607-2          CORRECTING ERRORS THAT RESULT IN AN UNDERPAYMENT (RESTORED BENEFITS)

Households are entitled to restored benefits when they are wrongfully denied benefits or received less benefits than it was entitled to as a result of agency error.

Restored benefits are not given to households for client-caused underpayments such as unreported decreases in income, unreported household members, and unreported deductible expenses.

Benefits will not be restored if lost more than 12 months prior to the month the loss was discovered.  Individuals disqualified for an intentional program violation (IPVIntentional Program Violation) are entitled to benefits lost during the months that they were disqualified only if the IPVIntentional Program Violation decision is reversed.

Households are entitled to restored benefits regardless of whether or not they are currently eligible for or receiving benefits.

The caseworker must document the reason for the restored benefits, the months affected, and the amount due to the household.

607-2 A.     HOW TO DETERMINE THE AMOUNT OF RESTORED BENEFITS

1. Determine the month the loss began.

2. Exclude months before the 12-month time limit.

3. Calculations for lost benefits are determined up to the date the error is corrected or the end of the certification period, whichever occurs first.

4. Determine if the household was eligible for each month the household lost benefits.

5. Obtain needed information to determine eligibility for any restored benefit month in question.

607-2 B.     NOTIFICATION OF RESTORED BENEFITS

Households will be notified of their right to restored benefits when the agency becomes aware of the error.  The notice will include the amount of benefits to be restored, and explain any offsetting for a claim.

607-2 C.     CHANGES IN HOUSEHOLD COMPOSITION

If a household's composition has changed since the loss occurred, restore benefits to the majority of the household members still together.  If the majority of the household cannot be located or are no longer living together, restore benefits to the household containing the head of household at the time the loss occurred.

607-2 D.     DISPUTED BENEFITS

Households entitled to restored benefits that disagree with the amount or any other action to restore lost benefits, have 90 days from the date of notification of the entitlement to request a fair hearing.  

If a fair hearing is requested prior to or during the time lost benefits are being restored, benefits will be restored as determined by the agency pending the hearing decision.  If the decision is favorable to the household, benefits will be restored in accordance with the decision. If a household claims it is entitled to restored benefits but the district office disagrees, benefits will not be restored pending the hearing decision.

All parties will comply with the fair hearing decision within 10 calendar days after receipt.