Generic Program Elements C. Issuing benefits

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APD Generic program elements

C. Issuing benefits

Effective 2/15/12

Issuing benefits is a separate function from eligibility determination. Consider the security of the benefits and the household's circumstances in determining the appropriate method of issuing benefits.

1. Issuing Benefits; General Information

Issue cash benefits by one of the following methods:

Issue health-insurance premium reimbursements (HIP) by Electronic Benefits Transfer (EBT), unless benefits are delivered by direct deposit.
For all other programs, issue benefits by check (printed check or direct deposit) to the primary person or the authorized representative, or by vendor payment.
For all filing groups with members working under a JOBS Plus agreement, the employer pays benefits in the form of wages, which are reimbursed by the Department.

Issue SNAP benefits by one of the following methods:

Except for FSCO clients and SNAP JOBS Plus clients. SNAP benefits should be issued via EBT.
FSCO may choose to receive benefits by either EBT or Direct Deposit.
FSCO without a bank account and who are unable to adapt to EBT are issued SNAP benefits by check.
For all other filing groups with members working under a SNAP JOBS Plus agreement, the employer pays SNAP benefits.

Issue medical benefits by providing the client with a medical card.

For more information on EBT, see Worker Guide F.3

2. Legal Status of Benefit Payments

Under Oregon law, cash benefits are not subject to assignment, transfer, garnishment, levy, or execution, as long as they can be identified as program payments and are separate from other money in the client's possession.
A cash payment accrues to and becomes vested in the client when issued.
Except for EBT, consider a benefit issued if the check has been handed to the client in the branch office, or mailed to the client. Consider a benefit issued, and received by the client, when a direct check deposit is made to the client's bank account.
For EBT, consider benefits issued and received when an EBT card and personal identification number (PIN) have been issued in person to the client and the benefits have been deposited to the client's EBT account.
SNAP benefits issued by EBT remain available for client access for 12 calendar months from the date of issuance. The EBT system expunges unused benefits after 12 calendar months.
Benefits to the client are unrestricted and do not require accountability for individual expenditures or amounts.

Note: Stores accepting SNAP benefits are required by federal law to restrict the usage to food items or eligible food-related items.

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3. Concurrent and Duplicate Program Benefits

Clients cannot receive benefits from the Department of the same type (that is cash, medical or SNAP benefits) for the same period as a member of two different benefit groups or from two separate programs (exceptions below). For example, a client cannot receive SNAP benefits in Portland and also receive SNAP benefits as a member of another household in Klamath Falls for the same time period.

A client cannot receive benefits from OHP, OSIPM or REFM while receiving a subsidy through the FHIAP program.

The exceptions to this policy follow:

If a GA client becomes eligible for TANF, a supplement would be issued to increase the client's benefits up to TANF payment standards.
A QMB-BAS client may also receive medical benefits from MAA, MAF, EXT or OSIPM.
A child who is an ERDC benefit group member may also be a member of the following benefit groups:
- A TANF benefit group when living with a nonneedy caretaker relative, if the caretaker relative is not the parent
- An OSIP-AB benefit group
SNAP clients who leave an eligibility group that includes a person who abused them and enter a domestic violence shelter/safe home may receive SNAP benefits twice that month.
A client may receive EA and cash payments from other programs for the same time period.

Clients cannot receive benefits of the same type (that is cash, medical or SNAP benefits) for the same period from both Oregon and another state, except as follows:

Medical benefits may be authorized for an eligible client if the client's provider refuses to submit a bill to the Medicaid agency of another state and the client would not otherwise receive medical care. Accept the client's statement as verification that a provider will not bill another state for needed medical services.
Do not supplement benefits for a person receiving benefits under the same program from another state who moves into Oregon, even if the benefit standards in Oregon are higher than those in the other state.

For a list of contacts for statewide verification of assistance, see Worker Guide B.5.

For information on how to process SNAP when a SSI recieient moves to Oregon from California, see SNAP F.15.

Applicants for SNAP from another state are not eligible in Oregon if they have already received their SNAP through EBT, even when they are unable to access the benefits. The state they left is responsible for issuing their SNAP benefits by a method they can use here.

If eligible, prorate benefits based on the application filing date unless the applicant is a migrant or seasonal farm worker. For more information, see SNAP Program Manual I.1.

