10-144-330 Me. Code R. § 7

Current through 2024-51, December 18, 2024

Section 144-330-7 - POLICIES AND PROCEDURES

A.Confidentiality

The Department of Health and Human Services must, by Federal and State rules, provide for the basic rights and dignity of all applicants or recipients of financial services regarding their confidentiality. The Department must ensure that information about the recipient is maintained in a confidential manner and only released under certain circumstances. All employees of the Department must adhere to this policy.

The Address Confidentiality Program, administered by the Secretary of State, provides address confidentiality for victims of domestic violence, stalking, or sexual assault and requires state and local agencies and the courts to accept a designated address as the program Participant's address when creating a public record. When an Applicant or Participant verifies that they are a certified participant in the Address Confidentiality Program, the designated address is the only address accepted and provided when staff is required to release information

Information requested from outside the Department shall be released by permission, subpoena, or for program administration limited to programs, which establish eligibility and provide services through agencies subject to comparable standards of confidentiality. Information may be released, or obtained, inside the Department when it is directly related to the administration of the HOPE Program and/or when information reported to the HOPE Program does not match information previously documented and currently being used to determine eligibility for another program administered by the Department.

B.Application Process and Decisions

(1)Application Process

a) An application must contain the Applicant's full name, mailing address, and manual or electronic signature. The application date is the date the paper or electronic document is received by the Department.

b) Missing documentation and verification will be requested in writing. Applicants will have twelve (12) days from the date of the letter to provide requested information to the Department. Failure to provide requested verifications within this timeframe will result in denial of the application. Applicants denied enrollment in the HOPE program for failure to provide verifications will have the decision reconsidered without a new application if the verifications are provided prior to the last day of the month following the month of denial.

c) Appeals of Department denials of applications must be filed within thirty (30) days of the date of the Department's written decision.

d) Completed applications must be received by the Department within six (6) months of the intended start date of the remedial, Training, or Education Program, or at any time during matriculation.

e) After receipt of an Application, the Department will request additional documentation from the Applicant in order to make a determination that the Training or Education Institution or Program is approved, when the Institution or Program is - an online program, a program without an Adequate Job Outlook, at an institution located outside of Maine, or at a for-profit entity.

f) Applicants who possess a bachelor's degree must include, with their application, a written letter petitioning the Department for a determination that the degree is not marketable in Maine, or with their current circumstances. An application lacking this petition will be denied.

g) When the HOPE Program is at maximum enrollment, new applications received will be denied. Applicants denied due to maximum enrollment must indicate their desire to be put on waitlist. The decision will be reconsidered without a new application if a program position is available prior to the last day of the month following the month of denial and the applicant requested to be added to the waitlist.

A waitlist for Applicants deemed otherwise eligible for the Program will be maintained by the Department and will follow these guidelines:

i. The waitlist will not exceed ten percent (10%) of maximum HOPE Program enrollment; and

ii. Applications will be processed first, from the waitlist, based on the date the application document is received. In the event that two (2) or more applications are received on the same day, Applicants with the shortest pathway to completion of their Training or Education Program will be processed first.

iii. An Applicant will remain on the waitlist until the last day of the month following the month of denial

h) Program enrollment begins with the first calendar day of the month eligibility is approved by the Department.

(2)Application Decisions

The Department will issue a written decision within thirty (30) days of receiving a completed application. If the decision is to deny the application, the notice of decision will state the reasons for the denial and notify the individual of their right to appeal the decision. Appeals will be processed pursuant to subsection (H) of this section.

C.Maintaining Enrollment

(1)Enrollment Period

Program enrollment will continue through the last day of the last month during which the Participant is matriculated in their Training or Education Program provided the Participant remains eligible or does not voluntarily withdraw. Individuals graduating from a Training or Education Program will be eligible for HOPE through the last day of the month of graduation. For Participants matriculated in an associate or bachelor's degree program, HOPE Program enrollment will continue if there is a summer break in classes, provided Participants are eligible and are registered for classes for the fall semester. The Enrollment Period may be extended for one month at a time if there is a finding of Good Cause per (3) below.

