11124 Computing the Overpayment - In calculating the amount of an incorrect benefit, the agency shall determine the point at which the correct information should have been reported and acted upon timely allowing for timely notice as appropriate. From that point the correct benefit for subsequent months shall be determined comparing the amount with the actual benefit issued.

 

For overpayments occurring when the household was subject to monthly reporting/ retrospective budgeting, and who failed to report a change, the first month of overpayment shall be the issuance month corresponding to the income month in which the change occurred.

 

For overpayments occurring when the household was subject to change or simplified reporting and prospective budgeting, the first month of overpayment shall be determined by allowing for the 10-day period to timely report changes and the 10-day period for Notice of Adverse Action.

 

EXAMPLE: If a notice of adverse action was required but was not sent, it should be assumed that the 10-day advance notice period would have expired without the household requesting a fair hearing. If a change was not reported, the claim shall be based on the first issuance that would have been affected had the household reported the change.

 

In situations of unreported income, the worker shall calculate the amount of overpayment using all nonexempt income the household actually received in the income month for the month of overpayment and considering expenses and deductions that were reported or were required to be reported, and should have been allowed at the time the original benefit for the month was determined. The budgeting method (prospective, retrospective, etc.) used when the benefit was initially determined is to be applied when recalculating. For persons with prospectively budgeted or averaged income the overpayment shall be determined using actual income received in the calendar month of the benefit. This includes using actual amounts for situations in which a conversion method (i.e., 4.3 times weekly amount) would have been used in change reporting situations. When determining an overpayment when the case was retrospectively budgeted, the overpayment shall be determined using actual unreported income from the second prior month (income month).

 

When determining an overpayment due to an agency error (such as a calculation error), the overpayment shall be calculated using all income, expenses, and deductions that should have been allowed at the time the original benefit was calculated. Actual income for the months in question does not have to be obtained from the client or employer in determining the amount of the overpayment.

 

In TAF the amount of retained current child support,received in the month at issue which is in excess of the correct benefit amount, must also be applied to reduce the overpayment. If the support is not retained by the agency or is less than the correct benefit amount, the overpayment collection is not affected by the support amount.

 

If the household received a larger benefit than it was entitled to receive, a claim shall be established against the household equal to the difference between the benefit the household received and the benefit the household should have received. Overpayments of $125 or less shall not be established if the provisions of 11122 (5) (a) and (b) are met and the overpayment was not discovered in a quality control review. All cash, child care and food assistance claims shall be established on the Overpayment/Claim Authorization (OVCA) screen on KAECSES/KsCares.

 

NOTE: Screen Print OVCA - At the time the claim is established on OVCA, a screen print of the claim shall be done and placed in the case file as documentation of the original amount of the claim and the months the claim covers. This is VERY IMPORTANT since the OVCA screen is not accessible once the claim has been paid off.

 

NOTE: Aged-off Benefits - When determining the benefit the household actually received, staff must initially include benefits that have been aged-off the eFunds System due to non-use. (The household has one year to request restoration of the unused benefits. See the EBT System Guide in the Appendix.) If the unused benefits are cancelled (expunged) after one year, then the amount of the overpayment for the respective months will modified based on the amount of expunged benefits for each month. See 11126.6.

 

The following special provisions apply when computing an overpayment:

 

  1. Failure to Report Earned Income Timely (Food Assistance Only) - If a household member fails to report earned income in a timely manner (per 9121 or 9122), the resulting overpayment shall be computed without allowing the 20 percent earned income deduction for those earnings that were not timely reported. Timely reported earnings would be allowed the 20 percent earned income deduction when calculating the overpayment.
     

