7-1-24) 25. Treasury Rate. The five (5) year security note rate listed in the “Daily Treasury Yield Curve Rate” by the US Treasury on January 1 of each year, and is used for the entire calendar year. (7-1-24) 26. Working Day. A calendar day when regular office hours are observed by the state of Idaho. Weekends and state holidays are not considered working days. (7-1-24)

01. AABD. Aid to the Aged, Blind, and Disabled. (7-1-24) 02. COLA. Cost of Living Adjustment. (7-1-24) 03. CSA. Community Spouse Allowance. (7-1-24) 04. CSNS. Community Spouse Need Standard. (7-1-24) 05. CSRA. Community Spouse Resource Allowance. (7-1-24) 06. EBT. Electronic Benefits Transfer. (7-1-24) 07. EITC. Earned Income Tax Credit. (7-1-24) 08. FSI. Federal Spousal Impoverishment. (7-1-24) 09. HCBS. Home and Community Based Services. (7-1-24) 10. ICF/IID. Intermediate Care Facility for Individuals with Intellectual Disabilities. (7-1-24) 11. INA. Immigration and Nationality Act. (7-1-24) 12. PASS. Plan for Achieving Self-Support. (7-1-24) 13. RSDI. Retirement, Survivors, and Disability Insurance. (7-1-24) 14. SSA. Social Security Administration. (7-1-24) 15. SSI. Supplemental Security Income. (7-1-24) 16. SSN. Social Security Number. (7-1-24) 17. TAFI. Temporary Assistance for Families in Idaho. (7-1-24) 18. VA. Veterans Administration. (7-1-24)

An individual applying for benefits, receiving benefits, or providing additional information as required by these rules, may do so with the depiction of the individual's name either handwritten, electronic, or recorded telephonically. Such signature serves as intention to execute or adopt the sound, symbol, or process for the purpose of signing the related record. (7-1-24)

01. Application Submitted by Participant. The participant must submit an application form to the Department. An adult participant, a legal guardian, or a representative must sign the application form. (7-1-24) 02. Application Submitted Through SSA Low-Income Subsidy Data Transmission. For low- income subsidy applicants identified on the SSA data transmission, the protected Medicare Savings Program application date is the day they applied for the low-income subsidy. (7-1-24)

The effective date for aid is the first day of the month of application. Medicaid eligibility begins as described in this rule. (7-1-24) 01. AABD Cash. AABD cash aid is effective on the application date. (7-1-24) 02. Normal Medicaid Eligibility. Medicaid coverage begins on the first day of the application month. (7-1-24) 03. Retroactive (Backdated) Medicaid Eligibility. Medicaid benefits must be backdated to the first day of the calendar month, for each of the three (3) months before the month of application, if the participant was Medicaid-eligible during that month. If the participant is not eligible for Medicaid when they apply, retroactive eligibility is evaluated. (7-1-24) 04. Ineligible Non-Citizen Medicaid. Ineligible legal or illegal non-citizen coverage is restricted to emergency services. Coverage begins when the emergency treatment is required. Coverage ends with the last day emergency treatment is required. (7-1-24)

The application must be processed within forty-five (45) days for an applicant sixty-five (65) years of age or older. The application must be processed within ninety (90) days for a disabled applicant. The time limit can be extended by events beyond the Department’s control. (7-1-24)

An application may be filed for a deceased person. The application must be filed within the backdated eligibility period. Medicaid can be approved, through the date of death, if an AABD applicant dies before eligibility is determined. (7-1-24)

Applicants must prove their eligibility for aid. The participant is allowed ten (10) calendar days to provide requested proof. The application is denied if the applicant does not provide proof in ten (10) calendar days of the written request and does not have good cause for not providing proof. The Department may also use electronic verification sources when they are available. (7-1-24)

A participant receiving AABD cash from another state must not receive AABD cash in Idaho until they are living in Idaho and the cash benefit has ended in the other state. A participant may receive Medicaid in Idaho before AABD cash or Medicaid stops in another state. AABD cash from another state is unearned income for Medicaid. Out-of-state medical coverage is a Medicaid third-party resource. Idaho residents temporarily out of the state, and not receiving aid, may apply for aid in Idaho. (7-1-24)

If a person is potentially eligible for AABD cash, TAFI, or foster care, only one (1) program may be chosen. (7-1-24)

The participant must be living in Idaho and have no immediate intention of leaving. For Medicaid, other persons are Idaho residents if they meet any of the following criteria. (7-1-24) 01. Foster Child. A participant living in Idaho and receiving child foster care payments from another state. (7-1-24) 02. Incapable Participant. A participant who is incapable of indicating their state of residency after age twenty-one (21) is considered a resident of Idaho when: (7-1-24) a. Their parent or guardian lives in Idaho; or (7-1-24) b. They reside in an Idaho institution. (7-1-24) 03. Placed in Another State by Idaho. A participant placed by the state of Idaho in an institution in another state. (7-1-24) 04. Homeless. A participant not maintaining a permanent home or having a fixed address who intends to remain in Idaho. (7-1-24) 05. Migrant. A migrant working and living in Idaho. (7-1-24)

A participant may be temporarily absent from their home and still receive AABD cash and Medicaid. A participant is temporarily absent if they intend to return home within one (1) month. Temporary absence may exceed one (1) month for a child attending school or vocational training or a participant in a medical institution, hospital, or nursing home. (7-1-24)

Any individual who participates in AABD cash, Health Care Assistance, or Medicaid benefits must provide proof of US citizenship unless they have otherwise met the requirements under 42 CFR 435.406, Citizenship and Non-Citizen Eligibility. (7-1-24)

01. SSN Required. The applicant must provide their SSN, or proof they have applied for an SSN, to the Department before approval of eligibility. If the applicant has more than one (1) SSN, all numbers must be provided. (7-1-24) a. The SSN must be verified by the SSA electronically. An applicant with an unverified SSN is not eligible for AABD cash, Health Care Assistance, or Medicaid benefits. (7-1-24) b. The Department must notify the applicant in writing if eligibility is denied or lost for failure to meet the SSN requirement. (7-1-24) 02. Application for SSN. To be eligible, the applicant must apply for an SSN, or a duplicate SSN when they cannot provide their SSN to the Department. If the SSN has been applied for but not issued by the SSA, the Department cannot deny, delay, or stop benefits. The Department will help an applicant with required documentation when the applicant applies for an SSN. (7-1-24) 03. Failure to Apply for SSN. The applicant may be granted a good cause exception for failure to apply for an SSN if they have a well-established religious objection to applying for an SSN. A well-established religious objection means the applicant: (7-1-24) a. Is a member of a recognized religious sect or division of the sect; and (7-1-24) b. Adheres to the tenets or teachings of the sect or division of the sect and for that reason is conscientiously opposed to applying for or using a national identification number. (7-1-24) 04. SSN Requirement Waived. An applicant may have the SSN requirement waived when they are: (7-1-24) a. Only eligible for emergency medical services under 42 CFR 440.255, Emergency and Poststabilization Services; or (7-1-24) b. A newborn child deemed eligible under 42 CFR 435.117, Deemed Newborn Children. (7-1-24)

An individual who meets eligibility criteria for a category of assistance but does not meet US citizenship requirements or eligible non-citizen requirements may receive medical assistance under a Title XIX or Title XXI coverage group as follows: (7-1-24) 01. Emergency Medical Conditions. An individual not meeting the US citizenship requirement may receive medical services necessary to treat an emergency medical condition, including labor and delivery. Emergency medical conditions have acute symptoms of severity, including severe pain. (7-1-24) 02. Determination of Emergency Medical Conditions. The Department determines if a condition meets criteria of an emergency medical condition. (7-1-24) 03. Limitation on Medical Assistance. Medical assistance is limited to the period established for the emergency medical condition. (7-1-24) 04. Documentation Waived. For undocumented individuals with emergency medical conditions, the SSN requirement is waived because an SSN cannot be issued. Individuals must be otherwise eligible for Title XIX or XXI. (7-1-24)

An institution provides treatment, services, food, and shelter to four (4) or more people, not related to the owner. A participant living in an ineligible institution an entire calendar month is not eligible for AABD cash, unless they qualify for the institution payment exception. (7-1-24) 01. Eligible Institutions for AABD and Medicaid. Are listed below. (7-1-24) a. Medical institution. A public or private medical institution, including a hospital, nursing care facility, or an ICF/IID is an eligible institution. A participant is not eligible for AABD cash if they are a resident of a medical institution the full month. (7-1-24) b. Child care institution. A non-profit private child care institution is an eligible institution. A public child care institution with no more than twenty-five (25) beds is an eligible institution. A child care institution must be licensed or approved by the Department. A detention facility for delinquent children is not a child care institution. A child care institution for mental diseases is an eligible institution if it has sixteen (16) beds or less. A participant is not eligible for AABD cash if they are a resident of a child care institution for the full month. (7-1-24) c. Community residence. A community residence is a facility providing food, shelter, and services to residents. A privately operated community residence is an eligible institution. A publicly operated community residence serving no more than sixteen (16) residents is an eligible institution. The Community Restorium in Bonners Ferry, Idaho, is an eligible institution even though more than sixteen (16) residents are served. (7-1-24) 02. Ineligible Institutions for AABD and Medicaid. Are listed below. (7-1-24) a. Public institutions, unless listed in Subsection 108.01 of these rules. (7-1-24) b. Institution for mental diseases, a facility maintained primarily for the care and treatment of persons with mental diseases. (7-1-24) c. Institution for tuberculosis, a facility maintained primarily for the care and treatment of persons with tuberculosis. (7-1-24) d. Correctional institution, a facility for prisoners, persons detained pending disposition of charges, or held under court order as material witnesses or juveniles. (7-1-24) 03. Medicaid Exception for Inmates. An inmate can receive Medicaid while they are an inpatient in a medical facility. The inmate must meet all Medicaid eligibility requirements. (7-1-24)

A participant may get AABD cash in an ineligible institution or a medical institution if they meet one (1) of the conditions listed below. (7-1-24) 01. First Month in Institution. An AABD participant can get AABD cash for the month they entered the institution. Eligibility for the entry month applies to these residents: (7-1-24) a. Resident of a public institution. The person is a resident if they, or anyone, pays for their food, shelter, and other services in the institution. (7-1-24) b. Patient in a medical institution. A person receiving room, board, and professional services in a medical institution, including an institution for tuberculosis or mental diseases. (7-1-24) 02. Temporary Institution Stay. An AABD participant can get up to three (3) months’ AABD payment during a temporary stay in an institution. A participant entering a public medical or psychiatric institution, a hospital, a nursing facility, or an ICF/IID may continue to get AABD payments. The Department must receive the temporary stay data no later than the ninetieth full day of confinement, or the release date, whichever is first. The payments may continue up to three (3) months if these conditions are met: (7-1-24) a. The Department is informed of the institutional stay. (7-1-24) b. A physician certifies the participant’s stay is not likely to exceed three (3) full months. (7-1-24) c. A signed statement from the participant or a responsible party showing the participant’s need to continue to maintain and pay for the place they intend to return to live. (7-1-24)

Special conditions for AABD when a participant is in an institution are listed below: (7-1-24) 01. Living Arrangement. AABD cash is paid based on the participant’s living arrangement the month before the first month in the institution. Changes in living arrangement costs are used to determine AABD cash eligibility and benefit amount. (7-1-24) 02. Participant Becomes Ineligible. If the participant becomes ineligible for AABD during their temporary institutional stay, their AABD payment must be ended after proper notice. (7-1-24) 03. AABD Status. A participant must get AABD for the month they enter the institution to receive continued AABD payments. (7-1-24) 04. Counting Three Full Months. A full month is a month the participant is in the institution every day of the month. If the participant enters after the first day of a month, the month of entry is not included in the three (3) full months. If the participant is discharged before the last day of the month, the month of discharge is not included in the three (3) full months. (7-1-24) 05. SSI Benefits. If SSA decides a participant’s SSI benefit will continue while the participant is in the institution, AABD payments can also continue. (7-1-24)

An administrator for public aid for a deceased participant’s AABD cash can be court-appointed. The administrator must spend AABD cash, accessible through EBT before the participant’s death, for the estate. The AABD cash can only be spent to meet the needs of the participant, or their dependents, for the month it was paid. If a participant had no debts for themself, or their dependents, the administrator must return the AABD cash to the Department. AABD benefits paid by direct deposit or posted to the participant’s EBT account, after the participant’s death, are the property of the State of Idaho. (7-1-24)

AABD cash received by a participant before their death is disbursed as part of the participant’s estate if it is probated. The probate administrator spends the AABD cash under their oath of administration. (7-1-24)

To qualify for AABD for the aged, a person must be age sixty-five (65) or older. (7-1-24)

To qualify for AABD for the blind or disabled, a person must meet the definition of blindness or disability used by the SSA for RSDI and SSI benefits. (7-1-24) 01. SSA Decision for Disabled. SSA’s disability decision is binding on the Department unless: (7-1-24) a. The participant states their disabling condition is different from, or in addition to, their condition considered by SSA, and the participant has not reapplied for SSI; or (7-1-24) b. More than twelve (12) months have passed since the SSA made a final determination the participant was not disabled, and the participant states their condition has changed or become worse since that final determination, and the participant has not reapplied for SSI. (7-1-24) 02. Medicaid Pending SSA Appeal. When SSA decides a participant is no longer disabled, they meet the AABD disability requirement and can continue receiving Medicaid if they appeal SSA’s decision. Medicaid ends if the SSA decision is upheld. (7-1-24) 03. Grandfathered Participant for Aid to the Permanently and Totally Disabled or Aid to the Blind. A participant is disabled if they were eligible as disabled in December 1973, and continues to meet the disability requirement in effect in December 1, 1973. They must also meet the other current eligibility requirements. (7-1-24)

A participant is ineligible to receive AABD for any month during which they are fleeing to avoid prosecution for a felony, fleeing to avoid custody or confinement after a felony conviction, or violating a federal or state condition of probation or parole. (7-1-24)

A participant is ineligible for AABD for ten (10) years if they were convicted in a federal or state court of having fraudulently misrepresented residence to get AABD, SSI, TAFI, Food Stamps, or Medicaid from two (2) or more states at the same time. (7-1-24)

Resources are cash, personal property, real property, and notes receivable. A participant, or spouse, must have the right, authority, or power to convert the resource to cash. The participant must have the legal right to use the resource for support and maintenance. Liquid resources are resources in cash or resources convertible to cash within twenty (20) workdays. Nonliquid resources are any resources, not in the form of cash, which cannot be converted to cash within twenty (20) workdays. (7-1-24)

The value of countable resources must be two thousand dollars ($2,000) or less, for a single person to be AABD eligible. A married person must have countable resources of three thousand dollars ($3,000) or less to be eligible for AABD cash. Resources are counted the first moment of each calendar month and apply to the entire month. (7-1-24)

A change in the value of resources is counted the first moment of the next month. (7-1-24)

A change in marital status changes the resource limit. The resource limit change is effective the month after individual participants are married, divorced, separated, or one (1) spouse dies. (7-1-24)

Property of any kind is a resource if the participant has an ownership interest in the property and the legal right to spend or convert the property to cash. (7-1-24)

An asset cannot be counted as income and resources in the same month. Assets received in cash or in-kind during a month are income. Income held past the month received is a resource. (7-1-24)

Except for checking and savings accounts and time deposits, each owner of shared property owns only their fractional interest in the property. The total value of the property is divided among the owners, in direct proportion to each owner’s share. (7-1-24)

Payment from the sale, exchange, or replacement of a resource is not income. The payment is a resource. (7-1-24)

A resource excluded by federal law is not counted in determining the resource amount available to the participant. (7-1-24)

Resource deeming is determined by the SSA Program Operations Manual System (POMS) SI 01330.00, Deeming Resources, incorporated by reference under Section 002 of these rules. The participant’s circumstances are assessed the first moment of the month. Deeming starts the first full calendar month the participant is in a deeming situation. Deeming ends the first full calendar month the participant is not in a deeming situation. Deeming to a child ends the month after the child’s eighteenth birthday. (7-1-24)

A participant living in an institution is not a household for resource computations. (7-1-24)

An asset is not a resource if the participant is unaware of their ownership. The asset is a resource the month after discovery. (7-1-24)

If more than one (1) vehicle is owned, the exclusion applies in the best way for the participant. (7-1-24) 01. One Vehicle Excluded. One (1) vehicle is excluded, regardless of value. (7-1-24) 02. Other Vehicles Not Excluded. The equity value of a vehicle not excluded under Subsection 222.01 of this rule is a resource. (7-1-24)

Burial funds up to one thousand five hundred dollars ($1,500) per person, set aside for the burial expenses of the participant or spouse, are excluded from resources. To be excluded, burial funds must be kept separate from assets not burial-related. A burial contract that can be revoked or sold, without significant hardship, is a resource. Any portion of the contract for the purchase of burial spaces is excluded from resources. A burial contract that cannot be revoked, and cannot be sold without significant hardship, is not a resource. The burial fund portion of the contract counts against the one thousand five hundred dollar ($1,500) burial funds exclusion. The burial space portion of the contract does not count against the burial funds exclusion. Interest earned on excluded burial funds is also excluded. (7-1-24) 01. Life Insurance Policy as Burial Funds. The participant can designate a countable life insurance policy as a burial fund. The face value of excluded life insurance policies on the participant counts against the burial funds exclusion. (7-1-24) 02. Face Value of Burial Insurance Policies Not Counted. The face value of burial insurance policies does not count toward the one thousand five hundred dollar ($1,500) life insurance limit, when computing the total face value of life insurance policies owned by a participant. Interest on excluded burial funds does not count toward the one thousand five hundred dollar ($1,500) burial funds exclusion. (7-1-24) 03. Effective Date of Burial Funds Exclusion. The exclusion is effective the month after the month the funds were set aside. Burial funds can be designated retroactively, back to the first day of the month the participant intended the funds to be set aside. The participant must confirm the designation in writing. (7-1-24) 04. Penalty for Misusing Burial Funds. If the participant does not get SSI, burial funds used for another purpose lose the exclusion. An overpayment must be recovered. If the participant gets SSI, and is penalized by SSA because they used excluded burial funds for another purpose, their AABD payment must not be increased to compensate the SSA penalty. (7-1-24)

A burial space is a burial plot, grave site, crypt, mausoleum, casket, urn, niche, or other repository normally used for the deceased’s remains. A burial space, or burial space purchase agreement, held for the burial of the participant, spouse, or other member of their immediate family, is an excluded resource. (7-1-24) 01. Burial Space Contract. Must list all burial spaces and include a value for each space or the total value of all the spaces. The contract must not require further payment after the contract is signed. (7-1-24) 02. Space Held by Ineligibles Excluded. A space held by an ineligible spouse or parent, for the burial of a participant, spouse, and any member of the participant’s immediate family, is excluded. A space held by a legal non-citizen sponsor, or essential person, for their own burial is excluded only if the sponsor is a member of the participant’s immediate family. (7-1-24)

Household goods and personal effects are excluded from resources, regardless of their dollar value. (7-1-24)

Real property is land, including buildings or immovable objects attached permanently to the land. Real property is a resource unless excluded. (7-1-24)

An individual’s home is property they own, and serves as their principal place of residence. Their principal place of residence is the place they consider their principal home. If the individual is absent from their home, it is still their principal place of residence if they intend to return. (7-1-24) 01. AABD Cash, and Medicaid With the Exception of Long-Term Care. For AABD Cash and Medicaid except for long-term care, the value of an individual’s home is an excluded resource. (7-1-24) 02. Long-Term Care Services. For long-term care services, when the value of a participant’s equity in the home is seven hundred fifty thousand dollars ($750,000) or less, the home is excluded as a resource. When the equity value exceeds seven hundred fifty thousand dollars ($750,000), the individual is ineligible for long-term care services. The equity value, regardless of the amount, is an excluded resource when one (1) of the following applies: (7-1-24) a. The spouse of the individual lives in the home; or (7-1-24) b. The individual’s child, who is under age twenty-one (21), or is blind, or meets the disability requirements for AABD cash, lives in the home. (7-1-24)

If the participant plans to buy another excluded home, proceeds from the sale of a participant’s excluded home are excluded resources. Proceeds from the sale of an excluded home must be used to replace the home within three (3) calendar months. Proceeds retained beyond three (3) calendar months are a countable resource. (7-1-24)

Cash and in-kind payments for replacement or repair of lost, damaged, or stolen excluded resources, are excluded resources for nine (9) months from the date received. This exclusion can be extended for cash payments, up to an additional nine (9) months. The extension can be made if, for the first nine (9) months, circumstances beyond the participant’s control prevent repair or replacement of the lost, damaged, or stolen property and keep the participant from contracting for repair or replacement. This exclusion can be extended for twelve (12) more months for a catastrophe the President declares a major disaster. Interest earned by funds excluded under this provision is excluded from resources. (7-1-24)

A participant’s ownership interest, in jointly owned real property, is an excluded resource as long as sale of the property will cause undue hardship to a co-owner. Undue hardship results if a coowner uses the property as their principal place of residence, would have to move if the property were sold, and has no other readily available housing. (7-1-24)

For the purposes of determining eligibility for an individual who is an American Indian, the following property is excluded: (7-1-24) 01. Property. Real property and improvements located on a reservation, including any federally recognized Indian Tribe's reservation, pueblo, or colony, and Indian allotments on or near a reservation as designated and approved by the Bureau of Indian Affairs. (7-1-24) 02. Natural Resources. Ownership interest in rents, leases, royalties, or usage rights related to natural resources resulting from the exercise of federally protected rights. (7-1-24) 03. Other Ownership Interests or Usage Rights. Ownership interests in or usage rights to property not covered by Subsections 242.01 or 242.02 of this rule that have a unique religious, spiritual, traditional, or cultural significance or rights that support subsistence or traditional lifestyle under applicable tribal law or custom. (7-1-24)

Resources associated with real property are mineral rights, timber rights, easements, leaseholds, water rights, remainder interests, and sale of natural resources. These resources are counted as real property. (7-1-24)

Resources are excluded as essential to self-support, if they fall into one (1) of the categories described below. (7-1-24) 01. Essential Property in Current Use. Property in current use in the type of activity that qualifies it as essential to self-support is excluded, regardless of value or rate of return. Trade or business property, government permits, and personal property used by an employee for work are excluded regardless of value or rate of return. If the property is not in current use, for reasons beyond the participant’s control, there must be a reasonable expectation the required use will resume. If the participant does not intend to resume the self-support activity, the property is a countable resource for the month after the month of last use. (7-1-24) 02. Nonbusiness Property Producing Goods or Services. Up to six thousand dollars ($6,000) of the equity value of nonbusiness property, used to produce goods or services essential to daily activities, is excluded regardless of rate of return. Equity value over six thousand dollars ($6,000) is not excluded. This exclusion is not used for income-producing property. (7-1-24) 03. Nonbusiness Income-Producing Property. Up to six thousand dollars ($6,000) equity in nonbusiness income-producing property is excluded if the property produces a net annual return equal to at least six percent (6%) of the excluded equity. If a participant owns more than one (1) piece of income-producing property, the six percent (6%) return requirement applies to each. The six thousand dollars ($6,000) equity value limit applies to the total equity value of all the properties meeting the six percent (6%) return requirement. If the earnings decline is for reasons beyond the participant’s control, up to twenty-four (24) months can be allowed for the property to resume producing a six percent (6%) return. If the property still is not producing a six percent (6%) return at the end of the twenty-four (24) month extension, the resource exclusion must end the month after the month the twenty-four (24) month period ends. (7-1-24)

PASS allows blind and disabled participants to set aside income and resources necessary for the achievement of its goals. Resources set aside as part of an approved PASS are excluded. The PASS disregard must not be applied to resources unless the participant would be ineligible due to excess resources. To disregard resources, the PASS must show how resources the participant has or will receive under the plan, will be used to obtain the PASS goal. The PASS must show how the disregarded resources will be identified separately from the participant’s other resources, list items or activities requiring savings or purchases and the amounts the participant anticipates saving or spending, and show a specific target date to achieve the objective. (7-1-24)

The purchase of a life estate interest in another individual’s home is a resource unless the purchaser resides in the home for a period of at least twelve (12) consecutive months after the date of purchase. (7-1-24)

Retroactive SSI and RSDI benefits are issued after the calendar month for which they are paid. Retroactive SSI and RSDI benefits are excluded from resources for nine (9) calendar months after the month they are received. Interest earned by excluded funds is counted as income. (7-1-24)

Assistance received because of a major disaster declared by the President is excluded from resources. Interest earned on excluded funds is excluded from income and resources. (7-1-24)

Cash paid by a recognized medical or social services program, for the participant to purchase medical or social services, is not a resource for one (1) calendar month after receipt. The cash must not be repayment for a bill already paid. (7-1-24)

Payments to Alaska Natives and their descendants from the Alaska Native Claims Settlement Act, under PL 100-241, are excluded from resources. (7-1-24)

Stock held by Alaska natives in regional or village corporations is inalienable for a twenty (20) year period under Sections 7(h) and 8(c) of the Alaska Native Claims Settlement Act. (7-1-24)

Payments, from a fund set up by a State to aid victims of crime, are excluded from resources for nine (9) months. Interest earned on unspent victims’ compensation payments is counted for income and resources. (7-1-24)