(2)Change Reporting

Changes in any eligibility factor expected to last thirty (30) days or more, or HOPE funded services expected to last fourteen (14) days or more, must be reported to the Department within ten (10) days of the Participant being aware of the change. Verification requirements for changes will be the same as verification requirements during the application process.

EXCEPTION:Participants must notify the Department within five (5) days of the date that it becomes known that there is a Temporary Absence from Home, where a child in the Family Unit will be absent from the home for 45 days or longer.

NOTE:The Department will request verifications and render decisions on reported changes consistent with the Application Process in Section 7(B)(2) for eligibility changes, or the Services process in Section 7(D) for changes in services.

(3)Good Cause

A finding of Good Cause allows the Applicant or Participant to temporarily suspend compliance with HOPE rules and policies for an expected period of no more than one calendar month. An Applicant or Participant's right to claim Good Cause will not be limited. Good Cause is the following:

a) Illness of the Applicant or Participant or the Applicant or Participant's child who resides in the Applicant or Participant's home and requires the Applicant or Participant to provide their care; or

b) Court-required appearance or incarceration; or

c) Incident or effect of domestic violence; or

d) A crisis, special circumstance, or other reason beyond the individual's control that causes an Applicant or Participant to suspend compliance with HOPE rules and policies.

e) For the purpose of extending the HOPE Enrollment Period, a credential requirement not being offered within the previously defined Enrollment Period would also constitute Good Cause. (E.g. a Participant graduates May 10^th, but an exam necessary to acquire the related credential is not offered until mid-June.)

NOTE: Applicants or Participants may request a Good Cause determination at the time they report a circumstance or within ten (10) days of receiving adverse notice. Verifications will be requested, and decisions rendered by the Department, consistent with the application process in Section 7(B).

D.Services

The Department pays the least expensive Support Service that is accessible for the Participant and is of acceptable quality as determined by the Department. The amount for Support Service benefits will be limited. Specific caps for Support Services are included in their descriptions in Section 4(B). Unused portions of Supports with an annual limit do not carry over to the next calendar year.

(1)Eligibility for Support Services

Support Services are paid subject to HOPE Program enrollment. Students must remain actively engaged in approved education activities for Support Service benefits to be issued.

(2)Process for Requesting Support Services

Requests for Support Services must be made directly to the Department through telephone, fax, email or mailed communication. A request may originate from a Participant, or from a Navigator on behalf of a Participant.

Authorization to pay or reimburse an expense must be obtained from the Department prior to the Participant incurring the expense.

Missing documentation and verification will be requested in writing. Participants will have 12 days from the date of the request to provide such documents or verification to the Department. Failure to provide requested verifications within this timeframe will result in denial of the Support Service.

(3)Authorization of Support Services

Support Services may be authorized, but not necessarily issued, for a twelve (12) -month period. The HOPE Program will not reimburse a Participant for an expense paid by another funding source, and the Participant must disclose all sources of aid.

Authorization of HOPE Program Support Services will follow these guidelines:

a) All actual expenses must be verified. Participants are required to provide receipts to the Department within ten (10) days of funds being issued. If receipts are not provided for issued payments within the timeframe allowed, or the amounts on the receipts are less than the Support Service benefit, or the purchase does not match what was authorized, an overpayment will be processed per Subsection (F) of this section.

b) The Department will issue payment or reimbursement for supports directly to a provider. When payments cannot be made directly to a provider, the Department will finalize payment to a Participant via EBT or check.

c) Participants seeking reimbursement for actual expenses paid for supports have the responsibility of requesting reimbursement within thirty (30) days of purchase to be considered an unmet need.

E.Verifications

Verification related to income, assets, Training or Education, and HOPE funded services is required by HOPE. Applicants and Participants have the primary responsibility of providing verifications. Applicants, receiving assistance under other DHHS-OFI Programs, requesting information on file be used for a HOPE Program determination may be asked to provide updated verification needed prior to the eligibility determination. Documents may be photocopied or sent electronically.

