Family Services, Dept. of

Eligibility Integrity Unit (EIU)

Chapter 2: Referrals for Claim Establishment of Overpaid Public Assistance Benefits

Effective Date: 01/18/2025 to Current

Rule Type: Current Rules & Regulations

Reference Number: 049.0037.2.01182025

Chapter 2

REFERRALS FOR CLAIM ESTABLISHMENT OF OVERPAID PUBLIC ASSISTANCE BENEFITS

Section 1. Types of Referrals for Claim Establishment. A referral for claim establishment shall be made when:

(a) The Department issued benefits for Supplemental Nutrition Assistance Program (SNAP), Personal Opportunities with Employment Responsibilities (POWER), Low Income Energy Assistance Program (LIEAP) or Child Care Assistance in error;

(b) The recipient inadvertently failed to report, or inaccurately reported a household circumstance or other event resulting in a potential overpayment while receiving public assistance benefits; or

(c) An Investigator believes an applicant or recipient committed an intentional program violation (IPV) against the program(s) for which he or she has applied for, or received a benefit from.

Section 2. Claim Establishment Intake Process.

(a) The Intake Process begins when a Department Benefit Specialist or an Investigator discovers a potential overpayment.

(b) The recipient's public assistance file is accessed through the Department's Electronic Document Imaging System.

(c) The Department's Benefit Specialist or an Investigator reviews the public assistance file to determine the time frame of the potential overpayment and to determine if other verification is required.

(d) Once verification is obtained, the Eligibility Investigator shall conduct a redetermination of public assistance benefits to ascertain whether benefits were overpaid.

Section 3. Notice of Overpayment.

(a) The Notice of Overpayment shall be sent to the debtor when the overpayment claim is established, except as provided in subsection (d) below.

(b) Content of Notice:

(i) The reason for the overpaid benefits;

(ii) The amount of the overpaid benefits;

(iii) The time frame of the overpaid benefits;

(iv) The error cause resulting in an overpayment claim, may be any of the following:

(A) Agency;

(B) Inadvertent household error;

(C) Documented evidence; or

(D) Fraud when an overpayment claim initially designated as documented evidence is verified to have been an IPV.

(v) The specifics of how and what was used to calculate the overpayment; and

(vi) The name of the Investigator to contact for repayment arrangements.

(c) The adult(s) responsible for the overpayment may request an administrative hearing after receipt of the Notice of Overpayment, in accordance with the Department's Contested Case Hearing Rules and Procedures.

(d) When the investigative circumstances dictate that the case shall be referred to the prosecuting attorney, the Notice of Overpayment will not be sent. Should the prosecuting attorney decline the case, or if other circumstances arise and the case will not be pursued through the criminal courts, a Notice of Overpayment shall be sent at that time.

Section 4. Performance Requirement. As part of a performance requirement of the POWER and Child Care Assistance Program(s), recipients shall sign a repayment agreement in order to receive continued benefits from those programs.