A federal tax refund or payment made by an employer, related to Earned Income Tax Credits (EITC), is excluded from resources for the month after the month the refund or payment is received. Interest earned on unspent tax refunds related to EITC is counted for income and resources. (7-1-24)

Excluded funds must be separately identifiable to remain excluded. (7-1-24)

A dedicated account for past-due SSI benefits, set up in a financial institution for an SSI participant under age eighteen (18) is an excluded resource. The account must be set up by the child’s SSI representative payee, and excluded by SSA. (7-1-24)

Support and Maintenance Assistance (SMA) is in-kind support and maintenance, or cash paid for food or shelter needs. It includes Home Maintenance Assistance aid to cover costs of heating or cooling a home. SMA is an excluded resource. (7-1-24)

Class action settlement payments in Susan Walker v. Bayer Corporation, et al., are excluded from resources for Medicaid by PL 105-33. These payments are not excluded for AABD cash. (7-1-24)

The principal balance of a real estate contract is excluded from resources of a participant in long-term care when the Department determines it is in the Department’s best interest to exclude the contract. The determination by the Department of its best interest is final. (7-1-24)

An entrance fee to a CCRC or a life care community is a resource if the participant or applicant for long-term care has discretion to spend the fee or if the fee may be used to pay for care in a contingency. A CCRC or life care community is a type of long-term care facility that offers varying levels of care and in which a resident contracts with the facility to obtain care that is intended to endure for the remainder of the resident’s life in exchange for valuable consideration. (7-1-24)

A trust is a resource to a participant with the legal right to revoke the trust, and use the principal for their own support and maintenance. See Sections 838 through 873 in these rules for treatment of trusts for Medicaid. (7-1-24)

Retirement funds are work-related plans for providing income or pensions when employment ends. A retirement fund, owned by a participant, is a resource if they have the option of withdrawing a lump sum, even though they are not yet eligible for periodic retirement payments. If the participant is eligible for periodic retirement payments, the fund is not a countable resource. The value of a retirement fund is the amount of money a participant can currently withdraw from the fund. (7-1-24)

An inheritance is cash, a right, including probate allowances, trust payments and annuities, or noncash items received as the result of someone’s death. Cash or noncash items in an inheritance are income the month received and a resource the next month. Participants are required to make claims and take all reasonable action necessary to obtain any inheritance to which they may be entitled. Failure to make such claims or take reasonable steps to obtain an inheritance is an asset transfer. A contested inheritance is not counted as a resource until the contest is settled and money is distributed. (7-1-24)

A life insurance policy is an excluded resource if its face value, plus the face value of all other life insurance policies the participant owns on the same insured person, totals one thousand five hundred dollars ($1,500) or less. If the face values exceed one thousand five hundred dollars ($1,500) the policies are a resource in the amount of the cash surrender value. (7-1-24)

Funds required to be made available for the care and maintenance of a participant, under a court order, are the participant’s resource. This is true even if the participant or their agent is required to petition the court to withdraw funds for the participant’s care. (7-1-24)

A participant ineligible due solely to excess nonliquid resources, can receive AABD cash and related Medicaid. The participant must meet two (2) conditions. First, their countable liquid resources must not exceed three (3) times the participant’s AABD cash budgeted needs. Second, the participant agrees, in writing, to sell excess nonliquid resources at their fair market value, within three (3) months. The value of excess real property is not counted as a resource, if the participant makes reasonable efforts to sell the property at its fair market value, and their reasonable efforts to sell are not successful. This exclusion is also used to compute deemed resources. (7-1-24) 01. Conditional Benefits Payments Disposal/Exclusion Period. The disposal and exclusion period for excess nonliquid resources begins on the date the participant signs the Agreement to Sell Property. The disposal and exclusion periods can begin earlier for a participant who met all requirements to receive conditional benefits before their first opportunity to sign the Agreement to Sell Property. The participant must sign the Agreement to Sell Property before their application is approved. (7-1-24) 02. Period for Disposal of Excess Resources. The disposal period for excess nonliquid personal property is three (3) months. One (1) three (3) month extension, for sale of personal property, is allowed when good cause exists. (7-1-24) 03. Good Cause for Not Making Efforts to Sell Excess Property. The participant has good cause for not making efforts to sell property, when circumstances beyond their control prevent their taking the required actions. Without good cause, the participant's countable resources include the value of the excess property, retroactive to the beginning of the conditional benefits period. (7-1-24)

AABD cash participants are subject to a period of ineligibility if they transfer resources for less than fair market value. The participant is not subject to a period of ineligibility if their total countable resources in the transfer month were under two thousand dollars ($2,000), even if they have kept the transferred resources. Excluded resources, except for the excluded home and associated property, are not subject to the resource transfer period of ineligibility. The exceptions to the period of ineligibility for transfer of resources are listed in Section 292 of these rules. (7-1-24) 01. Transfer of Resources. Includes reducing or eliminating the participant's ownership or control of the resource. Transfer of resources includes giving away cash resources without receiving fair market value. (7-1-24) 02. Transfer of Participant’s Resources by a Spouse of Either Spouse’s Resources. Subjects the participant to the resource transfer period of ineligibility. (7-1-24) 03. Transfer of Participant’s Resources by a Co-Owner. Subjects the participant to a period of ineligibility based on their share of the co-owed resources. (7-1-24) 04. Transfer of Participant’s Resources by a Legal Representative Such as a Legal Guardian or Parent of Minor Child. Subjects the participant to a period of ineligibility. (7-1-24)

The resource transfer period of ineligibility is a period of AABD ineligibility for up to sixty (60) months. The period of ineligibility begins the first day of the month after the transfer month. The participant must be notified in writing at least ten (10) days before a resource transfer period of ineligibility is imposed. (7-1-24)

The resource transfer penalty applies to any transfer for less than fair market value made during a period preceding a request for cash assistance. Any resource transferred, regardless of type, is subject to a look-back period of sixty (60) months. The look-back period is counted from the date of the application for cash, or the date of the transfer, whichever is later in time. (7-1-24)

The period of ineligibility is the number of months computed by dividing the difference between the fair market value of the resource and the amount the participant received for the resource by the full AABD allowances for the participant's living arrangement. For an applicant, the Department will use the full AABD allowance for the application month. For a participant, the Department will use the full AABD allowances for the transfer month. For an AABD couple, the period of ineligibility is computed by dividing the difference between the fair market value of the resource and the amount the participant received for the resource by the full AABD allowances for the couple's living arrangement. The number of months of ineligibility is computed to two (2) decimal places and rounded down to the nearest whole number. If the amount transferred is less than the participant's AABD allowances for one (1) month, the participant is not subject to a period of ineligibility. (7-1-24)

The period of ineligibility begins with the month after the month the transfer took place. The period of ineligibility continues whether or not the participant receives AABD. Ineligibility continues until all the resources are returned to the participant or spouse, adequate consideration for all the resources is received, sixty (60) months passes, or the penalty period ends. (7-1-24)

If the spouse applies after the period of ineligibility is computed, the Department will compute the spouse's period of ineligibility by multiplying the number of months in the period of ineligibility already expired by the full AABD allowances for the couple's living arrangement. The Department will subtract the total from the original difference between the fair market value of the resource and the amount the participant received for the resource. The Department will divide the remaining difference between the fair market value of the resource and the amount the participant received for the resource by the full AABD allowances for the couple's living arrangement for the first month of ineligibility. (7-1-24)

If the participant makes more than one (1) resource transfer, the difference between the fair market value of all the transferred resources and the amount the participant received for all the transferred resources is used to determine the length of the period of ineligibility. The period of ineligibility begins with the month after the month of the first transfer. (7-1-24)

A trust established from the participant's resources is a resource transfer for less than fair market value, unless it meets an exception in Section 292 of these rules. If the trust includes resources of another person, the resource transfer period of ineligibility applies to the participant's share of the trust. (7-1-24) 01. Payment from Trust Not for Participant. If a payment is made to another individual from a trust counted as a resource, and the payment is not for the benefit of the participant, the payment is a resource transfer for less than fair market value. (7-1-24) 02. Payment from Trust Restricted. If the participant acts so no payment from a trust counted as a resource can be made for any reason, the trust is a resource transfer for less than fair market value. By taking the action, the participant causes the trust to be no longer counted as a resource and the participant is subject to the period of ineligibility. The date of the action restricting payment is the date of the transfer. (7-1-24)

A participant or spouse is not subject to the resource transfer period of ineligibility if one (1) of the following conditions is satisfied. (7-1-24) 01. Home to Spouse. Title to the home is transferred solely to the spouse. (7-1-24) 02. Home to Minor Child or Disabled Adult Child. Title to the home is transferred to the child of the participant or spouse. The child must be under age twenty-one (21), blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. (7-1-24) 03. Home to Sibling. Title to the home is transferred to a sibling of the participant or spouse who must have had an equity interest or life estate in the transferred home and was residing in that home for at least one (1) year immediately before the month the home was transferred. (7-1-24) 04. Home to Adult Child. Title to the home was transferred to a child of the participant or spouse, other than a child under the age of twenty-one (21). The child must have resided in that home for at least two (2) years immediately before the month the participant entered a medical facility or long-term care. The child must have provided care to the participant, which permitted them to live at home rather than enter a medical facility or long-term care. (7-1-24) 05. Benefit of Spouse. Resources, other than the home, were transferred to the participant's spouse or to another person for the sole benefit of the spouse. (7-1-24) 06. Transfer from Spouse. The resources were transferred from the participant's spouse to another person for the sole benefit of the participant's spouse. (7-1-24) 07. Transfer to Child. The resources were transferred to the participant's child or to a trust established solely for the benefit of the participant's child. The child must be blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. The child may be any age. (7-1-24) 08. Transfer to Trust for Person Under Sixty-Five. The resources were transferred to a trust for the sole benefit of a person under age sixty-five (65) who is blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. (7-1-24) 09. Transfer to a Trust That Is a Countable Resource. The resources were transferred to a trust and the trust is a countable resource for AABD in the amount of the transfer. (7-1-24) 10. Intent to Receive Fair Market Value. The participant or spouse proves they intended to dispose of the resources at fair market value or for other adequate consideration, but can prove good cause for not doing so. (7-1-24) 11. Resources Returned. All resources transferred for less than fair market value have been returned to the participant. (7-1-24) 12. No AABD Purpose. The participant or spouse proves the resources were transferred exclusively for a purpose other than qualifying for AABD. Purposes other than qualifying for AABD include: (7-1-24) a. After the resource transfer the participant has a traumatic onset of disability. (7-1-24) b. After the resource transfer a previously unknown disabling condition is diagnosed. (7-1-24) c. After the resource transfer the participant has an unexpected loss of income or resources resulting in eligibility for AABD. (7-1-24) d. The resource was excludable in the transfer month. (7-1-24) e. The transfer of resources was court-ordered, provided the participant did not petition the court to order the transfer. (7-1-24) f. The participant took a vow of poverty and gave the resources to a religious order. (7-1-24) 13. Undue Hardship. The participant proves failure to receive AABD would deprive them of food or shelter and their total available funds, including income and liquid resources, are less than their AABD allowances for the month they claim undue hardship. Undue hardship must be proven for each month of the period of ineligibility. When determining total available funds for a child, the Department will count any income and resources deemed from their parents. (7-1-24) 14. Exception to Fair Market Value. The amount received is reasonable, even if less than fair market value if a forced sale was done under reasonable circumstances, and little or no market demand exists for the type of resource transferred, or the resource was transferred to settle a legal debt approximately equal to the fair market value of the transferred resource. (7-1-24) 15. No Benefit to Participant. The participant received no benefit from the resource because they or their spouse held title to the property only as a trustee for another person, or the transfer was done to clear title to property and the participant or spouse had no interest in the property that would benefit them. (7-1-24) 16. Fraud Victim. The resource was transferred because the participant or spouse was the victim of fraud, misrepresentation, or coercion. The participant or spouse must take all possible steps to recover the resources or property or its equivalent in damages. The participant must assign recovery rights to the State of Idaho. (7-1-24)

Ineligibility for AABD cash because of property transfer does not make the participant ineligible for Medicaid. (7-1-24)

Income is anything that can be used to meet needs for food, or shelter. Income is cash, wages, pensions, in-kind payments, inheritances, gifts, awards, rent, dividends, interest, or royalties the participant receives during a month. (7-1-24) 01. Cash Income. Is currency, checks, money orders, or electronic funds transfers. Cash income includes Social Security checks, unemployment checks, and payroll checks. (7-1-24) 02. In-Kind Income. Is not cash. In-kind income is food or shelter. Wages paid as in-kind earnings, such as food or shelter, are counted as unearned income. Other in-kind income is not counted. (7-1-24) 03. Inheritances. Is cash, a right, or noncash items received as the result of someone’s death. Cash or noncash items in an inheritance are income the month received and a resource the next month. A contested inheritance is not counted as income until the contest is settled and money is distributed. (7-1-24)

The participant must apply for benefits, including RSDI, VA, pensions, Workman’s Compensation, or Unemployment Insurance, when there is potential eligibility. The participant must apply when they reach the earliest age to qualify for the benefit. (7-1-24) 01. SSI. To get AABD cash, the participant must apply for SSI benefits, if they are potentially eligible. To get AABD-Medicaid, the participant does not have to apply for SSI benefits. (7-1-24) 02. VAIP. Participants entitled to a VA pension as of December 31, 1978, are not required to file for Veterans Administration Improved Pension Plan (VAIP), to get AABD cash or AABD-related Medicaid. (7-1-24) 03. Other Benefits. EITC, TAFI, BIA General Assistance, and victim’s compensation benefits are exempt from the filing requirement. (7-1-24)

Income is counted as income in the current month. If the participant keeps countable income after the month received, it is counted as a resource. (7-1-24)

Income is counted the earliest of when received, when credited to a participant’s account, or when set aside for the participant’s use. Income from SSA, SSI, or VA is counted for the month it is intended to cover. (7-1-24)

Eligibility for AABD cash and Medicaid is prospective. Expected income for the month is compared to the participant’s income limit that month. (7-1-24)

Income is projected for each month to determine AABD cash amount. Past income may be used to project future income. Expected changes must be considered. Income received less often than monthly and patient liability income are not prorated or converted. (7-1-24)

Monthly income is projected as described below. (7-1-24) 01. Converting Income to a Monthly Amount. If a full month’s income is expected, but is received on other than a monthly basis, the Department will convert the income to a monthly amount using one (1) of the formulas in the table below. TABLE 306.01 MONTHLY CONVERSION OF INCOME Conversion Procedure a. Weekly to Monthly Multiply weekly amounts by 4.3. TABLE 306.01 MONTHLY CONVERSION OF INCOME Conversion Procedure b. Biweekly to Monthly Multiplying bi-weekly amounts by 2.15. c. Semimonthly to Monthly Multiplying semi-monthly amounts by 2. d. Exact Amount Use the exact monthly income if it is expected for each month. (7-1-24) 02. Income Already Received. The Department will count income already received during the month and will convert the actual income to a monthly amount if a full month’s income has been received or is expected to be received as described below. (7-1-24) a. If the actual amount of income from any pay period a month is known, the Department will use the actual pay period amounts to determine the total month’s income and will convert the actual income to a monthly amount if a full month’s income has been received or is expected. (7-1-24) b. If no pay changes are expected, the Department will use the known actual pay period amounts for the past thirty (30) days to project future income and will convert the actual income to a monthly amount if a full month’s income has been received or is expected. (7-1-24) 03. Expected Income. The Department will count income that the participant and the Department believe the participant will get. The Department will convert expected income to a monthly amount as described below. (7-1-24) a. If the exact income amount is uncertain or unknown, the uncertain or unknown portion must not be counted. The certain or known amount is counted. (7-1-24) b. If the income has not changed and no changes are expected, past income can be used to project future income. (7-1-24) c. If income changes, and income received in the past thirty (30) days does not reflect expected income, income received over a longer period is used to project future income. (7-1-24) d. If income changes seasonally, income from the last comparable season is used to project future income. (7-1-24) 04. Ongoing Income. Comes from an ongoing source. It was received in the past and is expected to be received in the future. The Department will convert ongoing income to a monthly amount as described below. (7-1-24) a. If a full month’s income is not expected from an ongoing source, the Department will count the amount of income expected for the month. If actual income is known, the Department will use actual income. If actual income is unknown, the Department will project expected income and will convert income to a monthly amount. The Department will use zero (0) income for any pay period in which income was not received that month. (7-1-24) b. If a full month’s income from a new source is not expected, the Department will count the actual income expected for the month. The Department will not convert the income to a monthly amount. (7-1-24) c. If income stops and no additional income is expected from the terminated source, the Department will count the actual income received during the month. The Department will not convert the terminated source of income. (7-1-24) d. If a full month’s income is not expected from a new or terminated source, the Department will count the income expected for the month. If the actual income is known, the Department will use the known income. If the actual income is unknown, the Department will project the income and will not convert the income to a monthly amount if a full month’s income from a new or terminated source is not expected. (7-1-24) 05. Income Paid on Salary. Income paid on salary, rather than an hourly wage, is counted at the expected monthly salary rate. (7-1-24) 06. Income Paid at Hourly Rate. The Department will compute expected income paid on an hourly basis by multiplying the hourly pay by the expected number of hours the participant will work in the pay period. The Department will convert the pay period amount to a monthly basis. (7-1-24) 07. Monthly Income Varies. When monthly income varies each pay period and the rate of pay remains the same, the Department will average the income from the past thirty (30) days to determine the average pay period amount and will convert the average pay period amount to a monthly amount. When income changes and income from the past thirty (30) days is not a valid indicator of future income, a longer period of income history is used to project income. (7-1-24) 08. Income Received Less Often Than Monthly. Recurring income, such as quarterly payments or annual income, is counted in the month received, even if the payment is for multiple months. The income is not prorated or converted. If the amount is known, the Department will use the actual. If the amount is unknown, the Department will use the best information available to project income. (7-1-24)

An asset cannot be counted as income and resources in the same month. Assets received in cash or in-kind during a month are income. Income held past the month received is a resource. (7-1-24)

Adoption assistance payments, provided under Title IV-B or Title XX of the Social Security Act, are excluded income. Adoption assistance payments using funds provided under Title IV-E are income. The twenty dollar ($20) standard disregard is not subtracted. (7-1-24)

ABON is aid paid under a program using income as a factor of eligibility. ABON is funded wholly by a State, or a political subdivision of a State, or an Indian tribe, or a combination of these sources. Federal funds are not used. ABON is excluded income. (7-1-24)

BIA foster care payments are social services. They are excluded income for the foster child and foster family. (7-1-24)

To qualify for this exclusion, the student must be blind or disabled and be under age twenty-two (22). The student must be regularly attending high school, college, university, or a course of vocational or technical training designed to prepare them for gainful employment. The maximum monthly and annual exclusions cannot exceed the limits set by SSI for the current year. (7-1-24)

The SSA reimbursement for self-paid Medicare Part B “Buy-In” premiums is excluded. (7-1-24)

Payment from the sale, exchange, or replacement of a resource is excluded. The payment is a resource that changed form. (7-1-24)

Credit life or credit disability insurance covers payments on loans and mortgages, in case of death or disability. Insurance payments are made directly to loan or mortgage companies and are not available to the participant. These payments are excluded. (7-1-24)

Any grant, scholarship, or loan to an undergraduate for educational purposes, made or insured under any program administered by the Commissioner of Education, is excluded. (7-1-24)

Any grant, scholarship, or fellowship, not administered by the Commissioner of Education, and used for paying tuition, fees, or required educational expenses is excluded. This exclusion does not apply to any portion set aside or used for food or shelter. (7-1-24)

Payments received because of a major disaster, declared by the President, are excluded. This includes payments to repair or replace the person’s own home or other property and disaster unemployment aid. (7-1-24)

Compensation, other than wages, provided to volunteers in the Foster Grandparents Program, RSVP, and similar National Senior Volunteer Corps programs under Sections 404(g) and 418 of the Domestic Volunteer Service Act is excluded. (7-1-24)

Earned Income Tax Credits advance payments and refunds are excluded. (7-1-24)

Federal housing assistance is excluded. (7-1-24)

Foster care payments using funds provided under Title IV-B or Title XX of the Social Security Act are excluded. Payments for foster care of a non-SSI child placed by a public or private non-profit child placement or child care agency are excluded. Foster care payments using funds provided under Title IV-E are income. The twenty dollar ($20) standard disregard is not subtracted. (7-1-24)

Essential expenses of obtaining unearned income are subtracted from the income. An expense is essential if the participant would not receive the income unless they paid the expense. Expenses of receiving income, such as withheld taxes, are not subtracted. (7-1-24)

Garnishments of unearned income are counted as unearned income. Garnishments of earned income are counted as earned income. (7-1-24)

Governmental payments authorized by federal, state, or local law, for medical or social services, are excluded. Any cash provided by a nongovernmental medical or social services organization (including medical and liability insurers) for medical or social services already received is excluded. (7-1-24) 01. Medical Services. Are diagnostic, preventive, therapeutic, or palliative treatment. Treatment must be performed, directed, or supervised by a state-licensed health professional. Medical services include room and board provided during a medical confinement and in-kind medical items. (7-1-24) 02. Social Service. Any service, other than medical. Housebound and Aid and Attendance Allowances, including Unusual Medical Expense Allowances, received from the Veterans Administration are excluded. (7-1-24)

HEA and SMA are excluded. (7-1-24)

Payments made by Title XX or other governmental programs to pay an ineligible spouse or ineligible parent for in- home supportive services provided to a participant are excluded. In-home supportive services include attendant care, chore services, and homemaker services. (7-1-24)

Any income excluded by federal statute is excluded. (7-1-24)

The first thirty dollars ($30) of earned income and the first sixty dollars ($60) of unearned income per calendar quarter are excluded when they are infrequent or irregular payments. Income is infrequent if the participant receives it once in a calendar quarter from a single source. Income is irregular if the participant could not reasonably expect to receive it. (7-1-24)

Loans are excluded if the participant has signed a written repayment agreement. The signed agreement must state how the loan will be repaid. The signed written agreement can be obtained after the loan is received. Items bought on credit are paid with a loan and are not income. Money repaid to a participant on the principal of a loan is not income, it is a resource. Interest received by a participant on money loaned by them is countable income. (7-1-24)

Payments authorized by law made to people of Native American ancestry are excluded. (7-1-24)

Payments, other than a wage or salary, made under Chapter 35, Title 42, USC, Programs for Older Americans, are excluded. (7-1-24)

A personal service performed for a participant is excluded. Personal services include lawn mowing, house cleaning, grocery shopping, and babysitting. (7-1-24)

Rebates, refunds, AABD underpayments, and returns of money already paid are excluded. A replacement check is excluded. (7-1-24)

Relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisitions Policies Act of 1970, Subchapter II, Chapter 61, Title 42, USC, are excluded. Relocation payments paid to civilians of World War II per PL 100-383, are excluded. (7-1-24)

Replacement of a participant’s lost, stolen, or destroyed income is excluded. (7-1-24)

A returned mistaken payment is excluded. If the participant keeps the mistaken payment, it is income. (7-1-24)

Refunds of federal, State, or local taxes paid on income, real property, or food bought by the participant and their family, are excluded. (7-1-24)

Payments for utility costs made to low-income housing tenants by a local housing authority are excluded when paid directly to the tenant or jointly to the tenant and the utility company. (7-1-24)

Any payment made from a State-sponsored fund to aid victims of crime is excluded. (7-1-24)

Payments other than wages made to an eligible handicapped individual employed in a Vocational Rehabilitation Services project under Title VI of the Rehabilitation Act of 1973, are excluded. (7-1-24)

Payments to volunteers under Chapter 66, Title 42, USC Domestic Volunteer Services (ACTION programs) are excluded. Payments are not excluded if the Director of the ACTION agency determines the value, adjusted for hours served, is equal to or greater than the federal or state minimum wage. (7-1-24)

Class action settlement payments in Susan Walker v. Bayer Corporation, et al., are excluded for Medicaid but not for AABD cash. (7-1-24)

Weatherization assistance is excluded. (7-1-24)

For Medicaid only, all wages paid by the Census Bureau for temporary employment related to US Census activities are excluded. (7-1-24)

Earned income remaining after disregards and exclusions are subtracted, is counted in computing AABD cash. Wages are counted the month they become available to the participant. (7-1-24)

Countable self-employment income is the difference between the gross receipts and the allowable costs of producing the income, if the amount is expected to continue. Self-employment income is computed using one (1) of the methods listed in Subsections 401.01 through 401.03 of this rule. Subsection 401.04 of this rule can be used as an income deduction, if applicable. (7-1-24) 01. Self-Employed at Least One Year. For individuals who are self-employed for at least one (1) year, income and expenses are averaged over the past twelve (12) months. (7-1-24) 02. Self-Employed Less Than One Year. For individuals who are self-employed for less than one (1) year, income and expenses are averaged over the months the business has been in operation. (7-1-24) 03. Monthly Increase or Decrease. If a monthly average does not reflect actual monthly income because of an increase or decrease in business, the self-employment income is counted monthly. This method is not used for businesses with seasonal or unusual income peaks at certain times of the year. (7-1-24) 04. Net Self-Employment Income Seven and Sixty-Five Hundredths Percent Deduction. If net self-employment income is over four hundred dollars ($400) per year, seven and sixty-five hundredths percent (7.65%) is deducted. This deduction compensates for Social Security taxes paid. If self-employment Social Security tax is not paid, this deduction is not allowed. (7-1-24)