Missing documentation and verification will be requested in writing of the Applicant or Participant. Applicants and Participants will have twelve (12) days from the date of the request to provide such documents or verification to the Department. Failure to provide requested verifications within this timeframe will result in denial of the application or payment of support, and/or removal from the program. HOPE requires the following verifications:

(1)Non-financial Eligibility

a) Pregnant Person: Pregnancy must be verified by a medical statement that includes the expected date of birth.

b) Working Age: Proof of age may include a valid driver's license, a State identification card, or an official document showing birth date.

c) Maine Resident: Proof of Maine residency may include a valid State of Maine driver's license or identification card, a current residential lease agreement or mortgage document, a W-2 document not more than 18 months old, or a current utility bill in the Applicant or Participant's name.

d) U.S. Citizen: If not already verified by the Systemic Alien Verification for Entitlements (SAVES) Program, proof of a qualifying alien status may include a United States Immigration and Customs Enforcement (USCIS) document verifying identity, alien number, and status.

e) Social Security Number: All adult members of the Family Unit reporting income must provide a SSN or proof of application for a SSN.

f) Aptitude: Proof of aptitude is acceptance to the Training or Education Program except for those matriculated in for-profit institutions or lacking aptitude for reasons other than lacking training or education.

i. For those attending programs at for-profit institutions, proof of aptitude includes:

a. Current grades earned in the Training or Education Program; or

b. Prior certifications or previous postsecondary course work completed within the past 24 months; or

c. Verification of standardized adult student assessment scores within the past 24 months as recognized by Maine Department of Education; or

d. Letters of recommendation from Training or Education Institutions or employers written within the past twelve months; or

e. Verification of access to appropriate accommodations for disclosed physical or cognitive disability; or

ii. In situations where the Department is notified that even with training or education the individual would not meet the standards required by the professional licensing or regulatory board for the individual's chosen industry, proof of aptitude includes an employer's statement or documentation from a professional licensing entity that a waiver has been granted or showing training or education is the only barrier to employability within the desired industry that cannot be overcome with reasonable accommodations.

g) Lack of a marketable Bachelor's Degree: Proof that no currently held bachelor's degree is marketable may include:

i. copies of Maine licensing requirements for qualified individuals in the specified professional area as outlined by the Maine Office of Professional and Occupational Regulation,

ii. an employer statement,

iii. determination from worker's compensation board, or

iv. medical records supplied by a licensed medical or behavioral health provider.

h) Training or Education Institution

i. Eligible Institution: Proof of acceptable institutions may include a statement from the Navigator, proof of accreditation from a regional or national accrediting body recognized by the U.S. Department of Education as providing quality education per standards equivalent to those most currently in effect, used by, and published on the website of the New England Commission of Higher Education (NECHE), (A link to these standards can be found at https://www.maine.gov/dhhs/ofi/programs-services/hope/do-i-qualify⁵.) , a state licensing board, or an industry trade association's website.

ii. Matriculated Status: Proof of acceptance and matriculation may include an acceptance letter with intended start date, a conditional acceptance letter, proof of registration, unofficial transcript with declared major and anticipated date of graduation, attendance record, or grades from the Training or Education Program.

i) Training or Education Program

i. Cost-Effective: Proof that demonstrates lower total costs to the Department and the Applicant or Participant includes, but is not limited to: scholarship/financial aid awards from the institution; unofficial transcript showing successful completion of previous postsecondary coursework; school documents that show improved access to required courses, clinical placements, or internships; and/or documents that demonstrate improved access to, accommodations for a verified physical or cognitive disability, or necessary supports.

ii. Need for, and Participation in, Remedial Coursework: Proof of required remedial coursework includes, but is not limited to, letters as provided by the institutions outlining the mandated remedial services as a condition of matriculation in a particular program of study and remedial course descriptions, and/or attendance records from remedial course providers.

