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us-ky/manual/dcbs/dfs/volume-i-general-administration — Kentucky DFS Manual Volume I - General Administration · Axiom

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*MS 0015 (1) Volume 1 – General Administration *MS 0015 – 3/9/15 – OMTL-483 Ethics Policy for Family Support Employees The Department for Community Based Services (DCBS) and its employees must recognize the vulnerability of their clients and the serious responsibilities associated with the provision of public assistance. The behavior of human service professionals shall reflect an emphasis on integrity, professional trustworthiness, and on the values of respect for persons, competence, loyalty, diligence, honesty, and confidentiality. DCBS professionals have a duty to be familiar with their responsibilities under this manual section and to consider which ethical principles apply in a particular situation. If there is a conflict between two or more ethical principles and/or responsibilities in a particular case, staff should consult with his or her supervisor in choosing a proper course of action. Family Support employees: A. Adhere to standards of ethics, confidentiality, and security agreements; B. Execute their responsibilities on behalf of the citizens of the Commonwealth. As such, they do not use their positions for personal gain or influence; C. Strive to improve the quality and efficiency of services rendered by Kentucky state government; D. Are honest, objective, and diligent in the performance of their duties and responsibilities; E. Avoid leading or coaching program applicants or recipients into making statements or taking any other action in order to gain benefits to which the individual or household is not entitled; F. Avoid participation in any activity they know to be illegal or improper; G. Are continually aware of the public trust they hold and their obligation to maintain a high standard of integrity, competence, and dignity in the performance of their duties; H. Do not enter into any activity which may be in conflict with the interest of the citizens of Kentucky; I. Refrain from entering into any activity which may prejudice (or give the appearance of such) their ability to objectively perform their duties and responsibilities; J. Do not solicit or accept directly or indirectly, any gift, gratuity, favor, or other economic consideration from any person, group, private business or public agency, or from members of their immediate families, which may affect the impartial performance of the employee’s duties;

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MS 0020 (1) Volume 1 – General Administration MS 0020 – 6/5/23 – OMTL-626 General Case Processing A. [Eligibility determinations for the Kentucky Transitional Assistance Program (KTAP), Family Assistance Short Term (FAST), Kinship Care (KC), Supplemental Nutrition Assistance Program (SNAP), Modified Adjusted Gross income (MAGI) Medicaid, and Adult Medicaid (AMA) determinations are completed on Worker Portal. B. All individuals contacting the toll-free number or the local office requesting assistance are entered on Worker Portal by designated staff. C. Applications, recertifications and case changes can be processed by any worker statewide regardless of the county of residence. When a worker processes a case, the worker documents on Worker Portal comments any and all actions taken within the case at the time of processing. D. Workers cannot take or process an application of an individual who is a relative or close personal relationship. For procedural instructions on employee-related case processing, refer to MS 0025. E. Supervisors or designated persons accept and process applications filed by Department for Community Based Services (DCBS) employees. F. All applications or reapplications must be acted on promptly. No longer than 30 days should elapse between the application date and authorization for action date, with the exception of unusual case situations. If the time frames required by the specific program are not met, document the reason for the delay on Worker Portal comments. G. To ensure authorizations are completed promptly, cases processed by workers without case decision must be reviewed immediately. H. Ongoing eligibility is reviewed periodically as required by specific program guidelines. I. Deny an application for assistance or discontinue benefits if: 1. An individual withdraws the application or requests discontinuance; 2. It is established a technical or financial factor is not met; or 3. An individual fails to verify eligibility factors. J. All requested verification should be returned to the Centralized Mail Center. Staff in the Centralized Mail Center scans the verification into the Electronic Case File (ECF), which creates a task on the Worker Portal dashboard.

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MS 0025* (1) Volume 1 – General Administration MS 0025* - 10/1/19 – OMTL-553 Employee Related Case Processing Confidential cases, such as those involving Department for Community Based Services (DCBS) employees, an employee’s relative, any individual in which a conflict of interest may arise, any individual that resides at same physical residence as a DCBS employee and/or any other individuals with whom an employee has a close personal relationship are required to be processed and maintained by a supervisor or designated staff member. This is done to avoid any conflicts of interest and to ensure privacy. A. A relative is defined as “a parent, foster parent, parent-in-law, child, spouse, brother, foster brother, sister, foster sister, grandparent, grandchild, son-in law, brother-in-law, daughter-in-law, sister-in-law, cousin (up to first cousin), or other family member who resides in the same household.” B. A conflict of interest exists whenever employees are placed in a position where, for some advantage gained or to be gained personally, they find it difficult, if not impossible, to devote themselves with complete energy, loyalty, and singleness of purpose to the general public interest as represented by their employment with the department. C. Close personal relationships may include, but are not limited to: 1. Dating or co-habiting relationships; 2. Relationships in which business transactions are regularly conducted; 3. Personal friendships that transcend a casual acquaintance, such as: a person whose home is frequently visited by the employee, or vice-versa, or a person with whom the employee socializes “one-on-one” on a regular basis; 4. Individuals who reside at the same physical residence of the employee; or 5. Relatives as defined in item A. Any DCBS employee should remove themselves from acting on any official matter which involves a relative, close personal relationship, or their own records. When potential conflicts arise, the DCBS employee must immediately alert his/her supervisor or appropriate manager to the conflict of interest. D. Workers cannot take or process an application of an individual who is a relative as defined in item A, or close personal relationship as defined in item C. The worker is responsible for advising supervisory staff if an applicant is a relative or close personal relationship. The worker cannot provide case status information or inquire about the case for a relative. In addition, Family Support employees may not act on behalf of a payee by

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MS 0030 (1) Volume 1 – General Administration MS 0030 – R. 3/1/23 – OMTL-616 Case Record [The case record is the official document (electronic through Worker Portal or hardcopy) of the Department that establishes accountability for the expenditure of state and federal funds. Local management staff is responsible for ensuring case records are properly maintained, purged of obsolete material, and accessible to staff. This includes hard copy case records if the overpayment is pending or is established if the overpayment occurred prior to the implementation of the electronic case file (ECF). For purging of hardcopy records, refer to MS 0040, and for archiving, refer to MS 0045. A. Each hard copy file or Worker Portal/ECF contains pertinent information about each applicant and recipient and supporting documentation for every decision made regarding eligibility. At a minimum, this includes:] 1. Date of application; 2. Date and type of action (approval, denial, interim, special circumstances, restoration, etc.); 3. Documentation sufficient to support the eligibility determination; 4. Verification used in the determination of initial and continuing eligibility; 5. The basis for denial or discontinuance of assistance; 6. The condition that prompts a need for special accommodation to ensure access to benefits and services by individuals or families with a physical or mental condition; 7. Accommodation offered and accepted by an individual or family; 8. Signed applications; 9. [Copies of notices manually prepared and provided to the household; 10. Forms completed and/or provided by the household;] 11. Maintaining a single archival case file folder per case; 12. Annotating in red on the hard copy case record if an overpayment is identified, regardless if the overpayment is pending or is established if the overpayment occurred prior to the implementation of ECF. 13. The Kentucky Works Program (KWP) material is scanned into the ECF into the appropriate category for the specific verification or form received. The KWP material retained in the case file includes:

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MS 0040 (1) Volume 1 – General Administration MS 0040 – R. 6/1/18 – OMTL-529 Purging Obsolete Material Hardcopy case records are required to be retained for a length of time specified by each program. With the implementation of the Electronic Case File (ECF), existing hardcopy case records are retained following normal purging procedures. Any form or verification scanned into ECF will become a permanent record. To ensure records contain only relevant material, case records are purged of all outdated material. Material not directly related to eligibility or benefit authorization is not retained. Purged material is shredded or burned prior to disposal. Any claim established after the implementation of ECF must have the corresponding documentation noted as part of the claim case record in ECF. A. DO NOT PURGE a case record involved in an audit until the audit is completed, a response to the audit has been filed, and the audit is closed. B. For benefit programs except the Supplemental Nutrition Assistance Program (SNAP), material retained permanently in an active case is: 1. Case history sheets, PAFS-116; 2. Application and need determination forms; 3. All forms used to establish technical eligibility; 4. All forms relating to Long Term Care (LTC); 5. Hearing decisions on which eligibility is based; and 6. All forms and material related to fraud or overpayment claims. Kentucky Works Program (KWP) material is not purged from case records. It is retained indefinitely or until the Kentucky Transitional Assistance Program (KTAP) is inactive for five consecutive years. Form PAFS-706, Voter Registration Rights and Declination, is retained as part of the case record for three years from the date of completion. All other material, including the PA-10 series, MA-105 or PA-105, not required to substantiate a period of eligibility, is purged from active KTAP or Medicaid cases after five years. C. For SNAP cases, maintain all local office records related to certification and issuance such as monthly reports, application registers, and issuance listings, for a period of three years from the month of origin. Hard copy files that are marked “DO NOT PURGE” prior to ECF are maintained as a hard copy case record. Scan into ECF any part of a hard copy case record that

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MS 0100 (1) Volume 1 – General Administration MS 0100 – R. 6/5/23 – OMTL-626 Returned Checks Individuals must return any check for which they are not eligible. Individuals, their Authorized Representative (AR), or any other interested party may return checks to a Department for Community Based Services (DCBS) office. Checks may also be returned to Central Office. [A. For checks, including Kentucky Transitional Assistance Program (KTAP), Kinship Care (KC), Supplemental Nutrition Assistance Program (SNAP) Employment and Training Program (E&T), Kentucky Works Program (KWP) supportive services, State Supplementation, Family Assistance Short Term (FAST), which have been returned to Central Office, the Program Specialist will receive notification via email about the check and respond via email within five workdays. The response authorizes the appropriate action to:] 1. Cancel a check if: a. The recipient of the check died prior to the first day of the month for which the check was issued; b. The recipient has moved and cannot be located, and mail sent to the recipient by the local or Central Office has been returned to the local office. A check is not cancelled until procedures for returned mail in MS 0090 are completed and the recipient cannot be located. If, after the check has been cancelled but prior to the last day of the month covered by the cancelled check, the location of the recipient becomes known, the check must be made available to the recipient; c. The recipient voluntarily returned a check to avoid an overpayment; d. A supportive services provider returns a duplicate payment; e. A supportive services payment is returned due to an incorrect amount or provider on the check. In this instance, the correct payment is issued on Online Tracking Information System (OTIS); f. The individual is discharged from a Personal Care Home (PCH), unless the individual is going to another PCH or is receiving Community Integration Supplementation (CIS); g. The individual is discharged from a Family Care Home (FCH), unless the individual is going to another FCH; h. The individual is no longer receiving Caretaker Services or Community Integration Supplementation (CIS); or i. The payment was issued in error. [Note: Once the cancelled KTAP, KC, FAST, or State Supplementation check has been redeposited, the Family Self-Sufficiency Branch (FSSB) will

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MS 0110 (1) Volume 1 – General Administration MS 0110 – R. 5/1/24 – OMTL-647 Report of Nonreceipt of Benefits Issued by Check [If a payee reports non-receipt of a check or that a check has been lost or stolen, the payee may request a replacement of a check (Kentucky Transitional Assistance Program (KTAP), Kinship Care (KC), Supplemental Nutrition Assistance Program (SNAP) Employment and Training Program (E&T), Kentucky Works Program (KWP) supportive services, Family Assistance Short Term (FAST), Relocation Assistance Program (RAP), and State Supplementation).] A payee must report non-receipt, loss, or theft of a check within 12 months of the intended receipt in order to receive a replacement check. Replacement checks are not issued for requests made after 12 months. Example: The issuance date of the check is June 1, 2022. The individual may request replacement of the check until May 31, 2023. If the individual reports non-receipt, loss, or theft of the check on June 1, 2023or after, the replacement request is denied. A. When a payee reports non-receipt, loss, or theft of a check: 1. [Inquire the appropriate system to determine the date the check was issued. a. For KTAP, KC, FAST, SNAP E&T, and State Supplementation, access Worker Portal for issuance information. b. For RAP and KWP supportive services checks, access the Online Tracking Information System (OTIS) for check issuance information.] 2. The payee must wait 10 business days from the daily check issuance date before completing form PAFS-60, Affidavit, to request a replacement. 3. If the individual is reporting the non-receipt by phone, tell the individual that they have to go to the local Department for Community Based Services (DCBS) office to sign form PAFS-60. [If a FAST or KWP check is issued to a provider, send form PA-64, Provider Appointment Letter, to document the appointment to discuss non-receipt, loss, or theft of a check. Form PA-64 also provides instruction for the provider to return form PAFS-60 signed and notarized to the office.] 4. Determine if: a. The payee recently moved and failed to provide a forwarding address to the Post Office or a change of address was submitted too late to redirect mailing of the check; b. The check was lost or stolen and if the check was signed before the loss or theft; or

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MS 0110 (2) c. For a stolen check, the individual reported the theft to the police and obtained a copy of the police report. 5. Contact the Division of Family Support (DFS), KTAP Section at 502-564-3440 to determine if the check has been returned or cashed. a. If the check has not been returned or cashed, verbally schedule an appointment with the individual within three days to complete form PAFS 60. b. If returned, the check is re-mailed to the correct address. c. If cashed, follow procedures in MS 0115. B. At the time of the appointment to complete form PAFS-60: 1. [In OTIS, navigate to Payments and select the payment that is reported stolen, lost, or not received. Then choose “Issue PAFS-60” and enter comments in the “Supportive Service Request to Stop Payment” comment box. Once the comments have been entered, follow the steps B.2.– 6. 2. Complete the Update Benefit Status screen in Benefit Management in Worker Portal. This will create a task for the Family Self-Sufficiency Branch (FSSB).] 3. Generate form PAFS-60 Part I on the Update Benefit Status screen for the individual to sign while in the office. For FAST payments or payments from OTIS issued to a vendor, form PA-64, Provider Appointment Letter, is used to notify the vendor of the need to sign the affidavit, form PAFS-60. a. The form must be signed by the payee and Field Services Supervisor (FSS). If the FSS is unavailable, the form must be notarized. b. If the payee is a vendor who is signing the form outside of the office, form PAFS-60 must be notarized. c. Form PAFS-60 may also be signed by the Power of Attorney (POA) if verification of the POA is provided and scanned into the Electronic Case File (ECF). Note: Do not use a version of form PAFS-60 other than the one generated from Worker Portal. The use of any other version will be rejected and will result in an unnecessary delay for the individual. In addition, if form PAFS-60 Part I is not system-generated, then form PAFS-60 Part II cannot be generated. 4. Explain the following to the payee: a. The original check cannot be cashed once form PAFS-60 is signed and a stop payment has been placed on the check. b. If the original check, which is issued in a self-sealed envelope known as thermo-bond, is received after form PAFS-60 is signed, it must be returned

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3. If the individual denies the endorsement is his/hers, request the individual to provide a police report for the forged endorsement. 4. Scan the signed form PAFS-60 Part II and the police report into the Electronic Case File (ECF). Mail the original version of the form and police

report to: Division of Family Support MS 0115 (1) Volume 1 – General Administration MS 0115 – 5/1/24 – OMTL-647 Replacement of a Check that is Cashed If the original check is cashed before the stop payment is in place: A. The Division of Family Support (DFS) Central Office (CO) worker will update the Benefit Status on Worker Portal to “cashed”. This generates a notice, CHK-1, Notice of Replacement Check, to the individual stating that the check was cashed

and providing instructions on how to dispute that he/she cashed the check.

The CO worker obtains a copy of the cashed check and emails a copy to the Program Specialist. B. [When the individual comes to the local office to dispute the cashed check, have them view the cashed check signature. If the payee is a Kentucky Works Program (KWP) supportive services provider, send form PA-64, Provider Appointment Letter, to the provider to complete form PAFS-60 Part II. Form PAFS-60, Part I and Part II, is evidence in the event legal action is initiated for false swearing or fraud. Advise the individual that the form may be used as evidence and extend to the payee the opportunity to consult legal counsel, if desired, before signing the form.] 1. If the individual states he/she signed the check, send an e-mail to DFS explaining that the individual no longer claims non-receipt of the check. 2. [If the individual denies the endorsement is theirs, complete the Update Benefit Status screen. This will create a task to the Family Self-Sufficiency Branch (FSSB). Generate form PAFS-60, Part II on the Update Benefit Status screen and have the individual sign the form. Note: Do not use any version of form PAFS-60 other than the one generated from Worker Portal. The use of any other version will be rejected and will result in an unnecessary delay for the individual. In addition, if form PAFS-60 Part I is not generated from Worker Portal, form PAFS-60 Part II cannot be generated from the system.] Form PAFS-60 Part II must be signed by a Notary Public. The form cannot be signed by a staff person who is not a Notary Public. If a Notary Public does not sign the form, this will cause a delay in the replacement check.

Treasury will return the form and require a new form PAFS-60 Part II be completed with all the necessary signatures.

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MS 0120 (1) Volume 1 – General Administration MS 0120 – R. 9/1/21 – OMTL-581 Checks Received by the Local Office [Checks may be mailed by Central Office to the local office for the payee shown on the check to pick up. These include checks that have been replaced by Treasury due to being lost, stolen, and/or damaged, or a rejected direct deposit. In addition, the local office may receive checks from individuals, their Authorized Representative (AR), provider, or any other interested party who needs to return checks. If someone other than the payee on the check picks up the check, there must be an explanation in Case Notes as to who authorized the individual to receive the check. Any time a check is received in the local office, the worker must enter the check status information in Worker Portal under Benefit Management on the Update Benefit Status screen. This screen is also updated at the disposition of the check, whether picked up by the individual or returned to Central Office. A. Form PAFS-62, Local Office Check Log, is a mandatory form and must be completed and maintained for all checks received in the local office. Every check received in the local office must be entered on form PAFS-62 upon receipt, and the disposition of the check must be entered as well. It is extremely important that this form is updated appropriately with accurate information needed to track the checks received.] B. Form PAFS-62, Supp A, Affidavit of Check Receipt, is a mandatory form and must be completed and signed by the recipient and worker when the check is picked up. The form should be scanned into the Electronic Case File (ECF). C. If in 30 days, the individual has not picked up the replacement check: 1. Complete form PAFS-61, Disposition of Returned Check, to cancel the check. Scan the form into ECF. 2. Mail form PAFS-61 and the check to: Division of Family Support Family Self-Sufficiency Branch K-TAP Section 275 E. Main Street, 3E-I Frankfort, KY 40621 Annotate the envelope: Do Not Forward

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MS 0131 (1) Volume 1 – General Administration MS 0131 – R. 5/1/23 – OMTL-623 Electronic Income Verification (EIV) [Electronic Income Verification (EIV) is a method of obtaining verification of an individual’s earned income online. An online service may be used to assist individuals when verification of earned income is not readily available, and the individual advises the worker that verification of the income is available by a free online service. Before EIV can be used, the individual must be contacted to confirm the information provided through EIV is current and correct. Comments must be entered in Worker Portal to explain the verification of the income. This also applies to information received from the Eligibility Advisor (EA). Note: EA should be accessed before using any other online verification service.] A. It remains the individual’s responsibility to provide verification of earned income if information provided on an online service is incorrect or incomplete. B. [It is the agency’s responsibility to conduct thorough interviews to ensure that the employer’s name, rate of pay, hours worked, and pay schedule are documented in comments when earned income is reported and can be verified through an approved EIV.] C. EIV online services may have hidden fees that workers may not be aware of without completing additional research. Therefore, the online services must meet all of the following criteria: 1. The online service must be free. 2. The online service must not lead to a charge of any kind. 3. The information must be accessible to the caseworker directly. [If the EIV online service meets the criteria above, forward the information to the appropriate program branch inbox through the region’s Public Assistance Program Specialist (PAPS) for approval to use the service. Once approval has been received from Central Office (CO), the service can be used.] If the EIV online service is not approved, follow normal verification procedures. D. Do not utilize or set up accounts for EIV online services that do not meet the criteria listed above. Do not use an individual’s username and password to log on to the individual’s online account to verify earned income or allow an individual to use state computer equipment to do so.

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MS 0150 (1) Volume 1 – General Administration MS 0150 – R. 9/1/22 – OMTL-605 Confidentiality Requirements Disclosure of information concerning applicants and recipients of assistance or services from the Department of Community Based Services (DCBS) is limited to purposes directly connected with the administration of the program. Such purposes include establishing eligibility, determining amount of assistance, and providing services. A. Applicants and recipients must be protected from harassment and exploitation for political or commercial purposes. Case records or listings of these individuals may not be open for public inspection or used in any manner so as to become a part of public record. B. Respect the applicant’s/recipient’s right to privacy. 1. Do not conduct interviews with other individuals present unless the recipient consents. 2. Do not discuss or disclose information about the applicant/recipient with a collateral contact. 3. Do not discuss case situations informally or outside the office setting. 4. Do not provide any information by e-mail to the applicant/recipient. If you receive an e-mail from an applicant/recipient, respond with the following message: “I am not allowed to respond to e-mails regarding confidential information. Please call 1-855-306-8959 or come into the local office to discuss your request for information”. Before sending the e-mail, remove all confidential information, such as applicant’s/recipient’s name, social security number (SSN), or address, from the original e-mail, including the subject line. [5. Do not provide any specific information in a voicemail message to a generic voice mailbox or to a contact number that does not belong to the applicant/recipient. When a generic voicemail greeting is received, it is appropriate to state, “Hello. This is DCBS. Please call us back at 855-306 8959”. If calling another contact number, leave the same message.] C. All e-mail communication must be encrypted before it is sent outside of the state government e-mail system. Case information, including Personal Health Information (PHI), cannot be sent via unencrypted e-mail to agencies outside of the state government e-mail system. Encrypted communication is not sent to a recipient. 1. All e-mail messages should include the following confidentiality notice: “This electronic message is intended to be for the use only of the named recipient and may contain information that is confidential or privileged. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or use of the contents of this message is strictly prohibited. If you have received this message in error or are not the

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*MS 0175 (1) Volume 1 – General Administration *MS 0175 – 1/15/25 – OMTL-664 Disclosure of Information Case record information should never be shared with any individual or entity not authorized to obtain it. This also applies to testimony in court. However, through appropriate action, information may be requested to use in either legal action or personal business. A. Open Records Requests are requests for eligibility information for an individual(s). These can come from the individual themselves, law enforcement, or another individual or entity that would otherwise be unable to access these records. These requests are not generally completed by field staff. If documentation for an Open Records Request is received, the documentation should be forwarded through regional chain of command to the appropriate program inbox. Information regarding the submission of a request, including the information for media requests B. Subpoenas may be used as a request for information by the judicial system. Guidance regarding what can or cannot be disclosed based on the type of subpoena may be obtained from the regional attorneys or, if the regional attorney is unavailable or cannot help, the Cabinet for Health and Family Services (CHFS) Office of Legal Services (OLS) in Central Office. List of regional attorneys that may be able to assist 1. Contact the regional attorney or OLS at 502-564-7905 immediately upon receipt of a subpoena. If time permits, the regional attorney/OLS will assist. If time does not permit OLS assistance, take the following action: a. If the subpoena requests a Family Support worker to appear in court, the worker must appear in court with the requested information as directed. In addition, the worker should take a copy of KRS 205.175 and explain to the judge that all Family Support case records are confidential pursuant to KRS 205.175 and can only be released by court order. If the judge orders the release of the information, the worker must comply. b. If the subpoena requests a Family Support worker to appear in a setting other than the courtroom or in the presence of a judge, the employee must appear as directed and advise that all CHFS case information is confidential pursuant to KRS 205.175 and can only be released to a judge by a court order. (See Volume 3 MS 2040 if the individual presents a court order). c. If the subpoena requests release of information contained in the case file and the individual requesting information is acting on behalf of CHFS, such as a county attorney involved in child support activities, provide the requested information. 2. Grand jury subpoenas are not court orders and while a judge is not present at the proceeding, information may be released to the grand jury only if the

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MS 0180 (1) Volume 1 – General Administration MS 0180 – R. 11/1/19 – OMTL-555 Viewing of Case Record Material by Recipients and Representatives A. The following portions of the case record may be viewed at any time by the client or a representative designated by the recipient on form DCBS-1, Informed Consent and Release of Information and Records, or the DCBS-1A, Informed Consent and Release of Information and Records Supplement: 1. Forms completed or provided by the client; 2. Worksheets used in the eligibility determination; 3. Correspondence to and from the client; 4. Decisions from the Medical Review Team; 5. Non-confidential medical records of the client; B. The following portions of the case record cannot be viewed unless the client obtains a court order: 1. Medical records marked as “confidential – not to be viewed or shared with the patient”; 2. Names of individuals who provided information regarding the client; 3. The nature or status of criminal proceedings; 4. Records subject to Health Insurance Portability and Accountability Act (HIPAA) procedures. For more information regarding HIPAA, see MS 0160; 5. Child support screens, which contain the absent parent’s tax refund information. C. Case record inspection is conducted in any local office, with care taken that no part of the record is lost. Electronic Case File (ECF) documents must be printed for viewing. The client, Power of Attorney (POA), Authorized Representative (AR), or attorney cannot view the case material from the computer screen. If requested, copies of the record pertinent to the issue are prepared for and provided to the client or representative at any local office. Case material cannot be provided through e-mail or mail. The only exception to sending case material via mail is for a telephonic hearing. D. Information needed for the settlement of a deceased client’s affairs may be released to a bona fide representative or administrator of an estate, but are still subject to HIPAA requirements. See MS 0160.

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MS 0190 (1) Volume 1 – General Administration MS 0190 – R. 6/1/11 – OMTL-389 Agreement to Safeguard Information An agency, organization, or school may obtain recipient information if a Memorandum of Understanding (MOU) Safeguarding Information in Public Assistance Programs and Business Associate Agreement has been completed with the Department for Community Based Services (DCBS). These are confidentiality agreements that are negotiated and maintained by staff in the Division of Family Support (DFS). [A. To qualify to enter into an MOU, a requesting agency must meet the following criteria:] 1. The agency must be federally funded; 2. The agency must provide needs-based services, where eligibility is based on an income test; and 3. Staff of the agency must be subject to the same confidentiality requirements as Cabinet employees. B. Examples of agencies that meet the above criteria include public housing authorities and public Boards of Education. C. Organizations which do not meet the criteria include churches, associations sponsored by religious groups, civic clubs, United Way, the Red Cross, individuals such as temporary help in the local offices, custodians, guards, repairmen, summer workers, landlords, or students working on research papers. Case information can only be released to these groups/individuals if the recipient completes form DCBS-1, Informed Consent and Release of Information and Records, or DCBS-1A Supplement. [D. If an agency/organization/school meeting requirements in item A requests client information and does not have a current signed MOU agreement with DCBS, contact the Policy Development Branch (PDB). E. Staff in PDB: 1. Will initiate completion of the MOU directly with the agency; and] 2. Send out renewal agreements every two years to agencies that have an existing MOU. F. A listing of all currently active confidentiality agreements is maintained with DFS. To inquire about the status of a confidentiality agreement, contact PDB.