Allowable operating expenses subtracted from self-employment income are the allowable Internal Revenue Service self-employment expenses, except for those listed under Section 403 of these rules. (7-1-24)

Self-employment expenses not allowed are as follows: (7-1-24) 01. Payments on the Principal of Real Estate. Payments on the principal of real estate mortgages on income-producing property. (7-1-24) 02. Purchase of Capital Assets or Durable Goods. Purchases of capital assets, equipment, machinery, and other durable goods. Payments on the principal of loans for these items. (7-1-24) 03. Federal, State, and Local Income Taxes. (7-1-24) 04. Savings. Monies set aside for future use such as retirement or work-related expenses. (7-1-24) 05. Labor Paid to Any Family Member. (7-1-24) 06. Loss of Farm Income Subtracted From Other Income. (7-1-24) 07. Personal Transportation. (7-1-24) 08. Net Losses from Previous Periods. (7-1-24)

Royalties received as part of a trade or business, or for publication of the participant’s work, are earned income. Other royalties are unearned income. (7-1-24)

An honorarium for services rendered is earned income. An honorarium for travel expenses and lodging for a guest speaker is unearned income in the amount it exceeds the expenses. The portion that equals the expenses is excluded as an expense of obtaining the income. (7-1-24)

Payments for services performed in a sheltered workshop or work activities center are earned income. (7-1-24)

JTPA payments are earned income. JTPA payments for child care, transportation, medical care, meals, and other reasonable expenses, provided in cash or in-kind, are not income. (7-1-24)

Wages or salary paid under Chapter 35, Title 42, USC, Programs for Older Americans, is earned income. (7-1-24)

Basic pay is earned income. All other pay and allowances are unearned income. (7-1-24)

Net rental income is unearned income, unless from the business of renting real property. Net unearned rental income is gross rent less the expenses on the rental property as listed below. Net rental income from the business of renting properties is self-employment earned income. (7-1-24) 01. Interest. Interest and escrow portions of a mortgage payment. (7-1-24) 02. Real Estate Insurance. (7-1-24) 03. Repairs. Minor repairs to an existing rental structure. (7-1-24) 04. Property Taxes. (7-1-24) 05. Yard Care. Lawn care, including tree and shrub care and snow removal. (7-1-24) 06. Advertising Costs for Tenants. (7-1-24)

Money withheld by any benefit program to recover an overpayment is counted as income. Money withheld is not income if the overpaid benefit amount was used to compute AABD cash. (7-1-24)

RSDI monthly benefits are unearned income. The income is the amount reported by SSA, regardless of penalties to recover an SSI overpayment. (7-1-24)

SSI monthly payments are unearned income. The income is the amount reported by SSA, regardless of penalties to recover an SSI overpayment. An advance SSI payment to an applicant appearing SSI-eligible with a financial emergency, is not income the month received. When SSA reduces ongoing SSI to recover the advance, the SSI payment before the reduction continues to be counted as income. (7-1-24)

Black Lung payments are unearned income. (7-1-24)

Railroad Retirement Board payments are unearned income. (7-1-24)

Unemployment insurance benefits received under state and federal unemployment laws are unearned income. (7-1-24)

UGMA payments from the custodian to the minor are income to the minor. UGMA property, including earnings or additions, are not income to the minor until the month the minor becomes eighteen (18) years old. (7-1-24)

Workers’ compensation, less expenses required to get the payment, is unearned income. (7-1-24)

Military pensions are unearned income. (7-1-24)

VA pension payments are unearned income. The twenty dollar ($20) standard disregard is not subtracted, except by a special act of Congress. (7-1-24)

VA compensation payments to a veteran, spouse, child, or widow(er) are unearned income. (7-1-24)

VA educational payments funded by the government are excluded. (7-1-24)

Alimony, spousal, and other adult support payments are unearned income. (7-1-24)

Child support payments are unearned income. One-third (1/3) of a child support payment is excluded for the child receiving support. Child support collected by a State and retained for TAFI payments is not income. (7-1-24)

Dividends and interest are unearned income. (7-1-24)

Awards, gifts, and prizes are unearned income. (7-1-24)

Work-related payments that are not salary or wages are unearned income. (7-1-24) 428 – 430. (RESERVED)

FEMA funds are unearned income, unless excluded by the type of aid, such as medical services or Support and Maintenance Assistance. (7-1-24)

BIA GA payments are unearned income and are federally funded income based on need. They are paid in cash or in- kind. The twenty dollar ($20) standard disregard is not subtracted. (7-1-24)

BIA ACC and CWA payments, other than foster care made to participants out of an institution, are unearned income. (7-1-24)

Deposits to an unrestricted IIM account are income in the month deposited. (7-1-24)

Accelerated life insurance payments are unearned income in the month received. (7-1-24)

Payments received on the interest of a negotiable real estate contract are unearned income for Medicaid eligibility. Payments received on the principal of a negotiable real estate contract are a resource for Medicaid eligibility. Payments received on a nonnegotiable real estate contract are unearned income. Principal and interest payments received on an excluded real estate contract of a long-term care participant are unearned income for patient liability. (7-1-24)

Any gift from a tax-exempt nonprofit organization to a child under age eighteen (18), who has a life-threatening condition, is excluded from income under the conditions below. (7-1-24) 01. In-Kind Gift. Is excluded if the gift is not converted to cash. (7-1-24) 02. Cash Gifts. Are excluded up to two thousand dollars ($2,000) for the calendar year the cash gifts are made. (7-1-24)

Income deeming counts the income of another person as available to an AABD participant, for eligibility and the amount of AABD cash. Income is deemed to the participant from their ineligible spouse, and to the child participant from their ineligible parent. Income deeming starts the first full calendar month the participant is in a deeming situation. Deeming ends the first full calendar month the participant is not in a deeming situation. Deeming to a child ends the month after the child’s eighteenth birthday. (7-1-24) 01. Ineligible Parent. A natural or adoptive parent or stepparent, who does not receive AABD and lives in the same household as a child. (7-1-24) 02. Ineligible Spouse. A participant’s spouse living with the participant and not receiving AABD is an ineligible spouse. The ineligible spouse of the parent of a child participant, living with the child participant and their parent, is an ineligible spouse. (7-1-24) 03. Ineligible Child. A child under age twenty-one (21) who does not receive AABD, and lives with the AABD participant. (7-1-24) 04. Income Deeming Exclusions. Income excluded from deeming is listed in POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24)

Income is deemed from an ineligible spouse to the participant, if they live together. Income is deemed as described in Subsections 452.01 through 452.08 POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24)

Income is deemed from an ineligible parent, or their ineligible spouse, to a child participant under age eighteen (18) living in the same household. A stepparent’s income is deemed to the child for AABD cash, but not Medicaid. The income is deemed as described in POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24)

If a participant and an essential person live in the same household, the essential person’s income is deemed to the participant. If essential person deeming makes the participant ineligible, the Department will not use essential person deeming. The income is deemed as described in Subsections 454.01 through 454.06 POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24)

If a participant, their ineligible spouse, and their child participant live in the same household, income is deemed from the participant to the child participant. The income is deemed as described in POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24)

The Department will deem income as described in this rule, if the legal non-citizen’s sponsor signed an affidavit of support other than the I-864. The deemed income is counted, even if the participant does not live in the sponsor’s household. The sponsor’s income is not deemed to the participant for Medicaid. (7-1-24) 01. Three-Year Limit. The deeming period, regardless of admission date, is three (3) years after the date the legal non-citizen is lawfully admitted. Deeming stops the end of the month, three (3) years from the date the sponsored participant lawfully entered the US for permanent residence. (7-1-24) 02. Sponsored Legal Non-Citizen Exempt from Deeming. A lawfully admitted legal non-citizen participant is exempt from sponsor deeming if one (1) or more of the following conditions applies. (7-1-24) a. The legal non-citizen was admitted to the US as a refugee, asylee, or parolee. (7-1-24) b. The legal non-citizen first applied for AABD before October 1, 1980. (7-1-24) c. The legal non-citizen is a lawful permanent resident. (7-1-24) d. The legal non-citizen’s entry into the US was sponsored by a church, other social service organization, or an employer who has offered them a job. (7-1-24) e. The legal non-citizen becomes blind or disabled after they are admitted to the US. (7-1-24) f. The legal non-citizen was sponsored by and resides in the same household with their ineligible spouse or ineligible parent. The Department will use ineligible spouse and ineligible parent deeming, not sponsor deeming. (7-1-24) g. The legal non-citizen’s sponsor dies. (7-1-24) h. The legal non-citizen was legalized under the Immigration Reform and Control Act of 1986. (7-1-24) i. The legal non-citizen has lived in the US for thirty-six (36) months beginning with the month they were admitted for permanent residence or granted permanent residence status. (7-1-24) j. The legal non-citizen was admitted under Section 249 of the INA as a registry legal non-citizen. (7-1-24) k. The legal non-citizen is an applicant for permanent residence who is an Amerasian or a specified relative of an Amerasian. The Amerasian must be born in Vietnam between January 1, 1962, and January 1, 1976. A specified relative is a spouse, child, parent, or stepparent of the Amerasian, or someone who has acted in the place of a parent of an Amerasian and/or their spouse or child. (7-1-24) l. The legal non-citizen is an applicant for adjustment under the Cuban/Haitian provisions of Section 202 of the Immigration Reform and Control Act of 1986. (7-1-24) 03. Sponsor/Legal Non-Citizen Relationships. Sponsor/legal non-citizen relationships and deeming rules are listed in POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules. (7-1-24) 04. Sponsor to Legal Non-Citizen Deeming Procedures. The Department will budget the legal non- citizen’s actual needs, as if they are a single person living alone. The Department will subtract the legal non-citizen’s own income, less exclusions and disregards. The Department will subtract the couple’s income, less exclusions, from their needs. If there is no budget deficit, the participant is not eligible. If there is a budget deficit, the Department will follow the procedures in POMS Chapter SI 01320.000, incorporated by reference under Subsection 002.02 of these rules, to compute sponsor deemed income. (7-1-24)

If the legal non-citizen’s sponsor has signed an INS form I-864 Affidavit of Support, all income of the sponsor and the sponsor’s spouse is deemed to the legal non-citizen for AABD cash and Medicaid eligibility. Deeming continues until the legal non-citizen becomes a naturalized citizen or has forty (40) quarters of work. Exceptions are listed below: (7-1-24) 01. Battery Exception. The legal non-citizen or the legal non-citizen child's parent was battered or subjected to extreme cruelty in the US. There is a substantial connection between the battery and the participant's need for assistance. The person subjected to the battery or cruelty no longer lives with the person responsible for the battery or cruelty. (7-1-24) 02. Indigence. Alien sponsor deeming is suspended for twelve (12) months, if the legal non-citizen is not able to get food and shelter without AABD cash. (7-1-24)

The participant has financial need if their allowances, as described in Sections 501 through 513 of these rules, are more than their income. (7-1-24)

Each participant receives a basic allowance unless they live in a nursing facility. The basic allowance for each living arrangement is listed in this rule. The Semi-Independent Group Residential Facility, Room and Board, Residential and Assisted Living Facility, and Certified Family Home basic allowances do not change with the annual cost-of- living increase in the federal SSI benefit amount. (7-1-24) 01. Single Participant. A participant is budgeted five hundred forty-five dollars ($545) monthly as a basic allowance when living in a situation listed below. Beginning January 1, 2001, the basic allowance increase for a single participant is the dollar amount of the annual cost-of-living increase in the federal SSI benefit rate for a single person. (7-1-24) a. Living alone. (7-1-24) b. Living with their ineligible spouse. (7-1-24) c. Living with another participant who is not their spouse. (7-1-24) d. Living in another’s household. This includes a living arrangement where the participant purchases lodging (room) and meals (board) from their parent, child, or sibling. (7-1-24) e. Living with their TAFI child. (7-1-24) 02. Couple or Participant Living with Essential Person. A participant living with their participant spouse or their essential person is budgeted seven hundred sixty-eight dollars ($768) monthly as a basic allowance. Beginning January 1, 2001, the basic allowance increase for a couple is the dollar amount of the annual cost-of-living increase in the federal SSI benefit rate for a couple. The increase may be rounded up. (7-1-24) 03. SIGRIF. A participant living in a semi-independent group residential facility (SIGRIF) is budgeted three hundred forty-nine dollars ($349) monthly as a basic allowance. (7-1-24)

Special needs allowances are a restaurant meals allowance and a service animal food allowance. (7-1-24) 01. Restaurant Meals Allowance. Is fifty dollars ($50) monthly. A physician must state the participant is physically unable to prepare food in their home. A participant able to prepare their food, but living in a place where cooking is not permitted, may be budgeted the restaurant meals allowance for up to three (3) months. (7-1-24) 02. Service Animal Food Allowance. Is seventeen dollars ($17) monthly. The allowance is budgeted for a blind or disabled participant using a trained service animal. (7-1-24)

Room and board is a living arrangement where the participant purchases lodging (room) and meals (board) from a person they live with who is not their parent, child, or sibling. (7-1-24) 01. Budgeted Room and Board Allowance. Beginning January 1, 2006, a participant living in a room and board home is budgeted six hundred ninety-three dollars ($693). Beginning July 1, 2013, the Room and Board allowance will be adjusted annually by the percentage of the annual cost-of-living increase in the federal SSI benefit rate for a single person. This adjustment will be effective on January 1st of each year. The room and board allowance increase will be rounded to the next dollar. (7-1-24) 02. Basic Allowance for Participant in Room and Board Home. A participant living in a room and board home is budgeted seventy-seven dollars ($77) monthly as a basic allowance. Beginning July 1, 2013, this basic allowance will be adjusted annually by the percentage of the annual cost-of-living increase in the federal SSI benefit rate for a single person. This adjustment will be effective on January 1st of each year. The basic allowance increase will be rounded to the nearest dollar. (7-1-24)

A participant living in a RALF under IDAPA 16.03.22, “Residential Assisted Living Facilities,” or a CFH, under IDAPA 16.03.19, “Certified Family Homes,” is budgeted a basic allowance of ninety-six dollars ($96) monthly. Beginning July 1, 2013, this basic allowance will be adjusted annually by the percentage of the annual cost-of-living increase in the federal SSI benefit rate for a single person. This adjustment will be effective on January 1st of each year. The basic allowance increase will be rounded to the nearest dollar. (7-1-24) 01. Budgeted Monthly Allowance Based on Level of Care. A participant is budgeted a monthly allowance for care based on the level of care received as described in Section 515 of these rules. If the participant does not require State Plan Personal Care Services (PCS), their eligibility and allowances are based on the Room and Board rate in Section 512 of these rules. (7-1-24) 02. Care Levels and Monthly Allowances. Beginning January 1, 2006, care levels and monthly allowances are those listed in Table 513.02 below. Beginning July 1, 2013, the RALF and CFH allowances for participants living in a RALF or CFH on State Plan PCS will be adjusted annually by the percentage of the annual cost-of-living increase in the federal SSI benefit rate for a single person. This adjustment will be effective on January 1st of each year. This increase will be rounded to the next dollar. TABLE 513.02 - STATE PLAN PCS CARE LEVELS AND ALLOWANCES AS OF 1-1-06 Level of Care Monthly Allowance a. Level I Eight hundred and thirty-five dollars ($835) b. Level II Nine hundred and two dollars ($902) c. Level III Nine hundred and sixty-nine dollars ($969) (7-1-24) 03. CFH Operated by Relative. A participant living in a CFH operated by their parent, child, or sibling is not entitled to the CFH State Plan PCS allowances. They may receive the allowance for a person living with a relative as described in Section 501 of these rules. A relative for this purpose is the participant’s parent, child, sibling, aunt, uncle, cousin, niece, nephew, grandparent, or grandchild by birth, marriage, or adoption. (7-1-24)

Only a participant who receives an SSI payment for the month is eligible for an AABD cash payment in the same month. The AABD cash payment amount is based on the participant’s living arrangement described in Subsections 514.01 through 514.04 of this rule. An AABD cash payment is the difference between a participant’s financial need and their countable income. If the difference is not an even dollar amount, AABD cash is paid at the next higher dollar. (7-1-24) 01. Single Participant Maximum Payment. For a single participant described in Subsection 501.01 of these rules, the maximum monthly AABD cash payment amount is fifty-three dollars ($53). (7-1-24) 02. Couple or Participant Living with Essential Person Maximum Amount. For participants described in Subsection 501.02 of these rules, the maximum monthly AABD cash payment amounts are: (7-1-24) a. A couple receives twenty dollars ($20); or (7-1-24) b. A participant living with essential person receives eighteen dollars ($18). (7-1-24) 03. Semi-Independent Group Maximum Payment. For a participant described in Subsection 501.03 of these rules, the maximum monthly AABD cash payment amount is one hundred sixty-nine dollars ($169). (7-1-24) 04. Room and Board Maximum Payment. For a participant described in Section 512 of these rules, the maximum monthly AABD cash payment is one hundred ninety-eight dollars ($198). (7-1-24) 05. RALF and CFH. A participant residing in a RALF or CFH is not eligible for an AABD cash payment. (7-1-24)

The participant’s need for care, level of care, plan of care, and the RALF’s or CFH’s ability to provide care is assessed by the Bureau of Long-Term Care (BLTC) when a participant is admitted. The BLTC must approve the placement before Medicaid can be approved. (7-1-24)

A change in the participant's level of care affects eligibility as listed below. (7-1-24) 01. Increase in Level of Care. Is effective the month the BLTC reassesses the level of care. (7-1-24) 02. Decrease in Level of Care. When the BLTC verifies the participant has a decrease in their level of care, and their income exceeds their new level of care, their Medicaid must be stopped after timely notice. When the BLTC determines the participant no longer meets any level of care, their eligibility and allowances are based on the Room and Board rate in Section 512 of these rules. (7-1-24)

If a participant moves from a nursing home or hospital to a different living situation, other than a RALF or CFH, their AABD cash for the month is determined as if they lived in their new situation the entire month. Their AABD cash is their AABD allowances less their countable income. (7-1-24)

Income of an AABD participant and their participant spouse living in the same household is combined. The twenty dollar ($20) standard income disregard and the sixty-five dollar ($65) earned income disregard are subtracted once a month, per couple. Each member of a couple living in an institution must have income budgeted as a single person. A couple living together as of the first day of a month, is counted as living together throughout that month. Budgeting as a couple continues through the month the couple stops living together. For couple budgeting, a household is a home, a rental, another’s household, or room and board. (7-1-24)

The standard disregard is twenty dollars ($20), and is first subtracted from unearned income. If the unearned income is less than the standard disregard, the remainder of the standard disregard is subtracted from earned income. The participant retains the standard disregard for their personal use. (7-1-24) 01. Standard Disregard and a Couple. The Department will subtract the standard disregard only once a month from the combined income of a couple in the same household. (7-1-24) 02. Standard Disregard Exception. The standard disregard must not be subtracted from nonservice- connected VA payments, Title IV-E foster care payments, or BIA General Assistance. (7-1-24)

Earned income disregards are subtracted from AABD earned income in the order listed in Sections 542 through 547. They are subtracted the month the income is paid. (7-1-24)

Sixty-five dollars ($65) of earned income in a month are not counted. The Department will subtract the sixty-five dollar ($65) disregard only once a month from the combined income of a couple in the same household. The sixty- five dollar ($65) disregard is a work incentive. The participant retains the sixty-five dollar ($65) disregard for their personal use. (7-1-24)

IRWEs are items and services needed and used by a disabled AABD participant to work. The items must be needed because of the participant’s impairment, and may be bought or rented. The cost for IRWEs is subtracted from the participant’s earned income, for eligibility and AABD cash amount. An item disregarded as a blindness work expense, or as part of a PASS, cannot be disregarded as an IRWE. (7-1-24)

One-half (1/2) of remaining earned income, after the IRWE is subtracted, is not counted. The one-half (1/2) of remaining earned income is a work incentive. The participant retains the one-half (1/2) of remaining earned income for their personal use. (7-1-24)

The cost of earning income is subtracted from the earned income of a blind person. The blind person must be under age sixty-five (65). If the blind person is age sixty-five (65) or older, they must receive SSI for blindness, or have received AABD the month before they became sixty-five (65). (7-1-24) 01. Blind Work Expense Limit. Blindness work expenses are subtracted from earned income. The amount subtracted must not exceed the participant’s monthly earnings. (7-1-24) 02. No Duplication for Blind Work Expenses. Expenses, subtracted under the IRWE disregard, cannot be subtracted again under this disregard. (7-1-24)

A blind or disabled participant, with an approved PASS, must have income and resources disregarded. Conditions for this disregard are listed below. (7-1-24) 01. Under Age Sixty-Five. The participant must be under sixty-five (65), or receive AABD for the blind or disabled during the month of their sixty-fifth birthday. (7-1-24) 02. Approved PASS. A participant receiving SSI must have a PASS approved by SSA. A participant not receiving SSI must have a PASS approved by the Department. (7-1-24) 03. Income Necessary for Self-Support. The income and resources disregarded under the PASS must be necessary for the participant to achieve self-support. (7-1-24)

A PASS approved by the Department must be in writing, and contain all the following items: (7-1-24) 01. Occupational Objective. The PASS must have a specific occupational objective. (7-1-24) 02. Specific Goals. The PASS must have specific goals for using the disregarded income and resources to achieve self-support. (7-1-24) 03. Time Limit. The PASS must show a specific target date to achieve the goal. An approved PASS is limited to an initial period of eighteen (18) months. Extensions may be granted if needed. (7-1-24) a. The first extension period lasts up to eighteen (18) months. (7-1-24) b. A second eighteen (18) month extension period can be granted. (7-1-24) c. A final extension, up to twelve (12) months can be granted. The PASS can be extended a total of forty-eight (48) months, when the original PASS goal required extensive education or vocational training. (7-1-24) 04. No Duplication of Disregards. An item disregarded as an IRWE or under the blindness exception cannot be disregarded under the PASS. (7-1-24) 05. Resource Limitation. The PASS disregard must not be used for resources, unless the resources cause the participant to be ineligible without the PASS disregard. (7-1-24) 06. Disregard of Resources. The PASS must list the participant’s resources. The PASS must list any resources the participant will receive under the plan, and show how the resources will be used toward the occupational goal. The PASS must list goal-related items or activities requiring savings or purchases and the amounts the participant plans to save or spend, and list resources disregarded under the plan. The PASS must show resources disregarded under the plan can be identified separate from the participant’s other resources. (7-1-24)

The participant must be notified of changes in eligibility or AABD cash amount. The notice must give the effective date, the reason for the action, the rule that supports the action, and appeal rights. See 42 CFR 435.917. (7-1-24)

When a reported change results in closure or decrease, the participant must be notified at least ten (10) calendar days before the effective date of the action. (7-1-24)

Advance notice is not required when a condition listed below exists. The participant must be notified by the date of the action. (7-1-24) 01. The Department has Proof of the Participant’s Death. (7-1-24) 02. Participant Requests Closure in Writing. (7-1-24) 03. Participant in Institution. The participant is admitted or committed to an institution. Further payments to the participant do not qualify for federal financial participation under the State Plan. (7-1-24) 04. Nursing Care. The participant is placed in a nursing facility or an ICF/IID. (7-1-24) 05. Participant Address Unknown. The participant’s whereabouts are unknown. Department mail is returned with no forwarding address. (7-1-24) 06. Participant is Approved for Aid in Another State. (7-1-24) 07. Eligible One Month. The participant is eligible for aid only during the calendar month of their application for aid. (7-1-24) 08. Non-Citizen With Emergency. The participant is an illegal or legal non-citizen whose Medicaid eligibility ends the day their emergency medical condition stops. (7-1-24) 09. Retroactive Medicaid. The participant’s Medicaid eligibility is for a prior period. (7-1-24) 10. Special Allowance. A special allowance granted for a specific period is stopped. (7-1-24) 11. Patient Liability or Participant Participation Changes. (7-1-24) 12. Participant’s Level of Care Changes. (7-1-24)

If the SSA finds a participant is blind or disabled, based on an appeal of an SSA decision, the participant meets the disability requirements for AABD cash and related Medicaid on the effective date determined by SSA. AABD cash payments are effective no earlier than the month SSA issues the favorable decision for SSI payments. (7-1-24)

The participant must report changes in circumstances verbally or in writing, by the tenth of the month following the month in which the change occurred. The participant must show good cause for not reporting changes. If failure to report a change results in an overpayment, the overpayment must be recovered. (7-1-24)

The participant must prove continuing eligibility for aid when a change could affect eligibility, and is allowed ten (10) calendar days to provide requested proof. The case is closed if the participant does not provide proof within ten (10) days and does not have good cause for not providing proof. (7-1-24)

If a participant reports a change that results in an increase, AABD cash is increased effective the month of report. If a participant reports a change that results in a decrease, AABD cash is decreased or ended effective the first month after proper notice. (7-1-24)

