117-2           CONTINUED BENEFITS PENDING A FAIR HEARING DECISION

117-2 A.      TIME LIMITS

A recipient of Temporary Assistance, Medicaid, APA Adult Public Assistance , and Food Stamps who continues to satisfy all eligibility criteria other than those at issue in the fair hearing request may, upon filing a timely fair hearing request, have benefits continued pending the hearing decision. If a fair hearing request is not made timely, the recipient is not eligible for continued benefits, and benefits will be reduced or terminated as provided in the notice of adverse action.

Time limits for determining client’s eligibility for continued benefits:

1. Temporary Assistance, Adult Public Assistance and Medicaid hearing requests are considered timely for this purpose when made within the timely notice period. If only adequate notice is given to the client, the request must be made within 10 days of the date of the notice of action or within the 10 days following the effective date of the action.

2. Food Stamp Program hearing requests are considered timely for this purpose when made within the period provided by the notice of adverse action and if the recertification period is not yet expired. If a client claims good cause for not requesting the fair hearing timely, the hearing authority may order benefits to be reinstated to their prior level pending the fair hearing decision.

117-2 B.      PERIOD OF CONTINUED BENEFITS

For Temporary Assistance, Adult Public Assistance, and Medicaid,  benefits will not be suspended, reduced, discontinued or terminated for recipients who request a fair hearing within the timely notice period until after a fair hearing decision is made.  Recipients may specifically request that continued assistance not be issued or be discontinued pending a hearing decision.

For Food Stamps, benefits are continued through the current certification period. When a Food Stamp certification expires, benefits are issued based on the information provided on the recertification.

117-2 C.       CALCULATION OF CONTINUED BENEFITS

A household’s assistance will continue at the benefit amount authorized immediately before the adverse action, unless other factors that were not contested result in a benefit change or a food stamp certification period expires.  If the client is eligible for continued benefits, the agency is required to take action within five days to continue benefits, unless the client has specifically waived this right.

Continued benefits will be calculated as follows:

1. Determine the issue of the fair hearing.

2. Determine the benefits based on all current factors of eligibility including the issue in dispute.

117-2 D.      CONTINUED BENEFITS FOR ISSUES RELATING TO MASS CHANGE

If the fair hearing issue is a result of a mass change, the agency will reinstate benefits to the prior level only if:

1. An individual notice of adverse action was not sent to the recipient;

2. The request was received timely; and

3. The eligibility or benefits were improperly computed, the new law is being misapplied, or the federal policy is being misinterpreted.

117-2 E.      TERMINATION OF CONTINUED BENEFITS BEFORE THE FAIR HEARING DECISION

Any case action normally required by agency policy and procedures (such as changes in household composition, address changes, shelter deductions, etc.) will continue to be made after the continuation or reinstatement of benefits has been taken.  However, no action that directly relates to the issue of the hearing request can be taken until the fair hearing decision is made, the issue is resolved in a pre-hearing conference, or the food stamp certification period expires.  

Benefits may be reduced or terminated prior to the hearing authority’s decision when:

1. The hearing authority makes a preliminary determination, in writing or at the hearing, that the sole issue is one of State or Federal law and the client's claim that the agency improperly computed the benefits, misinterpreted or misapplied such law is invalid;

2. For Food Stamp issues, the certification period expires. The client may reapply when the benefits stop, but the level of benefits will be based on the reapplication, not on the level issued prior to the expiration of the certification period;

3. A change affecting the client's eligibility or benefit level, which is not related to the hearing issue, occurs while a hearing decision is pending and the client fails to request a hearing on this new action after the subsequent notice of adverse action; or

4. A mass change affecting the household's eligibility or level of benefits occurs while the hearing decision is pending.
    

The agency will follow normal adverse action notice procedures if benefits are reduced or terminated for other reasons while the hearing decision is pending.

117-2 F.      INELIGIBILITY FOR CONTINUED BENEFITS PENDING A FAIR HEARING DECISION

Clients are not eligible for continued benefits pending the fair hearing decision when the hearing authority rules that:

1. The issue relates to General Relief Assistance or Chronic and Acute Medical Assistance program benefits;

2. The request for the fair hearing was not made timely;

3. The sole issue is one of State or federal law or policy and not one of incorrect benefit computation;

4. The issue relates to a denial of an initial application for any assistance program or a denial of a food stamp recertification; or,

5. The issue relates to an action taken on a regularly scheduled food stamp recertification.  The level of benefits will be issued as determined in the recertification.