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MS 0210 [1] Volume 1 – General Administration MS 0210 – R. 6/1/26 – OMTL – 696 Civil Rights Overview [In accordance with Federal law, United States Department of Agriculture (USDA) and United States Department of Health and Human Services (HHS) policies, the Department for Community Based Services (DCBS) and contracted vendors cannot discriminate against any person in the provision of services and benefits based on race, color, national origin, disability, age, sex, and religious and political beliefs.] A. Policies and practices must conform to the following statutes: 1. [Title VI of the Civil Rights Act of 1964, which protects individuals from discrimination based on race, color, or national origin in any program or activity that receives federal funding. Specific discriminatory actions prohibited under Title VI include the following if the action is based on race, color, or national origin:] a. Providing services that are more limited in scope or lower in quality; or b. Limiting participation in a program. 2. [Section 504 of the Rehabilitation Act of 1973 protects qualified individuals with a disability from discrimination in the provision of any benefit or service provided under any program or activity that receives federal funding. Discriminatory actions prohibited under this authority may include the following if the action is based on disability:] a. Denying a qualified individual with a disability any aid, benefit, or service that is provided to others. b. Providing different or separate aid, benefits, or services to a qualified individual with a disability, unless such action is necessary to ensure that the aid, benefit, or service is equally effective as those provided to others. 3. [Title II of the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008 prohibit discrimination based on disability in programs and activities of all state and local governments. Specific discriminatory actions may include the following if the action is based on disability:] a. Imposing eligibility criteria that screen out or tend to screen out an individual with a disability from fully or equally enjoying any program or activity unless such criteria are shown to be necessary. b. Providing a qualified individual with a disability with an aid, benefit, or service that is not as effective in affording equal opportunity to gain the same result or reach the same level of achievement as that provided to others. c. [Denying an individual with a disability an equal opportunity to obtain

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MS 0210 [2] the same result, to gain the same benefit, or to reach the same level of achievement, in the most integrated setting appropriate to the individual’s needs. 4. The Age Discrimination Act of 1975 prohibits discrimination based on age in programs or activities receiving federal funding. 5. Discrimination based on religion is prohibited by a number of Federal laws and regulations. including Section 11(c) of the Food and Nutrition Act of 2008, as amended.] 6. Title IX of the Education Amendments of 1972 prohibits discrimination based on sex in any education program or activity that receives federal funding. 7. Civil Rights Restoration Act of 1987 (Public Law 100-259) clarifies the intent of Congress as it relates to the scope of Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975, to ensure nondiscrimination in all programs and activities of a recipient, whether those programs and activities are federally funded or not. 8. The Food and Nutrition Act of 2008, as amended, Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program, prohibits discrimination against any applicant or participant in any aspect of program administration for reasons of race, color, national origin, disability, age, sex, and religious and political beliefs. 9. Title III of the ADA and ADAAA prohibits discrimination based on disability by public accommodations and commercial facilities. 10.Section 1557 of the Patient Protection and Affordable Care Act (42 U.S.C. § 18116(a), 45 C.F.R. Part 92) [HHS]).] B. Ensure the following general requirements are met in the provision of all services and benefits to applicants and recipients: 1. [Do not discriminate against any individual for reasons of race, color, national origin, disability, age, sex, and religious and political beliefs in any aspect of program operation, including but not limited to the application process, benefit or claims determination, hearings, employability assessments, or work program components. 2. Explain and provide the Civil Rights pamphlet in the language and format the applicant can understand at the application and any time the individuals question or do not understand their rights.] The pamphlet can be accessed at: Cabinet for Health and Family Services Civil Rights Brochure. 3. [Provide assistance to any individual needing reasonable accommodation due to a disability they or another household member currently has or has

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MS 0220 [1] Volume 1 – General Administration MS 0220 – R. 6/1/26 – OMTL – 696 Interpreter Services for Deaf and Hard-of-Hearing Individuals. A. [All staff shall take appropriate steps to ensure that communications with applicants, participants, members of the public, and their representatives are as effective as communications with others. Staff shall furnish appropriate auxiliary aids and services where necessary to afford individuals with disabilities, including applicants, participants, members of the public, and their representatives, an equal opportunity to participate in and enjoy the benefits of a service, program, or activity of the agency. The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the method of communication used by the individual; the nature, length, and complexity of the communication involved; and the context in which the communication is taking place. In determining which type of auxiliary aids and services are necessary, a public entity shall give primary consideration to the requests of individuals with disabilities. To be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability.] When interpreter services are needed for a deaf or hard-of-hearing individual, do the following: 1. Document the case that the individual requires interpreter services and indicate how these services were provided. Answer Yes within Worker Portal to “Are Special Interviews Required?” and make the appropriate entry. 2. [At application, reapplication, and recertification, provide the individual with form CHFS-OHRM-EEO-2, Your Right to Effective Communication. Document in the case that the form was provided to the individual either by mail or in person. If Worker Portal is unavailable, the individual must complete the CHFS-OHRM-EEO-3, Waiver of Interpreter Services – form to be scanned to the Electronic Case File (ECF).] 3. If available, use qualified on-site personnel. A qualified interpreter is an interpreter who can interpret effectively, accurately, and impartially both receptively and expressively, using any necessary specialized vocabulary. There are three types of qualified interpreters: a. Certified Deaf Interpreter (CDI) – used for a deaf or hard-of-hearing individual, who can assist in providing an accurate interpretation using sign language. This includes Video Relay Services (VRS); b. Deaf/Blind Interpreter – used for a deaf and blind individual who places their hands over the hands of the interpreter to read signs through touch and movement; or

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MS 0220 [2] c. Oral Interpreter – used for a deaf or hard-of-hearing individual who can lip read. 4. When a worker becomes aware that a sign language interpreter is needed, they should contact their supervisor, and the supervisor should get approval for the request from their Service Region Administrator Associate (SRAA). 5. [Request services from the Kentucky Commission for the Deaf and Hard of Hearing (KCDHH) Access Center. The Access Center is a language interpreter referral service for state agencies. Information about services available from the Access Center is located at the Kentucky Commission on the Deaf and Hard of Hearing. a. The individual may have the telephone equipment to use VRS. VRS is a qualified interpreter service. b. To request an interpreter, go to the Kentucky Commission on the Deaf and Hard of Hearing and click on “Interpreting/CART”. Complete the KCDHH Inter-Agency Access Center request form. When completing the form, the SRAA’s contact information must be entered into the billing information sections. The requester fields should have information about a supervisor from the local office where the request was made, and the consumer is the individual who requires interpreter services. Notification is sent once the Access Center has received the request. Another notice is sent within a few days to confirm that an interpreter has been scheduled. Because it may take up to two weeks to schedule an interpreter, the worker should request the interpreter when scheduling appointments. When requesting an interpreter from KCDHH, provide the following information: 1) Local office supervisor name, address, and phone number; 2) The date services are needed; 3) The time (beginning and estimated end time); 4) The location of the assignment; 5) Type of assignment (application, meeting, etc.) 6) Name of the individual needing services; 7) Individual’s preferred mode of communication, if known; and 8) Billing information (SRAA name, address, and phone number). c. The interpreter who provides services must complete the Annual Required Affidavit for Bidders, Offerors, and Contractors. This form must be completed by the interpreter and uploaded to the Kentucky Information Technology Standards (KITS) system with the billing invoice.

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MS 0220 [3] d. After interpretation services are provided, the local office will receive a billing invoice. This invoice must be signed off on by an SRAA and uploaded to the KITS system with the Annual Affidavit for Bidders, Offerors, and Contractors. These forms may be uploaded by whoever has access to KITS. If the request form is signed off by someone other than a branch manager or SRAA, it will be rejected by the Accounts Payable Branch. 6. At application, reapplication, and recertification, or at any time an interpreter service is used, have the individual performing the interpreter service complete the confidentiality form, Business Associate Agreement. Scan a copy into ECF. 7. [Staff must not rely on an individual’s companion for sign language interpretation. Companions may be used only in the following situations: a. In an emergency involving an imminent threat to the safety or welfare of an individual or the public, an adult or minor child accompanying a person who uses sign language may be relied upon to interpret or facilitate communication only when a qualified interpreter is not available. b. In situations not involving an imminent threat, an adult accompanying someone who uses sign language may be relied upon to interpret or facilitate communication when a) the individual requests this, b) the accompanying adult agrees, and c) reliance on the accompanying adult is appropriate under the circumstances. This exception does not apply to minor children. B. In situations when a service is performed by an approved interpreter and a fee is charged, each interpreter has their own billing statement. State employees and unlicensed interpreters provided by the individual (e.g., family members, friends, etc.) are not paid for their interpretation services.] 1. Obtain a signed billing statement from the licensed interpreter, which includes: a. Name of interpreter; b. Social Security number or federal identification number; c. Address, telephone, and email, if available; d. Purpose of the assignment; e. Date the service was provided; and f. Amount of fee. The fee includes: 1) The hourly rate includes time spent travelling, time spent interpreting, and mealtime. Mealtime cannot exceed one hour. Interpreters shall also be paid for at least two hours of service, which can include waiting time due to delays in appointments and when an individual does not appear for the appointment.

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MS 0230 [1] Volume 1 – General Administration MS 0230 – R. 6/1/26– OMTL – 696 Limited English Proficiency (LEP) [The Cabinet must ensure all individuals with LEP have meaningful access to all programs and services administered by the Cabinet. LEP individuals are those who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English. Each local office must post notices in multiple languages in the local offices and program websites to inform the public of the availability of free interpreter services.] Use the following policy and procedures to identify LEP individuals and to provide LEP services to those individuals. A. When an individual comes into the local office to apply: 1. [Ask the individual for their primary language. Based on the individual’s statement, enter the language on Worker Portal. Do not assume an individual does not speak or understand English or assume the individual’s primary language based on appearance. If the individual does not speak or understand English, use the “I Speak” language identification posters to determine the primary language. If still unable to identify the language spoken, contact the Language Access Section for assistance;] 2. Inform the LEP individual that interpreter services are available at no cost to the individual using the “I Speak” posters; and 3. [If the individual indicates a primary language other than English and they do not want to use the approved interpreter service provided by the Cabinet, answer the corresponding waiver questions within Worker Portal to document the individual’s request. If Worker Portal is unavailable, the individual must complete the CHFS-OHRM-EEO-3, Waiver of Interpreter Services Form, and scan it into the Electronic Case File (ECF). If, during the interview, the worker cannot clearly understand the individual, a Cabinet approved interpreter must be contacted to stay on the line in the background to ensure the quality and accuracy of the interview. B. If an individual cannot understand verbal or written English, use one of the following options to access interpreter services: 1. Language Services Associates, Inc. (LSA/Interpretalk). The instructions for the LSA may be accessed at: Language Access Section Interpretalk Instructions. 2. Affordable Language Interpreter Video Relay Calling. Instructions for video relay calling can be accessed at: Affordable Language Interpreter Video Relay Calling. Video Relay Calling or a Virtual Face-to-Face interpreter should not be used for routine Supplemental Nutrition Assistance Program (SNAP) or Medicaid applications, even if the applicant is in the office. 3. Cabinet for Health and Family Services (CHFS) Qualified Interpreter Service. If LAS staff are not available, choose an interpreter from the CHFS

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MS 0230 [2]

approved list of Cabinet employees who are qualified to provide interpreter services. The list can be accessed at:

Office of Human Resource Management Interpretation Resources.

Note: If you work in the same local office with CHFS Approved Cabinet Employees who are qualified to provide interpreter services, you may contact them if they are available to interpret.

4. CHFS Qualified Community-Based Partner Interpreters. If there is a need to contact a qualified non-CHFS interpreter, the following resource can provide interpreter services for a variety of languages, including Spanish. The list can be accessed at: Office of Human Resource Management Interpretation Resources.

C. If the individual wants to use another individual to interpret for them, contact a Cabinet approved interpreter through CHFS LAS Interpreters, LSA/Interpretalk, or Video Relay Calling as needed, and explain to the individual that an approved interpreter is used even though they have another interpreter to ensure all the information, questions, and responses are interpreted correctly and without bias. Staff is encouraged not to allow minor children as interpreters unless all other options are exhausted.]

D. If a form is identified as needing translation into another language, forward the form to the Language Access Section by email. Forms and notices generated by Worker Portal are available in English and other languages.

E. If verification provided by the individual needs to be translated, send the material needing to be translated to the Language Access Section by email. Please include the date the information is needed and, if expedited translation is required due to time constraints, specify that in the request.

F. Document in Worker Portal and on the Online Tracking Information System (OTIS) when interpreter services are needed and used for all programs. Documentation should include:

1. When Special interviews are required;

2. The date services are requested and provided;

3. Which option is used; and

4. The reasons for the service, such as application or recertification interview, interim communications, or translation of forms or other written material.

G. [Make copies of “Know Your Rights” and have them available in the local waiting area. This brochure is available in ten languages and can be found at: Know Your Rights/English. The brochure must be downloaded from the website, with copies made for distribution.]

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MS 0240

[1]

Volume 1 – General Administration MS 0240 – R. 6/1/26– OMTL – 696 Civil Rights Complaints

Any individual who feels they have been discriminated against may file a complaint. Assist the individual in filing a complaint with any or all of the entities listed below. Retaliation against an individual who submits a complaint, assists in the investigation of a complaint, or interferes in the investigation of a complaint is prohibited by law. An employee who is determined to be in violation is subject to disciplinary action, up to and including dismissal.

A. [Use the Fair Hearing process if the individual alleges denial of eligibility because of agency policy.

B. Use the AD-3027, USDA Program Discrimination Complaint Form, if the individual alleges discrimination in the manner in which services are provided or refusal of access to services.

C. If form AD-3027 is submitted to the local office, forward it through the regional chain of command to the Cabinet for Health and Family Services, Office of Human Resource Management (OHRM), Equal Employment Opportunity Commission (EEOC) Compliance Branch at:

EEO/Civil Rights Compliance Branch 275 East Main Street, 5C-D Frankfort, Kentucky 40621 Telephone: (502) 564-7770 EXT. 4107

D. In addition to or in place of filing a complaint with the Cabinet, when discrimination is alleged in the provision of Supplemental Nutrition Assistance Program (SNAP) benefits, the individual may file a complaint with the U. S. Department of Agriculture (USDA) by writing or calling:

USDA, Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, S.W. STOP 9410 Washington, D.C. 20250-9410 (800) 795-3272 (voice) or (202) 720-6382 (TTD) Fax: (833) 256-1665 or (202) 690-7442 Email: programintake@usda.gov]

The complaint should be filed within 180 days of the alleged discriminatory action. Only the U.S. Secretary of Agriculture can extend the timeframe under special circumstances.

E. [In addition to or in place of filing a complaint with the Cabinet, when discrimination is alleged in the provision of Temporary Assistance for Needy Families (TANF)-funded programs (Kentucky Transitional Assistance Payment (KTAP), Family Assistance Short Term (FAST), Work Incentive Reimbursement (WIN), Relocation Assistance Program (RAP), Kinship Care, Kentucky Works Program (KWP)) or Medicaid, the individual may file a complaint by writing or calling:

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MS 0270 [1]

Volume 1 – General Administration MS 0270 – R. 6/1/26 – OMTL – 696 Required Explanations of Electronic Benefit Transfer (EBT)

During the certification interview, provide the household with the following explanations about EBT and the use of the EBT card and Personal Identification Number (PIN) in the language and format the Supplemental Nutrition Assistance Program (SNAP) applicant can understand:

A. [EBT is the system used to deliver SNAP, Kentucky Transitional Assistance Program (KTAP), Kinship Care, Kentucky Works Program (KWP), transportation, and Work Incentive Reimbursement (WIN) payments in Kentucky. EBT provides a safer, more secure method for recipients to receive benefits. EBT also eliminates the need to mail or have the recipients pick up benefits each month. Benefits are simply added to the recipient’s EBT account when an issuance is processed and are automatically available on the EBT card.]

B. EBT cards are the size and shape of typical bank credit cards. The card is red, white, and blue with an American flag design. The EBT card contains the recipient’s name and the EBT card number.

C. [All EBT cards are mailed with an inactive status. The card should be received by the recipient in approximately 7-10 business days. When the recipient receives the EBT card, a sticker is attached to the card advising them to call the Customer Service Representative (CSR) to activate the card. The EBT card will not work until it is activated.

D. Only one EBT card is issued per individual, regardless of the number of cases in the individual’s name and Social Security Number (SSN). Individuals who have an active EBT account for one type of benefit will not have a separate EBT account or be issued a separate EBT card for other types of benefits. The same EBT card is used to access SNAP, KTAP, Kinship Care, KWP transportation, and WIN payments.

For KWP transportation and WIN payments, if two individuals in the KTAP case are receiving either payment, each individual will have their own EBT card account.

Example 1: Mom has a KTAP, SNAP, and Kinship Care case. All three cases are in her name and SSN. Mom is issued one EBT card for all benefits.

Example 2: Mom and Dad have a KTAP and SNAP case in Dad’s name and SSN. Mom has a Kinship Care case in her name and SSN. Dad is issued an EBT card for the KTAP and SNAP benefits. Mom is issued an EBT card for Kinship Care benefits.

Example 3: Mom and Dad have a KTAP and SNAP case. The cases are in Mom’s name and SSN. Both Mom and Dad are working and receive transportation payments. Mom’s payments are posted to the EBT account along with the KTAP and SNAP benefits. Dad has his own EBT account and card for his transportation payments.]

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MS 0270 [2]

E. The EBT card is mailed in a card carrier, which is a two-sided heavy paper folder with slots cut to hold the card in place during mailing. Supplemental EBT educational information is printed on the card carrier covering such subjects as:

1. How and where to use the card;

2. How and when to use the CSR;

3. How to protect the card;

4. The need for Personal Identification Number (PIN) security; and

5. A non-discrimination statement.

F. SNAP households may designate a representative to receive and use the EBT card on their behalf. Naming an EBT representative allows that person to contact the Customer Service Representative (CSR) on the recipient’s behalf. If the household designates two representatives, one to apply for benefits and the other to use the EBT card, the household must specify which representative is to use the EBT card. Authorized representatives are not issued their own EBT card.

G. The EBT system distributes benefits to recipients through Point of Sale (POS) terminals located in authorized retailers. EBT system problems are handled by customer service support 24 hours a day, 7 days a week for recipients and retailers.

Cash benefits on the EBT system can be accessed as follows:

1. The EBT card cannot be used for any cash benefit transactions or withdrawals from Automatic Teller Machines (ATM) in liquor stores, adult- oriented entertainment establishments, or any casino, gambling casino, or gaming establishment.

2. The individual can withdraw cash at an ATM that displays the Quest logo. The individual gets one free withdrawal per month. The individual is charged a fee of 85 cents per withdrawal for subsequent withdrawals. The individual will also be assessed normal bank charges if the ATM charges a processing fee. The fee is deducted from the EBT account.

3. The individual can withdraw cash at a retailer’s POS terminal at authorized retailers with no charge at the time of a retail purchase. Individuals cannot request cash back from the SNAP benefits portion of the EBT account.

H. Give all households authorized to receive benefits the toll-free telephone number when problems arise with their card and/or PIN. The Customer Service telephone number is 1-888-979-9949. The number is printed on the back of the EBT card and on the training material the recipient receives in the mail.

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MS 0290 (1) Volume 1 – General Administration MS 0290 – R. 6/1/24 – OMTL-649 Security of EBT Cards Worker Portal tracks Electronic Benefits Transfer (EBT) cards from the initial request through the final process, eliminating the need for hardcopy logs that were previously used. The system has security measures in place to ensure separation of duties. EBT cards are sent to the household’s mailing address entered on Worker Portal. However, if the household has issues receiving mail, the EBT card can be mailed to the local office. [When a new card is requested, the worker selects the office location where the household wants to pick up the new card. When received in the mail, the receiving worker or administrative specialist updates the system to show the card as received in the local office. The same worker that made the EBT card request is not allowed to log the card as received in the local office. Additionally, when the individual comes in to pick up the EBT card, neither the worker that made the card request, nor the worker that logged the card as received by the local office, are allowed to give the card to household. The system requires the card to be updated as given to the household by a third, separate worker or administrative specialist. This individual verifies the identity of person picking up the card and enters case comments accordingly. In the event Worker Portal is unavailable, the worker should obtain a signed form EBT-29, Affidavit of EBT Card Receipt, give the card to the household and scan form EBT-29 into the electronic case file. The individual has 30 days from the date the card was received by the local office to pick up the EBT card. If the individual fails to pick up the EBT card by close of business on the 30th day, a task is generated to the supervisor to destroy the card the following business day. If the individual comes into the local office to pick up the card and the EBT card has been destroyed, request another card. When EBT cards are received in the local office and the envelope has been opened or a card is found and returned to the local office, update Worker Portal to show the card as received in that office. The supervisor and another employee destroys and/or witnesses the destruction of the EBT card if the card is returned to the local office, received damaged or not picked up within 30 days, and updates Worker Portal at the time of destruction.] To maintain the security of EBT cards in the local office: A. The Field Services Supervisor: 1. Maintains overall responsibility for secure storage of EBT cards and logging each card into Worker Portal; 2. Ensures EBT cards are NEVER left unsecured; 3. Routinely inspects the secure storage area;

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MS 0310 (1) Volume 1 – General Administration MS 0310 – R. 5/4/22 – OMTL-595 Time Limit for Using EBT Benefits A. [An Electronic Benefit Transfer (EBT) account must be debited by the recipient at least once every nine months for the Supplemental Nutrition Assistance Program (SNAP) or benefits will be removed. If the recipient fails to debit their EBT account at least once every nine months, the SNAP benefits in the account are expunged. When the benefits are expunged, they are deducted from the recipient’s EBT account and are no longer available to the recipient. The recipient cannot, under any circumstances, get expunged benefits back. 1. When the oldest SNAP benefit in the EBT account has not been used within nine months, the EBT system checks each benefit in the account to determine if it should be expunged. For a benefit to be expunged, the “Available Date” for that benefit must be at least nine months in the past. 2. The EBT system sends Worker Portal a file of all SNAP EBT accounts that have not had any debit activity for nine months. To ensure that the recipient is aware that they have had benefits removed from their EBT account, Worker Portal sends the household an expungement notice. This notice advises the recipients that they have not used their SNAP EBT account in the last nine months, the benefits listed on the notice have been expunged from their EBT account, and they cannot get these benefits back. If the recipient has a claim, these expunged benefits will be applied to that claim.] Note: If the case is inactive due to the only household member deceased, a notice will not be issued. 3. When benefits are expunged, Worker Portal updates the benefit segments with the amount expunged and the date. This information is available on the benefit inquiry screen. B. [The discontinuance of the case has no impact on the EBT account. As long as there are SNAP benefits in the account and the recipient is debiting the account at least once every nine months, the recipient has access to the EBT account. C. An EBT account must be debited every 12 months for Kentucky Transitional Assistance Program (KTAP) and Kinship Care (KC) benefits, or the above benefit expungement process will take place.] D. Access the EBT system at each reapplication to determine the status of an individual’s EBT card. E. If the EBT card status is anything other than active or inactive or if the EBT card number is blank, do the following: 1. Answer yes to the question “Does the household need a new EBT card?” 2. Tell the recipient their old EBT card will not work.

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MS 0340 (1) Volume 1 – General Administration MS 0340 – R. 7/1/16 – OMTL-504 Replacing EBT Card [All Electronic Benefit Transfer (EBT) cards are mailed with “Card Status” of “not activated”. When the recipient receives the card, the recipient calls the Customer Service Representative (CSR) to activate the card. Once this is done, the “Card Status” changes to “01” (active card). In most instances, when a recipient needs a replacement EBT card, he/she should call a CSR at 1-888-979-9949. If an EBT card is returned by the Post Office, the card status is changed by the EBT contractor to “undelivered”. If the client calls the CSR to request a replacement card, the CSR can replace the card only if the address that the client gives the CSR matches the address that is on Fidelity Information Service (FIS). If the address does not match, the client must contact the Department of Community Based Services (DCBS) office to request a replacement card.] A. Customer Service Responsibility Customer Service is responsible for issuing replacement cards except in the following situations: 1. Current card status is not “active" or "inactive". 2. [Recipient advises Customer Service that his/her address is different than the most recent address on the EBT system. If the recipient uses a mailing address, the mailing address must be given to the CSR when calling (not his/her home address). 3. Recipient advises Customer Service that his/her name is different than the name on the EBT system. 4. Recipient wants his/her replacement card sent to his/her local office. These replacements must be issued by a DCBS office.] B. Local Office Responsibility [In the above situations, the CSR refers the recipient to a DCBS office. Replacement cards are requested through the Benefit Management on Worker Portal.] 1. If the current card status on the EBT system is “11”, determine why the card was returned. If the current card status is "09", that card has been deactivated and a new card must be issued. a. [If the case is active or pending:] (1) If there is a new address for the case, update the address through the address change function or update the pending case before requesting the card.

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MS 0340 (2) (2) Enter the case number and select "Option 1" on "Case Change Menu”. (3) Enter a ‘Y’ for the question "Issue EBT Card", enter ‘C’ or ‘O’ for the question “Do you want EBT card mailed to the client or local office?”, and press enter. (The case address will be uploaded and cannot be changed on this screen.); and (4) When the message 'REQUEST PROCESSED' is received, PF3 to return to the 'Case Change Menu'. [If the case is active, the card will be sent to the recipient's mailing address if a ‘C” was entered for the ‘mailed to client or local office’ question. If an ‘O’ was entered, the card will be sent to the client’s DCBS office.] b. If there is no active or pending case in the head of household's Social Security Number: (1) Enter the case number and select "Option 1" on the "Case Change Menu". (2) Enter a "Y" for the question "Issue EBT Card?" (3) Enter the mailing address and press enter. (4) When the message "REQUEST PROCESSED" is received, PF3 to return to the "Case Change Menu". [If the case is inactive, the card will be sent to the mailing address. If the card should be mailed to his/her local DCBS office, enter the office address as the mailing address.] 2. If the recipient’s address has changed and their EBT card has been lost, stolen or damaged, follow steps as outlined in item 1. 3. For name changes, determine if the recipient wants to have a new card issued immediately. Explain to the recipient that if a new card is requested through the Kentucky Automated Management and Eligibility System (KAMES), the current card becomes invalid that evening. Benefits will be inaccessible until the new card is received. Advise the recipient that, if requested, the card replacement can wait until the current month’s benefits have been used or until access to benefits is not needed for several days. The recipient could call CSR to have the card replaced at a more convenient time. The advantage to waiting is the worker can make the name change on KAMES and KAMES can update the EBT system. This enables the CSR to authorize the replacement once the recipient calls. a. Procedures for Delayed Card Replacement (1) If the case is active:

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MS 0360 [1] Volume 1 – General Administration MS 0360 – R. 6/1/26 – OMTL – 697 The Quality Control (QC) System

[The state is federally required to provide a system of QC to ensure Supplemental Nutrition Assistance Program (SNAP), Medicaid benefits, Child Care Assistance Program (CCAP), and Kentucky Transitional Assistance Program (KTAP) are issued correctly. Penalties are imposed on any state that does not substantially reduce the error rate as determined by the QC process. The reviews are completed by QC analyst staff within the Office of Program Performance, with some second-level reviews completed by federal personnel. Sample cases are chosen monthly by means of systematic random sampling and are reviewed in depth to substantiate the worker's determination of eligibility and computation of the benefit allotment.

A. A QC review consists of:

1. Analysis of the case record, including adequacy of each step taken by the agency in the process of determining eligibility and the benefit allotment;

2. Interviews with benefit recipients either in person or by phone, including voice or video calls with the individual's consent.

3. Other investigations, including any collateral contacts necessary to ensure documentation of all eligibility factors and the accuracy of the benefit allotment; and

4. Preparation of form QC-343, Review Findings Notifications, as appropriate, to list errors and related observations, if any.

a. A positive QC error exists when the household receives an incorrect benefit allotment for any reason, resulting in either an over- or under- issuance of benefits. A positive QC error would also include households that were totally ineligible for benefits. These errors can be attributed to either the agency’s action or failure to act, or a household-related action.

Example: The household received $300 in benefits for the month of March. A QC review found that during the March SNAP application interview, the household failed to report their wages and exceeded the SNAP income limit for the application month.

b. A Case and Procedural Error Rate (CAPER) QC error would include when a case is denied or discontinued incorrectly, incorrect notices are issued to a household, the agency took incorrect action during certification, denies the case for incorrect reasons, etc.

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MS 0380

[1] Volume 1 – General Administration MS 0380 – R. 6/1/26 – OMTL - 697 Local Action on Quality Control (QC) Findings

[To ensure that the Office of Program Performance and local office staff meet time standards for responding to Quality Control (QC) reviews, after each case review, form QC-343, Review Finding Notification, is emailed to the regional Public Assistance Program Specialist (PAPS) or Service-Region Administrator Associate (SRAA), and Central Office staff. The notification will either request that corrections be completed or notify staff that no errors were found.

Note: It is the responsibility of the regional PAPS to forward to the appropriate Field Services Supervisor (FSSV) and to complete and track the timeliness of form PAFS 343.1, Response to Quality Control Errors, when required. Form PAFS 343.1 is only required for SNAP errors and related observations.

The following procedures apply to all Supplemental Nutrition Assistance Program (SNAP), Kentucky Transitional Assistance Program (KTAP), Kentucky Works Program (KWP), Medicaid, and Kinship Care (KC) reviews.

Immediately upon receipt of the form QC-343, review the case record in relation to the findings reported on form QC-343 and take the following action:

A. If the case is cited in error:

1. If the reported case findings are correct, take action to correct the case within 10 calendar days from the date on form QC-343.

2. If necessary, schedule an interview with the recipient.

3. If the recipient disputes the information as reported on form QC-343, additional collateral contacts may be necessary to substantiate or refute the QC findings.

4. If an under-issuance was identified on form QC-343, review and issue a supplement or restoration, if appropriate.

5. If an over-issuance was identified on form QC-343, review and determine whether a potential claim exists. If so, submit a claim referral via the Benefit Recovery Module within 20 calendar days from the date on form QC-343.

6. Scan form QC-343 into the Electronic Case File (ECF).

7. Within 20 calendar days from the date on form QC-343 and after corrections have been made to the case, the FSSV completes form PAFS- 343.1. This form identifies the error, what caused it, and details the

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MS 0380

(2) corrective action taken to prevent future occurrences. Once completed by the FSSV, the form is then submitted to the PAPS for review. Once reviewed and determined complete, the FSSV scans the form into ECF. Note: The FSSV and PAPS should ensure that the findings are shared with all staff in an effort to prevent the same type of error in the future.

8. If an over- or under-issuance is identified on the QC-343, the PAPS should email the PAFS-343.1 to the Division of Family Support, Integrity and Analysis Section upon completion to advise what determination was made and what actions were taken.

B. If the case was cited as correct, review form QC-343 for "Related Observations", which may identify changes that occurred that were not reported to the agency, resulting in a change in benefit allotment. Take appropriate case action within 20 calendar days from the date on form QC- 343.

Note: Form PAFS-343.1 must be completed for related observations on all SNAP reviews. If a response to a related observation is required for Medicaid, CCAP, KTAP, KC, or KWP review, it will be noted on form QC-343. Otherwise, responses are not required for related observations.

C. If form QC-343 indicates the recipient "refused" to cooperate with QC, take action to impose the disqualification. Refer to Volume I, MS 0390, to determine the appropriate action to take for each program.

D. If, as a result of the investigation, it is clearly established that the findings reported on form QC-343 are erroneous as of the review date, take the following actions to dispute the QC decision:

Note: An exception may not be filed for a review determined to be correct that only notes a related observation; however, a follow-up with QC may be sent for clarification. An exception may only be filed for a CAPER review with an incorrect case decision or for a Positive Error Rate (PER) finding that exceeds the current fiscal year allotment threshold amount.

1. Within 15 calendar days from the date on form QC-343, the FSSV provides the PAPS with the following information to take exception to the QC error as cited:

a. Case Name; b. Case Number; c. Region; d. County; e. Review Number; f. Review Month; and

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MS 0390 [1]

Volume 1 – General Administration MS 0390 – R. 6/1/26 – OMTL – 697 Refusal to Cooperate with Quality Control (QC)

[If form QC-343, Review Finding Notification, indicates an individual refused to cooperate with QC, take the following action:

A. For Medicaid:

1. The QC analyst sends the individual an appointment letter advising them that an analyst will call them at the time specified in the letter. While there are no sanctions or disqualifications placed against a recipient who refuses to cooperate with a Medicaid QC review, QC can ask for the case to be discontinued for failure to complete their eligibility review. When notified by QC that a Medicaid recipient failed to comply, discontinue their case using the non-cooperation option in the Withdrawal module.