If the Department is at fault for issuing a payment less than the participant should have received, the Department will issue a supplemental payment for the difference. (7-1-24)

If the participant is paid more AABD cash than they are eligible for, the Department must collect the overpayment. The Department must notify the participant of the right to a hearing, the method for repayment, and the need for a repayment interview. (7-1-24)

When an underpayment is computed, any overpayment for that month is subtracted from the underpayment. When an overpayment is computed, any underpayment for the month is subtracted. (7-1-24)

A participant may request a hearing to contest a Department decision. The participant must make the request within ninety (90) days of the date the Department mailed the notice of decision. Hearings will be conducted according to IDAPA 62.01.01, “Idaho Rules of Administrative Procedure,” and Office of Administrative Hearings General Order No. 1. (7-1-24)

The participant may continue to receive benefits upon request, pending the hearing decision. The Department must receive the participant’s request for continued benefits before the effective date of the Department’s action stated in the notice of decision. An applicant cannot receive continued benefits when appealing a denial for failure to provide citizenship and identity verification after the expiration of a reasonable opportunity period. (7-1-24) 01. Amount of Assistance. The Department will continue the participant's assistance at the current month's level while the hearing decision is pending, unless another change affecting assistance occurs. (7-1-24) 02. Continued Eligibility. The participant must continue to meet all eligibility requirements not related to the hearing issue. (7-1-24) 03. Overpayment. When the hearing decision is in the Department's favor, the participant must repay assistance received while the hearing decision was pending. (7-1-24)

If the participant receives Medicaid services during a month they are not eligible, the Department must collect the overpayment. If too little patient liability or participant participation is computed, the Department must collect the overpayment. The participant must be notified of the overpayment. (7-1-24)

01. Increase in Patient Liability. If the patient liability is increased for the current or a past month, the Department will collect the patient liability directly from the participant. (7-1-24) 02. Decrease in Patient Liability. If the patient liability is decreased for a current or past month, the funds will be paid to the provider and the provider must reimburse the participant for the portion of the costs the participant paid more than their patient liability. (7-1-24)

An eligibility redetermination is completed at least once every year and when a change affecting eligibility occurs. (7-1-24)

When the Department or federal government selects a case for review in the quality control process, the participant must cooperate in the review of the case. Benefits must be stopped, following advance notice, when a participant is unwilling to take part in the quality control process. If the participant reapplies for benefits, they must fully cooperate with the quality control process before the application can be approved. (7-1-24)

A participant must meet the eligibility requirements for at least one (1) Medicaid coverage group to be eligible for Medicaid benefits. Income and circumstances in the current month are used for eligibility for the current month. Resources are counted as of the first moment of the month. (7-1-24)

An adult participant, a legal guardian, or a representative of the participant must sign the application. The participant must submit the application to the Department. A Medicaid application may be made for a deceased person. (7-1-24)

Medical support rights are assigned to the Department by signature on the application. The participant must cooperate with the Department to secure medical support and payments to be eligible for Medicaid. The participant must cooperate on behalf of themself and any participant for whom they can legally assign rights. A participant who cannot legally assign their own rights must not be denied Medicaid if the legally responsible person does not cooperate. (7-1-24)

The participant must cooperate to identify and locate the noncustodial parent, establish paternity, and establish, modify, and enforce a child medical support order to be eligible for Medicaid. This includes support payments received directly from the noncustodial parent. The cooperation requirement is waived for poverty level pregnant women exempt from cooperating in establishing paternity and obtaining medical support from, or derived from, the father of a child born out of wedlock. A participant who cannot legally assign their own rights must not be denied Medicaid if the legally responsible person does not cooperate. (7-1-24)

Cooperation includes providing all information to identify and locate the noncustodial parent. Cooperation for Medicaid includes identifying other liable third-party payers. (7-1-24) 01. Name of Noncustodial Parent. The participant must provide the first and last name of the noncustodial parent. (7-1-24) 02. Information About Noncustodial Parent. The participant must also provide at least two (2) pieces of information, about the noncustodial parent, listed below: (7-1-24) a. Birth Date. (7-1-24) b. SSN. (7-1-24) c. Current address. (7-1-24) d. Current phone number. (7-1-24) e. Current employer. (7-1-24) f. Make, model, and license number of any motor vehicle owned by the noncustodial parent. (7-1-24) g. Names, phone numbers, and addresses of the parents of the noncustodial parent. (7-1-24)

The participant may claim good cause for failure to cooperate in securing medical and child support for themself or a minor child. Good cause is limited to the following: (7-1-24) 01. Rape or Incest. There is proof the child was conceived because of incest or rape. (7-1-24) 02. Physical or Emotional Harm. There is proof the child’s non-custodial parent may inflict physical or emotional harm to the participant, the child, the custodial parent, or the caretaker relative. There is proof another person may inflict physical or emotional harm to an AABD-related participant if the participant cooperates in securing medical and child support. (7-1-24) 03. Minimum Information Cannot Be Provided. Substantial and credible proof is provided indicating the participant cannot provide the minimum information regarding the non-custodial parent. (7-1-24)

If the participant claims good cause for not cooperating, but the Department determines there is not good cause, the participant must be given the opportunity to withdraw the application or have their Medicaid closed. (7-1-24)

01. Group Health Plan Enrollment Requirement. Each participant must apply for and enroll in a cost-effective employer group health plan as a condition of eligibility for Medicaid. Medicaid coverage must not be denied, delayed, or stopped pending the start of a participant's group health insurance coverage. A child entitled to enroll in a group health plan must not be denied Medicaid coverage solely because their caretaker fails to apply for the child's enrollment. (7-1-24) 02. Medicare Enrollment Requirement. Each participant who may be eligible for Medicare must apply for all parts of Medicare parts A, B, and D for which they are likely to be eligible, as a condition of eligibility for Medicaid. (7-1-24)

For Medicaid Qualifying Trusts established before August 11, 1993, the maximum payment permitted to be made to a participant from the trust must be counted for Medicaid eligibility. The maximum is counted whether or not the trustee actually distributes payments. (7-1-24)

A participant eligible for AABD cash is eligible for Medicaid, unless they are in an ineligible institution, receive excess payment from a Medicaid Qualifying Trust, or have an irrevocable trust that is not exempt. (7-1-24)

A resident of a long-term care facility must meet the AABD eligibility criteria to be eligible for Medicaid. A long- term care facility is a nursing facility or an ICF/IID. The need for long-term care is determined using IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24) 01. Resources of Resident. The resident’s resource limit is two thousand dollars ($2,000). Resources of a married person in long-term care are computed using Federal Spousal Impoverishment rules. Under the SSI method, spouses can use the three thousand dollar ($3,000) couple resource limit if more advantageous. The couple must have lived in the nursing home, in the same room, for six (6) months. (7-1-24) 02. Medicaid Income Limit of Long-Term Care Resident Thirty Days or More. The monthly income limit for a long-term care facility resident is three (3) times the federal SSI benefit for a single person. To qualify for this income limit, the participant must be, or be likely to remain, in long-term care at least thirty (30) consecutive days. (7-1-24) 03. Medicaid Income Limit of Long-Term Care Resident Less Than Thirty Days. The monthly income limit, for the resident of a long-term care facility for less than thirty (30) consecutive days, is the AABD income limit for the participant’s living situation before long-term care. Living situations before long-term care do not include hospital stays. (7-1-24) 04. Income Not Counted. The income listed in Subsections 720.04.a. through 720.04.e. of this rule is not counted to compute Medicaid eligibility for a long-term care facility resident. This income is counted in determining participation in the cost of long-term care. (7-1-24) a. Income excluded or disregarded in determining eligibility for AABD cash is not counted. (7-1-24) b. The September 1972 RSDI increase is not counted. (7-1-24) c. Any VA Aid and Attendance allowance, including any increment that is the result of a VA Unusual Medical Expense allowance, is not counted. These allowances are not counted for patient liability, unless the veteran lives in a state-operated veterans' home. (7-1-24) d. RSDI benefit increases from cost-of-living adjustments (COLA) after April 1977 are not counted if they made the participant lose SSI or AABD cash. The COLA increases after SSI or AABD cash stopped are not counted. (7-1-24) e. Income paid into an income trust exempt from counting for Medicaid eligibility under Subsection 872.02 of these rules is used for patient liability. Income paid to the trust and not used for patient liability is subject to the asset transfer penalty. (7-1-24) 05. Medicaid Participant Residing in a Skilled Nursing Facility. When a Medicaid participant who is a resident of a skilled nursing facility and meets that level of care as evidenced by the PAARR defined in IDAPA 16.03.26, “Medicaid Plan Benefits,” the resident is determined to be disabled for the duration of their residency in the skilled nursing facility. (7-1-24)

Participants who have received, or are entitled to receive, benefits under a Qualified Long-Term Care Partnership policy issued in Idaho after November 1, 2006, will have certain resources disregarded as described below. (7-1-24) 01. Value of the Participant's Resources. The total dollar amount of the insurance benefits paid out for a policy holder of a Qualified Long-Term Care Partnership policy is disregarded in calculating the value of the participant's resources for long-term care Medicaid eligibility. The amount that is disregarded is determined on the effective date of an initial application approval for long-term care Medicaid benefits. (7-1-24) 02. Resource Disregard Excluded from Estate Recovery. The amount of the resources disregarded from a Qualified Long-Term Care Partnership policy under Subsection 721.01 of this rule, is deducted from the assets of the estate for Medicaid estate recovery. (7-1-24)

Patient liability is the participant’s income counted toward the cost of long-term care. Patient liability begins the month after the first full calendar month the patient is receiving benefits in a long-term care facility. (7-1-24)

For a participant with no community spouse, patient liability is computed as described below. (7-1-24) 01. Income of Participants in Long-Term Care. For a single participant, or participant whose spouse is also in long-term care and chooses the SSI method of calculating the amount of income and resources, the patient liability is their total income less the deductions in Subsection 723.03 of this rule. (7-1-24) 02. Community Property Income of Long-Term Care Participant with Long-Term Care Spouse. Patient liability income for a participant, whose spouse is also in long-term care, choosing the community property method, is one-half (1/2) their share of the couple’s community income, plus their own separate income. The deductions under Subsection 723.03 of this rule are subtracted from their income. (7-1-24) 03. Income of Participant in Facility. A participant residing in the long-term care facility at least one (1) full calendar month, beginning with their most recent admission, must have the deductions in below subtracted from their income, after the AABD exclusions are subtracted from the income. Total monthly income includes income paid into an income (Miller) trust that month. The income deductions must be subtracted in the order listed. Remaining income is patient liability. (7-1-24) a. AABD Income Exclusions. Income excluded in determining eligibility for AABD cash is subtracted. (7-1-24) b. Aid and Attendance and UME Allowances. VA Aid and Attendance allowance and Unusual Medical Expense (UME) allowance for a veteran or surviving spouse is subtracted, unless the veteran lives in a state operated veterans' home. (7-1-24) c. SSI Payment Two (2) Months. The SSI payment for a participant entitled to receive SSI at their at- home rate for up to two (2) months is subtracted, while temporarily in a long-term care facility. (7-1-24) d. AABD Payment. The AABD payment, and income used to compute the AABD payment, for a participant paid continued AABD payments up to three (3) months in long-term care is subtracted. (7-1-24) e. First Ninety ($90) Dollars of VA Pension. The first ninety ($90) dollars of a VA pension for a veteran in a private long-term care facility or a State Veterans Nursing Home is subtracted. (7-1-24) f. Personal Needs. Forty dollars ($40) is subtracted for the participant’s personal needs. For a veteran or surviving spouse in a private long-term care facility or a State Veterans Nursing Home the first ninety ($90) dollars of VA pension substitutes for the forty dollar ($40) personal needs deduction. (7-1-24) g. Employed and Sheltered Workshop Activity Personal Needs. For an employed participant or participant engaged in sheltered workshop or work activity center activities, the lower of the personal needs deduction of two hundred dollars ($200) or their gross earned income is subtracted. The participant's total personal needs allowance must not exceed two hundred and thirty dollars ($230). For a veteran or surviving spouse with sheltered workshop or earned income, and a protected VA pension, the total must not exceed two hundred dollars ($200). This is a deduction only. No actual payment can be made to provide for personal needs. (7-1-24) h. Home Maintenance. Two hundred and twelve dollars ($212) is subtracted for home maintenance cost if the participant had an independent living situation, before their admission for long-term care. Their physician must certify in writing the participant is likely to return home within six (6) months, after the month of admission to a long-term care facility. This is a deduction only. No actual payment can be made to maintain the participant’s home. (7-1-24) i. Maintenance Need. A maintenance need deduction for a family member living in the long-term care participant’s home is subtracted. A family member is claimed, or could be claimed, as a dependent on the Federal Income Tax return of the long-term care participant. The family member must be a minor or dependent child, dependent parent, or dependent sibling of the long-term care participant. The maintenance need deduction is the AFDC payment standard for the dependents, computed according to the AFDC State Plan in effect before July 16, 1996. (7-1-24) j. Medicare and Health Insurance Premiums. Expenses for Medicare and other health insurance premiums, and deductibles or coinsurance charges are subtracted, and not subject to payment by a third party. Deduction of Medicare Part B premiums is limited to the first two (2) months of Medicaid eligibility. Medicare Part B premiums must not be subtracted, if the participant got SSI or AABD cash the month prior to the month for which patient liability is being computed. (7-1-24) k. Mandatory Income Taxes. Taxes mandatorily withheld from unearned income for income tax purposes are subtracted. To qualify for deduction of mandatory taxes, the tax must be withheld from income before the participant receives the income. (7-1-24) l. Guardian Fees. Court-ordered guardianship fees of the lesser of ten percent (10%) of the monthly benefit handled by the guardian, or twenty-five dollars ($25) are subtracted. Where the guardian and trustee is the same person, the total deduction for guardian and trust fees must not exceed twenty-five dollars ($25) monthly. (7-1-24) m. Trust Fees. Up to twenty-five dollars ($25) monthly paid to the trustee for administering the participant’s trust is subtracted. (7-1-24) n. Impairment-Related Work Expenses (IRWE). IRWEs for an employed participant who is blind or disabled under AABD criteria are subtracted. IRWEs are purchased or rented items and services that are purchased or rented to perform work. The items must be needed because of the participant’s impairment. The actual monthly expense of the impairment-related items is subtracted. Expenses must not be averaged. (7-1-24) o. Income Garnished for Child Support. Income garnished for child support to the extent the expense is not already accounted for in computing the maintenance need standard is subtracted. (7-1-24) p. Incurred Medical Expenses. Amounts for certain limited medical or remedial care expenses that have current balances owed and are deemed medically necessary as defined in IDAPA 16.03.26, “Medicaid Plan Benefits,” are subtracted. Current medical expenses that are not covered by the Idaho Medicaid Plan, or by a third party, may be deducted from the base participation amount. (7-1-24) q. Pre-existing Medical Expenses. Amounts for medical and remedial care expenses incurred within the three (3) months prior to the month of application are subtracted. The deductions for medical and remedial care expenses are limited to those medically necessary expenses incurred by the participant for the participant’s care. These deductions are limited to the amount of liability owed by the participant, and if applicable, after any third-party insurance has been applied. The deduction for medical and remedial care expenses that were incurred as the result of imposition of a transfer of assets penalty period is limited to zero. (7-1-24)

Income ownership of a long-term care participant with a community spouse is determined before patient liability is computed. The participant’s income ownership is counted as shown below. (7-1-24) 01. Income Paid in the Name of Spouse. Income paid solely in the name of a spouse, and not paid from a trust, is the separate income of the spouse. (7-1-24) 02. Payment in Name of Both Spouses. Income paid in the names of both the long-term care participant and the community spouse is divided evenly between each spouse. (7-1-24) 03. Payment in Name of Spouse or Spouses and Another Person. Income paid in the names of the participant and/or the community spouse and another person is counted as available to each spouse, in proportion to the spouse’s ownership. If payment is made to both spouses, and no proportion of ownership is specified, one-half of the income is counted to each spouse. (7-1-24) 04. Payment of Aid and Attendance. In the case of VA Aid and Attendance Allowance paid in the veteran’s name, with an increment for the veteran’s spouse, the increment is counted to the veteran. (7-1-24)

For a participant with a community spouse, patient liability is computed as described in Subsection 723.03 of these rules with the addition of the following steps for Community Spouse Allowance (CSA): (7-1-24) 01. Shelter Adjustment. The Department will add the current Food Stamp Program Standard Utility Allowance to the community spouse’s shelter costs. Shelter costs include rent, mortgage principal and interest, homeowner’s taxes, insurance, and condominium or cooperative maintenance charges. The Standard Utility Allowance must be reduced by the value of any utilities included in maintenance charges for a condominium or cooperative. The Department will subtract the Shelter Standard from the shelter and utilities. The Shelter Standard is thirty percent (30%) of one hundred fifty percent (150%) of one-twelfth (1/12) of the income official poverty line defined by the federal Office of Management and Budget (OMB) for a family of two (2) persons. The Shelter Adjustment is the positive balance remaining. (7-1-24) 02. Community Spouse Need Standard (CSNS). The Department will add the Shelter Adjustment to the minimum CSNS. The minimum CSNS equals one hundred fifty percent (150%) of one-twelfth (1/12) of the income official poverty line defined by the OMB for a family unit of two (2) members. The minimum CSNS is revised annually in July. The total CSNS may not exceed the maximum CSNS. The maximum CSNS is computed by multiplying one thousand five hundred dollars ($1,500) by the percentage increase in the consumer price index for all urban consumers (all items, US city average) between September 1988 and the September before the current calendar year. The maximum CSNS is revised annually in January. (7-1-24) 03. Community Spouse Allowance (CSA). The Department will subtract the community spouse’s gross income from the CSNS. The community spouse’s income includes income produced by their resources. The Department will round any remaining cents to the next higher dollar. Any positive balance remaining is the CSA. The CSA is subtracted as actually paid to the community spouse, up to the computed maximum. A larger spouse support amount must be used as the CSA, if court-ordered. The CSA ordered by a court is not subject to the CSA limit. (7-1-24)

A nursing home participant may receive a PNS to bring their gross income up to forty dollars ($40). Gross income is income after exclusions and before disregards, and includes money withheld to recover an AABD overpayment. The PNS is the difference between the participant's gross income and forty dollars ($40). If not in an even dollar amount, the PNS is rounded up to the next dollar. The participant's income including the PNS must not exceed forty dollars ($40). (7-1-24)

Either spouse may ask for a fair hearing to show the community spouse needs a higher CSA. The hearing officer must consider if, due to unusual conditions, using the computed CSA causes significant financial hardship for the community spouse. If the fair hearing decision finds the community spouse needs more income than the CSA, the CSA must include the additional income. (7-1-24)

There are three (3) methods for Medicaid eligibility of an aged, blind, or disabled married person: (1) the SSI method, (2) the Community Property (CP) method, and (3) the Federal Spousal Impoverishment (FSI) method. The FSI method takes precedence. If the participant is not subject to the FSI method, the CP or SSI methods can be used. (7-1-24)

Table 732 is used to determine the resource counting method for a married person. If an HCBS participant with a spouse at home is not eligible using the FSI method, resources are computed using the SSI/CP method. TABLE 732 - CHOOSING FSI, SSI, OR CP RESOURCE COUNTING METHOD SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) IN NURSING IN NURSING AT HOME WITH AT HOME WITH AT HOME NO HOME BEFORE  HOME ON OR HCBS BEFORE HCBS ON OR HCBS 9/30/89 AFTER 9/30/89 9/30/89 AFTER 9/30/89 SPOUSE TWO (2) IN NURSING HOME SSI/CP SSI/CP SSI/CP SSI/CP SSI/CP BEFORE 9/30/89 SPOUSE TWO (2) IN NURSING HOME ON OR SSI/CP SSI/CP FSI SSI/CP SSI/CP AFTER 9/30/89 SPOUSE TWO (2) AT HOME SSI/CP FSI SSI/CP SSI/CP FSI NO HCBS SPOUSE TWO (2) AT HOME WITH HCBS SSI/CP SSI/CP SSI/CP SSI/CP SSI/CP BEFORE  9/30/89 SPOUSE TWO (2) AT HOME WITH HCBS ON SSI/CP SSI/CP FSI SSI/CP SSI/CP OR AFTER  9/30/89 (7-1-24)

Table 733 is used to determine the income counting method for a married person. If a participant subject to the FSI method is not eligible using FSI, income is computed using the SSI/CP method. TABLE 733 - CHOOSING FSI, SSI, OR CP INCOME COUNTING METHOD SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) SPOUSE ONE (1) IN NURSING IN NURSING AT HOME AT HOME WITH AT HOME HOME BEFORE HOME ON OR WITH HCBS HCBS ON OR NO HCBS 9/30/89 AFTER 9/30/89 BEFORE 9/30/89 AFTER 9/30/89 SPOUSE TWO (2) IN NURSING HOME SSI/CP SSI/CP FSI SSI/CP SSI/CP BEFORE  9/30/89 SPOUSE TWO (2) IN NURSING SSI/CP SSI/CP FSI SSI/CP SSI/CP HOME ON OR AFTER 9/30/89 SPOUSE TWO (2) AT HOME FSI FSI SSI/CP FSI FSI NO HCBS SPOUSE TWO (2) AT HOME WITH HCBS SSI/CP SSI/CP FSI SSI/CP SSI/CP BEFORE  9/30/89 SPOUSE TWO (2) AT HOME WITH HCBS ON SSI/CP SSI/CP FSI SSI/CP SSI/CP OR AFTER  9/30/89 (7-1-24)

Table 734 is used to determine the patient liability or participant participation method for a married participant in long-term care or receiving HCBS. TABLE 734 - PATIENT LIABILITY OR PARTICIPATION METHOD SPOUSE ONE IN SPOUSE ONE IN SPOUSE ONE AT SPOUSE ONE AT SPOUSE ONE AT NURSING HOME NURSING HOME HOME HOME WITH HCBS HOME BEFORE ON OR AFTER 9/ WITH HCBS ON OR AFTER 9/ NO HCBS 9/30/89 30/89 BEFORE 9/30/89 30/89 TABLE 734 - PATIENT LIABILITY OR PARTICIPATION METHOD SPOUSE TWO  IN NURSING HOME SSI/CP SSI/CP FSI SSI/CP SSI/CP BEFORE  9/30/89 SPOUSE TWO IN NURSING SSI/CP SSI/CP FSI SSI/CP SSI/CP HOME ON OR AFTER 9/30/89 SPOUSE TWO AT HOME  FSI FSI N/A FSI FSI NO HCBS SPOUSE TWO AT HOME WITH HCBS SSI/CP SSI/CP FSI SSI/CP SSI/CP BEFORE  9/30/89 SPOUSE TWO AT HOME WITH HCBS ON OR SSI/CP SSI/CP FSI SSI/CP SSI/CP AFTER  9/30/89 (7-1-24)

The FSI method must be used to compute income and resources of a married participant who requires long-term care as defined in Section 010 of these rules, and who has a community spouse. The participant must have entered long- term care on or after September 30, 1989. Terms used in the FSI method are listed below. (7-1-24) 01. Long-Term Care Spouse. Must be in a medical institution or nursing facility, or be an HCBS participant, for thirty (30) consecutive days, or appear likely to meet the thirty (30) days requirement. (7-1-24) 02. Community Spouse. The spouse of the long-term care participant. A community spouse is not in long-term care and is not an HCBS participant. (7-1-24) 03. Continuous Period of Long-Term Care. A period of residence either in a medical institution with nursing facility services, or at home with HCBS. A continuous period of long-term care is also a combination of institution and personal care services likely to last at least thirty (30) consecutive days. Absence from the institution, or a lapse in HCBS eligibility of thirty (30) consecutive days breaks continuity. The thirty (30) consecutive days of long-term care must not begin on a day the participant is hospitalized. If the participant is hospitalized after the first day of the thirty (30) consecutive days, the hospital stay does not interrupt the thirty (30) consecutive days. (7-1-24) 04. Start of Continuous Period of Long-Term Care. The first month of long-term care or HCBS. (7-1-24) 05. Nursing Facility Services. Services at the nursing facility level or the ICF/IID level provided in a medical institution. (7-1-24)

The assessment date is the start date of the first continuous period of long-term care. The Department does a one-time assessment to determine the value of the couple’s community and separate resources as of the date of the first continuous period of long-term care. The resource assessment is done at the request of either spouse, after one (1) spouse is in long-term care or meets the level of care for HCBS, whether or not the couple has applied for Medicaid. State laws relating to community property or the division of marital property are not applied in determining the FSI total combined resources of the couple. (7-1-24)

The resource rules used in determining eligibility for AABD cash and Medicaid are also used in determining the couple's total combined resources for the FSI resource assessment with the following exceptions: (7-1-24) 01. Resources for Sale. Excess resources offered for sale, are not excluded from the couple’s total combined resources for the FSI resource assessment. (7-1-24) 02. Jointly Owned Real Property. Jointly owned real property that is not the principal residence of the participant is not excluded if the community spouse is the joint owner. (7-1-24) 03. Long-term Care Partnership Policy. Resources excluded because of a participant’s qualified long-term care policy are not excluded for the FSI resource assessment. (7-1-24) 04. Excluded Home. As defined in 42 USC 1396r-5(c)(5), an excluded home placed in trust retains its exclusion for purposes of the resource assessment. (7-1-24)