iii. Acceptability of Baccalaureate Program: Proof of an acceptable program includes school documents identifying the Applicant or Participant's declared major.

iv. Acceptability of programs that lead to a universally recognized and accepted credential that is not considered to lead to a job with an Adequate Job Outlook: Proof of an acceptable program includes, but is not limited to, an employer's statement showing wages, demand and employability within the desired industry; a bona fide job offer contingent upon securing the credential; or documentation from a workforce development entity indicating a labor market shortage in the specified industry.

v. Acceptability of a Career Pathway:

a. Proof that the combination of training and education aligns with the skill needs of employers within the individual's geographic region and trade of choice including, but not limited to:

1. CWRI or O*NET data showing that these skills are needed by employers; or

2. A statement from an employer within the individual's geographic region and trade of choice that these skills or credentials align with the needs within the region and trade and would lead to increased employability or wages; or

3. A statement from an approved Training or Education Institution or employer within the individual's geographic region and trade of choice detailing how the combination of these skills or credentials lead to a final outcome acceptable under (1) or (2) above. and

b. Proof that the intended career would result in a Substantial Improvement in Earnings and Benefits including but not limited to:

1. CWRI adjusted median wage information,

2. Paystubs from a current employer and a statement from a current or potential employer showing the new credential will result in a substantial increase in total compensation,

3. Statements from child care or other providers showing a substantial decrease in work related or family related expenses,

4. Verification of decreased mileage for commutes to work and other work related or family related services related to the credential, or

5. Government data showing substantial improvement to the Social Determinants of Health for the individual or their minor child(ren).

vi. Acceptability of programs exclusively online: Proof of an acceptable program includes, proof of the educational institution providing a local Maine contact support person and one or more of the following:

a. An employer's statement; or

b. an unofficial transcript showing successful completion of previous postsecondary coursework; or

c. documentation demonstrating prior experience in the field of study; or

d. medical records supplied by a licensed medical or behavior health provider verifying a medical condition of the individual or their minor child that would prohibit them from attending in-person classes; or

e. school documents that show improved access to required courses; or

f. documents that demonstrate improved access to accommodations for a verified physical or cognitive disability or necessary supports.

j) Satisfactory Progress: Proof of satisfactory progress may include unofficial transcript, proof of registration, or attendance record or grades from the Training or Education Program.

(2)Financial Eligibility

Applicants and Participants have the responsibility of providing verification of income and assets. Some examples of acceptable verifications for income include, but are not limited to, pay stubs, signed statement from an employer, award letters, worker's compensation records, General Assistance records, Beneficiary and Earnings Data Exchange (BENDEX), State Data Exchange (SDX), or support and alimony payments evidenced by court order, divorce or separation papers, check copies, income tax records, or self-employment records.

(3)Support Services

a) Tuition and Fees: Proof of unmet need for outstanding tuition and fees that prevent a Participant from matriculating, re-matriculating, or transferring credits must be supplied to the Department. This proof may include a school invoice that includes a statement of locked credits. Participants requesting support for tuition and fees must provide a current invoice and financial aid award letter from the Training or Education Institution. If either the outstanding tuition balance or the current tuition owed exceeds the HOPE limits, the Participant must verify their ability to pay the remaining unpaid balance before the Department will release funds.

b) Child Care: A completed DHHS child care packet must be supplied to the Department. The requested provider must pass a background check if unlicensed. If BMV records show the need, the provider will sign a form acknowledging they will not drive with children.

c) Transportation: Proof of the need for transportation supports must be supplied to the Department. This proof may include a copy of the Participant's course schedule, receipts for travel expenses, and mileage calculations.