2. If the Medicaid case discontinues due to not complying with QC, the Medicaid recipient may reapply at any time, following normal application policy, verification requirements, and procedures. There is no time frame the recipient must wait before reapplying for Medicaid.

B. For Kentucky Transitional Assistance Program (KTAP) and Kentucky Works Program (KWP), the QC analyst conducts a desk review of KTAP and/or KWP cases. No recipient interview is required; therefore, the cooperation of the recipient is not required, and no penalties are imposed.

C. For Kinship Care, the QC analyst contacts the household to request certain verifications and acquires independent verifications. There are no sanctions placed against a recipient who refuses to cooperate with the Kinship Care QC review.

D. For Supplemental Nutrition Assistance Program (SNAP):

1. If a household refuses to cooperate with the QC analyst in completing the case review, disqualify the household from further participation until the household cooperates with QC and provides the necessary information to complete the review.

a. When notified by QC that a household has refused to cooperate, enter a disqualification on the individual who refused to comply with QC. QC will identify this person on form QC-343. If QC cannot determine which member refused to cooperate, apply the disqualification to the head of household. Document this in case notes.

b. Once the disqualification has been applied, Worker Portal discontinues the case and issues a notice to the household, indicating the household’s refusal to cooperate as the reason for termination or denial of benefits, and states the actions the household must take if it wishes to reapply and cooperate.

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MS 0390

[2]

c. If the household disbands and members reapply within the QC review period or within 125 days of the close of the annual review period (October 1 through September 30 of any given year), the penalty follows the person who refused to cooperate, and the new household will be disqualified. The new household, containing the disqualified person, must cooperate with the QC analyst, even if the household is otherwise eligible for expedited services. Follow the steps outlined in steps d 1 and 2 below.

d. If the household remains intact and reapplies within the QC review period or within 125 days of the close of the annual review period (October 1 through September 30 of any given year), the household must cooperate with the QC analyst, even if the household is otherwise eligible for expedited services. Enter the application on Worker Portal and take the following steps:

(1) If the household states that it is unwilling to cooperate with the QC analyst, the disqualification remains on the system, and the reapplication will be denied for that reason. (2) If the household states that it is willing to cooperate with the QC analyst, hold the reapplication pending and take the following action:

(a) Notify the original QC Analyst or QC Branch Manager by email within 3 business days of the date of reapplication of the household’s intention to cooperate with the QC Analyst. Provide current identifying case information with the QC review number and review date from form QC-343.

(b) Upon notification that the household intends to cooperate, the QC analyst schedules an appointment with the household. After the QC interview is conducted, the analyst forwards a memorandum advising the local office either of the household’s decision to cooperate or of the household’s refusal to cooperate.

i. If the QC notice indicates the household’s refusal to cooperate, deny the reapplication.

ii. If the QC notice indicates the household’s willingness to cooperate, delete the disqualification and process the reapplication.

iii. If the reapplication is approved, and QC later determines the household is no longer cooperating with the review process, follow steps in D. 1. a above.

e. If the household reapplies more than 125 days after the end of the annual QC review period (September 30 of every year), cooperation with the state QC analyst for the prior review period is not required. However, the household must verify all eligibility requirements prior to being determined eligible.

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MS 0420

[1]

Volume 1 – General Administration MS 0420 – R. 6/1/26 – OMTL - 697 Quality Assurance (QA) Reports

[Quality Assurance (QA) captures the results of case reviews and compiles various reports. The reports summarize the reviews completed by each worker, unit, county, and region.

A. QA reports are used to:

1. Capture the results of case reviews;

2. Provide summarized reports identifying error trends in casework;

3. Determine error-prone areas and identify training needs;

4. Track case actions to determine if policy and procedures for all programs are applied correctly;

5. Provide an orderly method for case reviews; and

6. Compile data identifying strengths and weaknesses of individual workers or counties.

The following is a list of Quality Assurance reports available on Worker Portal. Employees and management at all levels must use the data found in the reports to improve accuracy and performance and to initiate corrective plans as needed.

1. QA Case Actions: This report compiles totals for all case decision actions taken on the Worker Portal. It can be broken down by Department for Community Based Services (DCBS) Region, County, and Program. The report breaks the reviews down by caseworker region, caseworker county, case action, review counts, reviews in error, and percentages of errors. The total number in error is divided by the total number of reviews, and the result is the error percentage. The report lists issuance errors that occur when an action is taken on a case, resulting in an incorrect benefit issuance.

2. QA Cases in Error: This report is used to identify the programs in which the most errors occur. It can be broken down by DCBS Region, County, and Program. It summarizes all of the cases in error. The report breaks the reviews down by worker, case number, review date, review level, review status, action due date, corrected timely, and error categories.

3. QA Detailed Activity: This report is used to look at cases read by a first- level or higher reviewer. It can be broken down by DCBS Region, County, and Program. It provides the total number of reviews completed. The report breaks the reviews down by case decision, caseworker, case

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MS 0440 (1) Volume 1 - General Administration MS 0440 - R. 7/1/25 - OMTL-674 Administrative Hearing Overview [Any applicant or recipient of any type of assistance from the Department for Community Based Services (DCBS) has the right to request a hearing before an impartial hearing officer, if dissatisfied with an action or inaction on the part of the Department that adversely affects their case. A. At the time of application and at the time of any adverse action affecting their status with the Department, inform the individual in writing of the right to discuss the situation with a worker and/or to request a hearing. Such information is included on various Agency forms mailed or given to the individual. In addition, applicants are provided the pamphlet, PAM-PAFS-326, Division of Family Support Administrative Hearing Procedures.] B. The hearing process consists of: 1. The request; 2. Preparation for and scheduling of the hearing; 3. The hearing itself; 4. Review of the recommended order; and 5. The final order. Additional recourse for the recipient following an adverse hearing decision is available through appeal to the Cabinet Secretary/Secretary’s Designee or Judicial review. C. For SNAP: 1. [An Agency Conference is offered to households adversely affected by an agency action. The household is advised that an agency conference is optional and in no way delays or replaces the fair hearing process. The worker, supervisor, and the household member and/or representative attend the agency conference. An agency conference may lead to an informal resolution of the dispute. However, a Fair Hearing must still be held unless the household makes a written or verbal withdrawal. If a written withdrawal is received by DCBS, the Agency needs to scan this document into the Hearings Module as “Letter – Withdrawing”. After this is complete, the Agency must also select the “Postponement/Withdrawal Request” button and complete the request. If the individual requests a withdrawal verbally, complete a withdrawal request via the Hearings Module by selecting the “Postponement/Withdrawal Request” button. Form PAFS-277, Hearing Withdrawal Confirmation Notice, will auto- populate and be mailed to the individual via the mail center. Form PAFS 277 is to be scanned into the Hearings Module as it is part of the official hearings record.

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MS 0440 (2) An agency conference for households contesting a denial of expedited services is scheduled within two working days unless the household requests it be scheduled later or states no agency conference is wanted.] 2. The Agency must expedite hearing requests from households, such as migrant farm workers, who plan to move from the jurisdiction of the hearing official before the hearing decision would normally be reached. Hearing requests from these households are processed faster than others if necessary to enable them to receive a decision and a restoration of benefits, if the decision so indicates, before they leave the area. 3. Employment and Training Program (ETP) activity that may be appealed includes any denial, reduction, or termination of benefits due to a determination of nonexempt status or a determination of failure to comply with a work requirement. Individuals or households may appeal actions such as exemption status, the type of requirement imposed, or refusal to make a finding of good cause, if the individual or household believes that a finding of failure to comply has resulted from improper decisions on these matters. When a fair hearing on these actions is scheduled, the caseworker must request ETP records from the ETP worker. The caseworker handles all local office activities prior to the hearing. The ETP worker and caseworker both attend the hearing. D. [The Office of Administrative Hearings (OAH), conducts hearings, upon request, for Kentucky Works participants. A participant is eligible for KWP supportive services while a hearing regarding a penalty is pending. Refer to Volume 3A, MS 4750 and MS 4770. E. Group Hearings. The Agency may respond to a series of individual requests for fair hearings by conducting a single group hearing if there is a single common issue in question. Hearing cases are consolidated only if the sole issue is related to a federal law, regulation or policy. In all group hearings, the policies governing hearings must be followed. Each individual is permitted to present their own case or be represented by legal counsel or other spokesperson.] Each individual has the opportunity to withdraw from the group if in the opinion of the hearing officer, the dissatisfaction results from actions in the individual’s case. F. [Telephonic Hearings. Hearings conducted via special telephone equipment may be held at the discretion of OAH. During a telephonic hearing, the hearing officer is at one location and the agency representative, recipient, and representative are at different locations. The recipient is notified by OAH that a hearing will be telephonic. If the recipient objects to a telephonic hearing, a face-to-face hearing is scheduled by contacting either OAH or the local office in writing prior to the scheduled hearing date.

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MS 0450 (1) Volume 1 - General Administration MS 0450 - R. 7/1/25 - OMTL-674 The Hearing Process The following procedures for administrative hearings are in accordance with the Kentucky Revised Statute KRS 13B, Administrative Hearings. If the hearing request involves a Medical Review Team (MRT) determination, refer to Volume 1 MS 0465. A. Upon receipt of a request for a hearing: 1. Complete a Request for Hearing through Worker Portal by accessing the Hearings tab at the top of the navigation page. a. [When hearing requests are received by call services, the call services worker completes the request through the Hearings Module. This generates a task for the Office of Administrative Hearings (OAH) to schedule the hearing. Once the hearing is scheduled, a task will generate to the Hearings Public Assistance Program Specialist (PAPS) to review and assign the hearing to staff as appropriate. b. Designated staff in the county of residence should try to resolve the issue before it goes to a hearing by offering the individual an opportunity to have an Agency Conference (see Volume 1 MS 0440, C. 1.). In addition, OAH will conduct a telephonic prehearing conference with the individual and agency to explain the administrative hearing and ensure they are conducted in a fair manner prior to swearing in both parties during the scheduled hearing time. However, if a hearing is required, a staff member must attend the hearing (Refer to item A.1.c.). c. A case decision worker, principal, or supervisor from the individual’s county of residence should attend the telephonic prehearing conference and the hearing. Depending on the individual county, who attends may vary. Do not ask OAH to reschedule a hearing because the designated person cannot attend the hearing and/or due to travel to another county. Another worker will have to attend the hearing if the designated worker is unavailable. d. The Regional Claims Worker (RCW) needs to thoroughly review the claim to be able to explain why the claim exists. If the issue is not resolved and a hearing is scheduled, the agency must submit the evidence to OAH via the Hearings Module and to the individual by mail at least eight days prior to the scheduled hearing. e. Telephonic prehearing conferences on claims are held to determine the matter of the claim and to resolve any issue with the claim. The RCW has the ability to ask for a dismissal of a hearing during the telephonic pre-hearing conference due to an untimely request, if an issue relates to another agency, or if there is no issue found. f. If Kentucky Claims Debt Management System (KCD) and Worker Portal Notices are a part of the evidence that is being presented, be sure to include the back of any notice included in the evidence to show the individual has been advised of their rights to request a fair hearing. Prior to uploading the evidence to the Hearings Module and mailing to the individual, ALL evidence must include a cover page labeled as: Exhibit 1, 2, 3 or Exhibit A, B, C, etc.

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MS 0450 (2) g. During the hearing process if the agency is asked to waive the timeframes of hearing procedures, the agency’s answer is always “NO”. Additionally, if another worker had input in the case or gathered collateral information during the time of the claim, include that worker(s) as a witness. Attendance by a Department for Community Based Services (DCBS) worker is mandatory under these circumstances so evidence is not considered “hearsay”. If investigative material is submitted into evidence that was gathered by the Office of Inspector General (OIG), then the OIG investigator must also be present, so the evidence is not considered “hearsay”.] h. Attending staff should have a summary written (may use form PAFS 78.1, Administrative Hearing Summary) and be prepared to represent the agency. Note: The DCBS representative should re-verify any collateral contact used as verification in the case to overcome the hearsay issue once the referral is received in the home county. If the contact is not willing to attend the hearing and testify, ask for a signed statement addressing the issue to be presented at the hearing. 2. [If the hearing issue involves a negative action, include a copy of the negative action notice (i.e., KIP-105 series, FS-105, MA-105, or PA-105), including the back page and forward to OAH. Limited KAMES-generated notices are maintained on the Report Distribution System (RDS) and may also be accessed through DocumentDirect. As RDS does not include the back page of a notice, it is advisable to have a current back page in the office and make a copy to include with the notice. The system-generated notices for Worker Portal are available in the Correspondence module. The back page is included with the notices in the Correspondence module. If the notice is not available at the time of the request, request the hearing through Worker Portal within 24 hours and forward the copy of the notice as it becomes available. 3. If the request is from an individual who has limited English proficiency and requires interpreter services or has a physical or mental condition which requires accommodation in order to participate in the hearing, annotate the hearing request with this information. 4. All requests must be sent to OAH, through the Hearings module in Worker Portal, within 24 hours of receipt, with exception of a hearing related to Medicaid payments or covered services.] 5. A request for a hearing related to Medicaid payments or covered services is heard by the Department for Medicaid Services (DMS). a. Annotate a short description in Notes when requesting the hearing request through Worker Portal. b. [Forward the hearing request within 24 hours to DMS via email to the Department for Medicaid Services or the following physical address: Department for Medicaid Services Administration & Financial Management

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MS 0450 (3) Administrative Service Branch 275 East Main Street, 6E-D Frankfort, Kentucky 40621-0001] c. DO NOT send the case record to DMS. d. The DCBS case worker does not attend the DMS hearing. 6. Individuals can also request DMS hearings by calling the Administrative Services Branch directly, at 502-564-9394.] B. Prepare for the hearing by reviewing the case record and writing a summary of the issue/action that prompted the request. If the hearing involves a claim issue, it may be necessary to contact the RCW for additional information about the case record and give a copy of the summary to the supervisor. 1. [Include in the summary all information, documentation, notices, forms, comments, etc., that support the action taken by the agency. Be clear and concise; include pertinent information with an explanation in the event the worker is unable to attend the hearing and the supervisor or another worker must represent the agency’s position. 2. If the issue involves proper notification, include any manual or system- generated notices that are related to the issue to present at the hearing. Ensure that the back page of every notice is included. 3. Include a copy of any manual section that relate to the issue/action. Include any pertinent policy clarifications that support the agency.] 4. DO NOT include unprofessional language or comments in the summary. C. [Upon receipt of the hearing request, OAH schedules the hearing and may need to contact the individual for clarification of the reason for the hearing. OAH notifies the individual and appropriate Regional Contact of the issue to be heard, along with the date, time and place of the hearing. The Hearings PAPS is responsible for notifying field staff of the hearing.] The worker and supervisor notify any witnesses of the scheduled date of the hearing. The worker, supervisor, or designated individual MUST prepare, attend, and actively participate in the hearing. A thorough review of the case record must be completed to determine if a worker verified information by collateral contact. If the case record reflects that this occurred, the worker who made the collateral contact MUST attend the hearing in order to avoid any “hearsay issues” that may arise. The Hearings PAPS is responsible for ensuring the agency representative is fully prepared. Claims Management Section (CMS) staff will attend Administrative Hearings which involve a claim compromise and/or State Tax Refund Intercept. D. [At the hearing, the burden of proof for the case action is the responsibility of the agency. The agency representative, worker, or individual attending the hearing must be prepared to present the facts surrounding the issue/action. Preparation is important because the hearing officer cannot consider any information or documentation not presented at the hearing.

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MS 0460 (1) Volume 1 - General Administration MS 0460 - R. 1/1/19 - OMTL-538 The Hearing Request A hearing request is a clear expression, either oral or written, to review a decision made by the Agency. A. The request must be made by the client, a household member, his/her counsel, or an individual acting on behalf of the household or recipient. B. Requests for a Hearing, Appeal or Withdrawal, either written or oral, are requested through Worker Portal for the client. 1. When requesting a hearing through Worker Portal for an Employment and Training Program/Kentucky Works Program (ETP/KWP) work program- related issue, indicate that the hearing request involves an ETP/KWP issue. 2. If received by phone or through the mail, indicate this in the comments section when requesting the hearing. 3. When a client has moved out of state and subsequently requests a hearing, tell the individual they may request a hearing to be held telephonically. C. When completing a request for a hearing, be specific when describing the client’s reason(s) for the hearing request. Use statements like: “The client does not agree with the amount of earnings counted in her Kentucky Transitional Assistance Program (KTAP) case”. Avoid vague statements such as “client request” or “client disagrees with denial”. In addition, if the hearing involves an emergency situation, clearly annotate on the Note screen that it is an emergency. D. A request for a Department for Community Based Services (DCBS) hearing may be submitted by the client or their representative directly to the Office of Administrative Hearings (OAH). E. [The client may voluntarily withdraw the hearing request any time prior to the hearing. If the client wishes to withdraw the request, complete a hearing request search through the Hearings Module, locate the client’s hearing request, and click the “Postponement/Withdrawal Request” button. Form PAFS-277, Hearing Withdrawal Confirmation Notice, will generate automatically to the client. Print the system-generated notice and attach in the Hearings module as is part of the official Hearings Record. Enter comments in the Hearings module as well as the respective Worker Portal case or claim. Be specific when describing the client’s reason(s) for the hearing withdrawal.] F. A request for a hearing related to Medicaid-covered service issues is heard by the Department for Medicaid Services (DMS). DCBS staff are not responsible for these hearings. Furthermore, DCBS staff do not attend these hearings. 1. Hearings may include, but are not limited to: a. Patient level of care status determinations in any type of vendor payment case;

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MS 0465 (1) Volume 1 - General Administration MS 0465 - R. 10/1/19 - OMTL-553 Hearing Requests Involving Medical Review Team Determinations A client may request an administrative hearing if he/she disagrees with a determination made by the Medical Review Team (MRT), only after negative action is taken on his/her case based on that determination. A. At the point of the original request for a hearing, ask the client if there is new medical evidence or a change in the client’s condition to justify resubmitting the case to MRT for redetermination. 1. If the client states there is new evidence or the condition has worsened, ask if the client has been to a doctor or medical facility or had tests run since the last MRT determination was submitted. 2. If there is new evidence or a worsened condition not considered by MRT, ask the client if he/she would like to resubmit the case to MRT. Advise the client that if he/she disagrees with the result of the redetermination, he/she can ask for a hearing based on the new action or inaction in the case. Resubmitting the case to MRT could eliminate the need for a hearing and provide benefits to the client in a timelier manner. It is the client’s choice to resubmit to MRT or to request the hearing. 3. If the client agrees to the submission of new information to MRT: a. Take a new application if the application or extension request was denied or reinstate the benefits of a discontinued case (other than an extension to 60 months of KTAP benefits); b. Complete form PA-601T, Referral for Determination of Incapacity/Disability, to include the new information provided by the client and annotate in red on top of the form that it is a redetermination based on new information; c. Have the client sign an original form MRT-15, Authorization to Disclose Information to the Cabinet for Families and Children, for each medical source (doctor, hospital, lab, clinic, etc.) plus two additional forms MRT 15. Sign the forms as a witness; and d. Upon completion of forms PA-601T and MRT-15, immediately forward to MRT the forms along with: (1) The last MRT determination packet, including: (a) Medical information; (b) The last form PA-601T, (c) PA-6, Incapacity Determination; or (d) PA-610, Certification of Permanent and Total Disability; and (2) Any new information/documentation the client may have provided. MRT will make a determination considering the new information provided by the client. Upon receipt of MRT’s determination, take appropriate action on the case. If the client disagrees with the action taken on the case, based on the new determination, the client can request a hearing.

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MS 0465 (2) B. If there is no new evidence or worsened condition or the client does not want to resubmit information for an MRT determination, submit a Request for Hearing, Appeal or Withdrawal through the Worker Portal by accessing the Hearings tab at the top of the navigation page. Advise the client of his/her right to request continuation of benefits pending the hearing and the obligation to repay benefits if the hearing officer does not rule in his/her favor. C. At the hearing, the client may present new medical information such as hospital records, new test results, a new specialist’s report, or appointment to support his/her claim of incapacity/disability. D. When a hearing involves an MRT determination, take a copy of the last packet of medical information, including form PA-601T and PA-601T, Sup. A, Supplement to Referral for Determination or Redetermination of Incapacity/Disability, if appropriate, that MRT used to make the determination along with several blank forms MRT-15 that can be completed, if needed, and form PA-6, Incapacity Determination, or form PA-610, Certification of Permanent and Total Disability, to the hearing. If this is done, and the client presents new medical information, the hearing officer can submit the information along with the interim order directly to MRT. Otherwise, the worker is responsible for submitting the information to MRT. E. At the hearing: 1. If the client does not provide any new evidence, the hearing officer drafts a recommended order based on the information presented by both parties. 2. If the client provides new medical evidence, the hearing officer drafts the interim order to remand the case to MRT for a redetermination. The interim order lists the new medical evidence to be considered by MRT. a. If all the information is available at the hearing, the hearing officer can send the redetermination request and interim order directly to MRT. b. If all the information is not available at the hearing, the worker is responsible for obtaining the information needed and submitting it to MRT. The worker must submit the request for redetermination to MRT within seven calendar days of the hearing. F. Once the request for redetermination is submitted to MRT, MRT has 30 calendar days from the date of the interim order to make a determination. If MRT needs additional time, it can request a 30-day extension. G. MRT will send form PA-6/PA-610 to the hearing officer. If it is a denial, MRT will also send the new information on which the redetermination was made. The hearing officer makes a decision based on additional information. H. [After 30 days, or 60 days, if an extension was granted, if the hearing officer has not received the MRT determination, a recommended order can be drafted without MRT input. A final order is required to be issued by the Cabinet Secretary/Secretary’s Designee. If the Agency is upheld in the final order, the client can request an appeal.

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MS 0470 (1) Volume 1 - General Administration MS 0470 - R. 7/1/16 - OMTL-504 Medicaid Hearing Request Due to the Loss of SSI In Kentucky, the Social Security Administration (SSA) determines Medicaid (MA) eligibility for individuals who receive a Supplemental Security Income (SSI) payment. Any individual who applies for SSI is also applying for MA. If SSI is approved, the individual is also approved for MA. If a recipient’s SSI is discontinued and a hearing is requested, the recipient can continue to receive MA during the hearing process only when they continue to receive the SSI payment. A. [Individuals who contact the local Department for Community Based Services (DCBS) office to appeal the termination of their SSI benefits must be referred to the SSA. Individuals approved by SSA for a continuation of SSI benefits while they are in the appeal process will receive MA coverage automatically and have a payment status code of C01, M01, or M02. Refer to the State Data Exchange (SDX) User Guide Payment Status Codes. B. If the SSI individual contacts the local DCBS office requesting a hearing due to the loss of their MA, the DCBS office handles the hearing request through the Worker Portal. C. Upon receipt of an MA hearing request, the worker should become familiar with the situation and be able to give the reason why MA benefits ended. Review and take the following information to the hearing: 1. PA-10-SSI notices which are located in the Worker Portal Correspondence Module;] 2. SDX screens (pages one and two of the discontinuance action) showing the pay status code and MA discontinuance date; and 3. An explanation of the discontinuance reason, which is located in the SDX manual under pay status codes. Copies of the SDX screens are presented at the hearing and may be viewed by the other attending parties to document the reason for the discontinuance. To ensure that the Internal Revenue Service (IRS) information is kept confidential, black out the wage information on page two of the SDX screen before other parties view the screen. Prior pages of the SDX record may need to be reviewed to find the correct discontinuance reason. However, a copy of the screens is NOT to be given to the hearing officer or the appellant. Once the hearing is over, shred the SDX screens. Provide a verbal explanation of the information contained on the SDX screens during the hearing.

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MS 0475 (1) Volume 1 - General Administration MS 0475 - R. 7/1/25 - OMTL-674 Hearing Time Frames A. For Kentucky Transitional Assistance Program (KTAP), Kinship Care (KC), Medicaid (MA), Family Assistance Short Term (FAST), Work Incentive Reimbursement (WIN), State Supplementation, a hearing request is considered timely if received by the Department: 1. Within 40 calendar days from the date form KIM-105 or MA-105 is sent on a proposed action; 2. Within 30 calendar days from the date form KIM-105 or MA-105 is sent on an action already taken; or 3. Whenever the hearing issue is a delay in action on the case and the action is still pending. B. For Supplemental Nutrition Assistance Program (SNAP), a household or member is allowed to request a hearing on any action by the Department or any loss of benefits which occurred in the prior 90 calendar days. 1. The household may request a hearing any time within the current certification period, only if disputing its current level of benefits. 2. Action by the Department shall include a denial of a request for restoration of any benefits lost more than 90 calendar days but less than a year prior to the request. C. For Child Care, a hearing request is considered timely if received by the Department within 30 calendar days from the effective date of the adverse action, not the date the DCC-105, Child Care Denial/Discontinuance Notice, is sent. D. [The Office of Administrative Hearings (OAH) acknowledges all hearing requests, conducts a hearing, and issues a recommended order within 60 to 90 days from a request for a hearing, the Cabinet Secretary/Secretary’s Designee shall consider the record. E. If the hearing request is untimely, forward the request and any information concerning why the request was untimely to OAH through Worker Portal. The hearing officer determines from the information provided whether the household had good cause for submitting an untimely request.] F. Individuals whose Supplemental Security Income (SSI) is discontinued and who request a hearing must be referred to the Social Security Administration (SSA) to appeal the termination of their SSI benefits. Individuals requesting a continuation of MA benefits must make that request with the SSA agency. If SSA approves the continuation of SSI benefits while they are in the appeal process then the individual will receive MA coverage automatically and they will have a payment status code of C01, M01, or M02.

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MS 0480

[1]

Volume 1 – General Administration MS 0480 – R. 6/1/26 – OMTL – 696 Scheduling the Hearing

A. [The Hearings Branch notifies the individual of the date, time, and place the hearing will be held via form, "Notice of Hearing", in a language and format the individual can understand.

The form also contains information regarding:

1. The individual’s right to bring an attorney and/or witnesses if desired.

2. An explanation that if the individual or a representative does not appear for the hearing, the individual will have a period of ten days to advise the Hearings Branch of the reason for not appearing. The Hearings Branch considers the reasons and determines if good cause exists. The request is considered abandoned and dismissed unless good cause for the absence can be shown.

3. All parties to the hearing are provided at least 10 days timely notice of the hearing to permit adequate preparation of the case, except for Temporary Assistance for Needy Families (TANF)-related, Low Income Home Energy Assistance Program (LIHEAP), or State Supplementation hearings. TANF- related, LIHEAP, or State Supplementation hearings require at least 20 days timely notice. However, the household may request less timely notice to expedite the scheduling of the hearing.

B. The individual may request and is entitled to a postponement without good cause if the request is made before the hearing. The postponement cannot exceed 30 days, and the time limit for action on the decision is extended for as many days as the hearing is postponed. For example, if a hearing is postponed by the household for 10 days, notification of the hearing decision is required within 70 days for SNAP or within 100 days for IM from the date of the request for a hearing. The worker notifies the hearing officer of the postponement.

C. Before conducting a claim hearing, review the Fraud Referral Overview Suspected Internal Program Violation (IPV) Screen on Worker Portal to determine if the claim location code is “Court”. If the claim is being prosecuted, contact the hearing officer or ask for a pre-hearing conference to inform the hearing officer that the court holds jurisdiction over the matter and request the hearing to be dismissed. Contact the Claims Management Section to verify if the claim has been referred for prosecution.

D. For Medical programs, an individual or their representative may request a delay of the hearing for reasons beyond the control of the individual. The decision to grant the delay is made by the hearing officer.]

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MS 0485 (1) Volume 1 - General Administration MS 0485 - R. 6/1/21 - OMTL-577 Program Participation Pending the Hearing – IM Programs A. [When the individual requests a hearing within 10 days of the date on the timely notice, the benefits remain reduced or inactive pending a hearing decision unless the individual specifically requests that the benefits, including supportive services, continue. Explain to the individual that if the Agency's decision is upheld, any overpayments resulting from continuation of benefits will have to be repaid. If the request is received within 20 days of the date of the timely notice, and the individual claims good cause for not reporting within 10 days, determine if the reason for the delay meets the following good cause criteria: 1. The individual was away from home during the entire timely notice period; 2. The individual was unable to read or comprehend the timely notice and the right to request a fair hearing; 3. The individual moved, which resulted in a delay in receiving or failure to receive the timely notice; 4. The individual had a serious illness; or 5. The delay was no fault of the individual. If good cause is determined and the individual requests continuation of benefits, reinstate the case within five work days. Accept the individual's statement for good cause unless there is reason to doubt. B. If the case is active and benefits are reduced and the individual requests a hearing within 10 days of the date on the timely notice, benefits remain reduced unless the individual specifically requests benefits continue. If the individual requests benefits continue, reinstate benefits within five work days at the level prior to the timely notice. C. If benefits are discontinued and the individual, within 10 days of the date on the timely notice, requests a hearing and continuation of benefits:] 1. Complete a Request for Hearing, Appeal or Withdrawal through Worker Portal by accessing the Hearing tab at the top of the navigation page. 2. If reason for discontinuance is "failure to keep recertification interview," complete a recertification. 3. [For all other reasons for discontinuance, annotate case notes in Worker Portal.]