The spousal share is one-half (1/2) of the couple’s total combined resources on the assessment date. The spousal share does not change, even if the participant leaves long-term care and then enters long-term care again. The Department must inform the couple of the resources counted in the assessment and the value assigned. The couple must sign the assessment form under penalty of perjury. The signature requirement may be waived for the long-term care spouse if they or their representative says they are unable to sign the resources assessment. A copy of the assessment form must be provided to each spouse when eligibility is determined or when either spouse requests an assessment prior to application. (7-1-24)

The CSRA protects resources for the community spouse. The CSRA is determined by subtracting the greater of the minimum resource allowance or the spousal share from the couple’s total combined resources as of the first day of the application month. The deduction must not be more than the maximum resource allowance at the time eligibility is determined. (7-1-24)

The maximum resource allowance is computed by multiplying sixty thousand dollars ($60,000) by the percentage increase in the consumer price index for all urban consumers (all items, US city average) between September 1988 and the September before the current calendar year. The minimum resource allowance is computed by multiplying twelve thousand dollars ($12,000) by the percentage increase in the consumer price index for all urban consumers (all items, US city average) between September 1988 and the September before the current calendar year. If the result is not an even one hundred dollar ($100) amount, the Department will round up to the next one hundred dollars ($100). The couple’s resources exceeding the CSRA are counted for the long-term care spouse. (7-1-24)

Income is determined prior to determining resources. If the couple’s income is more than the minimum CSNS, the CSRA cannot be increased. If the community spouse has less income than the minimum CSNS, the CSRA may be increased as provided in Section 745 of these rules. Couple income is the community spouse’s gross income plus the long-term care spouse’s income. The long-term care spouse’s income is their gross income less the AABD cash income exclusions and their patient liability income deductions, but not the CSA deduction. (7-1-24)

If the community spouse’s income, including income from their CSA and income-producing resources in their CSRA, is less than the minimum CSNS, the CSRA may be increased. The CSRA is increased by enough resources transferred from the long-term care spouse to raise the community spouse’s income to the minimum CSNS Resources included in the transfer are presumed to produce income at the treasury rate, whether or not the resources produce income. If the community spouse shows they are making reasonable use of their income and resources to generate income, the Department may waive the treasury rate requirement. Actual income produced by the resources transferred to the community spouse is used to compute the CSA. A higher CSA can be requested under Section 727 of these rules. If the transferred resources produce more than the treasury rate, the actual income produced is used to determine the additional resources that can be transferred to the community spouse in the CSRA. The long-term care spouse must transfer the resources to the community spouse, or the CSRA is not revised. (7-1-24)

The RTA is computed by subtracting the community spouse’s resources at the time of application from the CSRA. The community spouse must own less than the CSRA to get an RTA. The long-term care spouse may transfer the RTA to the community spouse without an asset transfer penalty. If the institutional spouse transfers more than the RTA, the amount of the couple’s resources over the CSRA counts as the institutional spouse’s resources. After the month, a long-term care spouse is determined Medicaid-eligible under FSI, resources of the community spouse are not considered available to them while they remain in long-term care. (7-1-24)

The long-term care spouse has sixty (60) days, from the date their application is approved, to transfer their ownership of the RTA resources to the community spouse. The long-term care spouse must state, in writing, their intent to transfer the RTA resources to the community spouse within the protected period before they can be Medicaid-eligible. Resources not transferred within the sixty (60) day protected period are available to the long-term care spouse, effective the day they entered the facility. (7-1-24)

The protected period can be extended beyond sixty (60) days, if necessary, because of the participant’s circumstances. (7-1-24)

When the community spouse is a Medicaid participant, the spouse’s resources are counted using Medicaid rules. The FSI rules apply only to the long-term care spouse. For the month the couple stopped living together, resources of the community spouse available for their Medicaid eligibility are the resources owned by the couple. (7-1-24)

When the community spouse is a Medicaid participant, the spouse’s income is counted using Medicaid rules. The FSI rules apply only to the long-term care spouse. The community spouse may choose between the SSI and CP methods for determining income for Medicaid eligibility. (7-1-24)

The FSI method of calculating income and resources stops the first full calendar month after a change in circumstances resulting in a couple no longer having a community spouse and a long-term care spouse. (7-1-24)

The Department must tell the participant about the CSA, the family member allowance, the CSRA and how it was computed, and the RTA. Any hearing requested about the CSRA or the RTA must be held within thirty (30) days of the date of the request for hearing. (7-1-24)

A married participant, not using FSI, must be furnished a written explanation of SSI and CP income and resource counting methods. The couple chooses the most useful method, based on their circumstances. The same method must be used for both spouses. (7-1-24)

The SSI method is the same method used to count income and resources for AABD cash. Income and resources of the participant and spouse are counted as mutually available. This method must be used for months either spouse gets SSI or AABD cash, or an SSI and/or AABD application is filed and approved. This method must be used for Medicaid eligibility, and liability for the cost of long-term care, whether or not one (1) or both spouses apply for Medicaid. For long-term care, the couple’s income and resources are mutually available when one (1) or both spouses apply during the month they separated, because one (1) or both left their mutual home to enter a long-term care facility. (7-1-24)

A married participant in long-term care, whose spouse is not in the community, can use the CP method. A married participant using the FSI method, but not income-eligible using FSI, may choose the CP method for income eligibility. The CP method must not be used for the FSI participant’s resource eligibility or patient liability. (7-1-24)

The CP method gives each spouse an equal one-half (1/2) share of the couple’s community income and resources. Each spouse also has their own separate income and resources. Whether the spouses live together or, if not living together, the length of time they have lived apart, does not change the way income and resources are counted. A spouse’s property includes income, personal property, and real property. The income and resources of a married couple acquired during the marriage are presumed to be community property of the couple. The couple can give evidence to rebut the presumption that property acquired during the marriage is community property. (7-1-24)

An agreement between spouses, transferring or assigning rights to future income from one (1) spouse to the other, is not valid for eligibility for Medicaid. (7-1-24)

The participant is budgeted as a single person if their spouse is not a Medicaid applicant, is not living with them, or was not living with them on the first day of the month. The participant and spouse are budgeted as a couple if they both apply and live together, or if they were living together on the first day of the month. (7-1-24)

The participant’s resource limit is two thousand dollars ($2,000) if their spouse is not a Medicaid applicant, is not living with them, or was not living with them on the first day of the month. The participant and spouse have a resource limit of three thousand dollars ($3,000) if they both apply and live together, or if they were living together on the first day of the month. (7-1-24)

The participant gets the twenty dollar ($20) standard disregard if their spouse is not a Medicaid applicant, is not living with them, or was not living with them on the first day of the month. If the participant has earned income, they get the sixty-five dollar plus one-half ($65 + 1/2) of the remainder earned income disregard. The participant and spouse get the standard disregard on their combined unearned income if they both apply, and live together, or if they were living together on the first day of the month. If either spouse has earned income, they get the earned income disregard from their combined earned income. (7-1-24)

An SSI recipient, or an individual who would be SSI eligible if they applied, is eligible for Medicaid if they meet any of the conditions below. (7-1-24) 01. Receives SSI. Gets SSI payments, even if eligibility is based on presumptive disability or presumptive blindness. (7-1-24) 02. Conditionally Eligible for SSI. Based on an agreement to dispose of excess resources. (7-1-24) 03. Eligible Spouse. Has their SSI payments combined with their spouse’s SSI payments. (7-1-24)

An SSI recipient is not eligible for Medicaid if they meet any of the conditions below. (7-1-24) 01. Medicaid Qualifying Trust. Has excess income from a Medicaid Qualifying Trust, created and funded before August 11, 1993. (7-1-24) 02. Noncooperation. Fails to cooperate in establishing paternity or securing support. (7-1-24) 03. Is in an Ineligible Institution. (7-1-24) 04. Trust. Has a trust that makes them ineligible for Medicaid. (7-1-24)

A resident of a long-term care psychiatric medical facility is eligible for Medicaid if they are age sixty-five (65) or older. They must meet all the requirements of a long-term care resident. (7-1-24)

A participant receiving RSDI is eligible for Medicaid if they became and remain ineligible for SSI payments as of April 2011, or for AABD cash or SSI payments from May 1977 through March 2011. The participant must still be entitled to AABD cash or SSI, except for a COLA in RSDI benefits. All RSDI COLAs received by the participant, and any person whose income and resources are counted in determining the participant’s eligibility, are disregarded for Medicaid. (7-1-24)

A participant may be eligible for Medicaid under Section 1619(b) of the Social Security Act either under federal or state criteria, depending on their circumstances. (7-1-24) 01. Federally Qualified Under SSA Section 1619(b). An SSI recipient with a disability, previously eligible for SSI cash, who, because of earnings from employment, no longer meets the financial eligibility requirements for SSI cash, is eligible for Medicaid. SSA determines the qualification for eligibility under Section 1619(b). (7-1-24) 02. State-Only Qualified Under SSA Section 1619(b). An AABD cash participant with a disability, who, because of earnings from employment, no longer meets the financial eligibility requirements for AABD cash, may be eligible for Medicaid. The Department determines eligibility for State-only Section 1619(b) Medicaid. State- only Section 1619(b) Medicaid is authorized under Section 1905(q) of the Social Security Act. (7-1-24) a. A participant must meet all the following requirements to be eligible for State-only 1619(b) Medicaid. The participant: (7-1-24) i. Received AABD cash in the month prior to the first month of their eligibility under this rule. (7-1-24) ii. Is under age sixty-five (65). (7-1-24) iii. Continues to have a disability. (7-1-24) iv. Must depend on Medicaid coverage to continue working. An individual depends on Medicaid coverage if they: (7-1-24) (1) Used Medicaid coverage within the past twelve (12) months; (7-1-24) (2) Expect to use Medicaid coverage in the next twelve (12) months; or (7-1-24) (3) Would be unable to pay unexpected medical bills in the next twelve (12) months without Medicaid coverage. (7-1-24) v. Is not able to afford medical insurance equivalent to Medicaid, including attendant care. The participant meets this requirement if their earnings are under the limit referred to in Subsection 782.02.a.vii. of this rule. (7-1-24) vi. Continues to meet all the non-disability eligibility requirements in these rules. (7-1-24) vii. Has annual gross earned income less than the current calendar year's charted threshold for Idaho as developed by SSA for federal qualification for Section 1619(b) Medicaid. The charted threshold for Idaho is SI 02302.200 Charted Threshold Amounts, incorporated by reference in Subsection 002.04. (7-1-24) b. State-only Section 1619(b) Medicaid ends when the participant meets one (1) of the following criteria. The participant: (7-1-24) i. Is no longer eligible for AABD cash for a reason other than excess earned income; (7-1-24) ii. Has gross earned income equal to or more than the current calendar year's annual earnings threshold for Idaho developed by the SSA for federal Section 1619(b) Medicaid; (7-1-24) iii. Is age sixty-five (65) or older; or (7-1-24) iv. Regains eligibility for AABD cash. (7-1-24)

An applicant denied Medicaid, because they do not meet SSI eligibility or RSDI disability requirements, can appeal the SSA denial with SSA. They can get Medicaid, if found eligible for SSI or Social Security disability because of their appeal. The effective date for Medicaid is the first day of the month that the Medicaid application was denied, by SSA. The participant’s eligibility for backdated Medicaid coverage must be determined. (7-1-24)

A Medicaid participant, denied RSDI or SSI because they are not disabled, can continue to get Medicaid if they appeal the SSA decision. The appeal must be filed within sixty (60) days of the SSA decision. If the final administrative decision rules against the participant’s appeal, Medicaid benefits must end. Medicaid benefits paid during the appeal are not an overpayment. (7-1-24)

A disabled child, not eligible for Medicaid outside a medical institution, is eligible for Medicaid if they meet the conditions below. (7-1-24) 01. Age. Is under nineteen (19) years old. (7-1-24) 02. AABD Criteria. Meets the AABD blindness or disability criteria. (7-1-24) 03. AABD Resource Limit. Meets the AABD single person resource limit. (7-1-24) 04. Income Limit. Has monthly income not exceeding three (3) times the federal SSI benefit payable monthly to a single person. (7-1-24) 05. Eligible for Long-Term Care. Meets the medical conditions for long-term care in IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24) 06. Appropriate Care. Is appropriately cared for outside a medical institution, under a physician’s plan of care. (7-1-24) 07. Cost of Care. Can be cared for cost effectively outside a medical institution. The estimated cost of caring for the child must not exceed the cost of the child’s care in a hospital, nursing facility, or ICF/IID. (7-1-24) 08. Share of Cost. The financially responsible adult of a certain disabled child, who has family income above one hundred fifty percent (150%) of the federal poverty guidelines, is required to share in the cost of the child’s Medicaid benefits pursuant to the Idaho Medicaid State Plan and Section 56-2203, Idaho Code. (7-1-24)

An aged, blind, or disabled participant, who is not income eligible for SSI or AABD cash, in their own home or community setting, is eligible for Medicaid if they meet the conditions below and meets all requirements in one (1) of the waiver Sections 788 through 789 of these rules. (7-1-24) 01. Resource Limit. Meets the AABD single person resource limit. (7-1-24) 02. Income Limit. Income of the participant must not exceed three (3) times the federal SSI monthly benefit for a single person. A married participant living at home with their spouse who is not an HCBS participant, may choose between the SSI, CP, and FSI methods. If their spouse is also an HCBS participant or lives in a nursing home, the couple may choose between the SSI and CP methods. (7-1-24) 03. Maintained in the Community. The applicant must be able to be maintained safely and effectively in their own home or in the community with the waiver services. (7-1-24) 04. Cost of Care. The cost of the participant's care must be cost effective as provided in IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24) 05. Waiver Services Needed. The participant must need and receive, or be likely to need and receive, waiver services for thirty (30) consecutive days. The participant is ineligible when there is a break in need for, or receipt of, waiver services for thirty (30) consecutive days. (7-1-24) 06. Effective Date. Waiver services are effective the first day the participant is likely to need and receive waiver services. Medicaid begins the first day of the month in which the first day of approved waiver services are received. (7-1-24) 07. Annual Limit. The Department limits the number of participants approved for waiver services each year. A participant who applies for waiver services after the annual limit is reached, must be denied waiver services. (7-1-24)

To be eligible for the Aged and Disabled (A&D) Waiver the participant must: (7-1-24) 01. Age Eighteen Through Sixty-Four. Be eighteen (18) through sixty-four (64) years old and meet the disability criteria, as provided in Section 156 of these rules, and need nursing facility level of care under IDAPA 16.03.26, “Medicaid Plan Benefits”; or (7-1-24) 02. Age Sixty-Five or Older. Be age sixty-five (65) or older and need nursing facility level of care under IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24)

To be eligible, the participant must be at least eighteen (18) years of age and need the level of care provided by an ICF/IID under IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24)

An individual is eligible to participate in the Medicaid for Workers with Disabilities coverage group if the individual meets the requirements below. (7-1-24) 01. Non-Financial Requirements. An individual must: (7-1-24) a. Be at least sixteen (16) but less than sixty-five (65) years of age; (7-1-24) b. Meet the Medicaid residency requirement under Section 100 of these rules; (7-1-24) c. Meet the citizenship requirements under 42 CFR 435.406, Citizenship and Non-citizen Eligibility; (7-1-24) d. Meet the SSN requirements under Section 10 3of these rules; and (7-1-24) e. Meet the child support cooperation requirements under Sections 703 through 706 of these rules. (7-1-24) 02. Disability. An individual must meet the medical definition for having a disability or blindness used by the SSA for Social Security Disability Insurance (SSDI) and SSI benefits. (7-1-24) 03. Employment. An individual must be employed which may include self-employment. Proof of employment must be provided to the Department. Hourly wage or hours worked will not be used to determine employment. (7-1-24) 04. Countable Resources. Cannot exceed ten thousand dollars ($10,000) for an individual or fifteen thousand dollars ($15,000) for a couple. When calculating resources, the following items will be excluded: (7-1-24) a. Any resources excluded under Section 210 and Sections 222 through 299 of these rules; (7-1-24) b. A second vehicle as described in Section 222 of these rules; (7-1-24) c. Life insurance policies; (7-1-24) d. Retirement accounts; and (7-1-24) e. Exempt trusts as described in Section 872 of these rules. (7-1-24) 05. Countable Income. Is calculated using exclusions and disregards as described in Sections 300 through 547 of these rules. The countable income for: (7-1-24) a. An individual cannot exceed five hundred percent (500%) of the current federal poverty guideline for a household of one (1). (7-1-24) b. A couple cannot exceed five hundred percent (500%) of the current federal poverty guideline for a household of two (2). (7-1-24) 06. Earned Income Test. Gross income is the total of earned and unearned income before exclusions or disregards. Each individual’s gross earned income must be at least fifteen percent (15%) of their total gross income to qualify. (7-1-24) 07. Cost-Sharing. A participant in the Medicaid for Workers with Disabilities coverage group may be required to cost-share; the costs are determined under the provisions of the Idaho Medicaid State Plan. (7-1-24)

A woman not otherwise eligible for Medicaid and meeting the conditions in Subsections 802.01 through 802.06 of this rule is eligible for Medicaid for the duration of her cancer treatment. Medicaid income and resource limits do not apply to this coverage group. (7-1-24) 01. Diagnosis. The participant is diagnosed with breast or cervical cancer through the CDC's National Breast and Cervical Cancer Early Detection Program. (7-1-24) 02. Age. The participant is under age sixty-five (65). (7-1-24) 03. Creditable Health Insurance. The participant is uninsured or, if insured, the plan does not cover her type of cancer. (7-1-24) 04. Non-Financial Eligibility. The participant meets the Medicaid non-financial eligibility requirements in Sections 100 through 108 and Sections 166 and 167 of these rules. (7-1-24) 05. Medical Support Cooperation. The participant meets the medical support cooperation requirement in Sections 702 through 706 of these rules. (7-1-24) 06. Group Health Plan Enrollment. The participant meets the requirement to enroll in available cost- effective employer group health insurance. (7-1-24) 07. Presumptive Eligibility. The Department can presume the participant is eligible for Medicaid, before a formal Medicaid eligibility determination is made. A clinic authorized to screen for breast or cervical cancer by the National Breast and Cervical Cancer Early Detection Program makes the presumptive eligibility determination. The clinic tells the participant how to complete the formal Medicaid determination process. The Medicaid notice and hearing rights do not apply to presumptive eligibility. No overpayment occurs if the formal Medicaid determination finds the participant is not eligible. (7-1-24) 08. End of Treatment. The Department determines the end of treatment date under IDAPA 16.03.26, “Medicaid Plan Benefits.” (7-1-24)

A participant age eighteen (18) or older is eligible for Medicaid if they received SSI or AABD cash based on blindness or a disability which began before they reached age twenty-two (22), and becomes ineligible for and remains ineligible for AABD cash or SSI because their disabled child RSDI benefit started or increased July 1, 1987, or later. (7-1-24) 01. RSDI Benefits Disregarded for Disabled Adult Child. If the participant became ineligible because they began receiving a disabled child benefit on or after July 1, 1987, the benefit amount and any later increases are disregarded. (7-1-24) 02. RSDI Increase Disregarded for Disabled Adult Child. If the participant became ineligible because their disabled child benefit increased on or after July 1, 1987, the increase and any later increases are disregarded. (7-1-24)

A participant who meets the conditions below is considered an SSI recipient for Medicaid. (7-1-24) 01. Age. The participant, age fifty (50) to age sixty four and one-half (64-1/2), began receiving early widows or widowers Social Security benefits. (7-1-24) 02. Lost SSI or AABD. The participant lost SSI or AABD cash because they began receiving early widows or widowers Social Security benefits. (7-1-24) 03. Received SSI or AABD. The participant received SSI or AABD cash in the month, before the month, they became ineligible because they began receiving early widows or widowers Social Security benefits. (7-1-24) 04. Widows or Widowers Benefits. The participant would still be eligible for SSI or AABD cash if their Social Security early widows or widowers benefits were not counted as income. (7-1-24) 05. No “Part A” Insurance. The participant is not entitled to Medicare Part A hospital insurance. (7-1-24) 06. Applied On or After January 1, 1991. The participant’s Medicaid application was filed, or pending, on or after January 1, 1991. (7-1-24)

A person meeting all requirements below is eligible for QMB, which pays Medicare premiums, coinsurance, and deductibles. (7-1-24) 01. Medicare Part A. The participant must be entitled to hospital insurance under Part A of Medicare at the time of their application. (7-1-24) 02. Nonfinancial Requirements. The participant must meet the Medicaid residence, citizenship, support cooperation, and SSN requirements. (7-1-24) 03. Income. Monthly income must not exceed one hundred percent (100%) of the Federal Poverty Guidelines (FPG). The single person income limit is the poverty line for a family of one (1) person. The couple income limit is the poverty line for a family of two (2) persons. The annual Social Security cost of living increase is disregarded from income, until the month after the month the annual FPG revision is published. AABD cash is not counted as income. The income exclusions and disregards used for AABD are used for QMB. (7-1-24) 04. Dependent Income. Income of the dependent child, parent, or sibling is not counted. (7-1-24) 05. QMB Dependent Family Member Disregard. A dependent family member is a minor child, adult child meeting SSA disability criteria, parent or sibling of the participant or spouse living with the participant. The family member is or could be claimed on the federal tax return of the participant or spouse. A participant with a dependent family member has an income disregard based on family size. The spouse is included in family size, whether or not the spouse is also participant. The disregard is based on the official poverty line income as defined by the OMB. The disregard is the difference between the poverty line for one (1) person, or two (2) persons if the participant has a spouse, and the poverty line for the family size including the participant, spouse, and dependent. (7-1-24) 06. Resource Limit. The resource limit is equal to the amount defined under 42 USC 1396d(p)(1)(C). The resource exclusions used for AABD are used for QMB. (7-1-24) 07. Effective Dates. The effective date of QMB coverage is no earlier than the first day of the month after the approval month. A QMB participant is not entitled to backdated Medicaid. (7-1-24)

A person meeting all requirements below is eligible for SLMB. Medicaid pays the Medicare Part B premiums for a SLMB. The income and resource exclusions and disregards used for AABD are used for SLMB. (7-1-24) 01. Other Medicaid. The SLMB may be eligible for other Medicaid. (7-1-24) 02. Medicare Part A. The SLMB must be entitled to hospital insurance under Part A of Medicare at the time of their application. (7-1-24) 03. Nonfinancial Requirements. The SLMB must meet the Medicaid eligibility requirements of residence, citizenship, support cooperation, and SSN. (7-1-24) 04. Income. The annual Social Security cost of living increase is disregarded from income, until the month after the month the annual FPG revision is published. The single person limit is based on a family of one (1). The couple limit is based on a family of two (2). The monthly income limit is up to one hundred twenty percent (120%) of the FPG. (7-1-24) 05. Resource Limit. The resource limit is equal to the amount defined under 42 USC 1396d(p)(1)(C). The resource exclusions used for AABD are used for SLMB. (7-1-24) 06. Effective Dates. SLMB coverage begins on the first day of the application month, which may be backdated up to three (3) calendar months before the application month. (7-1-24)

A person meeting all requirements below is eligible for QI. Medicaid pays the Medicare Part B premiums for a QI. The income and resource exclusions and disregards used for AABD are used for QI. (7-1-24) 01. Other Medicaid. The QI cannot be eligible for any other type of Medicaid. (7-1-24) 02. Medicare Part A. The QI must be entitled to hospital insurance under Part A of Medicare at the time of their application. (7-1-24) 03. Nonfinancial Requirements. The QI must meet the Medicaid eligibility requirements of residence, citizenship, support cooperation, and SSN. (7-1-24) 04. Income. The annual Social Security cost of living increase is disregarded from income, until the month after the month the annual FPG revision is published. The single person limit is based on a family of one (1). The couple limit is based on a family of two (2). The monthly income limit is up to one hundred thirty-five percent (135%) of the FPG. (7-1-24) 05. Resource Limit. The resource limit is equal to the amount defined under 42 USC 1396d(p)(1)(C). The resource exclusions used for AABD are used for SLMB. (7-1-24) 06. Coverage Limits. There is an annual limit on participants served based on availability of federal funds. New applications are denied when the annual limit is reached. (7-1-24) 07. Effective Dates. QI coverage begins on the first day of the application month, which may be backdated up to three (3) calendar months before the application month. (7-1-24)

A person meeting all requirements below is eligible for QDWI. The person must not be eligible for any other type of Medicaid. A QDWI is eligible only for Medicaid payment of their Medicare Part A premium. (7-1-24) 01. Age and Disability. The participant must be a disabled worker under age sixty-five (65). (7-1-24) 02. Nonfinancial Requirements. The participant must meet the Medicaid eligibility requirements of residence, citizenship, support cooperation and SSN. (7-1-24) 03. Section 1818A Medicare. SSA determined the participant meets the conditions of Section 1818A of the Social Security Act. (7-1-24) 04. Income. Monthly income must not exceed two hundred percent (200%) of the one (1) person official poverty line defined by the OMB. (7-1-24) 05. Resource Limit. The resource limit is equal to the amount defined under 42 USC 1396d(s). The resource exclusions used for AABD are used for QDWI. (7-1-24)