d) Books, Supplies, Tools, Equipment, home access to Technology or Software, and cost-effective Internet Access: Proof of the need for required items must be supplied to the Department. This proof may include a copy of the training or class schedule, a course description, a copy of the course syllabus, or a letter from the instructor or institution stating the item(s) is/are required of all students and is/are not supplied or available through the institution. Proof of unmet need for the item(s) includes-

i. Proof that the Participant has no financial aid to cover this expense such as a financial aid award letter or evidence of no financial aid; and

ii. An itemized copy of one or more of the following:

a. an estimate,

b. receipts showing proof of purchase, or

c. receipts showing payment of a bill.

e) Vehicle Inspection, Registration, and Repairs: Proof of necessary repairs from a licensed mechanic validating the need must be supplied to the Department. When a repair is required to pass inspection, the mechanic must supply a statement that the repair will lead to a valid inspection. If the cost of the request exceeds the HOPE limit, the Participant must verify their ability to pay the remaining balance before the Department will release funds. The Participant must provide a copy of their proof of current vehicle registration (except when the support request is for payment of vehicle registration), valid Maine driver's license, and proof of current liability insurance coverage.

f) Vehicle Insurance: Proof of an estimate or receipt from the insurance provider must be supplied to the Department along with a copy of the Participant's current Maine driver's license, current registration, and a copy of the insurance declaration page.

g) Corrective Eyewear: Proof of cost of the eyewear must be submitted to the Department prior to the eyewear being ordered. This proof may include an estimate from the eyewear vendor.

h) Dental Care: Proof from the dental provider verifying the cost and the need for the service must be submitted to the Department prior to the work being performed.

i) Other Supports: Proof of the need and necessity of the support to matriculate or remain matriculated in the Training or Education Program must be submitted to the Department. This proof may include a statement from the Navigator or Training or Education Institution.

(4)Questionable Items

Any other factors relevant to the HOPE Program eligibility or the authorization of Supports will need to be verified if the Department deems them questionable.

a) Factors will be considered questionable if:

i. The Department has received a community complaint in contradiction to circumstances as attested to by the Applicant or Participant; or

ii. The circumstances vary greatly from those previously known to the Department; or

iii. The circumstances as attested to by the Applicant or Participant are not consistent with those publicly known or that could reasonably be assumed.

b) Questionable items can be verified through the least restrictive and reasonable method available to the Applicant or Participant.

i. Preference will be given to documentary evidence such as bank statements or tenant agreements.

ii. Third party attestations are acceptable if:

a. Other documentary evidence is not readily accessible; and

b. The individual providing the attestation is a non-relative who can reasonably be assumed to know the circumstances.

Third party attestations can be written or verbal.

F.Overpayments

Program Participants will be responsible and accountable for the appropriate use of Support Service benefits paid. Individuals are responsible for repaying any overpaid benefits regardless of whether the overpayment was the result of an error on the part of the agency, the Participant or a Family Unit member; or an act by the Participant or Family Unit member with the intent of supports being overpaid.

The Department will notify the Participant, in writing, of the potential overpayment. This notice will state the potential overpayment amount, the details of the potential overpayment, and will allow the Participant twelve (12) calendar days from the date of the notice to respond to the Department. When a Participant does not respond to the notice, the overpayment information will be referred to the Department's FIRU. FIRU will determine the final overpayment amount and establish the method for recoupment.

When a Participant responds with updated verification that resolves the overpayment claim a written notice will be issued to the Participant stating the overpayment has been resolved. When a Participant responds to the potential overpayment notice with a claim of Good Cause for failure to submit receipts for Support Service payments issued directly to them, the Good Cause decision will be determined by the Department. The Participant will be notified in writing of the decision on the claim of Good Cause.

If an overpayment is made directly to a provider who misled or misrepresented the volume or amount of services provided or fees, the overpayment will be referred to the FIRU for further action and will not be imposed on the program Participant.

If a Participant withdraws or otherwise ceases attending their Training or Education Program during an academic period without Good Cause or without receiving a refund, the Department may establish an overpayment for the amount of the tuition paid and will follow the overpayment process regardless of the individual's enrollment status with the HOPE Program.