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MS 0490 (1) Volume 1 - General Administration MS 0490 - R. 2/1/15 - OMTL-481 Program Participation Pending the Hearing - SNAP Depending upon the circumstances of the case, the recipient is entitled to participate during the hearing process. The worker explains to the recipient that: A. Participation is continued in the following circumstances: 1. If the recipient requests a hearing during the 10-day timely notice period, participation is continued on the basis authorized immediately prior to the timely action notice unless the recipient specifically waives continuation of benefits. The recipient is advised that if the hearing finds the agency’s decision was correct and the household was ineligible for all or part of the Supplemental Nutrition Assistance Program (SNAP) benefits received pending the hearing officer's decision, a claim is established against the household for the value of extra benefits received. 2. If benefits are reduced or terminated as a result of a mass change without individual notice of timely action, benefits are reinstated on the prior basis only if the issue contested is that eligibility or benefits were improperly computed or that federal law or regulations were misapplied or misinterpreted by the agency and if the household requests the continuation. B. Once continued or reinstated, benefits are not reduced or terminated unless: 1. The certification period expires. Upon expiration of the certification period, the recipient can reapply and have eligibility redetermined. 2. A change affects the household's eligibility or basis of issuance while the hearing decision is pending, and the household fails to request a hearing after the subsequent notice of adverse action. 3. A mass change affects the household's eligibility or basis of issuance while the hearing is pending. 4. The hearing officer makes a preliminary determination in writing, and at the hearing, that the sole issue is one of federal law or regulation and the household's claim that the State Agency improperly computed the allotment or misinterpreted or misapplied such law or regulation is invalid. The household is notified by form KIM-105, General Notice of Action, when benefits are reduced or terminated pending the hearing officer's decision. 5. [The household fails to appear for the hearing, and the Office of Administrative Hearings (OAH) notifies the local office that the hearing request has been abandoned. If the household fails to appear, reduce benefits effective with the next monthly issuance. The household is notified by form KIM-105.]

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MS 0497

[1]

Volume 1 – General Administration MS 0497 – R. 6/1/26 – OMTL – 696 Individual Hearing Rights

[An individual not only has the right to request a hearing but also has additional rights.

A. Explain to the individual or their representative the following rights in a language and format they understand:

1. The right to a qualified interpreter if the individual is Limited English Proficient (LEP) and rights to reasonable modification and auxiliary aids and services for individuals with disabilities;

2. To present the case themselves or to have it presented by legal counsel or another representative. Inform the individual of the availability of free legal services;

3. To review the case record relating to the issue;

4. To bring witnesses to support their case in the hearing;

5. To present arguments without interruption;

6. To question any testimony or evidence and cross-examine witnesses; and

7. To submit evidence establishing pertinent facts and circumstances in the case.

B. Explain to the individual that the department does not provide payment for legal counsel but, if available, will refer them to a legal aid agency.

C. Provide the individual and the individual's representative or legal counsel with adequate opportunity to examine all documents and records to be used at the hearing, a reasonable time before the date of the hearing, as well as during the hearing. The contents of the case file, including the application form and documents of verification used by the agency to establish the household's ineligibility or eligibility and allotment, are made available. Confidential information, such as names of individuals who have disclosed information about the household without its knowledge or the nature or status of pending criminal prosecutions, is protected from release. If requested by the household or its representative, the agency provides a free copy of the relevant portions of the case file. Confidential information protected from release and other documents or records that the household will not otherwise have an opportunity to contest or challenge are not presented at the hearing, and do not affect the hearing officer's decision.

D. If the individual, after requesting a hearing, is dissatisfied with the medical evidence used in making the case decision, the individual may request an examination from another medical examiner. If an examination by an internist or specialist was received within three months prior to the date of the hearing request, the individual must specify the reason for the additional examination.

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MS 0500 (1) Volume 1 - General Administration MS 0500 - R. 8/1/18 - OMTL-533 Conduct of the Hearing A. Hearings are conducted by an impartial hearing officer who is knowledgeable of the Department's law, policy, and procedures. The Office of Administrative Hearings (OAH) operates independently and recommended orders are based only on information presented at the hearing. B. Hearings are privately conducted at a place convenient to the client and: 1. Are orderly but informal; 2. Conducted without the use of strict technical rules of evidence and procedure; 3. Provide a method by which the client can speak freely regarding facts and circumstances of the situation, refute testimony, and examine all papers and records introduced as evidence; 4. Provide the client the opportunity to submit additional evidence and to cross-examine witnesses; and 5. Concluded when the hearing officer is satisfied that sufficient evidence has been introduced to resolve the issue. C. The hearing is attended by the worker and/or supervisor and by the client or his/her representative or both. The hearing may also be attended by friends and relatives of the client, if the client so chooses. However, the hearing officer has the authority to limit the number of persons in attendance at the hearing if space limitations exist. D. At the hearing, the worker or individual must be prepared to present the facts surrounding the issue/action. Preparation is important because the hearing officer cannot consider any information or documentation not presented at the hearing. The preparation includes: 1. Reviewing the case record to become familiar with the case situation. 2. Drafting a presentation that is clear and concise. The written presentation can be entered into evidence after the oral presentation, if needed. 3. For hearings involving a Medical Review Team (MRT) determination, the medical information used by MRT for the determination must be presented in chronological order for each provider. The MRT packet contains a form titled “Case Development Sheet”. This form provides names and dates of requested medical information and contacts. In the MRT packet, the form follows the MRT decision. 4. [Making at least two copies of any forms, notices, documentation, and system screen prints (including Worker Portal comments) that are to be presented as evidence to support the issue or action. One copy is for the hearing officer and the other is for the client.]

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MS 0500 (2) 5. Making two copies of all pertinent manual sections that support the issue/action – one for the hearing officer and the other for the client. Use only Operation Manual Sections, including updates, and Family Support memorandums issued by the Division of Family Support Central Office. Do not submit training materials, forms, or items not issued or sanctioned by the Division of Family Support as evidence at the hearing. 6. Contacting individuals that may be witnesses for the Agency to notify them of the time and place for the hearing. Witnesses, if available, may agree to testify telephonically. These witnesses may include an individual from the MRT, Medicaid (MA), Targeted Assessment Project (TAP), Claims Management Section (CMS), Determining Eligibility through Extensive Review (DETER), etc. Witnesses should be briefed on the issue or action in order for them to testify effectively. When an individual agrees to testify as a witness for the Agency, information from the case record pertinent to the hearing issue is copied and forwarded to that individual. This will allow the individual to be prepared to testify. 7. If a collateral contact was used to verify a household situation and an administrative disqualification hearing is to be held, contact the persons who provided statements about the case to ask if they will attend the hearing. If the person will not attend, ask for a signed written statement supporting verbal information indicated in Worker Portal comments. Worker Portal comments alone are not acceptable sources of verification in a hearing. The worker who spoke to the collateral contact must also attend the hearing to verify statements made on Worker Portal and should be notified well in advance of the hearing date to ensure their attendance. 8. Taking the case record to the hearing to assist in responding to questions asked during the hearing. 9. Dressing professionally. 10. Using professional language when presenting the summary and evidence. When called upon to present the Agency’s position, speak clearly. Explain the policy and procedure used in terms that everyone attending the hearing can understand. If unsure of a response to a question, advise those present that the information is not available at the hearing but will be provided if necessary. E. If conclusive evidence is not produced at the hearing, the hearing officer may continue the hearing. If the hearing officer continues the hearing, the hearing process must still be completed within 60 calendar days of the hearing request for the Supplemental Nutrition Assistance Program (SNAP) or 90 calendar days for MA. If the hearing is continued, the client and workers are notified 10 days in advance of the time and place of the continued hearing. A client or representative may request the hearing officer to delay the recommended order for a reason beyond the control of the client. The decision to grant the delay and continue the hearing is made by the hearing officer.

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MS 0510 (1) Volume 1 - General Administration MS 0510 - R. 7/1/25 - OMTL-674 Recommended Order After completion of the hearing, the hearing officer drafts a recommended order. For Medicaid (MA), State Supplementation, Kentucky Transitional Assistance Program (KTAP), Kinship Care (KC), Kentucky Works Program (KWP), Family Assistance Short Term (FAST), and Child Care Assistance Program (CCAP) hearings, the recommended order is not the final order; therefore, action is not taken on the case until a final order is received. For Supplemental Nutrition Assistance Program (SNAP) related hearings, recommended orders will become the final order if no exceptions are taken, after the 15th day from the mail date of the recommended order. A. The hearing officer: 1. Reviews all evidence and drafts a recommended order. A recommended order: a. Summarizes the facts of the case; b. States the reason for the recommended order; c. Identifies the supporting evidence and the pertinent Operation Manual sections; and d. Cites pertinent state and federal regulations. 2. Ensures that the recommended order complies with federal and state law or regulation and is based on the hearing record. 3. Mails a copy of the recommended order for review to: a. The individual; b. The individual’s representative, if one was present at the hearing; and c. The Department for Medicaid Services (DMS), if the issue involved patient status in a skilled nursing home. 4. Uploads the recommended order to the Hearings Module, creating a task for the Hearings Public Assistance Program Specialist (PAPS) to review the order and take appropriate action. B. If at the hearing, the individual presents new medical evidence which may affect the determination of incapacity, disability or good cause the hearing officer will issue an Interim Order sending the case back to the Medical Review Team (MRT) for a redetermination using the new medical information. The hearing record will be held open for 30 days. Refer to MS 0465. C. The recommended order is reviewed by the parties listed in item A.3 and A.4. The parties have 15 calendar days from the mail date indicated on the recommended order to review and file any exceptions and/or rebuttals. Exceptions or rebuttals filed after the 15th calendar day are disallowed. 1. If the Agency determines that no exception is required in response to a denied Administrative Disqualification Hearing (ADH) or Fair Hearing

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MS 0510 (2) recommended order, the worker must visit the Hearings Module within five calendar days and click on the “Exceptions Request” button and select “No” to answer the question, “After reviewing the recommended order, do you believe exceptions should be filed?” After making the selection, briefly provide your explanation in the comments box and “Save” and “Submit”. This will create a task for Central Office staff to review. a. For SNAP-related hearings, if no exceptions to a recommended order are submitted to the Cabinet Secretary/Secretary’s Designee by the 15th calendar day, the recommended order becomes the final order then on the 16th day and the agency can take appropriate action on the case. b. For all other program-related hearings (MA, State Supplementation, CCAP, KTAP, KWP, FAST, KC), regardless of whether an exception is filed to a recommended order by the 15th calendar day, a final order is required to be issued by the Cabinet Secretary/Secretary’s Designee. The agency does NOT take any action until a final order is received. 2. The recommended order is reviewed to ensure that it is in accordance with regulations. If there are no exceptions or rebuttals to a SNAP program related recommended order received within the 15-day period, then on the 16th day the recommended order becomes the final order. [Note: Central Office will no longer receive notification of the recommended orders from the Office of Administrative Hearings (OAH) or final orders from the Cabinet Secretary/Secretary’s Designee. Hearings PAPS will receive notification through Worker Portal and be responsible for reviewing the orders to determine if an exception is required. If an exception is required, follow instructions below and follow the hearing procedure process for administrative disqualification hearings through Worker Portal.] 3. Exceptions by the Agency are filed by Division of Family Support (DFS) Central Office staff. a. Use the following procedures to file an exception; 1) Upon receipt of a recommended order, the worker and their supervisor have five calendar days from the date it was mailed to determine if an exception is needed. An exception can only be based on the facts and evidence presented at the hearing. New information or evidence may not be used to take exception. 2) The region drafts an exception outlining why the recommended order should be changed. 3) If the Agency determines that an exception is required in response to the ADH or Fair Hearing recommended order, the worker must visit the Hearings Module by the 5th calendar day from the date it was mailed and click on the “Exceptions Request” button and select “Yes” to answer the question, “After reviewing the recommended order, do you believe exceptions should be filed?” After making the selection, briefly provide your explanation and specify the evidence you are referring in the comments box and “Save” and “Submit”. This will

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MS 0520 (1) Volume 1 - General Administration MS 0520 - R. 1/1/19 - OMTL-538 Local Office Follow-up to a Final Order [When the final order signed by the Cabinet Secretary/Secretary’s Designee is received in the local office, the final order and recommended order are reviewed by the supervisor and worker for any reference to future action in the case. A. For reversals of denials or discontinuances of Income Maintenance (IM) cases, take case action to approve or reapprove the case and return the case record to active status. For reversals involving reduction of IM benefits, take case action within 10 days to restore benefits effective the date of the reduction action on which the hearing was held and authorize supplemental benefits, if appropriate. B. Final orders which result in an increase in the household’s ongoing Supplemental Nutrition Assistance Program (SNAP) allotment or the issuance of a supplemental or restoration must be reflected in the benefit allotment within 10 days of the receipt of the final order. If the final order is a result of a request for a casualty replacement that was denied, the casualty replacement must be issued within 10 days of the receipt of the final order. Determine if the recipient has an existing claim. If so, offset benefits, if appropriate. C. When a final order is received that instructs the worker to resubmit a case to Medical Review Team (MRT) for a determination of incapacity or good cause for the Kentucky Works Program (KWP) or for a determination of disability for Medicaid (MA), do the following: 1. Within two days of receipt of the final order, send an appointment letter to the client to complete an MRT Referral. Request the client bring in new or updated medical information. 2. At the appointment, complete an MRT Referral and include any new or updated medical information the client presented at the hearing or has been received since the hearing. Also, have the client sign form MRT-15, Authorization to Disclose Information to Cabinet for Families and Children. 3. Once the MRT request is completed on Worker Portal, a task is generated for MRT staff to complete the disability/incapacity determination. Once a determination has been made, a task is generated for a worker to take appropriate action based on MRT’s decision. If the client disagrees with the action taken based on the new determination, the client can request a hearing. D. If the final order includes recommendations for referrals to, for example, Rehabilitation Services, immediately follow up such recommendations.

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MS 0530 (1) Volume 1 - General Administration MS 0530 - R. 10/1/19 - OMTL-553 Appeal to the Cabinet Secretary/Secretary’s Designee An appeal to the Cabinet Secretary/Secretary’s Designee is the final administrative review available to a recipient dissatisfied with the decision of the hearing officer. A. Requesting an Appeal. If the recipient disagrees with the hearing decision, the recipient must appeal within 15 days of the date the hearing decision was mailed. The mailing date is the date on the hearing decision. The Cabinet Secretary/Secretary’s Designee, if requested by the recipient, may grant a 10 day extension to the 15-day time standard, if good cause for the delay is established according to MS 0475. Whenever an appeal is not made within the 15-day time standard, submit a memorandum with the appeal explaining the cause of the delay and request the Cabinet Secretary/Secretary’s Designee to determine if good cause for the delay exists. The recipient's request for appeal may be either a verbal or written request. The date of the verbal request is the date of the appeal; however, any verbal request must be confirmed in writing by the recipient. The written request is a letter from the recipient that is uploaded as an “exception” in the Hearings module. The date the letter is received establishes the date of the request for appeal. Encourage the recipient to make the appeal in the local office or via phone to avoid delay in requesting the appeal within the prescribed time frame. B. Forwarding the Appeal/Exception Request. Attach the appeal request in the Hearings Module as an “exception” document and annotate in comments that an exception was filed by the client. A task will be generated to the Cabinet Secretary/Secretary’s Designee to take appropriate action. Do not send the case record unless it is requested. The Cabinet Secretary/Secretary’s Designee will have the necessary material and tape of the hearing record. C. [Action after Submitting Request. Central Office will mail the client a copy of any exception filed by the Agency. All exceptions filed, regardless of origin, create a task for the Hearings Public Assistance Program Specialist (PAPS) to review. Parties may request permission within seven calendar days from the date of the filed exception to submit written arguments or new evidence regarding the appeal to the Cabinet Secretary/Secretary’s Designee. The Cabinet Secretary/Secretary’s Designee will send Medicaid hearings recipients an acknowledgement letter indicating the receipt the appeal/exception request.] If the Cabinet Secretary/Secretary’s Designee orders a special examination, the recipient is notified of the date, time, and place of the examination, with a copy of the notification sent to the local office. The recipient notifies the local office if they are unable to keep the appointment and the supervisor emails the Cabinet Secretary/Secretary’s Designee to advise and schedule a new appointment.

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MS 0560

[1]

Volume 1 – General Administration MS 0560 – R. 6/1/26 – OMTL – 696 Documentation of Alien Status

[Verify the status of an alien who is applying for benefits through the United States Citizenship and Immigration Services (USCIS) documentation.

Under no circumstances may a State agency:

A. Require any information about the citizenship or immigration status of anyone who is not applying for the Supplemental Nutrition Assistance Program (SNAP);

B. Deny SNAP to applying household members because a non-applicant household member has not disclosed their citizenship or immigration status or social security number; or

C. Try to establish or verify immigration status through any means other than the procedures outlined below. The Department of Homeland Security (DHS) has primary responsibility to determine the status of non-citizens.]

Aliens who left their homelands under emergency situations may not have all the required documentation for eligibility, such as verification or documentation of birth, marriage, divorce, or relationship. In the absence of the regular sources of verification, use Form I-94, I-151, I-551, or other entry documents to verify required information (e.g., age, relationship, or immigration status). Review and accept any documents brought from their homeland that verify the alien's situation. The individual’s statement may be accepted for verification of marriage, divorce, relationship, and death. USCIS documents may be used to verify date of birth. The individual’s statement is not acceptable to verify immigration status. Immigration status must be verified by USCIS documents.

Use the following chart as a guide to the USCIS documentation. This is not an inclusive chart. An individual may have a different USCIS document that identifies the immigration status and date of entry. Accept any USCIS documentation provided by the individual that verifies status and date of entry, unless it is questionable. Have the alien resolve any questionable status through USCIS.

Note: Concerning Form I-94, Arrival/Departure Record: On 4/30/13, Customs and Border Protection (CBP) automated the I-94 process at air and seaports only. Most non-alien visitors entering the country via air and seaports will no longer be issued a paper I-94. Instead, the admission information generally provided in the paper I-94 will be stamped on the traveler’s foreign passport (i.e., COA, date of entry, and expiration date), with the exception of the I-94 admission number. Aliens have to visit the U.S. Customs and Border Protection website to print their I- 94 admission number. Also, if an alien is unable to provide a passport with the admission stamp, a copy of their record of admission can be printed by the alien at this website.

[CBP no longer issues the paper I-94 card to refugees at Ports of Entry (POE); they will need to obtain the I-94 record online. CBP will stamp the refugee’s transportation boarding letter upon admission to the U.S., which is provided to the

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MS 0560

[2]

Principal Applicant of each refugee case. The transportation boarding letter will be the only document provided to the refugee with an official CBP refugee stamp.]

Derivative asylees and parolees will continue to receive a paper I-94. CBP will strike out the pre-printed number and hand-write the true I-94 number on the document. Use the handwritten I-94 number when verifying immigration status.

The I-94 has a letter that indicates the entry status. The letter will have a number after it, such as A-2, H-3, etc. Letter codes A through L indicate they entered the U.S. for a temporary reason.

The following list defines the specific letter codes:

A – Foreign government official; B – Visitor for business or pleasure; C – Alien in travel status; D – Alien crewman; E – Treaty trader, investor, and family; F – Student; G – Representatives and personnel of international organizations; H – Temporary worker; I – Members of foreign press, radio, or other information media; J – Exchange visitor; K – Fiancé or fiancée of a U.S. citizen and their children; or L – Intra-company transferees and their families.

If the I-94 has an entry other than codes A through L, the alien has entered the U.S. for permanent residence. The entry indicates the status of the alien, such as refugee, asylee, victims of human trafficking, and eligible relatives, etc.

Status of Alien USCIS Document Permanent resident alien before August 22, 1996 I-151 (Registration Receipt Card), commonly known as the “Green Card”, was replaced with the I-551 (Permanent Resident Card) in March 1996 Permanent resident alien on or after August 22, 1996 If a veteran of the US Military If active-duty US Military I-551 (Valid for 10 years)

DD-214 Discharge Certificate Any document showing an active status Refugee I-94 marked with "admitted under INA 207, "Refugee”, or "Refugee - Conditional Entrant." Asylee I-94 marked with "admitted under INA 208" or USCIS letter Deportation Withheld I-94 marked with "admitted under INA 243(h)" or letter from immigration Judge Amerasians I-94 or I-551 marked with an identifier in comments - AM1, AM2, AM3, AM6, AM7 or AM8 Parolees I-94 marked with "admitted under INA 212(d)(5)" The date will read "Indefinite". Conditional Entrants I-94 marked with "admitted under INA 203(a)(7)"

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MS 0560

[3]

Cuban/Haitian Entrants I-94 may be marked "admitted under INA 207", "Refugee", or "Refugee - Conditional Entrant". Battered Alien I-94 admitted under INA 204(a)(1)(A) or (B), or whose deportation is suspended under INA 244(a)(3) Victims of Human Trafficking and Eligible Relatives I-94 or visa with “T-1” category. Eligible relatives of the victims have T-2, T-3, T-4, or T-5 category designations. Afghan/Iraqi Special Alien Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SI1; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SI6. Spouse of an Afghan/Iraqi Special Alien Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SI2; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SI7. Unmarried dependent child of an Afghan/Iraqi Special Alien Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SI3; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SI9. Iraqi Special Alien under Section 1244 Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SQ1; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SQ6. Spouse of an Iraqi Special Alien under Section 1244 Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SQ2; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SQ7. Unmarried dependent child of an Iraqi Special Alien under Section 1244 Passport with an alien visa (IV) stamp noting the individual has been admitted under the IV category SQ3; DHS stamp or notation on passport or form I-94 showing date of entry or form I-551 (green card) SQ9.

Native Americans born in Canada Form I-181, Memorandum of Creation of Record of Admission for Lawful Permanent Residence, form I-551 with the code S13, an unexpired I-551 stamp in a Canadian passport, form I-94 with the code S13, or a letter or other tribal document certifying at least 50% American Indian blood

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MS 0562

[1]

Volume 1 - General Administration MS 0562 - R. 6/1/26 - OMTL- 696 [Documentation for Alien Victims of Trafficking

Traffickers force young men, women, and children into prostitution, slavery, and forced labor through coercion, threats of physical violence, psychological abuse, torture, and imprisonment. The worker doesn't need to determine whether someone is a victim of a severe form of trafficking or to contact the United States Citizenship and Immigration Service (USCIS) or any division of the Department of Justice (DOJ) to consult on these issues.

The Trafficking Victims Protection Act of 2000 (Public Law 106-386) provides that “victims of a severe form of trafficking” are eligible for benefits and services administered by the Department for Community Based Services (DCBS). Individuals identified as victims and their eligible relatives are treated as aliens who are admitted to the United States as refugees and are not barred from receiving benefits during their first five years in the United States. Eligible relatives include the spouse and dependent children of the victim, and if the victim is a child, the child's parents and siblings. This eligibility is without regard to the actual immigration status of such victims.

The Office of Refugee Resettlement (ORR) is designated to certify that an adult is a victim of a severe form of trafficking. Children under 18 years of age do not need to be certified. However, the child must still be determined eligible for benefits as a minor victim of a severe form of trafficking. ORR issues a certification letter for adults and a letter, similar to the adult certification letter, for children. These letters serve as verification that the individual is a victim of trafficking.

Use the following policy and procedures when processing cases that contain a member who is a victim of human trafficking.

A. Applications for Kentucky Transitional Assistance Program (KTAP), Medicaid, or Supplemental Nutrition Assistance Program (SNAP) who are victims of a severe form of trafficking must present their letter from ORR to the worker.

1. Accept the ORR letters in place of Immigration and Naturalization Service (INS) documentation. Victims of a severe form of trafficking are not required to provide proof of their immigration status. Do not complete a Systematic Alien Verification for Entitlement (SAVE) inquiry on the victims.

2. Email ORR to confirm the validity of the ORR letter and to notify ORR of the type of benefits for which the individual has applied.

B. The entry date for the individual is the certification date that appears in the body of the ORR letter.

C. If the individual does not have documents to verify identity, contact ORR for assistance.

D. If the individual does not have or cannot obtain a Social Security Number (SSN) for work purposes, assist the individual in obtaining an SSN for non-work

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MS 0562 [2]

purposes by providing the individual a letter for the Social Security office that includes: 1. The Cabinet’s letterhead;

2. The individual’s name;

3. The reason a non-work number is required; and

4. A statement of eligibility for the program benefits. This means that all the eligibility factors are verified and entered into the system for approval.

The letter cannot be a form letter, photocopied, or generic.

Do not delay, deny, or discontinue assistance pending the receipt of the SSN.

E. Determine technical and financial eligibility for the program and issue benefits, and if eligible, to the victim in the same manner as refugees.

If the application includes a member who is not a victim of a severe form of trafficking, this member is subject to the five-year ban for receipt of benefits unless their immigration status meets one of the statutory exceptions.

F. Email ORR at recertification.

1. If it is verified that the victim of a severe form of trafficking is recertified with ORR, take no further action until the next recertification.

2. If it is verified that a victim of a severe form of trafficking is not recertified with ORR, take action to have the recipient contact DCBS and determine if ongoing benefits are appropriate in another alien status.

G. At this time, there are no procedures to de-certify victims of severe forms of trafficking. The recipient should have an original updated letter of certification or a similar letter for children at recertification. The recipient’s ORR certification period is eight months and, in most cases, will not correspond with a given program’s certification period. If the household does not have an original updated letter from Health and Human Services (HHS), email ORR for assistance.

If, during an interview, it is determined that the alien is not or is no longer eligible based upon an email response received from ORR, determine eligibility using other criteria for them.

H. Anytime an applicant or recipient believes they may meet the definition of a victim of “severe forms of trafficking”, provide the individual the phone number of the Department of Justice, Division of Civil Rights, 888-428-7581, or the Refugee State Coordinator with Catholic Charities of Louisville, 502-636-9263.

If it is believed that a child has been subjected to a severe form of trafficking, the worker is to make a referral to Protection and Permanency (P&P). P&P makes the decision if the alleged maltreatment meets the adult or child eligibility criteria for intake.]

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MS 0566

[1]

Volume 1 - General Administration MS 0566 - R. 6/1/26 - OMTL- 696 Consideration of the Sponsor’s Income and Resources

[The income and resources of the sponsor and the sponsor’s spouse are deemed as available to a sponsored alien who completed the affidavit of support on or after Dec. 12, 1997.

A. Deeming the sponsor’s income applies to all aliens sponsored by individuals. Deeming continues until the alien gains citizenship.

1. The total income and resources of the sponsor and spouse are considered available to the alien’s household. Consider the deemed income as unearned income.

2. If a change in sponsorship occurs during the recertification period, verify and recalculate the deemed income and resources.

B. There are exceptions for deeming a sponsor’s income. Do not deem the sponsor’s income to the alien if one of the following exceptions applies:

1. If the alien is determined to be indigent. Apply the following conditions to determine indigence:

a. The amount of the sponsor's income and resources given to the alien does not exceed the amount agreed to in the affidavit; and

b. Without the assistance of the Cabinet, the alien would be unable to obtain food and shelter. In determining if the alien is indigent, consider the alien’s own income, plus any cash, food, housing, or other assistance provided by other individuals, including the sponsor.

Count only the amount actually provided by the sponsor for a 12- month period. The 12-month period for the indigent exception starts with the month the determination is made.

If an alien is determined indigent, forward the names of the sponsor and sponsored alien involved to the appropriate program branch in the Division of Family Support.

2. If the alien or alien’s child has been subjected to extreme cruelty or has been battered in the United States (U.S.) by:

a. A spouse or parent; or

b. A member of the spouse's or parent's family living with the alien or alien’s child, and the spouse or parent allows the cruelty or battery; or

3. If the alien is a child who lives with a parent who has been battered or subject to extreme cruelty in the U.S. by:

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MS 0570 [1]

Volume 1 – General Administration MS 0570 – R. 6/1/26 – OMTL - 696 Systematic Alien Verification for Entitlement (SAVE)

Federal law requires that the immigration status of aliens applying for benefits be verified. The Systematic Alien Verification for Entitlement (SAVE) is the U.S. Citizenship and Immigration Services (USCIS) system of verification for this purpose. SAVE is used to re-verify the initial documentation of the immigrant's status received from the alien. Any applicant who is not a U.S. citizen or national is required to carry immigration documentation that contains an Alien Registration Number (A-Number) or an I-94 Admission Number. These numbers are used to access SAVE.

[For aliens who have permanent resident status, the SAVE process is completed only once. For all other aliens, the SAVE process is repeated at every application or recertification, or until they are granted permanent resident status.]

Do not complete a SAVE inquiry on victims of human trafficking. However, do complete a SAVE inquiry on eligible family members of trafficking victims.

[Do not complete a SAVE inquiry on individuals who are not applying to receive benefits.

Under no circumstances may a State agency:

A. Require any information about the citizenship or immigration status of anyone who is not applying for the Supplemental Nutrition Assistance Program (SNAP);

B. Deny SNAP to applying household members because a non-applicant household member has not disclosed his or her citizenship or immigration status or Social Security Number(SSN); or

Use the following procedure when an alien applies for benefits.