All income and resources of a legal non-citizen’s sponsor are deemed for Medicaid eligibility if the sponsor has signed an I-864 affidavit of support. (7-1-24)

Income and resources of a child’s stepparent are not deemed to the child in determining their Medicaid eligibility. (7-1-24)

A person denied SSI or AABD cash because of the prohibition against payment to fugitive felons and probation and parole violators is not disqualified from Medicaid. (7-1-24)

Starting August 11, 1993, the participant is subject to a penalty if they transfer their income or resources for less than fair market value. The asset transfer penalty applies to Medicaid services received October 1, 1993 and later. Excluded resources, other than the home and associated property, are not subject to the asset transfer penalty. Asset transfers subject to penalty under these rules may be voided and set aside by court action as provided in Section 56- 218, Idaho Code. The asset transfer penalty applies to a Medicaid participant in long-term care or HCBS. A participant in long-term care is a patient in a nursing facility or a patient in a medical institution, requiring and receiving the level of care provided in a nursing facility. (7-1-24) 01. Rebuttable Presumption. Unless a transfer meets the requirements of Section 841 of these rules, it is presumed that the transfer was made for the purpose of qualifying for Medicaid. The asset transfer penalty is applied unless the participant shows that the asset transfer would not have affected their eligibility for Medicaid, or the transfer was made for another purpose than qualifying for Medicaid. (7-1-24) 02. Contract for Services Provided by a Relative. A contract for personal services to be furnished to the participant by a relative is presumed to be made for the purpose of qualifying for Medicaid. The asset transfer penalty applies unless the participant shows that: (7-1-24) a. A written contract for personal services was signed before services were delivered. The contract must require that payment be made after services are rendered. The contract must be dated, and the signatures notarized. Either party must be able to terminate the contract; and (7-1-24) b. The contract must be signed by the participant or a legally authorized representative through a power of attorney, legal guardianship, or conservatorship. A representative who signs the contract must not be the provider of the personal care services under the contract; and (7-1-24) c. Compensation for services rendered must be comparable to rates paid in the open market. (7-1-24) 03. Transfer of Income or Resources. Transfer of income or resources includes reducing or eliminating the participant’s ownership or control of the asset. (7-1-24) 04. Transfer of Income or Resources by a Spouse. A transfer by the participant’s spouse of either spouse’s income or resources, before eligibility is established, subjects the participant to the asset transfer penalty. After the participant’s eligibility is established, a transfer by the spouse of the spouse’s own income or resources does not subject the participant to the asset transfer penalty. (7-1-24) 05. Transfer of Certain Notes and Loans. Funds used to purchase a promissory note, loan, or mortgage are considered a transferred asset which subjects the participant to a period of ineligibility. The amount of the asset transfer of such note, loan, or mortgage is the outstanding balance due on the date of the Medicaid application, unless the note, loan, or mortgage meets the following: (7-1-24) a. Has a repayment term that is actuarially sound; (7-1-24) b. Provides for payments to be made in equal amounts during the term of the loan with no deferral and no balloon payments; and (7-1-24) c. Prohibits the cancellation of the balance upon the death of the lender. (7-1-24)

The asset transfer penalty is restricted Medicaid coverage. (7-1-24) 01. Restricted Coverage. Means Medicaid will not participate in the cost of nursing facility services or in a level of care in a medical institution equal to nursing facility services. The penalty for a person receiving PCS or community services under the HCBS waiver is ineligibility. (7-1-24) 02. Notice and Exemption. The participant must be notified in writing, at least ten (10) days before an asset transfer penalty is imposed. (7-1-24)

The asset transfer penalty applies to any transfer for less than fair market value made during a period preceding or following a request for long-term care services. Any asset transferred, regardless of type, is subject to a look-back period of sixty (60) months. The look-back period is counted from the date of the application for long-term care or HCBS services or the date of the transfer, whichever is later in time. (7-1-24)

The period of restricted coverage is the number of months computed by dividing the net uncompensated value of the transferred asset by the statewide average cost of nursing facility services to private patients. The cost is computed for the time of the participant’s most recent request for Medicaid. If the spouse becomes eligible for long-term care Medicaid, the rest of the period of restricted coverage is divided between the participant and spouse. (7-1-24)

Restricted coverage continues until the participant or spouse recovers all the assets, receives fair market value at the time of the transfer for all assets, or the period of restricted coverage ends. The penalty continues whether or not the participant is in long-term care. For assets transferred, the penalty period begins running the first day of the month after the month the transfer took place or was discovered to have taken place, or the date the individual would have been eligible for long-term care services or HCBS, if not for the transfer, whichever date is later in time. The value of all asset transfers made during the look-back period is accumulated for the purpose of calculating the penalty. If an additional transfer is discovered after the penalty has been served, a new penalty period begins the month following timely notice of closure of benefits. When a penalty period ends after the first day of the month, eligibility for long- term care services begins the day after the penalty period ends. (7-1-24)

A penalty period is computed for each transfer. One (1) penalty period must expire before the next begins. (7-1-24)

01. Transfer of a Remainder Interest. When a life estate in real property is retained by an individual, and a remainder interest in the property is transferred during the look-back period for less than the fair market value of the remainder interest transferred, the value of the uncompensated remainder is subject to the asset transfer penalty as described in Sections 831 through 835 of these rules. To compute the value of the life estate remainder, multiply the fair market value of the real property at the time of transfer by the remainder factor for the participant’s age at the time of transfer listed in the following table: TABLE 837.01 - REMAINDER TABLE Age Remainder Age Remainder Age Remainder Age Remainder 0 .02812 28 .03938 56 .20994 84 .63002 1 .01012 29 .04187 57 .22069 85 .64641 2 .00983 30 .04457 58 .23178 86 .66236 TABLE 837.01 - REMAINDER TABLE Age Remainder Age Remainder Age Remainder Age Remainder 3 .00992 31 .04746 59 .24325 87 .67738 4 .01019 32 .05058 60 .25509 88 .69141 5 .01062 33 .05392 61 .26733 89 .70474 6 .01116 34 .05750 62 .27998 90 .71779 7 .01178 35 .06132 63 .29304 91 .73045 8 .01252 36 .06540 64 .30648 92 .74229 9 .01337 37 .06974 65 .32030 93 .75308 10 .01435 38 .07433 66 .33449 94 .76272 11 .01547 39 .07917 67 .34902 95 .77113 12 .01671 40 .08429 68 .36390 96 .77819 13 .01802 41 .08970 69 .37914 97 .78450 14 .01934 42 .09543 70 .39478 98 .79000 15 .02063 43 .10145 71 .41086 99 .79514 16 .02185 44 .10779 72 .42739 100 .80025 17 .02300 45 .11442 73 .44429 101 .80468 18 .02410 46 .12137 74 .46138 102 .80946 19 .02520 47 .12863 75 .47851 103 .81563 20 .02635 48 .13626 76 .49559 104 .82144 21 .02755 49 .14422 77 .51258 105 .83038 22 .02880 50 .15257 78 .52951 106 .84512 23 .03014 51 .16126 79 .54643 107 .86591 24 .03159 52 .17031 80 .56341 108 .89932 25 .03322 53 .17972 81 .58033 109 .95455 26 .03505 54 .18946 82 .59705 27 .03710 55 .19954 83 .61358 (7-1-24) 02. Transfer of a Life Estate. When a life estate in real property is transferred by an individual during the look-back period for less than fair market value, the value of the life estate is subject to the asset transfer penalty as described in Sections 831 and 835 of these rules. To compute the value of the life estate, multiply the fair market value of the real property at the time of transfer by the life estate factor for the participant’s age at the time of transfer listed in the following table: TABLE 837.02 - LIFE ESTATE TABLE Age Life Estate Age Life Estate Age Life Estate Age Life Estate 0 .97188 28 .96062 56 .79006 84 .36998 1 .98988 29 .95813 57 .77391 85 .35359 2 .99017 30 .95543 58 .76822 86 .33764 3 .99008 31 .95254 59 .75675 87 .32262 4 .98981 32 .94942 60 .74491 88 .30859 5 .98938 33 .94608 61 .73267 89 .29526 6 .98884 34 .94250 62 .72002 90 .28221 7 .98822 35 .93868 63 .70696 91 .26955 8 .98748 36 .93460 64 .69352 92 .25771 9 .98663 37 .93026 65 67970 93 .24692 10 .98565 38 .92567 66 .66551 94 .23728 11 .98453 39 .92083 67 .65098 95 .22887 12 .98359 40 .91571 68 .63610 96 .22181 13 .98198 41 .91030 69 .62086 97 .21550 14 .98066 42 .90457 70 .60522 98 .21000 15 .97937 43 .89855 71 .58914 99 .20486 16 .97815 44 .89221 72 .57261 100 .19975 17 .97700 45 .88558 73 .55571 101 .19532 18 .97590 46 .87863 74 .53862 102 .19054 19 .97480 47 .87137 75 .52149 103 .18437 20 .97365 48 .86374 76 .50441 104 .17856 21 .97425 49 .85578 77 .48742 105 .16962 22 .97120 50 .83743 78 .47049 106 .15488 23 .96986 51 .83674 79 .45357 107 .13409 24 .96841 52 .82969 80 .43659 108 .10068 25 .96678 53 .82028 81 .41967 109 .04545 26 .96495 54 .81054 82 .40295 27 .96290 55 .80046 83 .38642 (7-1-24)

Except as provided in this rule, when assets are used to purchase an annuity during the look-back period, it is an asset transfer presumed to be made for the purpose of qualifying for Medicaid. To rebut this presumption, the participant must provide proof that clearly establishes the annuity was not purchased to make the participant eligible for Medicaid or avoid recovery from the estate following death. Proof is met if the participant shows the annuity meets the requirements Subsections 838.02 through 838.05 of this rule. (7-1-24) 01. Revocable Annuity. Is an annuity that can be assigned. The surrender amount of a revocable annuity is a countable resource. (7-1-24) 02. Irrevocable Annuity. The purchase price of an irrevocable, non-assignable annuity is treated as an asset transfer, unless the requirements of Subsections 838.03 through 838.05 of this rule are met. (7-1-24) 03. Irrevocable Annuity Life Expectancy Test. The participant’s life expectancy, as shown in the Social Security Actuarial - Period Life Table (2020), must equal or exceed the term of the annuity. Using the Table, compare the face value of the annuity to the participant’s life expectancy at the purchase time. The annuity meets the life expectancy test if the participant’s life expectancy equals or exceeds the term of the annuity. If the exact age is not in the Table, use the next lower age. See https://www.ssa.gov/oact/STATS/table4c6.html. (7-1-24) 04. State Named as Beneficiary. The purchase of an annuity is treated as an asset transfer unless the State of Idaho, Medicaid Estate Recovery is named as: (7-1-24) a. The remainder beneficiary in the first position for at least the total amount of medical assistance paid on behalf of the institutionalized individual under this title; or (7-1-24) b. The remainder beneficiary in the second position after the community spouse or minor or disabled child and is named in the first position if the community spouse or a representative of the minor or disabled child disposes of any remainder for less than fair market value. (7-1-24) 05. Equal Payment Test. The annuity must provide for payments in equal amounts during the term of the annuity with no deferral and no balloon payments made. (7-1-24) 06. Permitted Annuity. The purchase of an annuity is not treated as an asset transfer if the annuity meets any of the descriptions in Sections 408(b), or 408(q), Internal Revenue Code; or is purchased with proceeds from an account or trust described in Sections 408(a), 408(c), or 408(p), Internal Revenue Code, or is a simplified employee pension as described in Section 408(k), Internal Revenue Code, or is a Roth IRA described in Section 408A, Internal Revenue Code. (7-1-24)

A trust established wholly or partly from the participant’s assets is an asset transfer. Assets transferred to a trust on or after August 11, 1993 are subject to the asset transfer penalty, regardless of when the trust was established. If the trust includes assets of another person, the asset transfer penalty applies to the participant’s share of the trust. (7-1-24)

Transfer of an asset owned jointly by the participant and another person is considered a transfer by the participant. The participant’s share of the asset is used to compute the penalty. If the participant and their spouse are joint owners of the transferred asset, the couple’s combined ownership is used to compute the penalty. If the spouse becomes eligible for long-term care Medicaid, the rest of the period of restricted coverage is divided between the participant and spouse. (7-1-24)

A participant is not subject to the asset transfer penalty for taking any action described in Subsections 841.01 through 841.15 of this rule. (7-1-24) 01. Home to Spouse. The asset transferred was a home. Title to the home was transferred to the spouse. (7-1-24) 02. Home to Minor Child or Disabled Adult Child. The asset transferred was a home. Title to the home was transferred to the child of the participant or spouse. The child must be under age twenty-one (21) or blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. (7-1-24) 03. Home to Brother or Sister. The asset transferred was a home. Title to the home was transferred to a sibling of the participant or spouse. The sibling must have an equity interest in the transferred home and reside in that home for at least one (1) year immediately before the month the participant starts long-term care. (7-1-24) 04. Home to Adult Child. The asset transferred was a home. Title to the home was transferred to a child of the participant or spouse, other than a child under the age of twenty-one (21). The child must reside in that home for at least two (2) years immediately before the month the participant started long-term care. The adult child must prove they provided nursing facility level medical care to the participant which permitted them to live at home rather than enter long-term care. The child must not have received payment from Medicaid for home and community- based services provided to the participant. (7-1-24) 05. Benefit of Spouse. The assets were transferred to the participant’s spouse or to another person for the sole benefit of the spouse. (7-1-24) 06. Transfer From Spouse. The assets were transferred from the participant’s spouse to another person for the sole benefit of the participant’s spouse. (7-1-24) 07. Transfer to Child. The assets were transferred to the participant’s child, or to a trust established solely for the benefit of the participant’s child. The child must be blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. The child may be any age. (7-1-24) 08. Intent to Get Fair Market Value. The participant or spouse proves they intended to dispose of the assets at fair market value or for other adequate consideration. (7-1-24) 09. Assets Returned. All assets transferred for less than fair market value have been returned to the participant. (7-1-24) 10. Medicaid Qualification Not the Intent. The participant or spouse proves the assets were transferred exclusively for a purpose other than to qualify for Medicaid or to avoid recovery. (7-1-24) 11. Undue Hardship. The participant, their representative, or the facility in which they reside may request the hardship waiver. The hardship waiver must be requested in writing within ten (10) days of the date of the asset transfer penalty notice. Undue hardship exists if any of the conditions below apply. (7-1-24) a. The participant proves they are not able to pay for their nursing facility services or their waiver services by any means. (7-1-24) b. The participant proves that they have made reasonable efforts, consistent with their physical and financial ability, to recover the transferred asset. The participant must fully cooperate with the State of Idaho in efforts to recover the transferred asset and, upon request, must assign their rights to recover the asset to the State of Idaho. (7-1-24) c. The participant proves they did not knowingly transfer the asset. (7-1-24) d. The participant proves they would be deprived of food, clothing, shelter, or other necessities of life if the asset transfer penalty is imposed and they assign their rights to recover the asset to the State of Idaho. (7-1-24) 12. Exception to Fair Market Value. The amount received is adequate, even if not fair market value. This exception must meet one (1) of the conditions below. (7-1-24) a. A forced sale was done under reasonable circumstances. (7-1-24) b. Little or no market demand exists for the type of asset transferred and the lack of market demand was not created by a voluntary act of the participant to qualify for assistance or to avoid recovery. (7-1-24) c. The asset was transferred to settle a legal debt approximately equal to the fair market value of the transferred asset. (7-1-24) 13. No Benefit to Participant. The participant received no benefit from the asset. This exception must meet one (1) of the conditions below. (7-1-24) a. The participant or spouse held title to the property only as a trustee for another person and had no beneficial interest in the property. (7-1-24) b. The transfer was done to clear title to property. The participant or spouse had no beneficial interest in the property. The defect in the title was not created to transfer assets to qualify for assistance or avoid recovery. (7-1-24) 14. Fraud Victim. The asset was transferred because the participant or spouse was the victim of fraud, misrepresentation, or coercion. The participant or spouse must take all possible steps to recover the assets or property, or its equivalent in damages and assign recovery rights to the State of Idaho. (7-1-24) 15. Transfer to Trust of Disabled Person. The assets were transferred to a trust established solely for the benefit of an individual under sixty-five (65) years of age who is disabled. (7-1-24)

This trust treatment rule applies to all Medicaid participants. This rules applies to trusts established with the participant’s assets on August 11, 1993, or later, and to amounts placed in trusts on or after August 11, 1993. This rule does not apply to an irrevocable trust if the participant meets the undue hardship exemption in Subsection 841.11 of these rules. Assets transferred to a trust are subject to the asset transfer penalty. This rule does not apply to a trust created with assets other than those of the individual, including a trust established by a will. (7-1-24) 01. Revocable Trust. Is treated as listed below. A revocable burial trust is not a trust for the purposes of Subsection 871.01 of this rule. (7-1-24) a. The body (corpus) of a revocable trust is a resource. (7-1-24) b. Payments from the trust to or for the participant are income. (7-1-24) c. Any other payments from the trust are an asset transfer, triggering an asset transfer penalty period. (7-1-24) d. Under 42 USC 1396p(e)(5), the home and adjoining property loses its exclusion for eligibility purposes when transferred to a revocable trust, unless the participant or spouse is the sole beneficiary of the trust. The home is excluded again if removed from the trust. The exclusion restarts the month following the month the home was removed from the trust. (7-1-24) 02. Irrevocable Trust. Is treated as listed below. (7-1-24) a. The part of the body of an irrevocable trust, from which corpus or income payments could be made to or for the participant, is a resource. (7-1-24) b. Payments made to or for the participant are income. (7-1-24) c. Payments from the trust for any other reason are asset transfers, triggering the asset transfer penalty. (7-1-24) d. Any part of the trust from which payment cannot be made to, or for the benefit of the participant under any circumstances, is an asset transfer. (7-1-24) e. The effective date of the transfer is the date the trust was established, or the date payments to the participant were foreclosed. (7-1-24) f. The value of the trust, for calculating the transfer penalty, includes any payments made from that portion of the trust after the date the trust was established, or payments were foreclosed. (7-1-24) g. An irrevocable burial trust is not subject to treatment under Subsection 871.02 of this rule, unless funds in the trust can be paid for a purpose other than the participant’s funeral and related expenses. The trust can provide that funds not needed for the participant’s funeral expenses are available to reimburse Medicaid, or to go to the participant’s estate. (7-1-24)

A trust, created or funded on or after August 11, 1993, is exempt from trust treatment and not subject to the asset transfer penalty if it meets a condition below. (7-1-24) 01. Trust for Disabled Person. To be exempt, a trust for a disabled person must meet all the conditions below. (7-1-24) a. The trust contains the assets of a person under age sixty-five (65). (7-1-24) b. The person is blind or totally disabled under the Social Security and SSI rules in 20 CFR Part 416. (7-1-24) c. The trust is established for the person’s benefit by their parent, grandparent, legal guardian, or a court. (7-1-24) d. The trust is irrevocable. (7-1-24) e. The trust is exempt until the person reaches age sixty-five (65). After the person reaches age sixty- five (65), additions or augmentations are not exempt from trust treatment. (7-1-24) f. Upon the person’s death, the amount not distributed by the trust must first be paid to the State of Idaho, up to the amount Medicaid has paid on the person’s behalf. (7-1-24) 02. Income Trust. To be exempt, an income trust must meet all the conditions below. (7-1-24) a. The trust is established for the sole benefit of a person who would be eligible for Medicaid in long- term care, or eligible for HCBS except for excess income. (7-1-24) b. Any income, placed directly into an income trust in the same calendar month in which received by the recipient, is not considered income to the individual for determining long-term care Medicaid eligibility. Money paid into the trust is income for patient liability or participant participation. (7-1-24) c. The trust is irrevocable. The trust document may include a clause allowing the trust to be revoked if the participant leaves the nursing facility or HCBS for a reason other than death, and is no longer eligible for Medicaid because of excess income, if Medicaid is reimbursed up to the amount Medicaid has paid on the person's behalf. (7-1-24) d. Income transferred to the trust must be used to pay patient liability or participant participation. If income is not used to pay allowable expenses, it is subject to the asset transfer penalty, unless one (1) of the following exceptions applies. (7-1-24) i. Benefit of the spouse in Subsection 841.05 of these rules; (7-1-24) ii. Transfer from the spouse in Subsection 841.06 of these rules; or (7-1-24) iii. Undue hardship in Subsection 841.11 of these rules. (7-1-24) e. Upon the person’s death, the amount not distributed by the trust must first be paid to the State of Idaho, up to the amount Medicaid has paid on the person’s behalf. (7-1-24) 03. Trust Managed by Non-Profit Association for Disabled Person. To be exempt, a trust managed by non-profit association for a disabled person must meet all the conditions below. (7-1-24) a. The trust is established and managed by a nonprofit association. The nonprofit association must not be the participant, their parent, or grandparent. (7-1-24) b. The trust contains the assets of a disabled person. The person must be blind or totally disabled under Social Security and SSI rules in 20 CFR Part 416. (7-1-24) c. Accounts in the trust are established only for the benefit of disabled persons. An account can be established by the disabled person, their parent, grandparent, legal guardian, or a court. A separate account must be maintained for each beneficiary of the trust. For purposes of investment and management, the trust may pool the funds in the accounts. (7-1-24) d. The trust is irrevocable. (7-1-24) e. Upon the person’s death, the amount not distributed by the trust must first be paid to the State of Idaho, up to the amount Medicaid has paid on the person’s behalf. (7-1-24)

Cash payments from an exempt trust for a disabled person or a pooled trust must be treated as described below. (7-1-24) 01. Cash Payments from Exempt Trust. For a disabled person are income in the month received. (7-1-24) 02. Cash Payments from Pooled Trust. Are made directly to the participant are income in the month received. (7-1-24) 03. Payments for the Participant’s Food or Shelter. Are income in the month paid. The payments for food or shelter are valued at one-third (1/3) of the AABD budgeted needs for the participant’s living arrangement. (7-1-24) 04. Payments Not Made to Participant. Payments from the exempt trust not made to, or on behalf of, the participant are an asset transfer. (7-1-24)

Medicaid eligibility is redetermined each year. The redetermination for AABD cash is the Medicaid redetermination for participants receiving both programs. (7-1-24)

Section 56-202, Idaho Code, the Low-Income Home Energy Assistance Act of 1981, 42 U.S.C Sections 8621 to 8629, and 45 CFR Parts 260 - 265. (7-1-26)

These rules provide standards for the administration of the Temporary Assistance for Needy Families (TANF) program and the Low-Income Home Energy Assistance Program (LIHEAP). These rules do not apply to the Emergency Assistance for Families in Idaho program. (7-1-26) (Sections 100–199)

To be eligible for TANF, individuals must care for a dependent child or be pregnant and meet these requirements: (7-1-26) 01. Application. Submit a signed application; (7-1-26) 02. Residency. Individuals must reside in Idaho (absence allowed for up to one hundred and eighty (180) days), intend to remain, and not claim residency in another state; (7-1-26) 03. Household Unit. Only one (1) TANF cash benefit is allowed in the same month for the household unit; and (7-1-26) 04. Other Benefits. Households eligible for TANF may not also receive Aid to the Aged, Blind, and Disabled (AABD) cash or Foster Care payments. (7-1-26)

A household must include: (7-1-26) 01. Dependent Children. Children under the age of eighteen (18) who reside with a parent or caretaker relative, including siblings and half siblings, living in the same home. (7-1-26) 02. Parents. Individuals who have an eligible child living with them. (7-1-26) 03. Pregnant Woman. At least in the third trimester before the baby is due and is unable to work due to medical reasons. (7-1-26) 04. Spouses. A married spouse living in the home. (7-1-26) 05. Caretaker Relative. An adult family member (other than the parent) who is responsible for a dependent child. (7-1-26)

01. Income Determination. Eligibility and benefit amounts are based on countable income and resources including those of ineligible household members as determined by the Department. (7-1-26) 02. Caretaker Income. When a caretaker relative is applying solely for a relative child, only the child’s income is counted. (7-1-26)

The parent, or caretaker relative included in the grant, must cooperate with the Department to identify and locate any non-custodial parent, establish paternity, and establish, modify and enforce the child support order, unless good cause exists. (7-1-26)

Good cause for not cooperating with Child Support Services (CSS) are limited to: (7-1-26) 01. Rape or Incest. Proof is provided that the child was conceived as a result of rape or incest. (7-1-26) 02. Physical or Emotional Harm. Proof is provided that the non-custodial parent may inflict physical or emotional harm to the children, the custodial parent, or the caretaker relative. (7-1-26) 03. Minimum Information Cannot be Provided. Substantial and credible proof is provided indicating the participant cannot provide the minimum information regarding the non-custodial parent. (7-1-26)

The Department will provide notice of substance abuse screening and possible testing to each TANF applicant. (7-1-26) 01. Screening Requirement. The Department conducts substance abuse screening as a condition of receiving TANF cash assistance. (7-1-26) 02. Testing Requirement. The Department conducts substance abuse testing as a condition for receiving TANF cash assistance, if screening indicates the applicant is engaged in, or at high risk of, substance abuse. (7-1-26) 03. Treatment Requirement. Participants must enter a substance abuse treatment program and cooperate with treatment, if screening, assessment or testing shows them in need of substance abuse treatment. (7-1-26)