G.Intentional Program Violations (IPV)

When the Department determines that an Applicant or Participant took an action with the intention of receiving HOPE Program supports for which they knowingly were not eligible or spent support payments in a way that was not authorized, the Applicant or Participant will be referred to FIRU to decide if an IPV hearing is warranted.

The Department's FIRU must review the evidence that is provided to determine if an allegation that an Applicant or Participant has committed an IPV requires further action. When documentary evidence substantiates the allegation, an Administrative Disqualifications Hearing (ADH) is initiated by FIRU. The ADH procedures will follow the regulations set forth in the Maine Administrative Procedure Act, 5 MRSA §§ 8051 -10004. A guide to Administrative Hearings Regulations is available through the Office of Administrative Hearings. (https://www.maine.gov/dhhs/about-us/administrative-hearings⁶)

A HOPE Program Applicant or Participant who has been found to have committed an IPV will be disqualified from the HOPE Program for the following time periods: one year for the first violation; two years for the second violation; and permanently for the third violation. The Disqualification penalties imposed under the IPV affect the individual's HOPE eligibility and has no effect on HOPE eligibility of others in the Family Unit.

H.Appeals and Administrative Hearings

(1) HOPE Program decisions may be appealed by Applicants or Participants, in writing; or via telephone, fax or email within thirty (30) calendar days of the date of the HOPE written decision or Final Informal Review decision. Appeals are made to, or sent to, the HOPE Program Manager.

(2) The Applicant or Participant can request either an Informal Review or an Administrative Hearing.

(3) Informal Review

Once the request is received by the Department, the Department has ten (10) days to communicate with the Applicant or Participant and gather facts related to the appeal.

The Applicant or Participant has the responsibility of submitting verification of statements made to dispute a decision and will have twelve (12) days from the date of the request to provide such information.

The HOPE Program Manager or designee shall notify the Applicant or Participant, in writing, of the decision made as a result of the Informal Review.

If the Applicant or Participant disagrees with the results of the informal review, they may request an Administrative Hearing.

(4) Administrative Hearing

The hearing will be held in conformity with the Maine Administrative Procedure Act, 5 M.R.S. §8001 et seq. and the Department's Administrative Hearings Regulations.

The hearing will be conducted at a time, date and place convenient to the parties and at the discretion of the Office of Administrative Hearings, and a preliminary notice will be given at least ten (10) calendar days from the mailing date. In scheduling a hearing, there may be instances where the hearing officer shall schedule the hearing at a location near the Applicant or Participant or by telephone.

The Department and Applicant or Participant may be represented by others, including legal counsel, and may have witnesses appear on their behalf.

An impartial official will conduct the hearing.

The decisions, rendered by the hearing authority, in the name of the Maine Department of Health and Human Services will be binding upon the Department, unless the Commissioner directs the hearing officer to make a proposed decision reserving the final decision-making authorization to the Commissioner.

Any Applicant or Participant who is dissatisfied with the hearing authority's decision has the right to judicial review under Maine Rules of Civil Procedure, Rule 80C.

If the disputed decision involves suspension or termination of HOPE services which have been previously granted, and the Participant requests an Administrative Hearing within ten (10) days of the decision, HOPE services will continue pending outcome of the Administrative hearing. In cases where the Hearing decision rules in favor of the Department, the Department may seek recoupment for the Support Services paid on behalf of the Participant.

⁵ Individuals unable to access this link may request the information from the HOPE Program by mailing a request to DHHS OFI-HOPE Program, 11 State House Station, Augusta, ME 04333; calling (207) 624-4170; faxing a request to (207) 287-3455; or e-mailing a request to HOPE.DHHS@maine.gov

⁶ Individuals unable to access this link may request the information from the HOPE Program by mailing a request to DHHS OFI-HOPE Program, 11 State House Station, Augusta, ME 04333; calling (207) 624-4170; faxing a request to (207) 287-3455; or e-mailing a request to HOPE.DHHS@maine.gov

10-144 C.M.R. ch. 330, § 7