Use the following procedure to determine if the client received benefits from another state while receiving benefits in Oregon:

Contact the other state to see if benefits were issued to the client. See SPD WG B.5 for the statewide verifications of assistance.
If benefits were issued, but then returned and canceled, that is proof that the client did not receive benefits from the other state
If benefits were issued but not returned and canceled, have the client sign a statement that they did not receive benefits from the other state. If the other state says the benefit check was cashed, ask them to send a copy of the check to Oregon. Use the replacement check procedures to determine if the signature on the other state's check is the clients. If it is, the client is responsible for the overpayment.

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4. Assigning a Payee; Not EBT

When benefits are not issued by EBT, a person may be payee for a case regardless of whether they receive benefits on that case. They may be the payee for more than one program or case. The payee is the primary person or authorized representative.

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5. Dual Payee; When to Use

For GA, OSIP and REF, use a dual-payee check for protective payments if the benefit group has shown they are not able to properly manage benefits meant to meet their needs. Issue the dual-payee check in both the name of the client and the name of the service provider.

To make sure a JOBS or OFSET payment is used to meet a specific need, the branch office may write a dual-payee revolving fund check in the name of both the client and the vendor.

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6. Prohibition Against Benefits in Amounts Less Than $10

In the SNAP program:

A benefit group is not eligible for benefits in the initial month if the allotment is less than $10.
In an ongoing month, benefits are issued as follows:
- An eligible one- or two-person benefit group in a categorically eligible filing group receives a minimum monthly allotment of eight percent of the TFP for one person as determined annually by FNS.
- An eligible benefit group of three or more persons receives the calculated benefit except that a group whose calculated benefit is $1, $3, or $5 receives instead an allotment of $2, $4, or $6 respectively. A benefit group in a categorically eligible (see OAR 461-135-0505) filing group may be eligible for zero benefits ($0) for the certification period.

For REF, do not issue benefits if the computed monthly benefit is less than $10. People who do not receive a cash payment because the monthly benefit is less than $10 may be eligible for medical benefits. The $10 limitation does not apply to:

Special payments, such as one-time special needs, emergency assistance, supplements, or a benefit amount under $10 due to recovery of an overpayment.
Dual-payee payments made in money management cases if the monthly benefit amount is $10 or more. Issue to the client any remaining funds after the dual-payee payments are made.

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7. Immediate Issuance

Provide the client with an immediate issuance of benefits for new, reopened and restored cases if the client is eligible for a benefit and has emergent needs that must be met before a benefit can be issued through the automated computer system; or for SNAP, meets the criteria for expedited service.

Provide the client with an immediate issuance of benefits for ongoing cases if:

The Department fails to issue benefits promptly. This includes failure to process a complete and correct Monthly Change Report form within five working days after receipt. The five working days for processing the Monthly Change Report start on the first day of the payment month for reports received by the branch before the first day of the payment month.
An advance is necessary to enable them to enter low-cost housing administered by HUD. Utility and rental deposits, and up to one month's rent, may be advanced.

Provide immediate issuance of benefits as follows:

For cash benefits, issue by EBT, revolving fund check or the special cash pay system.
For medical benefits, issue a temporary medical ID card.
For SNAP, except for FSCO clients who receive a check because they cannot adapt to EBT, issue by FCAS into the EBT account.
For FSCO clients who receive benefits by check or DD, issue a revolving fund check (code 80).

Immediate issuance: 461-165-0070

8. Method for Delivery of Benefits

Benefits are delivered several ways, depending on the program and client situation. Send all mailed benefits to the client's residential address. A rural route box number is acceptable as a residential address.

Make either of the following exceptions on a case-by-case basis if directions to the home are included in the case record:

A post office box number can be used if any of the following is true:

There is no mail service to the client's home.
The client lives in a nonstandard living arrangement.
There have been verified cases of benefits being stolen from home mailboxes in the client's neighborhood.

Use General Delivery only if it is the client's sole means of mail receipt.

Give immediate-issue cash benefits to the client in the branch office if benefits cannot otherwise be issued within the program requirement for immediate need. Immediate-issue SNAP and cash benefits are issued via EBT.

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9. Alternate Methods for Delivery of Non-EBT Benefits

Redirect non-EBT benefits to the branch office if any of the following is true. The benefit group:

Is unstable (i.e., moving constantly, and the branch needs to reestablish contact when there has been an unreported change of address).
Is transferred to a new branch.
Has not cooperated in completing a QC review.
Must be contacted personally to obtain essential information that may affect eligibility or the correct computation of the benefit amount.

