117-13        RESTORATION OF ASSISTANCE FOLLOWING FAIR HEARING DECISION

When the Commissioner or Commissioner's designee determines that the agency's action was in error, assistance will be provided retroactively to the date that assistance would have been available if it had not been erroneously suspended, reduced, or terminated.

The agency will redetermine the client's eligibility for each month back to the date the adverse action took effect, in accordance with the fair hearing decision. If benefits were continued, it is still necessary to compute the correct amount of benefits the client is entitled to in each month and to issue corrected benefits or establish an overpayment claim. Staff must not assume that accurate benefit amounts were issued based on the client receiving continued benefits.

Guidelines for restoration of assistance and, if ordered by the Commissioner or his designee, calculating overpayment claims of continued benefits are as follows:

1. For each month the client was eligible (in the case of an erroneous closure or suspension) or was entitled to an additional amount of benefits (in the case of an erroneous reduction of benefits), restored benefits will be issued.
2. In the case of a denial action reversed by the Commissioner or his designee, eligibility will be determined for the period beginning with the date of the erroneous denial through the current month. Benefits must be issued for each month the client is found to be eligible. Eligibility for prior month's benefits, such as retroactive Medicaid assistance for the three months prior to the date of application, will also be determined, if applicable.
3. In cases of abandoned hearings, the agency must not wait until the administrative law judge issues a notice of abandonment or determines if good cause existed before stopping any continued benefits. The worker must immediately implement the adverse action originally taken.