A. Initiate a request for verification by SAVE. Send a memorandum with the following information to the Regional Office:

1. Case name and number;

2. For each alien member: name, the corresponding alien registration number, birthdate, the type of documentation provided, and if available, SSN and the I-94 admission number; and

3. Worker name, code, and phone number.

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MS 0590 (1) Volume 1 - General Administration MS 0590 - R. 8/1/22 - OMTL-603 Federal Benefit Changes Retirement, Survivors, Disability Insurance (RSDI), Supplemental Security Income (SSI), Railroad Retirement (RR), Black Lung, and designated Veterans Administration (VA) beneficiaries periodically receive a change in the benefit amount. A. Federal Benefit Changes 1. Medicaid (MA) and Kentucky Transitional Assistance Program (KTAP): [All recipients who receive these benefits are affected and are responsible for reporting the change within the appropriate timeframe in guidance with each program requirement.] Note: Individuals in Long Term Care (LTC) who only receive SSI are not affected by the conversion. 2. Supplemental Nutrition Assistance Program (SNAP): These changes in federal benefit income are known to the agency and are not required to be reported by SNAP recipients/households. a. The federal increase is considered a mass change. b. A notice of action taken is required, but a timely notice of a reduction or discontinuance of benefits is not required. B. [Worker Portal generates all required notices for any case action taken as a result of the conversion.] C. Verifying Benefits During the first week of December, request verification of benefits as follows: 1. Railroad Retirement [Benefits for these individuals may increase or decrease. Use form PAFS-54, Letter to Verify Railroad Retirement Benefits, or the “Active Cases with Black Lung, Railroad Retirement, or Veterans Income” listing to send one alphabetical list of claimants per local office to the appropriate RR District Office shown below. List the claimant’s name, wage earner’s name, and the claim number as it appears on the Medicare card. The Louisville District Office serves most Kentucky counties except those listed below:] Counties: Send to: Boone, Bracken, Cincinnati District Office Campbell, Gallatin, CBLD Center, RM. 201 Grant, Kenton, 36 East 7th Street Mason, Pendleton Cincinnati, Oh. 45202

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MS 0650 (1) Volume 1 - General Administration MS 0650 - R. 6/1/25 - OMTL-672 Voter Registration Procedures A. At application, recertification, and address change for the head of household (HOH) age 17 years or over: 1. For Face-to-Face Interviews: Enter if the HOH wants to register to vote in Worker Portal. [Form PAFS-706, Voter Registration Rights and Declination, is system- generated. The HOH signs and dates the form.] Form SBE 01, Commonwealth of Kentucky Voter Registration Application, is generated when the HOH, who is age 17 or older, states he/she is not registered to vote at the current residence and would like to apply to register. If the HOH is not present, the authorized representative is given form PAFS 706 and/or the Voter Registration Application, depending upon the response to the question to be completed by the HOH. 2. For Phone Interviews: Follow the instructions for face-to-face interviews and mail form PAFS-706 and/or the Voter Registration Application, depending upon the response to the question, to the household. Inform the HOH to return the forms along with other verification to the local Department for Community Based Services (DCBS) office. 3. For Mail-In Applications and Recertifications: The system generates and mails a letter of explanation, form PAFS-706, and form SBE 01 to LIS Medicaid referrals. All Simplified Assistance for the Elderly (SAFE) cases are mailed the explanation letter, PAFS-706, and the Voter Registration application. 4. For Address Changes: Anytime a home address is changed on the address case change screen, a letter of explanation, form PAFS-706, and the Voter Registration Application will be system-generated to the head of household. [Note: As the completion of form PAFS-706 is not an eligibility requirement, it will not be included on a Request for Information (RFI). B. If the individual wants to register to vote, the individual completes the Voter Registration Application by checking the party affiliation, reads or is read the voter declination statement on form PAFS-706 and signs and dates the Voter

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MS 0675 (1) Volume 1 - General Administration MS 0675 - R. 10/1/24 - OMTL-654 Resolving Match Discrepancies Use the following verification procedures when an Income and Eligibility Verification System (IEVS) discrepancy is identified in any program. A. Match Data Requiring NO Independent Verification: 1. Matching data from Supplemental Nutrition Assistance Program (SNAP), Unemployment Insurance, State Data Exchange (SDX) and Beneficiary Data Exchange (BENDEX) (Unearned Income) files require no independent verification UNLESS the data is questionable. 2. If the matching data is questionable (i.e., conflicts with previously verified case information), document the reason on Worker Portal. Resolve the discrepancy and take appropriate case action within 30 days of the match date. 3. If the matching data is not questionable (i.e., does not conflict with previously verified information), resolve the match within 30 days after the match date. 4. For data received from these sources which is not considered in the case record, adjust benefits within 30 days after the match date. B. Match Data Requiring Independent Verification: 1. Matching data from Wage Records, Internal Revenue Services (IRS) (Computer Matching Data) and BENDEX (Wage and Pension) files require independent verification since the data obtained in the match is several months old and may not reflect current household circumstances. Attempt to resolve 100 percent of matching data requiring independent verification within 30 days after the control date/match date; however, on an individual worker basis, 20 percent may remain unresolved for up to 90 days pending verification from the data source. This remaining 20 percent must be resolved within 90 days after the control date/match date. The 30 and 90-day timeframes DO NOT apply if the case is due for recertification prior to those timeframes. Resolve all matches before the recertification is processed. 2. General Procedure for Independent Verification: a. When a Match requiring verification is received the month prior to the recertification month, do not take action (issue an Request for Information (RFI)) AFTER the date of Cut-Off or Negative Action. Document Case Notes that a match has been received, the reason for not acting on it at that time, and that it must be acted on during recertification.

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MS 0675 (2) b. For Matches acted on during the month of recertification, discuss the match during the interview and request the individual provide the required verification to resolve the match before the recertification due date. Explain to the individual that the verification must be provided before the recertification can be approved. Document Case Notes thoroughly to ensure the worker processing the recertification is aware of the match and the requested verification. Note: For Medicaid cases without a recertification interview, contact the individual to discuss the match and request the individual provide the required verification to resolve the match. Issue an RFI and document in Case Notes. c. For cases not due for recertification, enter the information on Worker Portal and allow the system to issue an RFI requesting the necessary verification. If the requested verification is not returned timely, the system will take appropriate action. Allow the household 10 calendar days from the date of the notice to provide the requested verification. For Medicaid, allow the household 30 calendar days to provide the requested verification. Follow the below procedures and if the individual does not return the information, discontinue the case. When requesting verification by RFI, DO NOT list Federal Tax Information (FTI) on the form. FTI is data derived from the IRS such as: (1) BENDEX earned income; (2) IRS matching data; and (3) Other unearned income IRS computer matches. All screens containing FTI can be easily identified by the banner which states, “This screen contains IRS data – do not print.” The RFI must only request general information. NEVER list any specific information found on income match or computer match screens, such as the employer’s name or the amount of income. Example: A match shows that Bob earned wages of $3,000 from Wal- Mart in the 3rd quarter. On the RFI, the worker requests that the individual contact the Department for Community Based Services (DCBS) to discuss the income. The worker does not specify the name of the employer, amount of the wages, or any other information obtained from the computer match screens. When Bob contacts DCBS the worker asks if he works at Wal-Mart and requests his check stubs. No information from the match is listed on the RFI; therefore, no FTI is shared. The RFI and the check stubs are scanned into ECF. d. When verification, other than what was originally requested, is required as a result of contact with the recipient prior to expiration of the 10-day period, prepare another RFI, as appropriate and allow 10

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MS 0675 (3) calendar days for the recipient to return the additional verification. For Medicaid, allow 30 days for the recipient to return the verification. e. Upon receipt of verification, send the appropriate notice of eligibility/ineligibility, if required, and adjust benefits timely. f. Document all actions thoroughly and completely. g. [Resolve the exception through the Computer Match task.] 3. Wage Records. Use the following criteria to determine when a match requires independent verification. a. The matches which determine whether independent verification is required are the last available Wage Records quarter and the quarter prior to the last available Wage Records quarter. [Example: If the last available Wage Records quarter is the third quarter of 2023 (shown as 3/23) the quarter prior to the last available Wage Records quarter would be the second quarter of 2023 (shown as 2/23). (1) If there are no matches for either of those quarters, no independent verification is required to resolve the Wage Records match. Resolve the exception through the Computer Match task. (2) If a match is shown for either or both quarters, determine whether the income is currently being received by the member.] (a) If the case record contains adequate verification for resolution, document accordingly and resolve the Computer Match. (b) If independent verification is required, refer to item B. 2. b. After IEVS resolution, process any possible claim in accordance with MS 0870. 4. Computer Matching Data Information. Should recipients inquire about the source of Agency information, indicate the data was secured through computer matches made by the Agency. Use the following criteria to determine when a match requires independent verification. a. Independent verification is not required if the match data is currently considered in the case record or the case record contains adequate verification for resolution. Document accordingly and resolve the Computer Match. b. Independent verification is required if the case record does not contain adequate verification. Refer to item B. 2. Additionally, if a bank account has been closed, a statement from the bank or source is required to verify the closure. c. After IEVS resolution, process any possible claim in accordance with MS 0870.

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MS 0675 (4) [Note: When processing income matches with verification available on Eligibility Advisor (EA), it is not appropriate to use the income unless the individual confirms the employer’s name and wages shown on EA are correct. Refer to MS 0680. C. Public Assistance Reporting Information System (PARIS) Veterans Match – Individual Summary: PARIS Veterans Match – Individual Summary, is a quarterly report that matches the Social Security Number (SSN) of Worker Portal members receiving Veterans Administration (VA) benefits against the PARIS Veterans File. The report lists the case information, member information, and the VA matched data. The report includes a two-character Entitlement Code (ENT CODE) that identifies the payment type of the award. The first character indicates the type of service and the second character indicates if the payment is Pension or Compensation (Example: ENT CODE ‘71’ is ‘Vietnam Service Compensation’). Note: ENT CODE ‘51’ indicates a one-time compensation payment for the Month-of-Death. It is not identified in the key.] Use the key below to determine the payment type. First Position Second Position 0 - Gulf War Service 1 - Compensation 1 - WWI Service 2 - Protected Pension (veteran) 2 - WWII Service 4 - Section 306 Pension (veteran) 3 - Korean Conflict Service 5 - Death Compensation 4 - Peacetime Service 6 - Protected Pension (survivor) 7 - Vietnam Service 7 - Dependency Indemnity Compensation 9 - Philippine Service 8 - Section 306 Pension (survivor) D - Improved Pension (survivor) L - Improved Pension (veteran) The gross, net, and check amounts in the VA data portion are shown in whole dollars only (no cents). Therefore, if the individual receives a VA amount that includes cents, then the amount shown on the report will be less than the actual amount received. 1. If the VA income is already counting in the case for the member and the amount on the report differs within 0.99 cents, no change is required to the case except documentation of the match. 2. If the VA income is already counting in the case for the member and the amount on the report differs more than 0.99 cents, consider the income verified upon receipt of the match, the match amount as accurate, and correct the case accordingly. 3. If the VA income is not counting in the case, consider the income verified upon receipt of the match, the match amount as accurate, and correct the case accordingly.

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MS 0680 (1) Volume 1 - General Administration MS 0680 - R. 12/15/25 - OMTL-686 IRS Safeguarding Issues The Internal Revenue Service (IRS) requires that measures be taken to protect or safeguard confidential information. The IRS audits the Cabinet for Health and Family Services (CHFS) annually for compliance with these safeguarding requirements. The following procedures have been developed as a result of these requirements. A. General Safeguarding Procedures: Staff should take all precautions necessary to protect information that must be safeguarded, such as the following: 1. All Federal Tax Information (FTI) – including Computer Match, Income and Eligibility Verification System (IEVS), Beneficiary Data Exchange (BENDEX), earned income, and any other information that comes from the IRS. Worker Portal screens containing FTI are identified by the banner stating, “This screen contains IRS data – do not print.” FTI must NEVER: a. Be copied, e-mailed, printed, or faxed; or b. Be scanned into the Electronic Case File (ECF). 2. Two-barrier security is required for FTI. This means access to the material is locked by two locks. Place form DTA-FTI-1 (included as an attachment to the annually issued FSM, “IRS Safeguarding Procedures”), to the front of all file drawers or locked boxes (with two barrier security) where any potential FTI is held, identifying that those files contain FTI. Also, attach Form DTA-FTI-1 to the front of any file folders within the file so that it is visible to anyone who looks at those records. 3. Any material containing an individual's Social Security Number (SSN) must be safeguarded. Limit access to the case and other recipient-related information. 4. Minimize public access to confidential information: a. Secure work areas against unauthorized and unsupervised access; b. Ensure that during an interview, only the case record pertinent to that individual is visible on the desktop or surrounding areas; c. Ensure that computer terminals only display information related to that individual during interviews; and d. Sign off or lock computer terminals when not in use or when leaving the work area.

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MS 0680 (2) 5. Keep mailed information secure: a. Check mail trays for recipient information regularly; and b. Do not leave recipient information in mail trays overnight. 6. Properly dispose of case record material and other recipient information as follows: a. Shred the material into 5/16 inch or smaller strips; or b. Place in a designated box: (1) Seal the designated boxes and store in a secure location, preferably one that can be locked; and (2) Complete the Certificate of Disposal form. B. Procedures for Safeguarding IRS Information – Computer Match: 1. When an IRS match is received on the computer, and independent verification is required, do not print any Worker Portal screens containing IRS data. These screens can be identified by the banner, which states, “This screen contains IRS data – do not print.” Do not specify the IRS data in case comments 2. If verification is available through system inquiry for the match, and no claim is established, contact the individual to verify the information is accurate, then file the information in the case record and comment accordingly. If verification cannot be obtained through system inquiry, or the individual cannot be reached, the case must pend for the required information. Allowable comments in the case concerning the resolution of the match would be “Computer Match dated ‘mm/dd/yyyy’ resolved”. Generic employment information should be entered for Request for Information (RFI) that are mailed as a result of a computer match. Example: While processing an income match for wages from ABC Employment Agency, staff are unable to reach the individual to confirm that the wages shown on Eligibility Advisor (EA) are representative of anticipated ongoing income. Enter generic employer information when entering into Worker Portal, such as, but not limited to, Job beginning xx/xx/xxxx. It is important that the employer’s name is not entered into the case until it is confirmed with the individual that the information is correct. The RFI must not state the name of the matched employer. 3. If verification returned as a result of the request indicates the need for a claim referral, follow normal procedures in establishing a claim. Note: Form PAFS-7, Notification of Appointment/Request for Verification, is obsolete effective May 1, 2011; however, the log used to track FTI-1 is kept in a locked file and maintained for five years after the last item on the log is destroyed, at which point it is destroyed per procedures found in General Safeguarding Procedures, item D.

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MS 0680 (3) C. Procedures for BENDEX Information: 1. Do not scan any BENDEX information into ECF. BENDEX information is: a. Earned income data found on Worker Portal screens identified by the banner which states, “This screen contains IRS data – do not print;” and b. Retirement, Survivors Disability Insurance (RSDI) income data and earned income data found on BENDEX Inquiry and Kentucky Information Management System (KYIMS) Job Menu, program 39, New BENDEX. 2. Do not mention BENDEX in case comments. Document that the income amount was verified by system inquiry on mm/dd/yyyy. 3. If it is necessary to print and keep any BENDEX screen information, it must be stored under two-barrier security in a folder or file labeled with form DTA-FTI-1. The case record may only reference where verification is filed. 4. Do not copy, fax, or e-mail BENDEX information. D. Purging IRS Federal Tax Information found in Case Records: [Case records cannot contain any BENDEX information, IEVS information, or Department of Child Support Services (DCSS) screens containing IRS data. 1. Check all active and inactive case records for BENDEX information, IEVS information, and DCSS screens containing IRS data. 2. Purge BENDEX information, IEVS information, and DCSS screens containing IRS data found in the active and inactive case records. The purged information must be disposed of following the procedures in General Safeguarding Procedures, item A.6.] E. Penalties for Failure to Safeguard IRS Information: 1. Unauthorized inspection or disclosure of Federal income tax returns or return information may be punishable by a $5,000 fine, five years imprisonment, or both, plus the cost of prosecution, per Internal Revenue Code Section 7213(a); 2. A taxpayer may bring suit for civil damages in a US District Court for unauthorized disclosure or unauthorized inspection of returns and return information, per Internal Revenue Code Section 7431. This Section allows for punitive damages in case of willful inspection or disclosure or gross negligence, as well as the cost of the action; and 3. These civil and criminal penalties apply to the individual worker even if the unauthorized disclosures or unauthorized inspection were made after employment with the Agency terminated and if the individual is no longer an employee of the Commonwealth of Kentucky. F. Improper Inspection or Disclosure:

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MS 0690 (1) Volume 1 - General Administration MS 0690 - R. 5/1/25 - OMTL-669 Prisoner Match Workers must view the State Verification & Exchange System (SVES) prisoner match report found on the Living Arrangement screen for ALL household members age 15 and older at each application, recertification, and member add. A banner is also provided within the Living Arrangement details screen when the system has reviewed the report and a match is found for individuals in the case. The banner will continue to display until the case is disposed. When completing a Supplemental Nutrition Assistance Program (SNAP) application, recertification, or member add: A. [Check SVES for each household member age 15 and older and discuss any records found within the prior six months with the individual. Detailed notes are only required when verification must be requested for an individual with incarceration matches that include the date of confinement and discharge date for each record found within six months of the application date. Verification is not required for any periods of incarceration with a discharge date more than six months before the individual received SNAP benefits. Comments are not required for those members who do not have a match.] B. If a household member was incarcerated during the SNAP certification period, or six months prior to their SNAP application, verification of their release must be provided. Pend the case for verification of release date, if not readily available. A Request for Information (RFI) is generated requesting verification. The individual has 30 days to provide the verification if the record is reviewed at application or untimely recertification, and until the end of the month for a timely recertification. At member add, the information must be provided within 10 days. If the individual is unable to provide their release paperwork, a collateral contact should be made to the facility where they were incarcerated. The facility’s contact information is available on the report.

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MS 0730 (1) Volume 1 - General Administration MS 0730 - R. 12/1/16 - OMTL-510 Electronic Disqualified Recipient Subsystem (eDRS) The Electronic Disqualified Recipient Subsystem (eDRS) is a national database of all individuals disqualified due to an Intentional Program Violation (IPV) in the Supplemental Nutrition Assistance Program (SNAP). IPV disqualifications must be entered on the Worker Portal in order to track occurrences and to allow the matches of out-of-state disqualification information. The eDRS system sends and retrieves data via real time web service interface to transmit SNAP IPV disqualification information. A. [Effective March 16, 2016, staff in the Division of Family Support (DFS) who are working from the Program Integrity queue will receive eDRS tasks via the Worker Portal for disqualifications entered by other states. An eDRS query will be sent for each adult household member requesting SNAP benefits on Worker Portal at application, recertification, and at member add, if the new member is age 18 or older. If the query results in a match: 1. An eDRS task is created and sent to the Program Integrity queue. The disqualification details will automatically populate the IPV screen. This will provide the details of the IPV disqualification, including occurrence, decision date, start date, and length of the disqualification. Contact information for the originating state is also provided. 2. The worker starting the task must contact the originating state to request documentation of the IPV. In order to enter the IPV in the Worker Portal, one of the four types of supporting documentation must be obtained; either: a. A signed waiver of an Administrative Disqualification Hearing (ADH); b. An ADH order; c. A deferred adjudication agreement; or d. A court order. The document will verify the disqualification time period and how the IPV was determined. 3. The originating state has 20 days to provide the documentation. Non- expedited cases will not dispose until after the 20th day in order to allow time for the verification to be obtained. a. For cases meeting expedited criteria, process the case without the IPV verification and document in comments that information relating to an out-of-state IPV has been requested but not provided by the originating state. b. For cases not meeting expedited criteria, if the documentation is not received by the 20th day or by the 10th day for a member add, process the case without the information and document in comments that information

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MS 0810

(1) Volume 1 - General Administration MS 0810 - R. 8/1/26 - OMTL-703 How to Identify a Claim

A. [Identification of claims is an automatic process if an overpayment is detected by the Integrated Eligibility and Enrollment System (IEES) during case processing. For example, field staff make appropriate case changes and IEES detects a potential overpayment. At disposition, an automatic Discrepancy Referral information screen is triggered. Field Staff can create an overpayment discrepancy task for the Regional Claims Worker (RCW) to review from this screen. All other claims are manually referred.

B. A Manual Claim referral is created when the following occurs:

1. Supplemental Nutrition Assistance Program (SNAP) benefits are trafficked;

2. Benefits designated for a specific purpose are used to purchase unapproved items or services;

3. Claims identified as occurring prior to implementation of IEES and were not processed on Kentucky Claims Debt (KCD) Management System;

4. Medicaid Fraud;

5. Individual Child Care Fraud;

6. Child Care Provider Fraud;

7. Some supportive service payments are overpaid; or

8. When any overpayment is detected by field staff that is not automatically detected by IEES.

C. When completing a claim referral or while establishing a claim, staff will utilize one of the following detection code associated with how the claim was identified:

1. Batch Match/Computer Match: Used when computer file data from the Income and Eligibility Verification System (IEVS) is matched against case and member information on Worker Portal and the discovery of unreported income/resources results in an overpayment or incorrect issuance of benefits for all Family Support assistance categories;

2. Public Assistance Reporting Information System (PARIS): Used when a recipient match is received showing benefits were issued in more than one state for the same timeframe;

3. Hotline: Used when an overpayment is found due to a citizen, known or anonymous, contacting the Food and Nutrition Administration (FNA) through a Whistleblower Complaint or the Office of Inspector General

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MS 0810 (2) (OIG) through a Hotline Complaint with information pertaining to a benefit recipient that may be unreported or unknown to the agency. FNA or OIG will then route these complaints to the designated contact for investigation and dissemination;]

4. Quality Control (QC) reviews: Used once the QC process has been completed and a positive error for an over issuance has been detected;

5. Audit: Used when an overpayment is detected via the evaluation process conducted by the United States Department of Agriculture (USDA), Department of Health and Human Services (DHHS), Auditor of Public Accounts (APA), or the Government Accounting Office (GAO);

6. Quality Assurance (QA) review: Used when an overpayment is found by a supervisor, principal, Case Review Team (CRT), or the Division of Family Support (DFS) during any case review process;

7. Management Evaluation (ME) reviews: Used when an overpayment is detected during the review of SNAP cases conducted by ME staff;

8. Central Office: Used when an overpayment is detected by central office staff or when there is an overpayment involving an employee or Simplified Assistance for the Elderly (SAFE) claims;

9. Worker: Used when an overpayment is found during the course of regular casework via application, recertification, or case processing and the worker generates a claim referral, or while processing Fidelity Information Systems (FIS) fraud alerts;

10. Office of the Inspector General (OIG): Used when an overpayment is detected during an OIG investigation;

11. Client: Used when an overpayment is found from a report from the household;

12. Department of Child Support Services (DCSS): Used when an overpayment is found due to unreported child support income and DCSS informs the Department for Community Based Services (DCBS) of the income;

13. Third Party: Used when an overpayment is detected from information provided by a source outside of the agency (i.e., an employer);

14. Eligibility Advisor (EA): Used when an overpayment is detected by unreported income discovered via EA; or

15. National Accuracy Clearinghouse (NAC): Used when an overpayment is detected by the receipt of a notification from the NAC system for the receipt of duplicate benefits in more than one state for the same timeframe.]

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MS 0830 (2) b. For SNAP claims, sending forms FS-80, Notice of SNAP Suspected Intentional Program Violation (SIPV), and FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing, to a SNAP household with a claim that does not meet criteria for OIG referral or OIG does not pursue prosecution. c. RCWs are to update comments on IEES whenever any action is taken on a claim and to ensure that all appropriate dates and codes are entered on the Benefit Recovery screen, in order to document that appropriate action is taken during the claim process. For SNAP claims, update when: 1. Form FS-80 and FS-80A are mailed to the recipient; 2. Form FS-80A is signed and dated by the recipient and returned; 3. Form FS-111, Deferred Adjudication Disqualification Consent Agreement is signed and dated; or 4. An Administrative Disqualification Hearing (ADH) is requested, scheduled, affirmed, or reversed. Note: This information is reviewed for accuracy during the Case Review and the Management Evaluation (ME) review process. 11. Requesting and participating in SNAP ADHs or court proceedings to give testimony to identify a recipient and testify to the explanation given of the recipient’s rights and responsibilities. 12. Verifying and imposing SNAP disqualifications identified by the electronic Disqualified Recipient Subsystem (eDRS). 13. Providing an explanation of benefit reduction to affected households. 14. Responding to fraud hotline requests generated by OIG. 15. Accepting non-cash payments (checks, money orders, or EBT) and issuing receipts for payments brought to the local office for established claims. Non-cash payments are to be mailed to: Claims Management Section 275 E. Main St. 3E-I Frankfort, KY 40621. Advise the recipient to send any future payments to the Claims Management Section (CMS). 16. Referring questions relating to the payment of claims, other than those relating to benefit reduction, to CMS at 502-564-3440. 17. Referring all questions relating to tax intercepts, garnishment of wages, and other intercepts to CMS at 502-564-3440.

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MS 0870

(1)

Volume 1 – General Administration MS 0870 – R. 8/1/26 – OMTL-703 General Procedures for All Claims

[Potential claims are identified for active and inactive cases via an automatic Discrepancy Referral or a manual claim referral. For active cases, the Regional Claims Worker (RCW) responsible for reviewing claim referrals is assigned based on where the household or member lives. For inactive cases or households that have moved out of state, the RCW responsible for reviewing claim referrals is assigned based on the last region of residence where benefits were received.

A. The basic process for task creation for claim referrals includes the following:

1. During case processing, field staff process a change that creates the Discrepancy Overpayment information screen in the Integrated Eligibility and Enrollment System (IEES) or create a manual claim referral when IEES does not detect the potential overpayment.

2. Field staff create a manual Claim Referral for potential claims under the Benefit Management tab for Medical Assistance (MA), Temporary Assistance for Needy Families (TANF) related programs, Simplified Assistance for the Elderly (SAFE), and Supplemental Nutrition Assistance Program (SNAP) trafficking.

3. RCWs will receive a task for “Discrepancy Referral to Claims Worker” or a “Family Support Claim Referral Task”.

4. A Claim Referral is not considered a valid claim until it is investigated and moved from a pending claim status to an active claim status by an RCW.

Complete the following actions related to any suspected over-issuance occurring in the SNAP, SAFE, MA, Kinship Care (KC), Child Care Assistance Program (CCAP), Kentucky Transitional Assistance Program (KTAP), and KTAP-related programs administered by Family Support field staff:

B. Review the circumstances to determine the reason for the error and correct any active case. If an active SAFE case requires corrections, Central Office staff within the Nutrition Assistance Branch (NAB) must be notified via the SAFE inbox to act on the update.

C. Determine if any companion cases exist that may be affected by the potential claim.

D. After entering a change and running eligibility, if you are directed to the Overpayment Discrepancies screen, you will proceed with the following steps:

1. Scroll to the right of the screen to view all details that should be entered.

2. Select the proper method under the Detection drop-down.

3. Select the cause of the discrepancy under the Reason drop-down.

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MS 0870 (2)

4. Select claim type under the Category Type drop-down.

5. Select refer or not refer to claims.

6. Enter specific details regarding the discrepancy in the comment box, including why the claim was referred or not referred, including all relevant details regarding the referral.

7. Click Next to submit the discrepancy.

E. Potential claim referrals are submitted at the case level on IEES.

Exception: MA, SNAP Employment & Training (E&T), SNAP trafficking, Kentucky Works Program (KWP), and referrals with no associated case are submitted and entered on IEES under the individual level.]

F. RCWs are required to enter all available information for the potential claim on IEES within 10 days of the discovery date. The discovery date of the claim is the date that the RCW starts the task.

G. Scan claim information into the Electronic Case File (ECF). See MS 0850.

H. RCW staff will schedule an appointment with the household on IEES, if needed:

1. The scheduled appointment is to occur no later than 30 days from the discovery date.

2. Appointment notices should be sent to the household within 10 days of the discovery date of the claim.

3. Appointments are not required to be scheduled for Agency Error (AE) claims. Appointments are required for Inadvertent Household Error (IHE) and Suspected Intentional Program Violation (SIPV) claims and can be scheduled as a face-to-face or phone interview (except when a phone number is not available). See MS 1020 for SNAP trafficking procedures.

4. The RCW is responsible for contacting the individual at the time the phone interview is scheduled. The face-to-face interview is scheduled in the local office of the county where the client is active or last received in. If the individual is not currently receiving benefits and has moved out of the county that has the claim, the individual may travel to the county for the interview, be given a phone interview, or the new region may be asked to handle the claims interview.

5. Comments regarding the scheduling of the interview are required to be entered when it is scheduled and at the completion of the interview. If the individual is not reachable at the time of the scheduled interview, the RCW is required to leave a message on how to contact them and update comments regarding the outcome. Do not leave any confidential information on the voice recording.

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MS 0870 (3)

Note: If the claim is split due to household members moving in or out, a second appointment is not required. Only one interview is required.

I. Households that refuse to provide information required to determine ongoing eligibility are discontinued for non-cooperation.

J. Document claim comments as well as IEES case comments:

1. Every action taken and the date it happened.

2. List in chronological order the circumstances that resulted in the claim.

3. The date and time of the scheduled interview, if applicable, and the result of the interview at the time it was scheduled.

Example: 2/12/2020 – Interview appointment scheduled for 2/25/2020 at 1:00 p.m. Eastern Time. Appointment notice mailed to household on 2/12/2020. 2/25/2020 – Claim comments should include the phone number you contacted the client at and thoroughly explain the outcome of the interview appointment. This also includes reaching their voicemail and the need to leave a message for a return call.

4. False, misleading, or untimely statements made by the member(s).

5. List all verification used to determine the claim.

6. An explanation of the category of the claim.

7. An explanation of any corrective action taken to prevent future errors of the type that caused the claim.

8. For claims caused by unreported income, indicate who had the income, the type of income, name of employer if it is earned income, and the time period of receipt of the unreported income.

9. The hearing decision and other actions pertaining to the disposition of the claim, such as completion of a waiver to a hearing, termination of an Office of Inspector General (OIG) referral, or court disposition.