Additionally for FSCO, if an eligible individual receives a check for the value of their SNAP benefit because they are unable to adapt to EBT, DD is not an option, they have a history of theft from their mail, live in an area that has been identified by branch staff, or postal inspectors as high-risk for mail loss, they may receive their benefits redirected to the branch.

10. Issuance Date of Benefit

For all cash payments except Emergency Assistance:

An authorized cash payment check is dated on the first day of the payment period or as soon as practical thereafter.
Checks and medical cards are mailed so they can be delivered to the client on the first day of each month except in the following situations:
- Initial month benefits for cases that are new, reopened, or restored.
- If the first day of the month falls on Sunday or a holiday, the check is mailed in time for the client to receive it on Saturday or the mail day preceding the holiday.
- Checks redirected to the branch office may be released during the last workday preceding a weekend or holiday.

Benefits issued by EBT should be available on the first day of each month, except for the following:

Initial month benefits for cases that are new, reopened, or restored cases.
Benefits held by the branch office.
SNAP benefits sent through staggered issuance. Benefits are staggered based on the last digit of the case number over the first nine calendar days of the month except for:
- Benefits for the initial month of eligibility for a new or reopened case.
SNAP benefits issued through the SNAP cash-out program are available as follows:
- Benefits accessed throught an EBT account are available on the first day of the month.
- Checks are mailed the first day of the month.
- Direct-deposit funds are available on the third working day of the month.

SNAP benefits issued by EBT (except FSCO) are staggered based on the last digit of the case number over the first nine calendar days of the month. For SNAP changes that could not be made in time to adjust the monthly allotment, issue a supplement within 10 days of the date the change was reported.

The second month's allotment of SNAP benefits is not subject to staggered issuance if the filing group applies after the 15th of the month and the application is not for a redetermination of eligibility. Once eligibility for SNAP benefits is established for these groups, benefits are issued as follows:

If the SNAP case is opened on or by the last day of the initial month of eligibility, the computer will prorate benefits for the initial month and will automatically issue benefits for the second month on the first of that month; or
If the case is opened after the initial month of eligibility, the computer will prorate benefits for the initial month and will automatically issue benefits for the second month on the same day.
Federal regulations require that clients who qualify for SNAP and apply after the 15th of the month have their second month's benefits excluded from staggered issuance. The computer automatically issues the second month's benefits. No QC errors will be cited for second month's benefits excluded from staggered issuance when the second month's benefits are issued based on the first month's information. If the second month's benefits are incorrectly calculated due to a change that the branch could not act on, a supplemental payment may be made.

FSCO clients are not subject to staggered issuance of benefits.

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For OSIPM, mail a medical ID card on the first of each month to clients receiving Title XIX waivered services who contribute to their services by paying their excess income or cost of service (whichever is less) into the pay-in system (SFMU) or a maintenance trust and agency account. Do not hold the client's medical card until the payment is received. If payment is not received before the end of the payment month, consider QMB for the following month.

Use the trust and agency account only if the agency needs to act as the representative payee. Use form SDS 195 (Trust Agreement for Limited Accounts) and SDS 198 (Trust and Agency Action). Any questions should be directed to DHS accounting.

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11. Alternatives to Direct Money Payment

For GA, OSIP, and REF, the alternative to direct money payment is protective payments when the goal is to ensure that the benefits are used to meet basic needs. For REF, protective payments may be made whenever clients demonstrate such an inability to manage funds that the Department determines their benefits are not being used in their best interest.

Protective payment methods include the following:

Payments to authorized representatives
Dual-payee payments
Vendor payments (money management)

If a branch is paying a client's benefits by vendor payment, all money left over after the client's bills are paid are to go directly to the client.

For information on Payment Procedure for Client in Hospital see 461-165-0120.

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12. Payment of Benefits Out of State

For all programs except SNAP and GA, send benefits out of state if clients are absent from Oregon and they establish their intent to return within 60 days.

If clients are detained out of state beyond 60 days for medical reasons, determine continued eligibility and require the client to provide documentation of the need to remain in the other state.

For medical benefits, out-of-state medical expenditures must have prior authorization.

Refer out-of-state medical providers to OMAP for approval and copies of Oregon's fee schedule so they can accurately bill for medical services provided to the client.

Advise people receiving medical assistance, who are temporarily leaving Oregon, that they will receive only emergency medical coverage while they are out of state. If the client needs specific information, contact the "out-of-state" coordinator at OMAP.

Clients who are enrolled with an FCHP or PCO should contact their respective plan offices for information and/or authorization for out-of-state medical coverage.