01. Individual Responsibility Plan. An Individual Responsibility Plan (IRP) must be negotiated and signed by the mandatory adult household members as defined in these rules, with all application activities completed before eligibility can be approved. The household must continue to comply with ongoing IRP requirements to remain eligible. (7-1-26) 02. Modifications. If the participant cannot meet an IRP condition, the participant must notify the Department. The IRP may be renegotiated or modified when conditions change. (7-1-26)

If an individual commits IPV the Department will take all reasonable steps to recover the overpayment from the responsible individual. (7-1-26)

01. Applicant Voluntary Quit. An adult household member who quits a twenty-plus (20+) hour/week job within sixty (60) days of application without good cause results in ninety (90) days of ineligibility. (7-1-26) 02. Striking. If any adult household member is on strike, the entire household is ineligible. (7-1-26) 03. Work Activity Noncompliance. Failure to meet work activity requirements in the IRC, without good cause, counts as an occurrence. Penalties are based on the number of occurrences as follows: (7-1-26) a. First Occurrence. The household is ineligible for one (1) month or until compliance, whichever is longer. (7-1-26) b. Second Occurrence. The household is ineligible for three (3) months or until compliance, whichever is longer. (7-1-26) c. Third Occurrence. The household permanently is ineligible. (7-1-26) 04. Work Activity Penalties. Work activity penalties are applied as follows: (7-1-26) a. Individual Penalty. Penalties for individuals count towards an individual’s total number of sanctions. Any household an individual resides in during the period is subject to the penalty period. (7-1-26) b. Child Work Activity Penalty. A fifty-dollar ($50) penalty per month, per child sixteen (16) years of age or older, will be subtracted from the household grant if they do not meet work activity requirements while living in the household. (7-1-26) c. School Attendance Penalty. A fifty dollar ($50) monthly deduction per child applies if school-age children fail to attend school, unless participating in IRP-approved work activities. (7-1-26) 05. Paternity. If the grant is reduced by fifty percent (50%) for failure to establish paternity within twelve (12) months, child support penalties apply first before school or work penalties. (7-1-26) 06. IRP Noncompliance. Failing to meet IRP requirements without good cause will result in applicable penalties. (7-1-26)

In the event of an overpayment the participant will be notified of the overpayment including details on the recovery process, hearing rights, repayment methods, and the need to schedule a repayment interview. (7-1-26) (Sections 200–299)

To be eligible for LIHEAP, households must meet the following requirements: (7-1-26) 01. Application. Submit a signed application or have active Supplemental Nutrition Assistance Program (SNAP) benefits in the current LIHEAP season (October to September); (7-1-26) 02. Citizenship. Meet citizenship eligibility requirements; (7-1-26) 03. Income. Meet income eligibility requirements; (7-1-26) 04. Residency. Reside in Idaho; (7-1-26) 05. Verifications. Provide requested verifications; (7-1-26) 06. Benefits. Only one (1) LIHEAP regular assistance benefit and one (1) LIHEAP Crisis benefit per LIHEAP season; (7-1-26) 07. Responsibility. A household member is responsible for home energy costs and incur the costs either directly or as a designated portion of their rent; and (7-1-26) 08. Federal Income. Households in which one (1) or more individuals are receiving Supplemental Security Income (SSI) under Title XVI of the Social Security Act, SNAP, or means tested Veterans Affairs (VA) benefits are eligible for LIHEAP. (7-1-26)

All individuals or groups of individuals who are living together as one economic unit for whom residential energy is customarily purchased in common or who make designated payments for energy as a portion of rent. (7-1-26)

Gross income is counted for all household members, including income from ineligible household members, as determined by the Department. (7-1-26)

In the event of an overpayment, the participant will be notified of the overpayment, including details on the recovery process, hearing rights, and repayment methods. (7-1-26)

The Department will take all reasonable steps to recover the overpayment from the responsible individual who provided intentionally false or misleading information to obtain program eligibility. (7-1-26)

This program is contingent upon availability and receipt of funds appropriated through federal legislation. When federal funds are not available, these provisions or any part therein are considered dormant; there may be no advance notice of termination or reduction of benefits. If additional funds are available, a supplemental payment may be made at the discretion of the Administrator. (7-1-26)

Under Section 56-202, Idaho Code, the Director of the Department of Health and Welfare is authorized to promulgate, adopt, and enforce rules for the administration of public assistance programs. (3-17-22)

01. Title. These rules are titled IDAPA 16.06.12, “Idaho Child Care Program (ICCP).” (3-17-22) 02. Scope. These rules provide the requirements for determining participant and provider eligibility for the Idaho Child Care Program (ICCP) and issuing child care benefit payments. (3-17-22)

In addition to any actions specified in these rules, the Department may audit, investigate and take enforcement action under the provisions of IDAPA 16.05.07, “Investigation and Enforcement of Fraud, Abuse or Misconduct.” (3-17-22)

01. Compliance with Department Criminal History and Background Check. Criminal history and background checks are required for ICCP providers. Providers who are required to have a criminal history check must comply with IDAPA 16.05.06, “Criminal History and Background Checks.” (3-17-22) 02. ICCP Provider is Approved. The ICCP provider must have completed a criminal history and background check, and received a clearance, prior to becoming an ICCP provider. (3-17-22) 03. Availability to Work or Provide Service. (3-17-22) a. Those individuals licensed or certified by the Department are not available to provide services or receive licensure or certification until the criminal history and background check is completed and a clearance issued by the Department. (3-17-22) b. Individuals living in the home who have direct contact with children are allowed contact after the criminal history application and self-disclosure is completed as provided in Tittle 56, Chapter 27, Idaho Code, except when they have disclosed a disqualifying crime listed in IDAPA 16.05.06, “Criminal History and Background Checks.” (3-17-22) 04. Applicants, Providers, and Other Individuals Subject to Criminal History Check Requirements. The following applicants, providers, and other individuals listed below must submit evidence to the Department that the following individuals have successfully completed and received a Department criminal history and background check clearance: (3-17-22) a. All child care centers, group, family, relative, and in-home providers, including owners, operators, and staff, who have direct contact with children; (3-17-22) b. All individuals thirteen (13) years of age or older who have direct contact with children; and (3-17-22) c. All individuals thirteen (13) years of age or older who are regularly on the premises. (3-17-22) 05. Renewal of Criminal History and Background Check Requirement. Applicants, providers, employees, volunteers, and individuals thirteen (13) years of age or older who have direct contact with or provide care to children eligible for ICCP benefits must comply with these requirements and receive a clearance as provided in IDAPA 16.05.06, “Criminal History and Background Checks,” every five (5) years. (3-17-22) 06. Criminal History and Background Check at Any Time. The Department can require a criminal history and background check at any time on any individual providing child care to an ICCP eligible child. (3-17-22) 07. Additional Criminal Convictions. Once an individual has received a criminal history clearance, any additional criminal convictions must be reported by the child care provider to the Department when the provider learns of the conviction. (3-17-22)

The following definitions and abbreviations apply to this chapter: (3-17-22) 01. AABD. Aid to the Aged, Blind, and Disabled. (3-17-22) 02. Abuse or Abusive. Provider practices that are inconsistent with sound fiscal, business, or child care practices and result in an unnecessary cost to the Idaho Child Care Program, in reimbursement that is not necessary, or that fail to meet professional recognized standards for child care, or result in physical harm, pain, or mental anguish to children. (3-17-22) 03. Child. Any person under age eighteen (18) who is under the care of a parent, relative, or someone acting in loco parentis. (3-17-22) 04. Child Care. Care, control, supervision, or maintenance of a child provided for compensation by an individual, other than a parent, for less than twenty-four (24) hours in a day. (3-17-22) 05. Claim. Any request or demand for payment, or document submitted to initiate payment, for items or services provided under the Idaho Child Care Program. (3-17-22) 06. Department. The Idaho Department of Health and Welfare or its designee. (3-17-22) 07. Earned Income. Income received by a person as wages, tips, or self-employment income before deductions for taxes or any other purposes. (3-17-22) 08. Employment. A job paying wages or salary at federal or state minimum wage, whichever is applicable, including work paid by commission or in-kind compensation. Full or part-time participation in a VISTA or AmeriCorps program is also employment. (3-17-22) 09. Foster Care. The twenty-four (24) hour substitute care of children in the legal custody of the state of Idaho provided in a state licensed foster home by persons who may or may not be related to a child. Foster care is provided in lieu of parental care and is arranged through a private or public agency. (3-17-22) 10. Foster Child. A child in the legal custody of the state of Idaho placed for twenty-four (24) hour substitute care by a private or public agency. (3-17-22) 11. Foster Home. The private home of an individual or family licensed under the state of Idaho and providing twenty-four (24) hour substitute care to six (6) or fewer children. (3-17-22) 12. Fraud or Fraudulent. An intentional deception or misrepresentation made by a person with knowledge that the deception could result in some unauthorized benefit to himself or some other person. (3-17-22) 13. Good Cause. The conduct of a reasonably prudent person in the same or similar circumstances, unless otherwise defined in these rules. (3-17-22) 14. In Loco Parentis. Acting “in loco parentis” means a person who acts in place of a parent, assuming care and custody of a child by legal guardianship. (3-17-22) 15. Intentional Program Violation (IPV). An intentional false or misleading action, omission, or statement made in order to qualify as a provider or recipient in the Idaho Child Care program or to receive program benefits or reimbursement. (3-17-22) 16. Job Training and Education Program. A program designed to provide job training or education. Programs may include high school, junior college, community college, college or university, general equivalency diploma (GED), technical school, and vocational programs. To qualify as a Job Training and Education Program, the program must prepare the trainee for employment. (3-17-22) 17. Infant/Toddler. A child less than forty-eight (48) months of age. (3-17-22) 18. Incapacitated Parent. A parent who is determined by a licensed practitioner of the healing arts to be unfit, incapable, or significantly limited in their ability to provide adequate care for their child or ward. (3-17-22) 19. Knowingly, Known, or With Knowledge. With respect to information or an action about which a person has actual knowledge of the information or action; acts in deliberate ignorance of the truth or falsity of the information or the correctness or incorrectness of the action; or acts in reckless disregard of the truth or falsity of the information or the correctness or incorrectness of the action. (3-17-22) 20. Legal Guardian. A court-appointed individual who acts as the primary caretaker of a child or minor. (3-17-22) 21. Licensed Practitioner of the Healing Arts. A licensed physician, physician assistant, nurse practitioner, or clinical nurse specialist. (3-17-22)

The following definitions and abbreviations apply to this chapter of rules: (3-17-22) 01. Managing Employee. A general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of an organization or entity. (3-17-22) 02. Minor Parent. A parent under the age of eighteen (18). (3-17-22) 03. Non-Recurring Lump Sum Income. Income received by a family in a single payment, not expected to be available to the family again. (3-17-22) 04. Parent. A person responsible for a child because of birth, adoption, marriage, legal guardianship, foster care; or a person acting in loco parentis. (3-17-22) 05. Preventive Services. Services needed to reduce or eliminate the need for protective intervention. Preventive services permit families to participate in activities designed to reduce or eliminate the need for out-of- home placement of a child by the Department. (3-17-22) 06. Prospective Income. Income a family expects to receive within a given time. This can be earned or unearned income. (3-17-22) 07. Provider. An individual, organization, agency, or other entity providing child care. (3-17-22) 08. Relative Provider. Grandparent, great-grandparent, aunt, uncle, or adult sibling by blood or current marriage who provides child care. (3-17-22) 09. SSI. Supplemental Security Income. (3-17-22) 10. Special Needs. Any child with physical, mental, emotional, behavioral disabilities, or developmental delays identified on an Individual Education Plan (IEP) or an Individualized Family Service Plan (IFSP). (3-17-22) 11. State Median Income (SMI). State Median Income Estimates in the Code of Federal Regulations are available on the U.S. Government Publishing Office website at https://www.gpo.gov/fdsys. (3-17-22) 12. TAFI. Temporary Assistance for Families in Idaho. (3-17-22) 13. Unearned Income. Unearned income includes retirement, interest child support, and any income received from a source other than employment or self-employment. (3-17-22) APPLICATION REQUIREMENTS (Sections 050-069)

A family applying for child care benefits must submit a completed and signed application to the Department. (3-17-22) 01. Application Received. The Department will date stamp the application on the day the application is received. The applicant has thirty (30) days from the date the application is received by the Department to complete the application process by providing all required verifications. (3-17-22) 02. New Application Required. A new application is required if all requested verification is not provided within thirty (30) days from the date the application was received by the Department. The time limit can be extended by the Department for events beyond the Department’s control. (3-17-22) 03. Notification. The Department will act on applications for child care benefits within thirty (30) days of receipt. The applicant will be notified in writing of the approval or denial of the application and of the applicant’s right to appeal. (3-17-22)

An individual who is applying for benefits, receiving benefits, or providing additional information as required by this chapter, may do so with the depiction of the individual's name either handwritten, electronic, or recorded telephonically. Such signature serves as intention to execute or adopt the sound, symbol, or process for the purpose of signing the related record. (3-17-22) FINANCIAL CRITERIA FOR ICCP ELIGIBILITY (Sections 070-099)

To be eligible for child care assistance, a family's countable income must meet the following using the published Federal Poverty Guidelines (FPG) available on the U.S. Health and Human Services website at http://aspe.hhs.gov/ poverty. (4-6-23) 01. Income at Application. When applying, a family's income cannot exceed one hundred seventy- five percent(175%) of FPG for a family of the same size. (4-6-23) 02. Income During Eligibility Period. During the eligibility period, when a family's countable income exceeds eighty-five percent (85%) of the State Median Income (SMI) for a family of the same size, the family becomes ineligible for child care assistance. (3-17-22) 03. Income at Redetermination. At redetermination, if a family's income exceeds one hundred seventy-five percent (175%) of FPG for a family of the same size, the family may be eligible to receive a graduated phase out of child care assistance. (4-6-23)

All gross earned and unearned income is counted in determining eligibility and the child care benefit amount, unless specifically excluded under Section 072 of these rules. (3-17-22)

The following sources of income are not counted as family income. (3-17-22) 01. Earned Income of a Dependent Child. Income earned by a dependent child under age eighteen (18) is not counted, unless the child is a parent who is seeking or receiving child care benefits. (3-17-22) 02. Income Received for Person Not Residing With the Family. Income received on behalf of a person who is not living in the home. (3-17-22) 03. Educational Funds. All educational funds including grants, scholarships, an AmeriCorps Education Award, and federal and state work-study income. (3-17-22) 04. Assistance. Assistance to meet a specific need from other organizations and agencies. (3-17-22) 05. Lump Sum Income. Non-recurring lump sum income is excluded. (3-17-22) 06. Loans. A loan is money received that is to be repaid. (3-17-22) 07. TAFI and AABD Benefits. (3-17-22) 08. Foster Care Payments. (3-17-22) 09. AmeriCorps/VISTA Volunteers. Living allowances, wages and stipends paid to AmeriCorps or VISTA volunteers under 42 U.C.S. 5044, P.L. 93-113, Title IV, Section 404(g) are excluded as income. (3-17-22) 10. Income Tax Refunds and Earned Income Tax Credits. Income tax refunds and earned income tax credits are excluded as income. (3-17-22) 11. Travel Reimbursements. Reimbursements from employers for work-related travel. (3-17-22) 12. Tribal Income. Income received from a tribe for any purpose other than direct wages. (3-17-22) 13. Foster Parents’ Income. Income of licensed foster parents is excluded when determining eligibility for a foster child. Income is counted when determining eligibility for the foster parent's own child(ren). (3-17-22) 14. Adoption Assistance. Adoption assistance payments are excluded from income. (3-17-22) 15. Temporary Census Income. All wages paid by the Census Bureau for temporary employment related to U.S. Census activities are excluded for a time period not to exceed six (6) months during the regularly scheduled ten-year U.S. Census. (3-17-22) 16. Office of Refugee Resettlement Assistance. (3-17-22) 17. Workforce Investment Act (WIA) Benefits or Workforce Innovation and Opportunity Act (WIOA) Benefits. (3-17-22)

Court-ordered child support payments made by a parent who receives child care benefits are deducted from income when determining eligibility. The actual amount paid and the amount of the legal obligation for child support must be verified. (3-17-22)

01. Annual Self-Employment Income. When self-employment income is considered annual support by the household, the Department averages the self-employment income over a twelve-month (12) period, even if: (3-17-22) a. The income is received over a shorter period of time than twelve (12) months; and (3-17-22) b. The household receives income from other sources in addition to self-employment. (3-17-22) 02. Seasonal Self-Employment Income. A seasonally self-employed individual receives income from self-employment during part of the year. When self-employment income is considered seasonal, the Department averages self-employment income for only the part of the year the income is intended to cover. (3-17-22)

The Department calculates self-employment income by adding monthly income to capital gains and subtracting a deduction for expenses as determined in Subsection 075.03 of this rule. (3-17-22) 01. How Monthly Income is Determined. If no income fluctuations are expected, the average monthly income amount is projected for the certification period. If past income does not reflect expected future income, a proportionate adjustment is made to the expected monthly income. (3-17-22) 02. Capital Gains Income. Capital gains include profit from the sale or transfer of capital assets used in self-employment. The Department calculates capital gains using the federal income tax method. If the household expects to receive any capital gains income from self-employment assets during the certification period, this amount is added to the monthly income as determined in Subsection 075.01 of this rule to determine the gross monthly income. (3-17-22) 03. Self-Employment Expense Deduction. The Department uses the standard self-employment deduction in Subsection 075.03.a. of this rule, unless the applicant claims that their actual allowable expenses exceed the standard deduction and provides proof of the expenses described in Subsection 075.03.b. of this rule. (3-17-22) a. The self-employment standard deduction is determined by subtracting fifty percent (50%) of the gross monthly self-employment income as determined in Subsections 075.01 and 075.02 of this rule; or (3-17-22) b. The self-employment actual expense deduction is determined by subtracting the actual allowable expenses from the gross monthly self-employment income. The following items are not allowable expenses and may not be subtracted from the gross monthly self-employment income: (3-17-22) i. Net losses from previous tax years; (3-17-22) ii. Federal, state, and local income taxes; (3-17-22) iii. Money set aside for retirement; (3-17-22) iv. Work-related personal expenses such as transportation to and from work; and (3-17-22) v. Depreciation. (3-17-22)

Income is projected for each month. Past income may be used to project future income. Changes expected during the certification period will be considered. Criteria for projecting monthly income is listed below: (3-17-22) 01. Income Already Received. Count income already received by the household during the month. If the actual amount of income from any pay period is known, use the actual pay period amounts to determine the total month's income. Convert the actual income to a monthly amount if a full month's income has been received or is expected to be received. If no changes are expected, use the known actual pay period amounts for the past thirty (30) days to project future income. (3-17-22) 02. Anticipated Income. Count income the household and the Department believe the household will get during the remainder of the certification period. If the income has not changed and no changes are anticipated, use the income received in the past thirty (30) days as one indicator of anticipated income. If changes in income have occurred or are anticipated, past income cannot be used as an indicator of anticipated income. If income changes and income received in the past thirty (30) days does not reflect anticipated income, the Department can use the household income received over a longer period to anticipate income. If income changes seasonally, the Department can use the household income from the last season, comparable to the certification period, to anticipate income. (3-17-22) a. Full Month's Income. If income will be received for all regular pay dates in the month, it is considered a full month of income. (3-17-22) b. If income will not be received for all regular pay dates in the month, it is not considered a full month of income and it is not converted. (3-17-22) c. Income Paid on Salary. Income received on salary, rather than an hourly wage, is counted at the expected monthly salary rate. (3-17-22) d. Income Paid at Hourly Rate. Compute anticipated income paid on an hourly basis by multiplying the hourly pay by the expected number of hours the client will work in the pay period. Convert the pay period amount to a monthly amount. (3-17-22) e. Fluctuating Income. When income fluctuates each pay period and the rate of pay remains the same, average the income from the past thirty (30) days to determine the average pay period amount. Convert the average pay period amount to a monthly amount. (3-17-22)

If a full month's income is expected, but is received on other than a monthly basis, convert the income to a monthly amount using one of the formulas below: (3-17-22) 01. Weekly Amount. Multiply weekly amounts by four point three (4.3). (3-17-22) 02. Bi-Weekly Amount. Multiply bi-weekly amounts by two point one five (2.15). (3-17-22) 03. Semi-Monthly Amount. Multiply semi-monthly amounts by two (2). (3-17-22) 04. Monthly Amount. Use the exact monthly income if it is expected for each month of the certification period. (3-17-22)

A family must not be in possession of assets exceeding one million dollars ($1,000,000). (3-17-22) NON-FINANCIAL CRITERIA (Sections 100-199)

Eligible parents may choose among the following types of child care providers available under ICCP: (3-17-22) 01. Child Care Center. A child care center cares for thirteen (13) or more children. (3-17-22) 02. Group Child Care. Group child care is for seven (7) to twelve (12) children. (3-17-22) 03. Family Child Care. Family child care is for six (6) or fewer children. (3-17-22) 04. Relative Child Care. Relative child care is for six (6) or fewer related children. (3-17-22) 05. In-Home Child Care. In-home child care is provided by a relative or non-relative in the home of the child. Eligibility for in-home child care is determined in accordance with Section 400 of these rules. (3-17-22)

The family must live in the state of Idaho, and have no immediate intention of leaving. (3-17-22)

A natural or adoptive parent, or other individual who lives with and exercises parental control over a minor child who has an absent parent, must cooperate in establishing paternity for the child and obtaining child support at application and redetermination. (4-6-23) 01. Providing All Information. “Cooperation” includes providing all information to identify and locate the non-custodial parent, unless good cause for non-cooperation exists. (3-17-22) 02. Established Case for Custodial Parent. After Child Support Services (CSS) has established a case for a custodial parent, all child support payments must be sent directly to CSS. If the custodial parent receives child support directly from the non-custodial parent, the custodial parent must forward the payment to CSS for receipting. (4-6-23) 03. Failure to Cooperate. (3-17-22) a. This includes failure to complete the non-custodial or alleged parent information or filiation affidavit as requested, failure to sign the limited power of attorney, or evidence of failure to cooperate provided by CSS. (4-6-23) b. When a parent or individual fails to cooperate the family is not eligible to participate in the Idaho Child Care Program. (4-6-23) 04. Cooperation Exemptions. The parent or individual will not be required to provide information about the non-custodial or alleged parent or otherwise cooperate in establishing paternity or obtaining support if good cause for not cooperating exists. Good cause for failure to cooperate must be provided. (4-6-23) a. Good cause for failure to cooperate in obtaining support is: (3-17-22) i. Proof the child was conceived because of incest or forcible rape; (4-6-23) ii. Proof the non-custodial parent may inflict physical or emotional harm to the children, the custodial parent, or individual exercising parental control. This must be supported by medical evidence, police reports, or as a last resort, an affidavit from a knowledgeable source; and (4-6-23) iii. Substantial and credible proof is provided indicating the custodial parent cannot provide the minimum information regarding the non-custodial parent. (3-17-22) b. A parent or individual claiming good cause for failure to cooperate must submit a notarized statement to the Department identifying the child for whom the exemption is claimed and the reasons for the good cause claim. (4-6-23) c. The cooperation requirement will be waived if good cause exists. No further action will be taken to establish paternity or obtain support. If good cause does not exist, the parent will be notified that they are not eligible to receive ICCP benefits, until child support cooperation has been obtained. (4-6-23)

A family is a group of individuals living in a common residence, whose combined income is considered in determining eligibility and the child care benefit amount. No individual may be considered a member of more than one (1) family in the same month. The following individuals are included in determining the family composition: (3-17-22) 01. Married Parents. Married parents living together in a common residence, includes biological, adoptive, step-parent, guardian, and foster parent. (3-17-22) 02. Unmarried Parents. Unmarried parents who live in the same home and who have a child in common living with them. (3-17-22) 03. Dependents. Individuals who are dependents of a parent, guardian, or caretaker relative and living in the home at the primary residence. (3-17-22) 04. Minor Parent. A minor parent and child are considered a separate family when they apply for child care benefits, even if they live with other relatives. (3-17-22) 05. Individual Acting In Loco Parentis. An individual acting in loco parentis who is eligible to apply for child care benefits, and the child’s natural or adoptive parents are not living in the home. (3-17-22) 06. Citizenship or Alien Status Requirement. Family members who are not citizens or living lawfully in the United States will not be counted in the family size. The income of those non-counted family members will be counted when determining the household’s income according to Sections 070 through 099 of these rules. (3-17-22)