10. Any action by the RCW that deviates from the normal procedures.

K. Compute the claim amount based on available information, i.e., wage records, batch match, Eligibility Advisor, driver's license, etc. RCWs are not to investigate using Facebook, Google, or by calling family, friends, employers, or landlords to seek information about the individual that the household did not verify. If a collateral contact is used to substantiate a claim, request and obtain written verification from the source for the claim record.

[Example 1: The case record contains form PAFS-76 that was completed by the landlord. When the RCW contacts the verification source to determine time period of household composition, it is found it

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MS 0870 (4)

was not completed by the landlord. In the claim, it is notated that the individual returned false verification, as the landlord did not complete the PAFS-76.

Example 2: The case record contains form PAFS-700 from the individual’s employer. The employer can be contacted to verify information pertaining to an individual’s employment but is not to be questioned about the individual’s living situation.

Example 3: An individual applied for SNAP benefits on 3/21/2023. Over the course of their certification period, the employment reported at the application ended with the last pay received in June 2023. The individual never reported the change to the agency, and the income continued to count in the case. A claim referral was submitted after the recertification interview for a potential overpayment due to the individual starting new employment on 6/15/2023, and the household failed to report exceeding the gross income limit by 7/10/2023. During the claim investigation, the RCW should attempt to verify the income and termination through the use of form CL-700, Verification of Employment and Wages, a collateral contact, or other acceptable forms of verification. The RCW should not consider terminated income in claim calculations if they are able to obtain verification of the termination and final wages, even when the termination is not reported by the household. Claim calculations utilize the household’s actual income received during a benefit month when determining if an overpayment of benefits occurred.]

L. If verification of the claim cannot be substantiated by any available source, determine if the claim should be referred to OIG for further investigation. If the claim does not meet the criteria for a referral to OIG, then no claim exists. If information later becomes available to establish the claim, it can be reentered as a potential claim on the Benefit Recovery Module.

M. Potential fraud claims that meet the criteria in MS 0910 are referred to OIG for further investigation. If a disability exists or Limited English Proficiency (LEP) is present, prior to completing a referral to OIG, seek an assessment of the individual’s ability to understand program rules from the Department of Community Based Services (DCBS) Equal Employment Opportunity (EEO) Coordinator or Cabinet for Health and Family Services (CHFS) EEO Compliance Branch, 275 East Main Street 5 C-D, Frankfort, KY 40621 or call 502-564- 7770.

[N. State Supplementation potential claim referrals are sent directly to the Medical Support and Benefits Branch (MSBB):

1. If detection is made by field staff for a potential State Supplementation claim, a manual claim referral is submitted on the Benefit Recovery module within the Benefit Management tab.

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MS 0880 (1) Volume 1 – General Administration MS 0880 – R. 3/1/22 – OMTL-592 General Procedures for a Suspected Fraud Claim A preliminary determination of suspected fraud is made after review of the information available to the worker regarding the circumstances of the claim and the individual’s statements regarding the reason(s) for the claim. The supervisor must agree with the findings of the worker referring the case(s) to the Office of Inspector General (OIG) for possible prosecution. Use criteria in MS 0910 to refer a case to OIG. A. Fraud is suspected when an individual: 1. Makes a false or misleading statement in order to receive benefits; 2. Misrepresents, conceals, or withholds factual information in order to receive benefits; 3. Commits a violation of the Food and Nutrition Act relating to the use, presentation, transfer, acquisition, receipt, or possession of Supplemental Nutrition Assistance Program (SNAP) benefits. Specifically prohibited is: a. Purchasing a controlled substance using SNAP benefits; b. Purchasing firearms, ammunition, or explosives using SNAP benefits; c. Buying or selling SNAP benefits on or after August 22, 1996; and d. Making a false statement on or after August 22, 1996, pertaining to identity or residence in order to receive duplicate benefits. 4. Permits an individual other than those listed on the Kentucky Health Card to obtain health care benefits; 5. Misuses a Medicaid-covered service, such as medical transportation, for a non-medical purpose; or 6. Misuses supportive service payments. B. [Suspected fraudulent SNAP claims are established on the Benefit Recovery Module as a Suspected Intentional Program Violation (SIPV). After the claim has been established as SIPV, a change in status must be completed within 90 days. If the claim is not referred to OIG, pursue the Intentional Program Violation (IPV) by sending form FS-80, Notice of SNAP Suspected Intentional Program Violation, and form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing, to the recipient for signature. If form FS-80A is not returned, is returned unsigned, or without a date, submit a request for an Administrative Disqualification Hearing (ADH) within three calendar days. See MS 1070 for ADH procedures.] C. A SNAP claim is not considered fraud unless:

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MS 0890 (1) Volume 1 – General Administration MS 0890 – R. 7/1/21 – OMTL-580 How to Determine the First Month of a Claim To determine the first month of the claim, apply the following rules. A. [For applications that are incorrectly processed based on information provided at the interview, the claim is established for the effective month of approval and continues for every subsequent month the incorrect information is used. Example: The individual applies for benefits and fails to report a source of income. The claim begins the month of approval and continues until the income is considered in the determination of the benefit. B. The 10-10-10 formula is used to determine the first month of the claim. 1. Determine when the change became known to the household; 2. From that date, allow the household 10 days to report; 3. Allow the worker 10 days to act on the report; and 4. Allow 10 days for adverse action. 5. The month in which the adverse action period ends determines the first month of the claim. The beginning month of the claim is the next month after adverse action ends. C. Simplified Reporting households have until the 10th of the month following the month a change occurs to report a required change. Example: A household’s income increases above the permitted gross limit in August. The individual has until September 10 to report the change. The worker has 10 days to act on the change (September 20), and 10 days (September 30) are allowed for adverse action. The first month of the claim is October. D. A reportable Kentucky Transitional Assistance Program (KTAP) or Kinship Care (KC) change is required to be reported within 10 days. When changes decrease benefits or result in discontinuance of a case, the change must be entered on the Integrated Eligibility and Enrollment System (IEES) by either the negative action cutoff or Child Care Assistance Program (CCAP)/KTAP/Medicaid (MA) cutoff date, whichever affects the next month’s benefits. Example 1: An individual reports a member of the benefit group left the home on September 5, 2010. CCAP/KTAP/MA cut-off is September 21, 2010. Negative action cut-off is September 20, 2010. As this change will decrease benefits, the change must be entered by September 20, 2010, to be effective for October

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MS 0900 (1) Volume 1 – General Administration MS 0900 – R. 10/1/24 – OMTL-658 Determining Eligibility Through Extensive Review The Determining Eligibility Through Extensive Review (DETER) program is offered by the Office of Inspector General (OIG) to prevent individuals from receiving benefits fraudulently. A DETER referral is appropriate ONLY if a specific issue affecting eligibility is identified. Cases that appear suspect are referred to the DETER program for investigation. A. Refer only applications and reapplications that cannot be resolved through normal case processing. DETER is not used on Expedited Supplemental Nutrition Assistance Program (ExSNAP) applications or State Supplementation applications. Only send a DETER referral if there has been a break in benefits. A break in benefits is defined as there is at least one month in between receipt of benefits. Example: An individual received benefits in January. The case discontinued effective February. The individual reapplies in February. Do not complete a DETER referral as there has not been a break in benefits. Example: An individual received benefits in January. The case discontinued effective February. The individual reapplies in March. A DETER referral can be completed since there has been at least a one month break in benefits. 1. Access the DETER function on the case summary screen on the Integrated Eligibility and Enrollment System (IEES). a. Enter detailed comments in the DETER referral window regarding the allegation and what case type is being referred to DETER. b. Scan all related information into the Electronic Case File (ECF). 2. DETER is operational in all counties. 3. Caseworkers must explore all avenues available to resolve the issue before referring the case to DETER. An inappropriate DETER referral will be returned to the worker. B. After satisfying the verification requirements or when all avenues have been exhausted, use the following guidelines to determine if a referral to DETER is appropriate. 1. During the initial application, the caseworker suspects the individual may have withheld information during the interview. 2. The individual provides any verification relative to the eligibility determination that appears to have been altered or not authentic. 3. The applicant provides contradictory information relative to any eligibility factor.

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MS 0900 (2) 4. The individual does not respond during application or reapplication to questions relating to eligibility. Example: The individual states rent and utilities are being paid, no income is reported, and individual does not have a valid explanation as to how the expenses are being paid. C. [In instances where there are two days or less until the case must be processed, a DETER investigation is not possible. The case should be processed and then a Manual Claim Referral created for regional claim staff to review and submit to OIG.] D. After the DETER referral is made, pend the case for up to 15 days or until the case due date, whichever occurs first, to allow the investigator time to gather information and report findings. The investigator has up to 15 calendar days to complete the investigation and provide their findings unless the case due date is less than 15 calendar days from the date of the DETER referral. If there are not 15 days prior to the case due date you must specify, in the DETER comments box, the case due date. Once the DETER investigation is complete, OIG returns the final report to the worker who initiated the DETER referral and the worker’s supervisor. 1. Comment thoroughly the reason for the DETER investigation and pending the application. 2. Pend the case until forms DTR-2, Case Detail Summary Sheet, DTR-2A, DETER Response and Request for Action, and DTR-3, DETER Investigation Report, are received from the DETER investigator or until the case reaches its due date, whichever comes first. Do not pend cases past their due date. Example: A SNAP application is taken on January 1. After verification had been returned on January 23, the worker noticed an altered verification form and initiated a DETER referral. There are not 15 days prior to the case due date of January 30. When the worker creates the DETER referral, they must specify in the DETER comment box that the investigation needs to be completed by January 29. Example: A SNAP application is taken January 1. The individual first stated the father of the child was in the home, but then she stated the father of the child was out of the home. The worker, through all avenues of questioning, cannot determine if the father is in the home. On January 1 the worker submits a DETER referral. The worker would not need to specify a due date when the DETER referral is submitted as there is more than 15 days before the case is due. E. Caseworkers will receive forms DTR-2, DTR-2A, DTR-3, and a document titled Report Attachments containing any supporting documentation obtained during the investigation via e-mail. Caseworkers must review all information provided

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MS 0910 (1) Volume 1 – General Administration MS 0910 – R. 11/1/25 – OMTL-685 Referral of Claims to the Office of Inspector General The Department for Community Based Services (DCBS) contracts with the Office of Inspector General (OIG) of the Cabinet for Health and Family Services (CHFS) to investigate and pursue prosecution of individuals suspected of fraudulently receiving or trafficking program benefits. A. The following claims are referred to OIG for investigation: 1. Medicaid (MA) claims, regardless of the amount, when an individual has withheld or provided false information to receive assistance. MA claims are not entered on the Integrated Eligibility and Enrollment System (IEES) unless adjudicated through the court system. 2. [A Kentucky Transitional Assistance Program (KTAP), Kentucky Works Program (KWP) supportive services, Kinship Care (KC), Family Assistance Short Term (FAST), Work Incentive Reimbursement (WIN), Relocation Assistance Program (RAP), or Supplemental Nutrition Assistance Program (SNAP) case suspected of fraud, when the claim amount: a. Is estimated to be $10,000 or more due to unreported wages only; b. Is estimated to be $3,000 or more for reasons other than unreported income; c. There is a companion case(s), and the combined amount is estimated to be $3,000 or more; or d. There is a companion MA case with at least one month of suspected ineligibility. 3. SNAP trafficking cases/referrals that are believed to be $10,000 or more. 4. SNAP trafficking involving controlled substances, firearms, ammunition, or explosives, regardless of the suspected amount. Note: Any trafficking that does not meet the criteria of items 3 or 4 will need to be handled administratively. 5. Child Care Assistance Program (CCAP) recipient eligibility claims estimated to have a value of $5,000 or more AND suspected to be fraudulent. 6. Child Care provider claims of $10,000 or more and evidence of fraudulent billings, limited to the availability of funds. 7. Low-Income Home Energy Assistance Program (LIHEAP) cases, regardless of the amount.]

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MS 0910 (2) B. Take the following actions when suspected fraud is discovered and the claim meets the criteria in Item A: 1. Calculate the claim based on available verification. 2. Complete form Claim/MA-1, Medical Assistance Eligibility Summary, for claims that include Medicaid. 3. Navigate to the OIG Fraud Claims Tracking SharePoint site and create a new PAFS-88 referral. Enter all relevant claim information in the referral, clearly explain the allegation, and indicate which programs are associated with the overpayment. 4. Upload supporting documentation using the Doc Link hyperlink for the referral. 5. Submit the PAFS-88 referral for supervisor review by updating the referral status. The assigned claims supervisor will review the referral, determine if the referral is appropriate, and ensure all required steps have been completed. The supervisor will have the option to reject the referral or approve and submit the referral for Claims Management Section (CMS) review. 6. CMS reviews the referral and supporting documentation before submitting the referral to OIG on the OIG Fraud Claims Tracking SharePoint site. C. OIG may request a claim to be recalculated based on the findings of the investigation. Complete all recalculations within 15 calendar days of the request by OIG. These computation requests are sent directly to OIG. Contact the OIG investigator and email CMS if there will be a delay in completing computations. D. OIG has a 90-day timeframe to complete the investigation and determine if prosecution will be pursued. 1. If prosecution is not pursued, OIG closes their case and returns the claim to DCBS for administrative action, which must be taken within 10 calendar days. For SNAP claims: a. If fraud is highly suspected, pursue administrative establishment of an Intentional Program Violation (IPV) claim. See MS 1070. b. If the claim was caused by the client but fraud cannot be determined, change the category on the Worker Portal form Suspected Intentional Program Violation (SIPV) and complete as an Inadvertent Household Error Claim (IHE). c. If OIG determines the claim resulted from an Agency Error (AE), review the claim circumstances. The DCBS claims worker determines the appropriate category of a claim. If an AE is found, change the indicator on IEES, and take appropriate action on the claim.

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MS 0920

(1)

Volume 1 – General Administration MS 0920 – R. 8/1/26 – OMTL-703 Fraud Hotline Referrals

A. The Office of Inspector General (OIG) maintains a toll-free hotline, 1-800-372- 2970, to report suspected fraud.

1. When a caller contacts the local office regarding fraud for any program, provide the toll-free hotline number.

2. Use this number to report alleged Medicaid (MA) vendor fraud.

3. Use this number to report alleged employee fraud.

4. If an individual indicates they are unable to leave a message when they call the fraud hotline, take the information and email OIG.

B. OIG screens complaints and sends valid hotline referrals via email to the designated contact for each region within the Department of Community Based Services (DCBS). The DCBS contact is required to respond within 20 calendar days with the outcome of the complaint.

[When a hotline referral is received:

1. Scan a copy of the hotline referral to the Electronic Case File (ECF). If there is an individual name and number listed as the complainant, attempt to contact and obtain any supporting documentation from them. Attempt to contact the household to discuss the allegation. Do not reveal the complainant's information. Review the case to determine if incorrect benefits were issued. Verify any necessary information and secure substantiating documentation. Document thoroughly in case comments any action taken pertaining to the referral.]

2. If the hotline referral is determined to involve suspected trafficking allegations, refer to MS 1020, Trafficking and Retailer Fraud.

3. If a change becomes known to the agency through a hotline referral, enter the change on the Integrated Eligibility and Enrollment System (IEES). IEES will generate a Request for Information (RFI) requesting verification of the change. When the requested verification is returned, enter the verification in IEES and allow the system to process the change. If the verification is not returned, IEES will act on the change according to policy in Volume 2 MS 6750 and MS 6760, as appropriate.

Example: It is reported that a non-custodial parent (NCP) is in the home with income. Enter the information on IEES and allow the case to pend for verification of household composition and income.

4. If sufficient information is not provided to enter the change on the system, select the Unclear Information button on the Case Summary screen and send the RFI notice requesting the specific verification needed to process the change. Document the case thoroughly as to why the question was utilized and what is requested on the RFI. Allow the household 10 days from the date the RFI is mailed to provide the verification. If the mandatory

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MS 0920 (2)

verification is not returned at the end of 10 days, the case will automatically deny/discontinue for non-cooperation.

5. If it is determined there is a possible overpayment of benefits, complete the Overpayment Discrepancy screen or enter a Manual Claim Referral on IEES within 15 calendar days from the date of the hotline referral.

6. If it is determined no overpayment exists based on the hotline referral information, indicate the reason for no action on IEES and return to the designated DCBS contact within 15 calendar days from the date of the hotline referral.

C. [The Food and Nutrition Administration (FNA) maintains a hotline number for the general public to report suspected fraudulent activity. FNA compiles the Whistleblower complaints and sends a report via email to the Integrity and Analysis Section (IAS) for review. IAS will send valid complaints via email to the designated contact for each region within DCBS.

When a Whistleblower complaint is received:

1. Enter the complaint on the Complaint Module in IEES. Scan a copy of the hotline referral to the Electronic Case File (ECF). If there is an individual name and number listed as the complainant, attempt to contact and obtain any supporting documentation from them. Attempt to contact the household to discuss the allegation. Do not reveal the complainant's information. Review the case to determine if incorrect benefits were issued. Verify any necessary information and secure substantiating documentation. Document thoroughly in case comments any action taken pertaining to the referral.

Note: Not all whistleblower complaints will necessarily be fraud. Some complaints may be issues regarding case processing and other general case resolution issues.

2. Review the case to determine if incorrect benefits were issued. Verify any necessary information and secure substantiating documentation. Document thoroughly in case comments any action taken pertaining to the referral.

3. Only use collateral contacts as a verification source as a last resort in these complaints.

4. If a change becomes known to the agency through a Whistleblower complaint, enter the change on IEES. IEES will generate an RFI requesting verification of the change. When the requested verification is returned, enter the verification in IEES and allow the system to process the change. If the verification is not returned, IEES will act on the change according to policy in Volume 2 MS 6750 and MS 6760, as appropriate.

Example: It is reported that a non-custodial parent (NCP) is in the home with income. Enter the information on IEES and allow the case to pend for verification of household composition and income.

5. If sufficient information is not provided to enter the change on the system, select the Unclear Information button on the Case Summary screen and

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MS 0920 (3)

send the RFI notice requesting the specific verification needed to process the change. Document the case thoroughly as to why the question was utilized and what is requested on the RFI. Allow the household 10 days from the date the RFI is mailed to provide the verification. If the mandatory verification is not returned at the end of 10 days, the case will automatically deny/discontinue for non-cooperation. If it is determined there is a possible overpayment of benefits, complete the Overpayment Discrepancy screen or enter a Manual Claim Referral on IEES within 15 calendar days from the date of the Whistleblower complaint.

6. For Whistleblower complaints alleging fraudulent household composition, please review the complaint thoroughly and if the complaint appears to be valid complete the Overpayment Discrepancies Screen or enter a Manual Claim Referral within the timeframe mentioned above so the complaint can be reviewed and sent to OIG if necessary.

Example: A whistleblower complaint is received and alleges the individual’s reported household composition is fraudulent; the father of the youngest child is, and has always been in the home, and the oldest child, which the individual has included in the household, is not in the home. The complaint states there is proof of the individual’s statements being false and social services can be contacted to verify. In this instance, an Overpayment Discrepancy or a Manual Claim Referral would be completed. The Regional Claims Worker (RCW) would send the complaint to OIG as the documentation provided by the individual would be considered questionable and the complaint appears to be valid.

7. For Whistleblower complaints alleging unreported wages, use any verification source available to the agency. If wages are found, complete the Overpayment Discrepancies screen or enter a Manual Claim Referral screen within the timeframe mentioned above.

8. For Whistleblower complaints alleging unreported or incorrectly reported self-employment income, complete the Overpayment Discrepancies screen or enter a Manual Claim Referral in the timeframe mentioned above so the complaint can be reviewed and sent to OIG if necessary.

9. If it is determined no claim overpayment exists based on the Whistleblower complaint, indicate the reason for no action on IEES and respond to IAS within 15 calendar days from the date of the whistleblower complaint.

10. If the Whistleblower complaint is determined to involve allegations of suspected trafficking, refer to MS 1020, Trafficking and Retailer Fraud.

11. A summary of actions taken by the agency must be submitted to IAS, using the proper chain of command, within 25 calendar days of receipt of the Whistleblower complaint.]

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MS 0940 (1) Volume 1 – General Administration MS 0940 – R. 12/1/21 – OMTL-586 Who Must Pay a Claim The following persons are responsible for paying a claim: A. Each person who was an adult member of the household when the claim or Supplemental Nutrition Assistance Program (SNAP) trafficking occurred. Example: A household consists of four members: two adults and two children. One adult is the head of household (HOH) and the case is in their name and social security number. An overpayment is discovered, and a claim established. Because the individual has an active case, the claim will automatically be repaid by benefit reduction. If the case is discontinued, benefit reduction ceases and a demand letter is issued from the Integrated Eligibility and Enrollment System (IEES) to the head of household. If the other adult member of the household subsequently reapplies for benefits, responsibility for repayment transfers to the active case and benefit reduction will be imposed. Example: A household consists of four members: three adults and one child. One adult is the HOH and the SNAP Eligibility Determination Group (EDG) is in his name. The second adult is disqualified for failure to comply with the Employment and Training Program (E&T). The third adult is an ineligible student. An overpayment is discovered, and a claim established. In this instance the only liable member is the HOH. Members that are disqualified or are ineligible and not included in the benefit group are not liable for overpayments that occur while they are not included in the benefit group. [B. Head of Household (HOH), the individual who signs the SNAP application, regardless of their eligibility in the SNAP case. Example: Household of three members: two adults and one child, age 15. HOH, who completed the interview and signed the application, is an ineligible student. An overpayment is discovered, and a claim is established. Both adults are liable for the claim, even though the HOH was an ineligible student and not included in the benefit group. The HOH signed the application taking responsibility for the benefits issued on behalf of the household. Example: Household of four members: two ineligible immigrant adults and two children, ages 15 and 16. Both adult ineligible immigrants would be liable for the claim established as they would otherwise be considered in the benefit group, citizenship aside.] C. A sponsor of an immigrant household member if the sponsor is solely at fault;

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MS 0950 (1) Volume 1 – General Administration MS 0950 – R. 10/1/24 – OMTL-658 Claim Repayment Methods Claims may be repaid using one of the following methods: A. Lump Sum. For active or inactive households, if the household elects to pay the claim at one time, collect a lump sum payment. Acceptable methods of payment are a check or money order made out to the Kentucky State Treasurer, Electronic Benefit Transfer (EBT) benefits, or online at kynect via debit/credit card. Do not accept cash. 1. Do not require the household to liquidate all its resources to make a lump sum payment. 2. It is permissible for the household to make a lump sum payment as partial repayment of the claim. 3. If the household chooses to make a monthly or lump sum payment from EBT benefits, complete form EBT-6, Claims Repayment Request, for the Supplemental Nutrition Assistance Program (SNAP) claim. Submit to the Claims Management Section (CMS) by postal mail or by fax to 502-564 9810. 4. If the household voluntarily returns an issued benefit check to use as payment on a claim, issue a PAFS 30.3, Multi-Program Claims Receipt, to the individual. Forward the check along with a copy of the PAFS 30.3 to: Department for Community Based Services Division of Family Support Program Integrity Branch Claims Management Section 275 East Main Street, 3 E-I Frankfort, Ky 40621 B. Installments. If the individual with an inactive benefits case chooses to pay by installment payments, form KCD 1.11, Repayment Agreement, is required to be completed and returned to CMS within a designated time frame. An individual who is paying a claim by benefit reduction in an active case can also choose to make additional payments by installment. Notify CMS of the individual’s request. Below shows the minimum payment required based on the claim threshold: $0 to $1,000 $25 $1,001 to $5,000 $50 $5,001 to $10,000 $75 $10,001 to $15,000 $100 $15,001 to $20,000 $125 $20,001 and higher $150 C. [Benefit Reduction. If any liable member is active in a case, the benefits are reduced to recover the remaining claim balance not paid by a lump sum

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MS 0950 (2) payment. The Integrated Eligibility and Enrollment System (IEES) reduces benefits automatically. Benefit reduction can occur from more than one case at a time if there is more than one liable member actively receiving in separate cases. The initial benefit, when a household is first certified, cannot be reduced. Benefit reduction cannot be used to repay SNAP Employment & Training (E&T), Family Assistance Short Term (FAST), Work Incentive Reimbursement (WIN), Supportive Services, Remedial Health Care, Summer Electronic Benefit Transfer (SEBT), or Aid for Families with Dependent Children (AFDC) program claims.] D. The minimum benefit amount recovered each month by benefit reduction calculated by the Integrated Eligibility and Enrollment System (IEES) is: 1. SNAP Agency Error (AE) or Inadvertent Household Error (IHE) Claims - the greater of 10 percent of the monthly benefit or $10. The individual can choose to increase the reduction amount. 2. SNAP Intentional Program Violation (IPV) Claims - the greater of 20 percent of the monthly benefit entitlement or $20. The individual can choose to increase the reduction amount. 3. 10 percent of the Kentucky Transitional Assistance Program (KTAP) or Kinship Care (KC) maximum payment for claims established due to overpayments of KTAP, KC, Relocation Assistance, Education Bonuses, or Kentucky Works supportive services. A minimum amount of $1 is issued in cases with benefit reduction. 4. The $16 minimum SNAP benefit level for one and two-member households applies only to the allotment prior to reduction. Actual benefits for any size household may be zero if benefit reduction occurs. E. Tax Intercept. CMS obtains payment through intercept of State and Federal tax refunds, lottery offsets, stimulus payments, and other options. F. Expunged Benefits. Expunged benefits are applied to claims. This payment method is an automated function by IEES, and no action is required by staff. If an individual has multiple claims, the expunged benefits are applied to the oldest claim first. G. [Restorations. Claims can be offset using up to all of a restoration, as needed, for repayment. When a case is owed a restoration, IEES will match prior to issuing the restoration. When a claim(s) exists, update IEES case comments about the payment being applied to the claim(s). IEES will apply the appropriate amount of the restoration towards the amount owed in the claim(s). Any remaining amount of the restoration owed to the individual is issued to the individual by IEES.]

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MS 1000 (1) Volume 1 – General Administration MS 1000 – R. 7/1/21 – OMTL-580 Categories of Supplemental Nutrition Assistance Program (SNAP) Claims [A claim occurs when a household receives benefits to which it is not eligible or traffics SNAP benefits. Refer to MS 1020 for information on trafficking. There are three main categories of claims for SNAP and one temporary category. A. Agency Error (AE) – occurs when the claim is caused by a worker’s action or failure to take action, which includes: 1. Failure to take prompt action on a client-reported change; 2. Incorrectly computing income and deductions; 3. Failure to take prompt action on a change known to the agency. 4. Incorrect benefit issuance related to system defects or errors. B. Inadvertent Household Error (IHE) – occurs when the claim is caused by a misunderstanding or an unintended error by the client. 1. This includes claims caused by: a. Failure to provide correct or complete information; b. Failure to report a change in circumstances timely; c. Receipt of benefits pending the outcome of a hearing that upholds the agency; d. The agency’s inability to prove fraud in a hearing or court proceeding. e. Suspected Intentional Violation Claims (SIPV) claims in which the head of household is deceased and there are other adult members in the home. 2. If the agency has sufficient evidence to pursue an Intentional Program Violation (IPV) but the application(s) for the claim period cannot be located, pursue the claim as an IHE. C. Intentional Program Violation (IPV) – occurs when it is established by an individual signing form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing, a hearing officer’s order is issued granting the IPV, an individual signing form FS-111, Deferred Adjudication Disqualification Consent Agreement, or prosecution through court. 1. This includes claims caused by: a. Deliberately made a false or misleading statement. b. Deliberately misrepresented, concealed, or withheld facts.

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MS 1005

(1)

Volume 1 – General Administration MS 1005 – R. 8/1/26 – OMTL-703 No Claim Determination

A. [A claim cannot be established when it is unclear if the individual completed an application or if an interview was conducted and there is no associated signed application.

The exceptions are:

1. Applications initiated by the individual on the Self-Service Portal (SSP); or

2. Instances of electronic benefit transfer (EBT) card trafficking or misuse. An individual who is alleged to have trafficked or misused benefits must have had their own historical Supplemental Nutrition Assistance Program (SNAP) and been informed of the program rules to be held accountable.

Example: An interview is completed by the Regional Claims Worker (RCW) and the individual states they had not been contacted or been in the office to complete an interview. The RCW’s investigation additionally finds no signed application on file. Since there is no clear evidence that the individual made an application, there would be no claim. However, the SNAP case should be discontinued.

Example: An individual applied for SNAP using SSP. The agency approved the application without conducting an interview. Since an application was initiated on the SSP, a claim can be pursued.

Example: An individual purchased SNAP benefits from a household with active benefits. The individual who purchased SNAP benefits has never had a SNAP case of their own and never been informed of the program rules. Since there is no clear evidence the individual who purchased SNAP benefits was aware of the program rules, a claim cannot be pursued.

Example: An individual sold their SNAP benefits to someone outside of their SNAP household. During the recertification, the agency failed to capture a signature on the KIF-101, Application for SNAP Benefits. Since the household has a historical record of completed signed applications, the agency can validate that the individual was made aware of the program rules and a claim can be pursued.]

B. If the claim referral has been completed and a determination of “No Claim” is made, document the case comments regarding the basis of the determination.

C. MS 1010, Procedures for Specific Households, should be referenced regarding procedures associated to lost or unsigned applications and electronic signature applications.

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MS 1010 (2)

Review for a potential claim if a household contains an ineligible member and they fail to report a change that would make the ineligible member's status change to eligible, causing their income and resources to count towards eligibility. This includes member statuses such as an ineligible student, a member having a work-related disqualification, a fleeing felon, a probation or parole violator, and ineligible immigrants.