The Oregon Trail card can be used to access SNAP and cash benefits in almost all locations in the U.S. When a client leaves the state with benefits remaining they will need to locate a retailer or ATM that accepts the Oregon Trail card.

For GA cash, do not send benefits out of state.

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13. Endorsement of Benefits

The client or the client's payee must endorse checks issued in payment of a benefit. The endorsement on the check must be the same as the name appearing as payee.

The client may endorse a check with a mark or thumb print if duly witnessed by two people giving their full names and addresses.

Benefits issued via EBT may be used only with the Oregon Trail debit card and the client's matching PIN.

The person with power of attorney may:

Act as authorized representative or alternate payee.
Endorse and cash the benefit check as in the following example:

John Doe (Recipient)
by Richard Jones (Power of Attorney)

For all programs except SNAP, any cash benefit issued to clients before their death is available to their survivors.

For information on deceased persons that have not completed the application see 461-115-0070.

Checks may be endorsed in the name of the deceased beneficiary by the surviving spouse or next-of-kin, or by the administrator of their estate. The Department uses the following procedure:

Before the next-of-kin endorses a check, the check must be presented to the branch office.
The Department will rubber-stamp the endorsement on the check only if it has been determined that the client died on or after the first day of the period for which the payment was provided.
The endorsement must show both the name of the deceased beneficiary and the name of the surviving spouse or next of kin, as well as the relationship of the endorser to the beneficiary.
The person who endorses the check receives the proceeds of the benefit.

For cash benefits in an EBT account (except for FSCO), the Department will designate an adult survivor as the alternate payee. The Department will issue the payee an EBT card and PIN to access the balance in the EBT account.

For SNAP, there is no survivor's right to benefits unless the survivor is independently entitled to benefits as a member of the benefit group. When the survivor is not in the benefit group:

The Department will request the return of non-negotiated FSCO checks to the branch.
For SNAP benefits that were issued via EBT, if noone remains in the benefit group, the Department will cancel the remaining benefits from the EBT account.

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14. Restoring Benefits

A client is entitled to a supplemental payment of lost benefits, even if the client is currently ineligible, if the client received fewer benefits than he or she was entitled to because of any of the following reasons:

A change that would cause an increase in benefits was reported before the first of the payment month, but too late for the branch to adjust the next payment.
The branch caused an administrative underpayment. Administrative underpayments include, but are not limited to, the following:
- Failing to take action on information reported.
- Using an incorrect effective date.
- Denying, closing or reducing benefits in error.
- Making calculation errors.
A client is entitled to a supplemental payment of lost benefits, even if the client is currently ineligible, if:
- The restoration results from a final order in a contested case.
- The Department withheld too much of the client's grant in the collection of an overpayment.
- The restoration results from a court order.
The amount restored is issued in addition to the benefits that a currently eligible group is entitled to receive. For SNAP, the branch office must honor reasonable requests by benefit groups to restore benefits in monthly installments.
A benefit group that moves from the State of Oregon can still receive any restoration of benefits due it.

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15. Calculating Restored/Supplemented Benefits

Supplemental benefits are calculated and paid as follows:

The effective date of the lost benefits is determined. The benefit group is not eligible for restored benefits any month that eligibility for those benefits cannot be established. Give the benefit group an opportunity to prove eligibility for any months in question.
Calculate the correct benefit amount for the months the benefit group was underpaid, or closed or denied in error.
Subtract the amount the benefit group actually received from the amount they should have received.
Offset the amount of restored benefits with previous overdue or suspended overpayments.

Restore benefits to the group containing the largest number of people who were benefit group members at the time the loss occurred. If the location of this group is unknown, restore benefits to the benefit group containing the primary person at the time the loss occurred. Use the AFS 362 to notify the benefit group of the restoration.

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16. Benefits for Less Than a Full Month

In the SNAP, GA, OSIP and REF programs, if in a month a benefit group is eligible for less than a full month's benefits (such as the initial and closing months), benefits for that month are determined as follows:

The benefit amount for a full month is determined.
The full benefit amount is divided by the number of days in the payment month to determine the daily benefit.
The daily benefit is multiplied by the number of days in the month the group is eligible. The result is the benefit amount for the partial month (prorated benefit), except as adjusted by rounding below.
Rounding is used in the calculation of the prorated benefit as follows:
- For SNAP and REF, if the prorated benefit is not a whole dollar amount, the prorated benefit is rounded to the next lower whole dollar.
- For GA and OSIP, the prorated benefit is not rounded.

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