  2. Overpayments caused by Not Including a Person Who is Required to be Included in the Assistance Plan - The following provisions apply:
     

    1. Food Assistance - For overpayments involving the household's or the agency's failure to include an individual or individuals, the agency must first attempt to determine the amount of overpayment by determining what the household should have received, including the individual(s), their income, resources, and deductions had these factors of eligibility been correctly budgeted. If this information is not readily available, it must be requested from the household. If the household refuses to cooperate in providing the necessary information and eligibility for the months in question cannot be determined, the claim shall be computed by considering that the household was totally ineligible. All claims computed under this provision must contain adequate documentation to support the finding of total ineligibility.
       

    2. Cash Assistance - When a client fails to timely report a change, the agency may not learn of a person who is required to be included in the assistance plan until some time after the date the person should have been included. In these instances, the following provisions are applicable. If a father's entry into the home is not timely reported, he shall be treated as the father for the prior period as well as current and future months. However, if in accordance with the provisions in 2167, he is referred to CSE for a voluntary paternity acknowledgment and he cooperates but chooses not to sign necessary documents because he questions that paternity, he shall not be treated as the father to the child for the prior or current period. In this instance, a corrective benefit determination must be based on the assumption that he would not have been treated as the father had the change been reported timely.
       

      1. Eligibility for the entire assistance unit shall first be determined for the current and future months. The person to be added shall be budgeted prospectively for the first two months. (Applicable only to benefit months subject to monthly reporting.) If otherwise eligible and any necessary information is provided timely, the person's needs shall be added the month after the change was reported or discovered by the agency, whichever is earlier. If information is not provided timely, the person's needs shall be added the month after the month information is received. See 7401 or 9121 (4).
         

      2. Eligibility for the entire assistance unit shall then be redetermined for the prior months retroactive to the month the individual would have been required to be included in the plan had the change been reported timely. Since underpayments are not granted in situations where the change is not timely reported (see 11112 (4), the first month which can be affected would be a month in which an overpayment occurs and could occur no sooner than the first month following the month the change was required to be reported (e.g., via monthly report form) allowing for timely notice.

        The redetermination for the retroactive period must include all factors of eligibility except for nonfinancial procedural requirements such as applying for or providing an SSN and application for potential resources. However, non-procedural factors such as citizenship and alienage requirements, participation in labor disputes, vehicle registration, and financial factors must be met in the retroactive period.
         

      3. If the addition of the person results in ineligibility due to excess resources, there is ineligibility for the entire family and the resulting overpayment must be determined and recovery attempted per 11120.
         

      4. If adding the person does not result in ineligibility, a cash determination is required. The person's needs and income shall be included as appropriate and any resulting overpayment must be determined and recovery attempted per 11120. However, the assistance unit will not be entitled to any resulting underpayment amount which is determined, nor can such underpayment be used to offset any overpayments.
         

      5. For a person who would have qualified for cash except for the failure to timely report the change, retroactive medical coverage shall be provided for up to three months prior to the month the change becomes known to the agency. Such coverage must be requested by the assistance unit and is limited to persons who would have qualified for FFP medical coverage during the prior period.
         

  4. Medical Assistance Provisions - For medical program purposes, when a recipient fails to meet an increased spenddown resulting from an increased income or other changes of circumstances within an eligibility base period, medical payments previously made within the base period shall not be considered overpayments unless it is determined that the client willfully withheld information. In the case of willful withholding of information, overpayments shall be computed from the date the case should have been adjusted had the information been timely reported. The amount of the overpayment shall be computed based on payment information from the Adult and Medical Services Commission. For alleged fraud situations referred to the Fraud Unit, that unit is responsible for obtaining the necessary information and forwarding it to the worker.

    For other overpayment situations, information on claims can be obtained through the MMIS system. See the SRS MMIS User Reference for Field Staff Manual.
     

  5. Voluntary Assigned Support - An overpayment caused by voluntary assigned support which is received and retained by the client in violation of the assignment will be collected by EES staff by computing the amount of overpayment, establishing a claim and initiating recovery. This applies to the TAF case and the corresponding food assistance case. Also see 2164 and 6220(4)(c). Court ordered assigned support which is retained in violation of the assignment will be collected by CSE.