G. Disqualified Members

Review for a potential claim if a household containing a disqualified member fails to report a change in income or resources. Disqualified members are those disqualified for an Intentional Program Violation (IPV), a work penalty, enumeration, child support delinquency, or for failure to meet citizenship requirements.

H. Fleeing Felons

Review for a potential claim if a household member has an outstanding felony warrant and received benefits while the warrant was in effect.

I. Simplified Reporting (SR)

1. SR policy was implemented effective February 1, 2002, and includes all cases with earned income, including self-employment.

2. SR policy was expanded effective March 1, 2003, to include all cases except households in which all members are elderly or disabled with NO earned income.

3. SR policy was expanded effective April 1, 2009, to all households.

J. Dual Participation (SNAP)

An overpayment can occur when an individual gives false or misleading information about their identity and/or place of residency in order to receive benefits in multiple states simultaneously. A claim pursued for dual participation requires contacting the other state(s) and obtaining verification that the benefits were issued for the same time period as in Kentucky, and the issued benefits from each state were accessed and used. It is not dual participation if benefits are only accessed in one state.

[Example 1: An individual applies in Kentucky and states they are not receiving benefits in any other state. A report verifies the individual was receiving benefits in another state for the same time period. Verification was received confirming the individual accessed and used the benefits from the other state at the same time the individual was receiving and using benefits in Kentucky. This would be explored as a Dual Participation Claim and pursue the associated Intentional Program Violation (IPV) disqualification.

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(3)

Example 2: An individual applies in Kentucky and states they are not receiving benefits in any other state. A report verifies the individual was active in another state at the time she was approved for benefits in Kentucky; however, the issued benefits in the other state have not been used. Due to SR rules, there is no claim for benefits issued in the other state as an address change falls under SR guidelines. A claim is pursued for benefits issued in Kentucky as the individual is required at application to report receipt of benefits from another state. Verification of benefit issuance and closure of the other state’s case is required to determine the overpayment period. A Dual Participation claim would not be explored as the individual did not use the benefits issued from both states. This does not prevent the claim from being explored as an IPV.]

K. Missing/Unsigned Applications (SNAP)

A missing/unsigned SNAP application does not prevent a SNAP claim from being established.

Example 1: A claim referral is completed on an individual. The referral is split into two claims due to the household situation and each claim will be assigned a different claim number. Both claims are referred to the Office of Inspector General (OIG) for prosecution. The first claim case is prosecuted, but the second claim is returned to the local office for administrative action due to a missing recertification application. The Integrated Eligibility and Enrollment System (IEES) indicates the individual completed the recertification timely, information was updated on IEES, and OIG evidence supports an intentional program violation. However, without the application being located in the case record, there is not sufficient evidence to prove fraud in a hearing or court proceeding. In this instance, the second claim was returned for administrative action because an IPV cannot be pursued. The second claim would be established as an Inadvertent Household Error (IHE).

Example 2: An individual applied for and was approved for SNAP on August 1, 2012. The household exceeded the income limit in September 2012 and did not report it until the recertification interview in July 2013. The claim is referred as a Suspected Intentional Program Violation (SIPV). Upon review, the RCW cannot locate the signed application and without the application, there is insufficient evidence to support an IPV. The overpayment would be pursued as an IHE claim.

[Example 3: The recipient completed a recertification on June 1, 2012. The household exceeded the income limit in August 2012 and the individual reports the change untimely to the agency. The Agency was unable to locate a signed copy of the application from the June recertification. In this instance, the correct category would be an IHE.

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MS 1015 (1) Volume 1 – General Administration MS 1015 – R. 6/1/24 – OMTL-649 Drug and Alcohol Abuse Treatment Center Claims Drug and Alcohol Abuse (DAA) treatment centers are responsible for the misuse of Supplemental Nutrition Assistance Program (SNAP) and/or the misrepresentation of information on behalf of a center resident. Pursue a claim in either of these instances. The DAA facility is responsible for repayment of a claim established due to misuse of benefits or misrepresentation of information. These types of claims are established for SNAP over-issuances that occurred on or after January 1, 2010. Establish a claim in the name of the resident if an agency error occurs. The resident is responsible for repayment of the claim. If the resident has an active case on the Integrated Eligibility and Enrollment System (IEES), it will be subject to benefit reduction. A. Establish separate claims for each resident whose benefits are overpaid if the treatment center is the cause of the overpayment or the misuse. 1. DAA facility claims are established under provider/facility claim establishment. 2. The claim is established as an Inadvertent Household Error (IHE) on the Benefit Management module. 3. All DAA facility claims are in the name of the treatment center. The Benefit Management module will assign a 10-digit claim number when the claim is submitted. 4. If there are multiple claims against the treatment center, each claim will have a different claim number. 5. The resident of the DAA is not responsible for the repayment of the IHE claim; therefore, if the resident has an active SNAP case on IEES, he/she is not subject to benefit reduction. B. [The organization authorized by the Food and Nutrition Service (FNS) as a retail food store can be penalized or disqualified if it is determined administratively or judicially that benefits have been misappropriated or used for purchases that did not contribute to a certified participant's meals. The office promptly notifies the Nutrition Assistance Branch (NAB) by memorandum through the appropriate chain of command when it has reason to believe that an organization is misusing benefits. NAB notifies FNS upon receipt of the memorandum from the local office. NAB takes no action against the organization or institution prior to FNS action. See Volume 2 MS 2660 for more details regarding claims on DAA facilities.]

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MS 1020

(1) Volume 1 – General Administration MS 1020 – R. 8/1/26 – OMTL-703 Trafficking and Retail Fraud

A. Trafficking is the act of:

1. Buying, selling, stealing, or exchanging Supplemental Nutrition Assistance Program (SNAP) benefits, SNAP Electronic Benefit Transfer (EBT) cards, card numbers, Personal Identification Numbers (PIN), or manual vouchers for cash or consideration other than eligible food either directly, indirectly, in complicity or collusion with others, or acting alone;

2. Attempting to buy, sell, steal, or otherwise affect an exchange of SNAP benefits issued and accessed via EBT cards, card numbers, and PIN, 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;

3. [Exchanging an EBT card and/or card information or SNAP benefits for firearms, ammunition, explosives, or controlled substances. The Office of Inspector General (OIG) identifies and refers all cases involving firearms, ammunition, explosives, or controlled substances to the Kentucky State Police (KSP);]

4. Purchasing a product with SNAP 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;

5. Intentionally reselling or exchanging eligible food purchased with SNAP benefits for the purpose of obtaining cash and/or other considerations; or

6. Retailers knowingly purchasing products originally purchased with SNAP benefits in exchange for cash or considerations other than eligible food.

B. Trafficking hotline referrals are sent from OIG to the Integrity and Analysis Section (IAS). IAS will refer trafficking hotline referrals for individuals to Regional Claims Workers (RCW) for investigation. If EBT account transactions indicate trafficking or misuse of benefits, follow the trafficking procedures outlined in D of this section, or MS 1025 for EBT misuse. The claim is only entered on the Benefit Recovery module when one of the following requirements has been met:

1. The recipient signs and dates form FS-80A (TR), Voluntary Waiver of SNAP Administrative Disqualification Hearing (ADH); 2. An Intentional Program Violation (IPV) is granted by an ADH;

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(2)

3. A completed FS-111, Deferred Adjudication Disqualification Consent Agreement, signed by the recipient and the prosecuting attorney, is received; or

4. The claim has been adjudicated in court.

C. For allegations received and/or identified by field staff, a manual claim referral is created by accessing the benefit recovery through the Benefit Management tab on the Integrated Eligibility and Enrollment System (IEES).

D. [When allegations that an individual has trafficked SNAP benefits are received by the regional claims staff, use the following procedures:

1. Access the individual’s account on the EBT website and review transaction information for the period described in the allegation. Review transaction history for the following activity. Include only transactional data that would support a strong pattern of trafficking through clear and convincing evidence.

Review EBT transaction history for the following:

a. Whole dollar transactions. These indicate payments of credit accounts, cash transactions, or gas purchases.

b. Back-to-back transactions within a time period too short for the scanning of eligible items. This indicates ineligible sales or cash transactions.

c. Large purchases at a retailer that carries a limited or minimal amount of eligible food items. This indicates payments made on credit accounts or cash transactions.

d. Vendor location. Determine if the individual bypassed other EBT vendors in their area to make purchases at the vendor’s location identified by their EBT transactions. Utilize the SNAP Retailer Locator, which provides locations of retailers who accept SNAP benefits. Bypassing other vendors in their area indicates the individual has a unique reason for making transactions at that specific vendor. During the interview, question the individual regarding the reason.

Note: When retailer trafficking fraud is believed to be occurring by assisting the individual in committing fraud, the retailer should be submitted to IAS for the store to be investigated by the United States Department of Agriculture (USDA).

e. A large or questionable number of lost or stolen EBT cards and/or substantial requests for replacement EBT cards. This indicates the individual is selling the card, reporting it lost or stolen, and requesting a new EBT card and PIN to receive the next month’s benefits.

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MS 1020

(3)

f. Rapid benefit depletion. When an individual uses a large portion of their benefits in a short period of time upon receiving them. This indicates purchasing food items for another household or buying food items with the intent to sell for cash.

g. All day spending. When a pattern of purchases at the same store throughout the day is identified during the review of the EBT transactions. This indicates that the individual is allowing someone outside of their benefit group or not an authorized representative access to use the EBT card to make purchases.

h. An excessive number of invalid PIN entries or attempted purchases with insufficient funds. These indicate the individual is allowing someone outside of their benefit group or not an authorized representative access to use the EBT card to make purchases.

Example 1: During a claim interview, an individual acknowledges selling their EBT card with $200 of available SNAP benefits for $100 by providing their PIN to an individual outside of a local discount store. A review of the EBT transactions confirms the date and the amount of benefits on the card. The actions by both the individual selling their benefits and the individual purchasing the benefits are trafficking. The claim amount is $200.00 and an IPV is pursued against the recipient and other individual(s) who made the purchase, if identified. If the recipient signs and dates form FS-80A (TR) or an Intentional Program Violation (IPV) is established by an ADH, use disqualification code Trafficking - Administrative Finding.

Example 2: A fraud hotline report is received from OIG alleging that a recipient who has $400 of benefits on the card sold $100 of SNAP benefits for $50. It is the worker’s responsibility to confirm that the actual transactions support the allegations in the fraud hotline report. The worker should identify all transactions that support the allegation. A review of transactions on the EBT website confirms the date and amount of the reported transaction and supports the allegation that trafficking occurred. The amount of the claim is the amount of benefits trafficked as verified per transaction. During the interview to discuss the transactions, if the recipient admits to the violation that benefits were sold signs and dates form FS-80A (TR), or an IPV is established by an ADH, use disqualification code Trafficking - Administrative Finding.

Example 3: If items purchased through a store credit account are non- eligible items, the use of the EBT card or benefits on the card

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MS 1020

(4)

for payment of the credit account is pursued as trafficking. During a claims interview, a recipient admits to paying on a store credit account with an EBT card. A review of the EBT website account confirms numerous whole dollar ($15.00; $12.00; $18.00) transactions which indicate suspicious purchases. Trafficking is pursued and the retailer information needs to be reported to IAS to submit to Food and Nutrition Services (FNS).

Example 4: A hotline referral was received stating that a retailer purchased 20 cases of soda from a recipient who purchased the soda with SNAP benefits. Trafficking is pursued against the recipient and OIG is notified by the person who received the referral using procedures outlined in Item E of this section, of the retailer’s participation in the transaction.

2. If after reviewing the EBT transaction history and, using professional judgement, no suspicious activity is found or the identified activity does not indicate a strong pattern of trafficking, the RCW has the discretion not to pursue a trafficking referral. Annotate IEES with detailed comments as to the reason for the determination that no trafficking exists.]

3. If trafficking activity has been identified, take the following action:

a. Make copies of the EBT account showing the identified trafficking activities and/or excessive card history.

b. Include all supporting documentation, such as hotline reports or third- party reports, in the claim file.

c. Schedule a telephonic appointment with the recipient to discuss the trafficking activity identified. Schedule an appointment using the IEES scheduling system. If requested, an in-person appointment can be held in the local office of the county where the recipient resides. Discuss all documentation supporting the allegations with the recipient.

d. Thoroughly document the discussion with the recipient as the information obtained is the basis for action taken by the Department of Community Based Services (DCBS).

e. If the household later contacts the agency to cooperate, an interview should be conducted. When a claims specialist is not available onsite for a walk-in recipient, each local office will have a designated worker to interview recipients who come in to resolve a fraud or trafficking complaint.

4. If after a review of the documentation and/or discussion with the recipient (if

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MS 1020

(5)

an interview was conducted), it is determined that no dollar amount can be established, no claim exists, or there was a valid reason for the excessive card replacements, indicate the reason for the action in detailed IEES comments and scan the documentation into the electronic case file. 5. If after a review of the documentation and/or discussion with the recipient (if interview was conducted), trafficking or another program violation is pursued, provide the household with form FS-80 (TR) and form FS-80A (TR). If the recipient reviews the forms and signs and dates form FS-80A (TR), enter a Trafficking - Administrative Finding disqualification on IEES. 6. If form FS-80A (TR) is mailed and returned signed and dated, enter a Trafficking - Administrative Finding disqualification on IEES.

7. If form FS-80A (TR) is not returned, is returned unsigned, or is returned without a date, request an ADH. See MS 1070.

8. Claims pursued as trafficking are not established as Suspected Intentional Program Violation (SIPV) claims. The claim is only entered on the Benefit Recovery module when one of the following requirements has been met:

a. The recipient signs and dates form FS-80A (TR);

b. An IPV is granted by an ADH;

c. A completed FS-111 signed by the recipient and the prosecuting attorney is received; or

d. The claim has been adjudicated in court.

E. When an excessive card task is received by regional claims staff, use the following procedures:

1. When the first excessive card task is received, access the recipient’s account on the EBT website and review transaction information for the prior 12 months from the task received date for trafficking activity.

2. If after reviewing the EBT transaction history no trafficking activity is detected, annotate in IEES with detailed comments regarding the first excessive card task and the determination that no trafficking exists.

3. If trafficking activity is detected, follow the same procedures outlined in item D of this section. When conducting the appointment, regional claims staff should also discuss proper card security and use with these recipients.

4. For subsequent excessive card tasks received by regional claims staff, take the following action:

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MS 1020

(6)

a. Review EBT transaction history from where the prior excessive card task review ended to present for trafficking activity.

b. If trafficking activity is detected, follow the same procedures outlined in item D of this section. When conducting the appointment, regional claims staff should also discuss proper card security and use with these recipients.

c. If no trafficking activity is detected and the recipient was not contacted over the initial excessive card task, an appointment is required to be scheduled to discuss the reason behind the excessive number of cards that have been issued and to counsel the recipient on proper card security and use.

i. During the appointment, question the recipient to determine if the number of replacement card requests is reasonable. Counsel the recipient on proper card security and use. Enter detailed comments about what was discussed. If the recipient continues to receive subsequent excessive card tasks, a new appointment is not required unless review of EBT transaction history shows additional patterns of trafficking. Comments should be entered to detail the findings of the review.

ii. If regional claims staff are not able to reach the recipient for the scheduled appointment, annotate in IEES that the interview was attempted. With subsequent excessive card tasks, regional claims staff must continue to schedule an appointment with the recipient until contact is made to discuss why so many cards have been requested and proper card security and use. Once the recipient is reached and provides a reasonable explanation, if they continue to receive subsequent excessive card tasks, a new appointment is not required unless review of EBT transaction history reveals a pattern that is indicative of trafficking. Review findings for each excessive card task should be annotated in IEES.

F. [FNA investigates, prosecutes, and disqualifies a retailer when fraud is substantiated.

1. FNA notifies IAS that a retailer is disqualified and provides a listing of SNAP benefit recipients who had transactions meeting trafficking criteria at that store during the investigated period.]

2. IAS forwards the information of the SNAP recipients involving high dollar amounts to OIG, which makes a determination whether to pursue prosecution.

3. A list of recipients not pursued by OIG for prosecution is forwarded back to

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MS 1025

(1) Volume 1 – General Administration MS 1025 – R. 8/1/26 – OMTL-703 Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer (EBT) Misuse

A. EBT misuse is defined as:

1. [Using SNAP benefits in any way other than to purchase food for eligible household members.

2. If the benefits were used incorrectly, but not in a way that meets the definition of trafficking in MS 1020, consider the violation to be misuse. The most common example of misuse is maintaining a credit account with a retailer for the purchase of eligible food but redeeming SNAP benefits on a date other than when the food was received to repay the credit account.

B. When an allegation that a recipient has misused SNAP benefits is received or misuse is detected during casework, the Regional Claims Worker (RCW) should not place a pending claim on the Integrated Eligibility and Enrollment System (IEES) Benefit Recovery module for investigation. Instead, the investigation should be annotated in case comments regarding the issue at hand and that field staff are not to discuss the investigation with the recipient. The RCW should follow all other trafficking procedures outlined in MS 1020 when investigating misuse.

C. A claim amount is not required to pursue EBT misuse.

D. Schedule an appointment and pursue an Intentional Program Violation (IPV) disqualification, unless it is determined during the investigation that misuse is no longer suspected.

E. If an Administrative Disqualification Hearing (ADH) is necessary, the hearing type will be ADH - Misuse.]

Example 1: The payment with an EBT card on a credit account in which only eligible food items were purchased is not considered trafficking but is against program rules. SNAP benefits must be debited at the time the food is received.

[Example 2: Allowing someone who is not authorized to use the EBT card and personal identification number (PIN) access to the EBT card and PIN to make purchases. Only members of the approved SNAP household or a designated Authorized Representative (AR) who has been appropriately added to the case may use the EBT card on behalf of the household.

Note: If the only adult household member becomes incarcerated or

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MS 1030 (1) Volume 1 – General Administration MS 1030 – R. 7/1/21 – OMTL-580 How to Calculate a Supplemental Nutrition Assistance Program (SNAP) Claim For each month that a household is suspected of receiving an overpayment, determine the correct amount of SNAP benefits, if any, the household was entitled to receive. Use the policy in effect at the time the claim occurred. When calculating a SNAP claim, the worker is only required to verify and use new information that was not considered when the benefits were authorized. The worker is not required to re-verify all factors pertaining to the household. Exception: All errors found during any SNAP case review, including Management Evaluation (ME) and Quality Control (QC) reviews, must be corrected to ensure that the basis of issuance is correct based on the review findings. All claims are calculated on the Benefit Recovery module. A. Date of Discovery: 1. Agency Error (AE) claims cannot be calculated for more than 12 months prior to the date of discovery. If the claim also extended into the discovery month or subsequent months, these months are included in the claim period. Example: It is discovered in February 2005 that a household received excess benefits for the period January 2004 through March 2005. A change was completed to correct benefits effective April 2005. The claims months are February 2004 through January 2005 (12 prior months), with the discovery month of February. January 2004 is not a claim month since it is more than 12 months prior to the discovery date. 2. Inadvertent Household Errors (IHE) with a Suspected Intentional Program Violation (SIPV), Inadvertent Household Errors (IHE), and Intentional Program Violation (IPV) cannot be calculated for more than six years prior to the discovery date. If an SIPV claim is not determined to be fraud by admission, hearing, or prosecution, it must be recalculated as an IHE or AE claim. B. Household Composition When establishing a claim containing household members that are not active during the entire time frame of the claim, establish separate claims containing the appropriate active household members. Example 1: A claim contains three adult household members for the period of January through June. The head of household (HOH) is an active member for the entire six months of the certification period. The second adult household member was only an active member of the case from March to April. The third adult household member was only an active member of the case from May to June. Three

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MS 1030 (2) separate claims are established. The first claim would contain the HOH and would be established for the months of January and February. The second claim would contain the HOH and second household members for the months March and April. The third claim would contain the HOH and the third household member for the months of May and June. Example 2: A claim contains three adult household members and one child for the period of July to December. The HOH was active six months of the certification period. The child and second adult household member were active from September to October. The third household member was active from November to December. Three separate claims are established. The first claim would contain the HOH for the months of July and August. The second claim would contain the HOH, the second household member and the child for the months of September and October. The third claim would contain the HOH, the second household member, the child, and the third household member for the months of November and December. C. Utility Allowance: Households entitled to use the Standard Utility Allowance (SUA) or Basic Utility Allowance (BUA) were required to use the appropriate standard effective June 2003. Beginning June 2003, actual utility expenses are used only if the household was not entitled to the SUA or BUA. Prior to June 2003, the household had the option of using a standard deduction or actual expenses. D. Earned Income: When calculating an IPV or IHE claim involving unreported earnings, do not apply the 20 percent earned income deduction to the part of the earnings the household did not report timely, when this is the reason for the claim. E. Cash Assistance and Other Related Program Payments: All cash assistance payments received should be considered in the SNAP claim calculations if the cash assistance payment is not the basis of the claim. Example: An individual applies for SNAP and Kentucky Transitional Assistance Program (KTAP) benefits for herself and two children. The individual reports wages from employment as well as income from self- employment. The agency failed to enter self-employment income, and SNAP and KTAP benefits are approved considering wages only for the household’s income. A KTAP claim is established for the overpayment of KTAP benefits issued to the household due to incorrectly considered income. The full KTAP payment(s) will be considered in the SNAP claim calculations, though a claim has been established to recoup the incorrectly issued payment(s). F. Reported Information/Changes:

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MS 1030 (3) For reported information/changes not considered in the original benefit, use the reported income received for the appropriate household member’s reported expenses (except for utility), household size, and any other household circumstances not considered. 1. Reported income at application or recertifications does not have to be re verified. Use the converted income that was used in the original allotment. 2. When calculating the claim, use all other household circumstances that were correctly considered. Include the actual income that was omitted in error. 3. If wages were known and not acted on, allow the actual dependent care expenses as a deduction. Budget the reported wages that were not acted on by using the anticipated converted income that should have been used in the original allotment. 4. [Reported, but unverified reported wages. If income were reported to the agency and verification was not provided, the worker should first attempt to obtain the missing income verification. If the verification is not returned, the worker may then use wage match data to calculate the claim. When using wage match data, use the gross quarterly income, divide by three months, and round to the nearest dollar to obtain the average monthly amount. If the employment was less than three months, average the gross amount over the period of time between the beginning and end dates of employment. This date may be determined by contact with the employer or client. Example: An individual reports at the SNAP recertification that they began new employment four months prior to the recertification date. The case was pended for verification of employment to confirm the start date and to ensure the household did not exceed gross income limits. No verification was returned to the agency, and the case discontinued for failure to provide mandatory verification. A claim referral was later submitted for failure to report this income. When investigating, the worker would first attempt to obtain missing income verification before using wage match data.] 5. Consider any countable income from ineligible and disqualified members. Refer to MS 1010. 6. For prorated or annualized income, count the prorated or annualized amount for each month of the claim, even in months when the income was not received (Example: countable student income). 7. Consider any countable unearned income. 8. Consider any deductions that were reported but not acted upon.

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MS 1030 (4) 9. Consider any deductions that were considered in the case during the claim period. G. Unreported Changes/Information: For unreported information/changes that were not considered in the original benefit, use the actual income for the appropriate household member(s) that was not reported, actual household size, and any other household circumstances that were required to be reported. 1. Consider actual income. Do not average and convert any income that was not reported. 2. Reported income does not have to be re-verified. Use the anticipated converted income that was used in the original budget. 3. When calculating the claim, use all other household circumstances that were correctly considered. 4. Do not allow the earned income deduction for that portion of the earned income not reported. If the household reports part but not all of the earned income, allow the deduction on the part that was reported. 5. [Verify wages. If wages are discovered but verification has not been provided, the worker should first attempt to obtain the missing income verification. If the verification is not returned, the worker may then use wage match data to calculate the claim. When using wage match data, use the gross quarterly income, divided by three months, and round to the nearest dollar to obtain the average amount per month. If the employment was less than three months, average the gross amount over the period of time between the beginning and end dates of employment. This date may be determined by contact with the employer or individual.] 6. Consider any countable income from ineligible and disqualified members. 7. For prorated or annualized income, count the prorated or annualized amount for each month of the claim, even in months when the income was not actually received. Example: Countable student income. 8. Consider any countable unearned income. 9. Consider changes in deductions if required to be reported. Otherwise, consider deductions that were used in the case for the claim period. 10. Do not consider expenses on unreported self-employment/farm income. 11. Do not consider unreported deductions. 12. Consider any deductions that were considered in the case during the claim period.

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MS 1040 (1) Volume 1 – General Administration MS 1040 – R. 7/1/21 – OMTL-580 Joint Non-Fraud and Fraud Claims [A joint claim occurs when there is more than one category of claim for the overpaid period. When a claim occurs due to an Intentional Program Violation (IPV) and an Agency Error (AE) or Inadvertent Household Error (IHE), calculate on the Integrated Eligibility and Enrollment System (IEES) each type of claim as outlined below. Enter claim comments in the Benefit Management Module explaining how the claims are computed. A. Compute the AE or IHE claim prior to completing the IPV claim. 1. Enter the actual amount of benefits the household received during each month in question. To determine the amount the household actually received, do the following: a. Access the Benefit Issuance screen from the IEES Benefit Management tab; b. Search the associated case and benefit period as indicated for the overpaid benefits. c. Any overpayment which occurred more than 12 months (one year) prior to the discovery of the overpayment is not included in an AE claim. An overpayment which occurred more than 72 months (six years) is not included in an IHE claim.] 2. Enter the issuance case data, correcting the AE or IHE claim factor but excluding the IPV factor. 3. The amount of the AE or IHE claim is the difference between the two allotment totals. 4. Establish the claim(s) as active to start recoupment. B. IPV claim. 1. [Use the data from the associated AE and/or IHE claims and include the IPV change. 2. Subtract the corrected benefit amount, which includes all known changes, from the benefits from the associated AE and/or IHE claims. The difference is the IPV claim amount. 3. Take action as appropriate for IPV claims independently from the AE or IHE portion of the claim.] Example: An IPV claim is identified due to an individual’s deliberate failure to report Retirement Survivors Disability Insurance (RSDI) income. Upon further review, it is discovered that the individual was given a

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MS 1050 (1) Volume 1 – General Administration MS 1050 – R. 7/1/21 – OMTL-580 How to Process an Intentional Program Violation Claim [If a potential Supplemental Nutrition Assistance Program (SNAP) benefits claim occurs in an active or inactive case, enter the claim on Integrated Eligibility & Enrollment System (IEES). A suspected fraud claim is calculated and established as a Suspected Intentional Program Violation (SIPV). The IEES SIPV category code can be calculated for up to six years from the discovery date. A claim is not categorized as an Intentional Program Violation (IPV) until fraud is established by:] • The individual signing and dating form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing (ADH); • A final order issued by the Office of Administrative Hearings (OAH) states IPV occurred; • The individual signing and dating form FS-111, Deferred Adjudication Disqualification Consent Agreement; or • A court finding of guilt. A. Refer the following situations to the Office of Inspector General (OIG) for further investigation. See MS 0910. 1. [The claim amount is estimated to be $3,000 or more for reasons other than income; 2. Is estimated to be $10,000 or more due to unreported wages only; or 3. There is a companion Medicaid case with at least one month of expected ineligibility.] B. For claims that do not include at least one month of Medicaid ineligibility and do not meet the criteria above: 1. Send form FS-80, Notice of SNAP Suspected Intentional Program Violation, to the household within 10 days of establishing the claim. 2. Include form FS-80A with form FS-80 when mailing to a household in which the person suspected of fraud does not have a mental disability. The option to waive a disqualification hearing is not offered to a person with a mental disability. 3. Allow 10 days for return of the FS-80A. a. If the household does not return form FS-80A, refer for an Administrative Disqualification Hearing (ADH). See MS 1070. b. If form FS-80A is returned and the individual waives the ADH by signing and dating the form:

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MS 1050 (2) [IEES is accessed, the date the form is signed by the individual is entered on the claim adjustment screen, and the claim category is changed from SIPV to IPV. If the case is inactive, email the Claims Management Section (CMS). c. The worker enters the appropriate disqualification for the member on IEES for active and inactive cases using the following steps from the IEES “Manage IPV (eDRS)” on the individual screen: 1) Select Program SNAP; 2) Select YES under Sources (this is the only option); 3) Select the IPV occurrence; 4) Enter the decision date (the date the FS-80A was signed); 5) Enter the verification date (the date the FS-80A was received by the agency); 6) Enter the start date; and 7) Enter the end date If the SNAP benefits case is active, you must enter the case and rerun eligibility to impose the IPV disqualification. If there are no active cases, you must go to the individual summary screen and select “Manage IPVs”. Once the recipient serves their disqualification period, eligibility will have to be run before the recipient is added back to the SNAP EDG.] C. Per federal regulation, no further administrative appeal procedure exists after an individual waives his/her right to an ADH and a disqualification penalty is imposed. The disqualification penalty cannot be changed by a subsequent fair hearing decision. The individual is entitled to seek relief in a court having appropriate jurisdiction. D. When OIG advises they will not pursue prosecution in a case, but fraud is still suspected, follow procedures in B. If fraud is ruled out, change the category of the claim to IHE or AE and recalculate the claim amount. E. If the final order from the Office of Administrative Hearings (OAH) establishes an IPV, disqualify the member on IEES. If the final order does not establish IPV, change the category of claim to IHE or AE per the findings of the hearing officer. Recalculate an AE claim for 12 months (one year) from the discovery date and an IHE claim for 72 months (six years) from the discovery date.