A family can only receive child care benefits for eligible children. A child is eligible for child care benefits under the following conditions: (3-17-22) 01. Immunizations Requirements. A child must be immunized in accordance with Chapter 11, Title 39, Idaho Code. Child care benefits can continue during a reasonable period necessary for the child to be immunized. Parents must provide evidence that the child has been immunized unless the child is attending school. (3-17-22) 02. Citizenship or Alien Status Requirement. A child must be one (1) of the following: (3-17-22) a. A citizen; (3-17-22) b. Living lawfully in the United States. (3-17-22) 03. Child's Age Requirement. A child must be under thirteen (13) years of age to be eligible for child care benefits, unless they meet one (1) or more of the following criteria: (3-17-22) a. A child is eligible for child care benefits until the month of their nineteenth birthday if they are physically or mentally incapable of self-care, as verified by a licensed mental health professional or licensed practitioner of the healing arts. (3-17-22) b. A child may be eligible for child care benefits until the month of their nineteenth birthday if a court order, probation order, child protection, or mental health case plan requires constant supervision. (3-17-22) 04. Child Custody. A child may move from one (1) parent's home to the other parent's home on a regular basis. The child may be a member of either household, but not both households. If the parents cannot agree on the child's household for the child care benefit, the child is included in the household with primary custody. Primary custody is determined by where the child is expected to spend fifty-one percent (51%) or more of the nights during a benefit period. When only one (1) parent applies for ICCP benefits, the child may be included in that parent's household even though they do not have primary physical custody of the child. (3-17-22)

An incapacitated parent, unable to adequately care for the children in a two (2) parent family, is not required to have any qualifying activities as listed under Section 200 of these rules, as long as the other parent is participating in qualifying activities. A single parent family in which the parent is incapacitated is not eligible for ICCP. A parent with a disability does not automatically qualify as an incapacitated parent. (3-17-22) QUALIFYING ACTIVITIES (Sections 200-299)

To be eligible for child care benefits, each parent included in the household must need child care because they are engaged in one (1) of the qualifying activities listed in Subsections 200.01 through 200.05 of this rule. (3-17-22) 01. Employment. The parent is currently employed. (3-17-22) 02. Self-Employment. The parent is currently self-employed in a business that is a sole proprietorship. A sole proprietorship is a business owned by one (1) person. Restrictions apply for self-employment as follows: (3-17-22) a. For the first twelve (12) months of self-employment benefits, actual activity hours are used. (3-17-22) b. At month thirteen (13), the number of activity hours will be limited. To calculate the activity hours, the net monthly self-employment income is divided by the current federal minimum wage. The qualifying activity hours are the lesser of the calculated activity hours or actual activity hours. (3-17-22) 03. Training or Education. The parent is attending an accredited education or training program. The following restrictions apply to training or education activities: (3-17-22) a. On-line classes cannot be counted as a qualifying activity for child care. (3-17-22) b. Persons who are attending post-baccalaureate classes with no other qualifying activity, do not qualify for child care benefits. (3-17-22) c. More than forty-eight (48) months of post-secondary education has been used as a qualifying activity. (3-17-22) 04. Preventive Services. The parent is receiving preventive services as defined in Section 011 of these rules. The Department will verify the continued need for preventive services at least every three (3) months. (3-17-22) 05. Personal Responsibility Contract (PRC) or Other Negotiated Agreement. The parent is completing Personal Responsibility Contract (PRC) or other self-sufficiency activities negotiated between the Department and the parent. (3-17-22)

01. Activity Hours. Activity hours are projected for each month to determine if payment is made on a full-time or part-time basis. Past activity hours may be used to project future activity hours if the employer and number of hours worked are the same and are expected to remain the same throughout the certification period. Hours for each qualifying activity must be projected individually and converted to a monthly amount. (3-17-22) 01. Weekly Hours. Multiply weekly amounts by four point three (4.3). (3-17-22) 02. Bi-weekly Hours. Multiplying bi-weekly amounts by two point one five (2.15). (3-17-22) 03. Semi-Monthly Hours. Multiplying semi-monthly amounts by two (2). (3-17-22) 04. Monthly Hours. Use the exact monthly hours if it is expected for each month of the certification period. (3-17-22)

An eligible family who loses or ceases its qualifying activity, may continue to receive assistance for up to three (3) months to engage in a job search and resume work, or resume attendance at a job training or educational program. (3-17-22)

Parents must contact the Department to request approval of in-home child care. Only parents who have qualified activities outside their home will be considered for in-home care approval. The Department limits the approval of all in-home child care under ICCP to the following circumstances: (3-17-22) 01. Three or More Children in the Home. There are three (3) or more ICCP eligible children in the home who are not in school at any time during the day and require child care. (3-17-22) 02. Fewer Than Three Children in the Home. If there are fewer than three (3) children in the home who are eligible for ICCP and require child care, in-home care will be approved by the Department only when one (1) of the following special circumstances are met: (3-17-22) a. Parents' qualifying activity occurs during times when out-of-home care is not available. If child care is needed during any period when out-of home care is not available, in-home care will be approved for the entire time care is needed. A family is not expected to change between out-of-home and in-home care. (3-17-22) b. The family lives in an area where out-of-home care is not available. (3-17-22) c. A child has a verified illness or disability that would place the child or other children in an out-of- home facility at risk. (3-17-22)

Annually each in-home care provider is responsible to ensure that health and safety requirements are met for children being cared for in the children’s own home, as defined in Section 802 of these rules. (3-17-22) PAYMENT INFORMATION (Sections 500-599)

Care provided to an eligible child by an eligible child care provider is payable subject to the following conditions: (3-17-22) 01. Payment for Employment, Training, Education, or Preventive Service Hours. Child care must be reasonably related to the hours of the parent's qualifying activities. (3-17-22) 02. One-Time Registration Fees. One-time fees for registering a child in a child care facility are payable above the local market rate, if the fee is charged to all who enroll in the facility. Reimbursement can not exceed two hundred fifty dollars ($250) and must be usual and customary rates charged to all families. Registration fees are separate from local market rates. (3-17-22)

Care provided to an eligible child is not payable under the following conditions: (3-17-22) 01. Family Member or Guardian Providing Child Care. A parent, step-parent, or guardian will not be paid for providing child care to their own child or ward. (3-17-22) 02. Provider Living at Same Address as Child. ICCP will not pay for in-home child care if the provider lives at the same address as the child. (3-17-22) 03. School Tuition, Academic Credit, or Tutoring. ICCP payments will not be made for school tuition, academic credit, or tutoring for school age children; this includes: (3-17-22) a. Any services provided to such students during the regular school day, including kindergarten; (3-17-22) b. Any services for which such students receive academic credit toward graduation; or (3-17-22) c. Any instructional services which supplant or duplicate the academic program of any public or private school. (3-17-22)

Child care payments will be based on Subsections 502.01 through 502.04 of this rule. (3-17-22) 01. Payment Rate. Payment will be based on the lower of the provider’s usual and customary rates or the Local Market Rate (LMR). (3-17-22) a. The local market rates for child care are the maximum monthly amounts that ICCP will pay for any given category of child care in a geographic area designated by the Department. The local market rates for child care are established based on a comprehensive survey of child care providers. Using information gathered in the survey, including the age of child, the type of child care, and the designated area where the provider does business, a local market rate is specified for each category of child care. The rate survey is conducted triennially. (3-17-22) b. Payment rates will be determined by the location of the child care facility. (3-17-22) c. If the child care facility is not in Idaho, the local market rate will be the rate where the family lives. (3-17-22) 02. Usual and Customary Rates. Rates charged by the child care provider must not exceed the usual and customary rates charged for child care to persons not entitled to receive benefits under ICCP. (3-17-22) 03. In-Home Care. Parents are responsible to pay persons providing care in the child’s home the minimum wage, as required by the Fair Labor Standards Act (29 U.S.C. 206a) and other applicable state and federal requirements. (3-17-22) 04. Payments. Payments will be issued directly to eligible providers. (3-17-22)

Eligible families, except TAFI families participating in non-employment TAFI activities and guardians of foster children, must pay part of their child care costs. (4-6-23) 01. Provider Responsibility. Providers are responsible for ensuring families pay the determined child care costs and must not waive these costs. (4-6-23) 02. Family Payment. Family income and activity for the month of the child care will determine the family share of child care costs. The payment made by the Department will be the allowable local market rate or billed costs, whichever is lower, less the co-payment. (4-6-23)

01. Post-Secondary Student. (3-17-22) a. A post-secondary student who works less than ten (10) hours per week will be required to pay a co- payment. (3-17-22) b. A post-secondary student who works ten (10) hours or more per week will have a co-payment based on family income. (3-17-22) 02. High School or GED Student. A student who is in high school, or who is taking GED courses will have a co-payment based on family income. (3-17-22)

If child care arrangements would otherwise be lost, child care may be paid when a child temporarily stops attending child care for no longer than (1) calendar month and plans to return. (3-17-22) CHANGE REPORTING REQUIREMENTS FOR THOSE RECEIVING CHILD CARE BENEFITS (Sections 600 - 699)

A family who receives child care benefits must report the following permanent changes by the tenth day of the month following the month in which the change occurred. (3-17-22) 01. Change in Permanent Address. (3-17-22) 02. Change in Household Composition. (3-17-22) 03. Change in Income. When the household's total gross income for family of the same size exceeds any of the following: (3-17-22) a. One hundred and thirty percent (130%) of the Federal Poverty Guidelines (FPG); (3-17-22) b. Eighty-five percent (85%) of the State Median Income (SMI); or (3-17-22) c. The graduated phase-out income limit as defined in the Idaho Child Care State Plan. (3-17-22) 04. Change in Child Care Provider. (3-17-22)

01. Redetermination. The Department will redetermine eligibility for child care benefits at least every twelve (12) months. (3-17-22) 02. Graduated Phase Out. At redetermination, if a household's income exceeds one hundred seventy- five percent (175%) of FPG for a family of the same size eligible children may receive a graduated phase out benefit that is limited to twelve (12) months following the completion of a redetermination under the Idaho Child Care State Plan. (4-6-23) PAYMENT ADJUSTMENTS AND PENALTIES (Sections 700-704)

When the Department has underpaid a family's child care benefits, a supplemental payment will be made. (3-17-22)

The Department may recoup or recover the amount paid for child care services from a provider or a parent. Interest will accrue on these overpayments at the statutory rate set under Section 28-22-104, Idaho Code, from the date of the final determination of the amount owed for services. Interest will not accrue on overpayments made due to Department error. An overpayment due to family, agency, or provider error, IPV or fraud must be recovered in full. A parent or provider may negotiate a repayment schedule with the Department. (3-17-22)

An IPV is an intentionally false or misleading action or statement as identified below in Subsections 702.01 through 702.08 of this rule. An IPV is established when a family member or the child care provider admits the IPV in writing and waives the right to an administrative hearing, or when determined by an administrative hearing, a court decision, or through deferred adjudication. Deferred adjudication exists when the court defers a determination of guilt because the accused family member or child care provider meets the terms of a court order or an agreement with the prosecutor. (3-17-22) 01. False Statement. An individual makes a false statement to the Department, either orally or in writing, in order to participate in the Idaho Child Care Program. (3-17-22) 02. Misleading Statement. An individual makes a misleading statement to the Department, either orally or in writing, to participate in the Idaho Child Care Program. (3-17-22) 03. Misrepresentation of Fact. An individual misrepresents one (1) or more facts to the Department, either orally or in writing, to participate in the Idaho Child Care Program. (3-17-22) 04. Concealing Fact. An individual conceals or withholds one (1) or more facts to participate in the Idaho Child Care Program. (3-17-22) 05. Non-Compliance With Rules and Regulations. An individual fails repeatedly or substantially to comply with this chapter of rules. (3-17-22) 06. Violation of Provider Agreement. An individual knowingly violates any term of their provider agreement. (3-17-22) 07. Failure to Meet Qualifications. A provider fails to meet the qualifications specifically required by this chapter of rules or by any applicable licensing board. (3-17-22)

When the Department determines an IPV was committed, the party who committed the IPV loses eligibility for ICCP. If an individual has committed an IPV, the entire family is ineligible for child care benefits. If a child care provider has committed an IPV, the provider is ineligible to receive payments. The period of ineligibility for each offense, for both participants and providers, is as follows: (3-17-22) 01. First Offense. Twelve (12) months, for the first IPV or fraud offense, or the length of time specified by the court. (3-17-22) 02. Second Offense. Twenty-four (24) months for the second IPV or fraud offense, or the length of time specified by the court. (3-17-22) 03. Third Offense. Permanent ineligibility for the third or subsequent IPV or fraud offense, or the length of time specified by the court. (3-17-22)

The Department may deny payment for the reasons described in Subsections 704.01 through 704.05 of this rule. (3-17-22) 01. Services Not Provided. Any or all claims for child care services it determines were not provided. (3-17-22) 02. Services Not Documented. Child care services not documented by the provider as required in Subsection 810.01 of these rules. (3-17-22) 03. Contrary to Rules or Provider Agreement. Child care services provided contrary to these rules or the provider agreement. (3-17-22) 04. Failure to Provide Immediate Access to Records. The Department may deny payment when the provider does not allow immediate access to records as provided in Subsection 810.02 of these rules. (3-17-22) 05. Paying for Attendance. Payment will be denied if an eligible provider pays directly or indirectly, overtly or covertly, for a child to attend the provider’s child care facility. (3-17-22)

If a funding shortfall is projected, the Department may reduce child care benefits to ensure that ICCP operates within its financial resources. (3-17-22) ENFORCEMENT REMEDIES (Sections 750-799)

Under Section 56-209h, Idaho Code, the Department may terminate the provider agreement of, or otherwise deny provider status for a period up to five (5) years from the date the Department's action becomes final to any individual or entity providing ICCP. (3-17-22) 01. Submits an Incorrect Claim. Submits a claim with knowledge that the claim is incorrect. (3-17-22) 02. Fraudulent Claim. Submits a fraudulent claim. (3-17-22) 03. Knowingly Makes a False Statement. Knowingly makes a false statement or representation of material facts in any document required to be maintained or submitted to the Department. (3-17-22) 04. Immediate Access to Documentation. Fails to provide, upon written request by the Department, immediate access to documentation required to be maintained. (3-17-22) 05. Non-Compliance With Rules and Regulations. Fails repeatedly or substantially to comply with the rules and regulations governing Idaho child care payments. (3-17-22) 06. Violation of Material Term or Condition. Knowingly violates any material term or condition of the provider agreement. (3-17-22) 07. Failure to Repay. Has failed to repay, or was a managing employee or had an ownership or control interest in any entity that has failed to repay, any overpayments or claims previously found to have been obtained contrary to statute, rule, regulation, or provider agreement. (3-17-22) 08. Fraudulent or Abusive Conduct. Has been found, or was a managing employee in any entity which has been found, to have engaged in fraudulent conduct or abusive conduct. (3-17-22) 09. Failure to Meet Qualifications. Fails to meet the qualifications specifically required by rule or by any applicable licensing entity. (3-17-22)

The Department may refuse to enter into a provider agreement for the reasons described in Subsections 751.01 through 751.06 of this rule. (3-17-22) 01. Convicted of a Felony. The provider has been convicted of a felony or is under investigation for the commission of a felony. (3-17-22) 02. Committed an Offense or Act Not in Best Interest of Child Care Participants. The provider has committed an offense or act which the Department determines is inconsistent with the best interests of ICCP participants. (3-17-22) 03. Failed to Repay. The provider has failed to repay the Department monies which had been previously determined to have been owed to the Department. (3-17-22) 04. Investigation Pending. The provider has a pending investigation for program fraud or abuse. (3-17-22) 05. Terminated Provider Agreement. The provider was the managing employee, officer, owner, or spouse, partner, or relative of an owner of an entity, whose provider agreement was terminated under Section 750 of these rules. (3-17-22) 06. Excluded Individuals. The provider has a current exclusion from participation in federal programs by the Office of Inspector General List of Excluded Individuals and Entities. (3-17-22)

When the Department determines actions defined in Sections 701 through 705, 750, and 751 of these rules are appropriate, it will send written notice of the decision to the provider or person. The notice will state the basis for the action, the length of the action, the effect of the action on that person's ability to provide services under state and federal programs, and the person's appeal rights. (3-17-22)

The Department will promptly notify all appropriate licensing authorities having responsibility for licensing of a Department action, and the facts and circumstances of that action. The Department may request certain actions be taken and that the Department be informed of actions taken. (3-17-22) PROVIDER ELIGIBILITY (Sections 800-808)

All providers of child care who receive a Department subsidy must be licensed or must comply with: applicable State Daycare licensing requirements in Title 39, Chapter 11, Idaho Code; these rules; local licensing ordinances; or tribal ordinances. If both state requirements and ordinances apply to a provider, the provider must comply with the stricter requirement. A provider operating outside Idaho must comply with the licensing laws of their state or locality. (3-17-22)

All child care providers must complete a series of health and safety trainings during an orientation period of not more than ninety (90) days, in addition to ongoing annual training that address each of the following topics: (3-17-22) 01. Infectious Diseases. The prevention and control of infectious diseases (including immunization). (3-17-22) 02. Sudden Infant Death Syndrome. The prevention of sudden infant death syndrome and use of safe sleeping practices. (3-17-22) 03. Medication. The administration of medication, consistent with standards for parental consent. (3-17-22) 04. Allergic Reactions. The prevention of and response to emergencies due to food and allergic reactions. (3-17-22) 05. Environmental Safety. Building and physical premises safety, including identification of and protection from hazards, bodies of water, and vehicular traffic. (3-17-22) 06. Child Abuse Prevention. Prevention of shaken baby syndrome, abusive head trauma, child maltreatment, and recognition and reporting of child abuse and neglect. (3-17-22) 07. Emergency Preparedness. Emergency preparedness and response planning for emergencies resulting from a natural disaster, or a man-caused event. (3-17-22) 08. Hazardous Substances. Proper handling, storage, and disposal of medicines, cleaning supplies, and other hazardous substances, including biocontaminants. (3-17-22) 09. Transportation. Appropriate precautions in transporting children, including the use of child safety restraints and seat belts. (3-17-22) 10. Child Development. Address major domains such as cognitive, social, emotional, physical development, and approaches to learning. (3-17-22)

All providers must comply with the health and safety requirements under this rule. All providers must agree to an annual, unannounced health and safety inspection, except for in-home child care under Section 401 of these rules. Compliance with these standards does not exempt a provider from complying with stricter health and safety standards under state law, tribal law, local ordinance, or other applicable law. (4-6-23) 01. Age of Provider. All child care providers providing services must be eighteen (18) years old or older. Persons sixteen (16) or seventeen (17) years old may provide child care if they have direct, on-site supervision from a licensed child care provider who is at least eighteen (18) years old. (3-17-22) 02. Sanitary Food Preparation. Food for use in child care facilities must be prepared and served in a sanitary manner. Utensils and food preparation surfaces must be cleaned and sanitized before using to prevent contamination. (3-17-22) 03. Food Storage. All food served in child care facilities must be stored to protect it from potential contamination. (3-17-22) 04. Hazardous Substances. Medicines, cleaning supplies, and other hazardous substances must be handled safely and stored out of the reach of children. Biocontaminants must be disposed of appropriately. (3-17-22) 05. Emergency Communication. A telephone or some type of emergency communication system is required. (3-17-22) 06. Smoke Detectors, Fire Extinguishers, and Exits. A properly installed and operational smoke detector must be on the premises where child care occurs. Adequate fire extinguishers and fire exits must be available on the premises. (3-17-22) 07. Hand Washing. Each provider must wash their hands with soap and water at regular intervals, including before feeding, after diapering or assisting children with toileting, after nose wiping, and after administering first aid. (4-6-23) 08. CPR/First Aid. All providers must have current certification in pediatric rescue breathing (CPR) and pediatric first aid treatment from a certified instructor. (3-17-22) 09. Health of Provider. Each provider must certify that they do not have a communicable disease or any physical or psychological condition that might pose a threat to the safety of a child in their care. (4-6-23) 10. Child Abuse. Providers must report suspected child abuse to the appropriate authority. (3-17-22) 11. Transportation. Providers who transport children as part of their child care operations must operate safely and legally, using child safety restraints and seat belts as required by state and local statutes. (3-17-22) 12. Disaster and Emergency Planning. Providers must have documented plans for emergencies resulting from a natural disaster, or man-caused event that include: (4-6-23) a. Procedures for evacuation, relocation, shelter-in-place, lock-down, communication and reunification with families, continuity of operations, and accommodation of infants and toddlers and children with disabilities or chronic medical conditions. (4-6-23) b. Procedures for staff and volunteer emergency preparedness training and practice drills. (3-17-22) c. Guidelines for the continuation of child care services in the period following the emergency or disaster. (3-17-22) 13. Environmental Safety. Building and physical premises must be safe, including identification of and protection from hazards that can cause bodily injury including electrical hazards, bodies of water, and vehicular traffic. (3-17-22) 14. Safe Sleep. Providers must place newborn infants to twelve (12) months in a safe sleep environment. Safe sleep practices include alone, on their backs, and in a Consumer Product Safety Commission (CPSC) certified crib. (4-6-23) 15. Behavior Management and Discipline. Methods of behavior management and discipline for children must be positive, consistent, and based on each child's needs, stage of development, and behavior. Discipline is to promote self-control, self-esteem, and independence. Providers must certify that they will not harm, shake, or abuse children, and that children in their care will not experience maltreatment under 45 CFR 98.41. (4-6-23)

Each child care provider must receive and ensure that each staff member who provides child care receives and completes twelve (12) hours of ongoing training every twelve (12) months after the staff member's date of hire. (3-17-22) 01. Training Contents. Training must be related to continuing education in child development, teaching and curriculum, health and safety, and business practices. Pediatric rescue breathing (CPR) and pediatric first aid treatment training will not count towards the required twelve (12) hours of annual training. (3-17-22) 02. Documented Training. It is the responsibility of the child care provider to ensure that each staff member who provides child care has completed twelve (12) hours of training each year. The training must be documented in the staff member's record. (3-17-22) 03. Staff Training Records. Each child care provider is responsible for maintaining documentation of staff's training and must produce this documentation when the provider agreement is renewed annually. (3-17-22)

01. Compliance. All providers must sign and comply with a provider agreement. (3-17-22) 02. Provide Direct Care. Except for Child Care Centers described in Subsection 101.01 of these rules, the individual who signs the provider agreement must provide the majority of direct care to the children in that child care facility. (3-17-22)

Applicants, providers, employees, volunteers, and all other individuals age thirteen (13) or older who have direct contact with or provide care to children eligible for ICCP benefits must comply with the requirements and receive clearance as provided in IDAPA 16.05.06, “Criminal History and Background Checks,” every five (5) years. (3-17-22)

Providers must certify that they are not, through stipulation or adjudication, under the purview of the Child Protective Act, Section 16-1600, Idaho Code, or the Juvenile Corrections Act, Section 20-501 through 20-547, Idaho Code. Any person who has a substantiated child protection complaint cannot be a provider. (3-17-22)

Providers serving families who receive a child care subsidy must allow parents or caretakers unlimited access to their children and to persons giving care, except that access to children will not be required if prohibited by court order. (3-17-22)

A child care provider must report any of the following changes within ten (10) days: (3-17-22) 01. Change in Provider Charges. The provider changes any rate for child care services. (3-17-22) 02. Child Stops Attending Care. A child covered under ICCP stops attending child care, or is taken to another child care provider. (3-17-22) 03. Change of Provider Address. The provider changes the location where child care is provided. (3-17-22) 04. Change in Who Lives in Home. An individual who provides child care in their home must report when any other person moves into the home. (3-17-22) 05. Intent Not to Renew License. The provider intends not to renew their license, or other required certifications. (3-17-22) 06. Death or Serious Injury. Providers must report when a child sustains a serious injury or dies while at the location of, or as a result of participating in child care. (3-17-22)

The Department will make public by electronic means, in an easily accessible format: (3-17-22) 01. Monitoring and Inspection Reports. The results of all child care monitoring and inspection reports. (3-17-22) 02. Substantiated Complaints. Substantiated complaints about failure to comply with child care laws, rules, and policies, that include information on the date of such an inspection, and where applicable, information on corrective action taken. (3-17-22) 03. Death and Serious Injury. The total number of deaths, serious injuries, and instances of substantiated child abuse that occurred in child care settings each year. (3-17-22)

01. Documentation of Services. Providers must generate documentation at the time of service sufficient to support the reimbursement for child care services. Documentation must be legible and retained for a period of three (3) years from the date the child care was provided. Documentation to support child care services includes: (3-17-22) a. Records of attendance, including signatures of a parent or guardian; (3-17-22) b. Immunization records, conditional admittance form, or exemption form according to IDAPA 16.02.11, “Immunization Requirements for Licensed Daycare Facility Attendees.” (3-17-22) c. Billing records and receipts; (3-17-22) d. Policies regarding sign-in procedures, and others as applicable; and (3-17-22) e. Sign-in records, electronic or manual, or the Child and Adult Food Care Program records. (3-17-22) 02. Immediate Access to Records. Providers must grant to the Department and its agents, immediate access to records for review and copying during normal business hours. These records are defined in Subsection 810.01 of this rule. (3-17-22) 03. Copying Records. The Department and its authorized agents may copy any record as defined in Subsection 810.01 of this rule. The Department may request in writing to have copies of records supplied by the provider. The requested copies must be furnished within twenty (20) working days after the date of the written request, unless an extension of time is granted by the Department for good cause. Failure to timely provide requested copies will be a refusal to provide access to records. (3-17-22) 04. Removal of Records From Provider's Premises. The Department and its authorized agents may remove from the provider's premises copies of any records defined in Subsection 810.01 of this rule. (3-17-22)