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MS 1060 (1) Volume 1 – General Administration MS 1060 – R. 7/1/21 – OMTL-580 Criteria for Pursuing an Intentional Program Violation Claim The burden of proof to establish an Intentional Program Violation (IPV) is on the agency. Evidence used to demonstrate this must support the accusation of IPV and prove intent to commit food benefits fraud. An IPV may also be pursued due to an out-of-state match via the Electronic Disqualified Recipient System (eDRS). A. Evidence may include, but is not limited to: 1. A signed Supplemental Nutrition Assistance Program (SNAP) benefits application used to determine eligibility for the claim period. A lost, unsigned, or otherwise unavailable application does not prevent establishing a claim; 2. Computer printouts; 3. Income and Eligibility Verification System (IEVS) records; 4. Form PAFS-700 or CL-700, Verification of Employment and Wages; 5. Form PAFS-76 or CL-76, Information Request; 6. Form PAFS-702 or CL-702, Proof of No Income; 7. [Prior IPV documentation; and 8. Integrated Eligibility & Enrollment System (IEES) notices to the recipient. Example 1: The individual applied for SNAP on January 1, 2021, for a household of one. The individual reported no source of income for self, which was verified by use of a PAFS-702. The SNAP application was approved on January 16, 2021. On April 1, 2021, the agency obtained verification confirming that the individual went to work on October 1, 2020, and was actively working at the time of the January 1, 2021, application. During the claims interview, the individual admitted that the income was not reported so that more benefits could be obtained as the individual was struggling to pay bills. The evidence would include the application, PAFS-702, IEES comment entries from the SNAP application interview, SNAP approval notice, wage records confirming employment, claim interview comments, and any other documentation supporting the claim establishment and IPV disqualification penalty. Example 2: The individual applied for SNAP on January 1, 2021,

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MS 1070

(1)

Volume 1 – General Administration MS 1070 – R. 7/1/25 – OMTL-674 Administrative Disqualification Hearings

[An Administrative Disqualification Hearing (ADH) is conducted by the Office of Administrative Hearings (OAH) to determine if an Intentional Program Violation (IPV) has occurred. The format of the hearing is similar to that of a fair hearing, except the burden of proof is on the agency.]

A. Refer a case for a disqualification hearing via form FS-79, Request for an Administrative Disqualification Hearing, by submitting a hearing request from the claim adjustment screen, within three calendar days if there is sufficient evidence to substantiate a claim of IPV and one or more of the following situations apply:

1. The claim does not meet the criteria for referral to the Office of Inspector General (OIG);

2. The facts of the case do not warrant civil or criminal prosecution, and OIG closes its case; or

3. Form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing (ADH), is not received signed within 10 calendar days of being sent to the household.

B. [Review Integrated Eligibility & Enrollment System (IEES) for previous disqualifications before completing the FS-80A. Make OAH aware of the prior IPV that was established by indicating on the FS-80A whether it is a first, second, or third offense. If the individual commits an IPV after July 1, 2013, the waiver can be offered to establish an IPV for each program violation.]

C. Access the “Claim Adjustment” screen on your navigation panel through Benefit Management and click “Request ADH” to start the administrative hearing process. For trafficking-related ADH requests, start the hearing request process via the “Hearings” tab, as a claim will not already be established.

D. Complete form FS-79 and attach it with all the evidence that will be presented at the hearing in the Hearings module under the appropriate hearing ID “Exhibits – Agency”.

E. Only evidence listed on form FS-79 can be introduced at the hearing. If information is not listed on form FS-79 or evidence is missing, submit a “Withdraw Request” via the Hearings module before the hearing is scheduled and resubmit a new form FS-79 with the correct information and all necessary evidence following the process outlined in C above. All evidence must be labeled as Exhibit 1, 2, 3 or Exhibit A, B, C, etc. prior to uploading to the Hearings Module and mailing to the individual. Complete the FS-79 using the following guidelines:

1. Provide a detailed explanation of the charges, attaching additional sheets if necessary.

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MS 1070

(3)

4. Electronic Signature application(s) and dates are verified by IEES inquiry. However, in pursuing the IPV claim, provide the hard copy application to show that the electronic signature was used to process the SNAP application for the period of the claim.

5. Voice-Recorded Signature applications and dates are verified through IEES. However, in pursuing the IPV claim, you must present the original Voice Signature Application, the completed Voice Signature Application Instruction Letter that was scanned into the Electronic Case File (ECF) for the SNAP case (if available), and IEES comment entries showing who completed the interview for the associated application.

6. Any prior disqualification verification, i.e., FS-80A, FS-111, court documentation, prior hearing affirmation, or out-of-state disqualification verification, must be included in an evidence packet and be presented during the ADH.

7. [When a hearing is requested on IEES, tasks are systematically created for the requested hearings based on SNAP, Medicaid, Kentucky Transitional Assistance Program (KTAP), and Child Care Assistance Program (CCAP) eligibility, and Claims. A task will be sent to OAH along with any documentation associated with the hearing request. The type of hearing requested will determine the task that is created by OAH and the type of notice sent back to each region. The regions have assigned a designated Hearings Public Assistance Program Specialist (PAPS) who will be a part of the queue to receive tasks concerning the notices for the different types of hearings. The Hearing PAPS will log the hearing notices and assign a task to the appropriate supervisor/worker for that region. They will monitor the hearing process and track results.]

8. Once an ADH has been requested through IEES, corrections cannot be made to the hearing request on IEES; instead, “Withdraw Request” will need to be completed, and a new hearing request completed if corrections are required prior to the scheduling of the hearing.

9. Individuals who are not on IEES or have never had a case on KAMES, i.e., “caseless individuals”, must first be assigned an Individual number prior to requesting a hearing. The individual number is created by clicking on the Individual tab at the top of the navigation page through IEES. Enter the required information on the individual. Once all information is entered, the system navigation will take you to the Individual Summary screen. Now that the individual is known to IEES, the worker may create a manual claim against the individual and request a hearing through Benefit Management or the Hearings Module, whichever is appropriate.

F. [OAH schedules the hearing and provides written notice to the household at least 30 days in advance of the hearing date. The notice advising of the date and time of the hearing is sent to the household and a task is generated for the Hearings PAPS to review.

1. Hearings held telephonically – an agency representative must be present at

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MS 1070

(4)

each hearing. In the instance that the assigned claims worker is unable to attend the hearing, the agency cannot ask OAH to reschedule. Instead, another claims worker will be assigned to attend the hearing. Additionally, if another worker or individual gathered information for the claim/investigation, include that individual as a witness. Attendance by a Department for Community Based Services (DCBS) worker is mandatory under these circumstances so that the evidence is not considered “hearsay”.]

Example: A Protection and Permanency (P&P) worker reported to the local office that the individual lost custody of their children a year ago and they are all residing in foster care. The case was referred to claims for an investigation. The claims worker contacted the P&P worker and obtained written records to confirm the allegation and was the basis for claim establishment based on the household size not being reported accurately. The evidence should include verification obtained from P&P. The P&P worker must be requested to attend as an agency witness to the telephonic hearing to testify to the validity of the investigation and findings.

2. [Hearings held face-to-face - an agency representative must be present at each hearing. In the instance that the assigned claims worker is unable to attend the hearing, the agency cannot ask OAH to reschedule. Instead, another claims worker will be assigned to attend the hearing. Prepare a copy of the evidence for the individual to receive at the scheduled face-to- face hearing. Additionally, if another worker or individual gathered information for the claim/investigation, include that individual as a witness. Attendance by a DCBS worker is mandatory under these circumstances so that the evidence is not considered “hearsay”.]

Example: The Office of Inspector General (OIG) conducted an investigation that substantiated an allegation that the recipient was not accurately reporting their household size and income. OIG was able to obtain multiple collateral contacts through the course of the investigation, along with other verification sources to support the allegation. The evidence should include the OIG Investigation received in full. The OIG Investigator must be requested to attend as an agency witness to the face-to-face hearing to testify to the validity of the investigation and findings.

G. A requested hearing may be withdrawn by utilizing the “Postponement/Withdrawal Request” button on the Hearings Summary page in the Hearings when:

1. Information becomes available that indicates IPV did not occur. Contact the individual when this occurs.

2. The individual signs form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing.

3. It is later discovered that information or evidence pertaining to the claim

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MS 1070 (5) and its establishment is missing. Re-submit a new form FS-79 with the correct information and all the necessary evidence following the process outlined in C above prior to the scheduling of the hearing. H. The preparation for and conduct of an administrative disqualification hearing is the same as a fair hearing. Refer to MS 0450 B for more information. I. [After the hearing is conducted, OAH issues a hearing officer’s order, which is sent for review to all participants at the hearing. Follow policy in MS 0510 C when filing an exception to a hearing officer’s order.] J. The Cabinet Secretary/Secretary’s Designee issues the final order, and copies are mailed to the individual and uploaded to the Hearings module, creating a task for the Hearings PAPS for review. 1. If the final order determines an IPV occurred, enter the IPV disqualification on IEES and update the claim category within three calendar days of receiving the order. 2. If the case is active, change the category to IPV on IEES. If inactive, contact the Claims Management Section (CMS) to change the category, including the individual's name and claim number in the subject line. 3. If the final order determines an IPV did not occur and an SIPV claim has been established, recalculate the claim amount as appropriate and make system entry changes on IEES to show the correct claim category, IHE or AE. If the case is not active, contact CMS to change the category or terminate the claim if the claim period is more than 12 months (one year) prior to the discovery date for AE claims or 72 months (six years) prior to the discovery date for IHE claims. 4. The claims worker updates IEES to reflect the dates that forms FS-80 and FS-80A are sent and when the ADH hearing has been requested, scheduled, affirmed, or reversed. K. If the individual is dissatisfied with the final order, a petition can be filed in the Circuit Court of the county where the member resides within 30 days of receipt of the final order. Although a court appeal may be filed, the disqualification is imposed on IEES; however, it may be subject to change by the decision of the Court.

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MS 1100 (1) Volume 1 – General Administration MS 1100 – R. 3/1/22 – OMTL-592 Regional Claims Staff Procedures for Acting on Administrative Disqualification Hearing Final Order When a final order is received and: A. [The final order states that the member did not commit an Intentional Program Violation (IPV), take action on the case as directed by the final order within three calendar days. B. The member is found guilty of an IPV. Refer to MS 1110 if a claim has been established. The disqualification is entered within three calendar days of the notification. C. The hearing was dismissed: 1. Update the Comments screen on the Integrated Eligibility and Enrollment System (IEES) to show the Administrative Disqualification Hearing (ADH) was dismissed, making sure to annotate the reason for dismissal. 2. Scan the final order and the recommended order into the Electronic Case File (ECF) under the Hearings tab under the associated claim number upon receipt. Any hard copy documents in local office storage will need to be scanned to ECF for cases that were prior to ECF. 3. Due to a lack of service, also annotated as “Unclaimed” or “Undeliverable”, if/when a new address becomes known to the Agency, a new FS-80, Notice of SNAP Suspected Intentional Program Violation, and FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing, will need to be generated and mailed to the recipient. Allow 10 calendar days for the return of the FS-80A before requesting an ADH. If the FS-80A is not returned, is returned unsigned, or is returned without a date, request a new ADH within three calendar days. a. Request a new ADH by accessing the claim adjustment screen on the left navigation panel and click the blue “Request Administrative Disqualification Hearing” button under the associated claim number to start ADH request process. b. Upload a new FS-79, Request for an Administrative Disqualification Hearing, and all associated evidence, along with a copy of the previous hearing decision/final order, into the newly associated Hearing ID. c. The agency must have the evidence submitted as an attachment to the associated hearing on the Hearings module and mailed to the individual at least eight days prior to the scheduled telephonic hearing. Prior to attaching the evidence to the hearing and mailing to the individual, all evidence must be labeled as Exhibit 1, 2, 3 or A, B, C, etc. Provide a summary of the evidence on the FS-79.

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MS 1110

(1)

Volume 1 – General Administration MS 1110 – R. 10/1/24 – OMTL-658 Intentional Program Violation Disqualification Penalties

A disqualification is entered on the Integrated Eligibility & Enrollment System (IEES) within three calendar days of notification that an individual has committed an Intentional Program Violation (IPV).

A. Notification of an IPV is:

1. a signed form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing;

2. an FS-111, Disqualification Consent Agreement;

3. a final order from an administrative disqualification hearing (ADH); or

4. a court decision or agreement that finds the individual guilty.

B. When it has been determined that an individual has committed an IPV, the individual is disqualified on IEES even if the individual is not currently participating in or has never received, Supplemental Nutrition Assistance Program (SNAP) benefits.

C. When entering an IPV on IEES, take action within three calendar days and follow the below logic as it pertains to your case.

Example 1: A Recommended Order is received with a date stamp of June 7, 2022. The order becomes the Final Order at close of business (COB) on the 15th day if no exceptions are filed. This order becomes Final at COB June 22, 2022, with the first day to act falling on June 23, 2022. Timely action will need to be taken on June 23, 2022, or June 24, 2022, as June 25, 2022 (third calendar day) falls on a weekend and would be lost as an action day.

Example 2: Form FS-80A is returned signed and dated by the individual on May 6, 2022. While the form can be acted on and appropriate action taken the day it is received, the three-calendar-day rule is still applied from the date the form is received for timeliness standards. Timely action will need to be taken by COB May 9, 2022, with May 7, 2022, and May 8, 2022, lost as they fall on a weekend.

D. An individual committing an IPV indicated below is disqualified for the period shown. Multiple disqualifications may be imposed concurrently and not consecutively. Disqualification periods can overlap one another depending on the decision date entered. The disqualification is entered on IEES.

1. Trafficking SNAP benefits of $500 or more on or after August 22, 1996. Disqualification can only be imposed based on a Federal, State, or local court order.

Disqualification: Permanent for the first offense.

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MS 1110 (3) Offense: Application fraud/non-report of changes on IEES. Example: A recipient applies (or recertifies) for SNAP benefits and reports no income. It is later discovered the individual was employed and was receiving wages at the time of the application interview. 7. Commits an IPV and another IPV listed above does not apply to the offense committed. Disqualification: a. 12 months for first offense. b. 24 months for the second offense. c. Permanently for the third offense, or d. The length of the penalty assigned by the court. Offense: Application Fraud/non-report of changes on IEES. E. The amount of time served while disqualified is determined by the offense and whether it is the first, second, or third occurrence. Disqualification occurrences are counted cumulatively for all offenses. Example: A person commits an IPV, then a trafficking offense. The trafficking disqualification is added to the IEES as a second occurrence, not a first. F. For permanent disqualifications check the box titled “Permanent Disqualification” located under “Occurrence” on the IPV details screen. This will automatically upload “99” in the number of months field. “99” in this instance is not the number of months disqualified, “99” is what is accepted on the Electronic Disqualified Recipient Subsystem (eDRS) for the permanent disqualification. G. When an IPV disqualification is entered on IEES, the disqualification “Valid From" date starts the first month action can be taken to change SNAP eligibility. For disqualifications that are the result of a court order, use the circuit/district court entered stamp date as the disqualification decision date. For disqualifications that result from form FS-80A, the disqualification decision date is the date the individual signed and dated form FS-80A. Enter the date the Agency received the form as the verification date. 1. If the "Decision Date" is on or before SNAP cut-off, the "Start Date" is the first day of the following month. 2. If the "Decision Date" is after SNAP cut-off, the "Start Date" is the first day of the month after the month following the disqualification decision month. H. The “End Date” is entered based on the number of months the recipient is disqualified.

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MS 1110 (4)

1. Individuals who are permanently disqualified have the "From Date" set as described in Item C above. The "Through Date" is left blank.

2. The disqualification period is automatically uploaded after all the required disqualification information is entered.

I. If a notice of IPV determination is received while the case is pending, enter the IPV disqualification on the system.

1. IEES sets the disqualification period based on the information entered.

2. After IEES uploads the disqualification dates, return to the pending application and rerun eligibility.

3. If the disqualification period includes the pending eligibility period, the disqualification is applied when the application is disposed.

J. An IPV disqualification does not pend for adverse action.

K. Once a disqualification period begins, it continues uninterrupted for the entire number of months, regardless of whether the disqualified individual’s household is eligible for benefits. The disqualification period does not start and stop depending on the household's eligibility.

L. After disqualification periods have ended, the disqualified individual must be added back to the SNAP case as a household member. Complete a case change to add the individual.

M. If a disqualification is not imposed timely, impose the penalty showing the proper disqualification period. Establish an Agency Error (AE) claim for any months benefits were received when the individual should have been disqualified in accordance with MS 1030.

Example: An individual should have been disqualified for the months of January through December the same year. In June, it is discovered that the disqualification penalty was not imposed. At the time of discovery, enter the disqualification on the IEES showing the disqualification period January through December. Establish an AE claim for January through June if the individual received benefits.

N. When a determination of an IPV is reversed by a court of appropriate jurisdiction, reinstate the individual if the household is currently eligible. Restore any benefits lost as a result of the disqualification, not to exceed 12 months prior to the date of notification of the court's reversal of the imposed disqualification. An individual is not entitled to restoration of lost benefits for the period of disqualification based solely on the fact that a criminal conviction could not be obtained unless the individual successfully challenges the disqualification in a separate court action.

O. [When any active disqualification is changed from active to inactive, manually complete form FS-105, Notice of Eligibility or Ineligibility, and issue to the intended individual and scan a copy into the Electronic Case File (ECF). This is

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MS 1150 (1) Volume 1 – General Administration MS 1150 – R. 7/1/21 – OMTL-580 Treasury Offset Program (TOP) The Treasury Offset Program (TOP) is authorized by federal law to collect delinquent Supplemental Nutrition Assistance Program (SNAP) debts owed to the federal government. SNAP claims are considered federal debts and are subject to TOP collection efforts. Note: Claims in other programs administered by the Department for Community Based Services (DCBS) are not subject to TOP collection efforts. The Integrated Eligibility and Enrollment System (IEES) monitors collections of SNAP claims and systematically determines if the claim has reached delinquency status for submission to TOP. Individuals who contact the local office with questions about the collection of their claim through TOP should be directed to the Claims Management Section (CMS) at 502-564-3440. [Claims in which an intercept has occurred will display on the TOP Claims report on IEES. This report is monitored by CMS. A. Individuals must do one of the following to avoid their debt being submitted to TOP: 1. Repay the debt by sending a check or money order payable to Kentucky State Treasury for the full amount owed to: Cabinet for Health and Family Services Division of Family Support Claims Management Section 275 East Main Street 3E-I Frankfort, KY 40621 2. Agree to and comply with a repayment plan, if unable to pay debt in full, by completing a KCD-1.11, Repayment Agreement form. The individual must agree to a repayment plan acceptable to CMS and make regular payments by the agreed date as required in the repayment plan. Note: Only one repayment agreement will be accepted/entered on IEES. If a household fails to comply with its agreement, the claim will be referred for TOP action. 3. Request a state review in writing if the individual believes the debt is not owed, past due, or legally enforceable. The individual must send evidence to support his/her position to: Cabinet for Health and Family Services Division of Family Support Claims Management Section 275 E. Main Street 3E-I Frankfort, KY 40621 CMS will notify the individual of the decision regarding the debt.

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MS 1150 (2) 4. Verify bankruptcy: If the individual filed for bankruptcy and the automatic bankruptcy stay is in effect, the individual is not subject to offset or other collection actions. Intentional Program Violation (IPV) SNAP claims established by court order, waiver, or Administrative Disqualification Hearing (ADH), are not affected by the bankruptcy petition. CMS receives notification of bankruptcy from the federal court, but will accept official documentation provided by the individual or legal representative. B. Criteria for sending a delinquent claim to TOP: 1. A SNAP claim; 2. A current claim balance of greater than $25; 3. Not currently in benefit reduction status; 4. Not in compliance with a KCD 1.11 that was accepted by the agency or failure to return KCD 1.11 timely; 5. Not included under an automatic stay due to bankruptcy; and 6. Not currently under a court’s restitution order or a restitution order was issued but the ordered amount to be paid is not being met by the individual.] C. Collection process before going to TOP: 1. [A claim is considered delinquent when a KCD 1.11 has not been entered into and a payment has not been received within 30 days of the initial demand letter or is one day late on a previously arranged repayment plan. 2. At 90 days after the debt becomes delinquent, the KCD-1.60, 60 Day Notice, is sent to the individual. This notice includes information on how the individual can avoid having the debt submitted to TOP and the type of federal payments that may be offset to collect on the claim. A KCD-1.60 is sent to all adult liable members for the claim period. 3. If after 60 days from the date of the KCD-1.60 the client has not responded, the debt is submitted to TOP. Note: A total of 120 days must elapse from the delinquent date before a claim can be submitted to TOP.] D. Eligible Federal Payments: TOP will reduce or withhold payments in the amount of the debt owed by the individual from the following federal sources: 1. Income tax refunds, including Earned Income Tax Credit. 2. Up to 15 percent of a federal salary payment, including military. 3. Up to 25 percent of a Federal Retirement payment.

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MS 1200 (1) Volume 1 – General Administration MS 1200 – R. 6/5/23 – OMTL-626 Cash Assistance and Other Related Program Claims A. Claims occur in the cash assistance programs when the benefit issued exceeds the eligible amount and there is a loss to the Agency. This includes receipt of benefits pending resolution of a hearing when the Agency is upheld. Cash assistance programs are: 1. Aid for Families with Dependent Children (AFDC) - the last month benefits were issued in this program was September 1996. A claim must be established and collection pursued for all overpayments discovered on or after April 1, 1982. Use claim type codes ‘AFDC’ on the Integrated Eligibility and Enrollment System (IEES). 2. Kentucky Transitional Assistance Program (KTAP) - the month benefits were first issued in this program was October 1996. Use claim type codes ‘KTAP’ on IEES. a. Claims are established and collection pursued for all overpayments occurring due to recipient error, fraud, or non-fraud, regardless of the discovery date. b. Claims are established and collection pursued for all overpayments occurring on or after February 1, 2025, due to agency error. 3. Kinship Care Program (KC) – the month benefits were first issued in this program was October 1999. Use claim type codes ‘Kinship Care’ on IEES. a. Claims are established and collection pursued for all overpayments occurring due to recipient error, fraud or non-fraud, regardless of the discovery date. b. Claims are established and collection pursued for all overpayments occurring on or after February 1, 2025, due to agency error. B. Related program claims occur when an individual erroneously receives or uses a payment intended for Kentucky Works (KWP) supportive services or short- term assistance. Use claim type code ‘KWP’ on IEES. Related programs are: 1. Kentucky Works Supportive Services. Claims are established and collection pursued for all overpayments occurring on or after January 1, 2006. An overpayment occurs when the recipient is not eligible for KTAP but is authorized a supportive service or is KTAP eligible but fraudulently receives the payment. Forgery of form PA-33, Verification of Kentucky Works Participation, does not automatically establish a claim. Example: The participant received transportation assistance for August prospectively. In September, they return form KW-33 to verify

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MS 1210 (1) Volume 1 – General Administration MS 1210 – R. 1/1/26 – OMTL-689 How to Calculate a Cash Assistance and Other Related Program Claim A. Claims are calculated and computed on the Integrated Eligibility and Enrollment System (IEES) for Aid for Families with Dependent Children (AFDC), Kentucky Transitional Assistance Program (KTAP), Kinship Care (KC), and Family Assistance Short Term (FAST). 1. Use the actual income and deductions to determine the benefit the case should have received for a given month. 2. A claim does not result solely from normal fluctuations in income which do not last over 30 days. Normal fluctuations include fifth or periodic paychecks or sporadic overtime. 3. Earnings deductions are not appropriate for any month when wages were not reported timely or at all. 4. [If child support is collected by the Department of Child Support Services (DCSS) the amount of a claim may be reduced by the child support collected and retained by the Cabinet. See MS 1230.] 5. When computing a claim for a prior period, use policy in effect at the time the claim occurred. 6. If the case is ineligible, a claim must be established for any supportive services, education bonuses, or relocation payments authorized to a member in the ineligible month. 7. If the claim is established and a subsequent claim for a different time period or different circumstance is discovered, do not add the claims together. Complete the claim process; however, do not reduce the benefits or seek cash repayment until the first claim is repaid in full. Example: A claim has been established for January, February, and March due to unreported wages. Subsequently, the individual fails to report receiving unemployment benefits causing a claim for April and May. Separate calculations are completed for each circumstance. A separate Electronic Case File (ECF) is maintained for each claim. 8. If it is discovered prior to the claim being established, that the individual has not cashed or used the benefits on the Electronic Benefit Transfer (EBT) card for the exact months for which the claim is being established, form EBT-61, EBT Benefits Account Adjustment Request, can be complete to correct the error. For returned checks, complete form PAFS-61, Disposition of Returned Checks. B. Claims are manually computed, and the total claim amount entered on Worker Portal for the following types of overpayments: 1. Supportive services overpayments occur when:

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MS 1210 (2) a. The individual is ineligible for KTAP but receives supportive services. The claim amount is the amount of supportive services authorized for or to the individual during the ineligible month. If it is later determined the individual was ineligible for KTAP at the time payment was authorized, establish a claim. b. The agency erroneously authorizes payments. The claim amount is the difference between the correct payment and authorized amount. c. If it is determined that the individual fraudulently received supportive services, establish a claim. The claim amount is the amount of supportive services that was authorized. Note: Failure to meet Kentucky Works Program (KWP) participation is not a reason to establish a claim on transportation payments. If transportation was authorized correctly at the time of issuance, there would be no claim. 2. FAST and Family Alternative Diversion (FAD) overpayments occur when the individual is not technically eligible for FAST/FAD. The claim amount is the total of all FAST/FAD payments issued. 3. Relocation Assistance Program (RAP) overpayments occur when: a. The individual does not meet eligibility criteria for a payment. The claim amount is the amount issued for relocation expenses. b. The individual purchases items or services that are not approved by the agency. The claim amount is the amount not spent on approved items. 4. Education bonus overpayments occur when: a. The individual receiving the bonus is not eligible for KTAP or KC in the month of graduation. b. The payment is erroneously issued. c. Proof of graduation is falsified. d. In all instances, the claim amount is the amount of the bonus. 5. Work Incentive (WIN) reimbursement overpayments occur when: a. The individual receiving WIN reimbursements is not employed. b. The household does not contain a dependent child. c. The income of the household exceeds 200 percent of the federal poverty limit. d. The earned income that caused discontinuance of the KTAP benefit is not reported timely.

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MS 1230 (1) Volume 1 – General Administration MS 1230 – R. 1/1/26 – OMTL-689 Retained Child Support Consider child support retained by the Agency when calculating any Kentucky Transitional Assistance Program (KTAP) or Kinship Care (KC) claim. A. [Retained support is the amount of collected support reported by the Department of Child Support Services (DCSS) minus collections forwarded (e.g., escrow) to the recipient as verified on the DCSS External Search accessed from the Kentucky Online Gateway (KOG). B. If retained child support is equal to or more than the benefits issued for a month (before benefit reduction), there is no claim. C. If the absent parent is known, access the DCSS External Search to determine the retained support by DCSS. 1. Launch the DCSS External Search application from KOG and select participant/case inquiry to determine if child/spousal support is paid. 2. Use the column “Distribution Date (MM/YYYY)” on the DCSS Payment Distribution Inquiry Screen to determine the month of receipt. 3. Use the column “CSUP Retained by State” to determine the amount of State retained support for the month. 4. If more than one payment is received during the month, the screen will display the total dollars distributed to the participant and/or retained by the State. D. Calculate the amount of child support kept by the state and compare that monthly amount to the amount of benefits issued for each month of the potential claim. 1. If the retained child support for an individual month equals or is greater than the KTAP benefits received for that month, no claim exists for that month. Update the Integrated Eligibility and Enrollment System (IEES) to show the claim was not established. Example:The individual received $235 KTAP benefits. The individual was only entitled to $150. Child support was retained in the amount of $235. 2. If the retained child support for the month is less than the KTAP issued, subtract the corrected benefit amount for that month from retained child support. Deduct the remaining child support from the overpayment for that month. Example:$210 of KTAP benefits is issued. The correct amount is $100. Child support of $140 was retained by DCSS.] Calculate using the following steps:

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MS 1240 (1) Volume 1 – General Administration MS 1240 – R. 7/1/25 – OMTL-674 Medical Assistance Claims A. Medical Assistance (MA) claims occur when a recipient or responsible party, age 18 or older, causes a financial loss to Medicaid by: 1. Deliberately making false or misleading statements in order to obtain MA benefits. 2. Allowing an individual other than those listed on the Kentucky Health card to obtain health care benefits by use of the household’s Kentucky Health card; or 3. Inappropriately using a covered service (e.g., using Non-Emergency Medical Transportation to go to work, etc.). B. When an overpayment of MA occurs due to suspected fraudulent actions: 1. [Field staff will complete a manual Family Support Claim Referral task on the Integrated Eligibility and Enrollment System (IEES). 2. A Regional Claims Worker (RCW) will review the MA claim referral and determine if there has been an overpayment of MA benefits. 3. The RCW rejects the MA claim referral on the system and refers the suspected MA claim to the Office of Inspector General (OIG). In situations where the RCW determines there is no overpayment, the RCW will reject the referral on the system and thoroughly comment. 4. When a companion case is suspected of fraud, involving at least one month of MA ineligibility, all cases must be referred to OIG regardless of the dollar amount. 5. Enter comments on the IEES regarding the referral to OIG on all associated cases and/or claims. 6. Complete form Claim/MA-1, Medical Assistance Eligibility Summary, indicating the eligibility status for each household member. OIG will obtain the dollar amount of Medicaid usage for each ineligible month. This will be added to the overpaid benefits from the other programs to determine if prosecution will be pursued.] C. A Medical Assistance claim is entered on IEES only when the claim is adjudicated through the court. If OIG determines the medical card was not used during the ineligible period or fraud cannot be established, there is no claim on IEES. D. Payments on Medical Assistance claims are handled by the Claims Management Section (CMS). OIG may recommend the collection of

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