Okla. Admin. Code § 340:65-3-1

Current through Vol. 42, No. 6, December 2, 2024

Section 340:65-3-1 - Eligibility determination

(a)Eligibility determination. The eligibility determination process includes the applicant filing a signed application, the worker certifying or denying benefits, and all subsequent activities required to receive continuous benefits. The applicant has the right and responsibility to participate in the eligibility determination process and is relied on as the first source of information.

(1) Someone acting on the applicant's behalf, such as an authorized representative or a person with power-of-attorney, may complete the application for all programs except for Temporary Assistance for Needy Families (TANF). The applicant must complete and sign a TANF application.

(2) For another person to apply on the applicant's behalf, the applicant must designate the person as the authorized representative on the signed application or the person provides a completed Form 08MP008E, Authorized Representative Request, or a statement signed by the applicant giving the person permission to act on his or her behalf. The SoonerCare (Medicaid) programs allow others to apply for the applicant without a written designation.

(b)Filing an application. A household must complete an application to apply for the Child Care Subsidy Program, Low Income Home Energy Assistance Program (LIHEAP), SoonerCare (Medicaid) Program, Supplemental Nutrition Assistance Program (SNAP), State Supplemental Payment (SSP), TANF, or Diversion Assistance (DA). The applicant may request one or more benefits on the same application except for LIHEAP because it is not an ongoing benefit.

(1) The applicant may apply for benefits online, with a worker in an Oklahoma Human Services (OKDHS) office or an embedded work location, or by downloading a paper application and bringing or mailing or faxing it to an OKDHS office or an embedded work location..

(2) When someone applies on behalf of the applicant, the person may apply in any county.

(3) When the applicant applies for TANF cash assistance, OKDHS assigns the applicant's TANF Work activities based on his or her needs, convenience, and career pathway.

(c)Signature requirements. The applicant, guardian, or someone acting on the applicant's behalf, such as an authorized representative or a person with power of attorney, must sign the application prior to benefit approval.

(1) The applicant must sign TANF and DA applications. When the TANF applicant lives with his or her spouse, they must both sign the application.

(2) The applicant may voluntarily withdraw the request for benefits or services before or after signing the application.

(3) An applicant who is:

(A) eligible for Medicare signs the application using the name on his or her Medicare Health Insurance Benefits (HIB) card; or

(B) not eligible for Medicare signs the application using the name shown on his or her Social Security card.

(d)Interview requirements. Interview requirements vary by program.

(1) Per Section 206.10 of Title 45 of the Code of Regulations, OKDHS staff must complete a face-to-face TANF certification renewal interview every 12 months. The face-to-face interview may occur in the OKDHS office, at a home visit, or through a virtual video conference.

(2) The applicant must complete a phone or face-to-face interview that may be a virtual video conference interview, for the:

(A) Child Care Subsidy Program;

(B) SSP Program;

(C) SoonerCare (Medicaid) long-term care programs, such as ADvantage Waiver, nursing home care, or personal care;

(D) SoonerCare (Medicaid) programs that categorically relate to the aged, blind, and disabled population, such as Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Disabled and Working Individuals (QDWI);

(E) SNAP;

(F) Supplemental Security Income-Disabled Children's Program, or

(G) TANF, except for the certification renewal every 12 months.

(3) An interview is not required when a person applies for:

(A) LIHEAP; or

(B) SoonerCare (Medicaid), when the Oklahoma Health Care Authority is responsible for determining eligibility, per Oklahoma Administrative Code (OAC) 317:35-5-63.

(e)Worker responsibilities. During the eligibility determination process, the worker is responsible for:

(1) informing the applicant of the:

(A) OKDHS responsibility for reaching a decision and notifying the applicant of eligibility or ineligibility within the appropriate time limits, per OAC 340:65-3-5;

(B) applicant's right to request a fair hearing and obtain representation from any person the applicant chooses, per OAC 340:2-5. The applicant may request a fair hearing when there is a:

(i) delay beyond the established time limits for determining eligibility, per OAC 340:65-3-5; or

(ii) disagreement with any action taken on the case;

(C) applicant's legal responsibility to report all facts pertinent to eligibility;

(D) types of changes the applicant must report within 10-calendar days;

(E) penalty for failing to report changes;

(F) program requirements and information needed to establish eligibility for each program for which the applicant applied. The worker uses Form 08AD092E, Client Contact and Information Request, to request verification and gives the applicant at least 10-calendar days to comply, per OAC 340:65-3-2.1;

(G) type of assistance OKDHS provides in establishing eligibility;

(H) permission the applicant gives OKDHS to obtain information from sources other than the applicant by signing the application; and

(I) applicant's responsibility to cooperate with federal and state officials when his or her case is selected for a Quality Control review;

(2) collecting information necessary for determining the applicant's initial and continuing eligibility. Information is verified when not questionable or inconsistent with known facts, and the information provider is the primary source of the information. Unless questionable, the worker accepts, without further verification, the:

(A) applicant's statement concerning:

(i) residency;

(ii) relationship;

(iii) age;

(iv) living in the home of a relative payee;

(v) a minor parent living in the home of a relative;

(vi) Social Security number (SSN);

(vii) household members; and

(viii) third party insurance; and

(B) unearned income information obtained through:

(i) Beneficiary and Earnings Data Exchange System, from the Social Security Administration (SSA);

(ii) Supplemental Security Income/State Data Exchange System, from SSA;

(iii) Unemployment Insurance Benefits (UIB), from the Oklahoma Employment Security Commission; and

(iv) workers' compensation documents from the Workers' Compensation Commission; and

(C) alien status information obtained through Systematic Alien Verification for Entitlements (SAVE), from the United States Citizenship and Immigration Services;

(3) contacting other persons who may be able to help establish eligibility;

(4) determining if the applicant or other persons seeking assistance currently receive benefits from another state, when he or she has resided in Oklahoma for less than 12 months;

(5) recognizing expressed or implied needs that include:

(A) determining if there is a need for crisis intervention;

(B) addressing the applicant's social services needs; and

(C) making appropriate referrals; and

(6) denying the application when sufficient facts are available to substantiate ineligibility or the applicant fails to cooperate in determining eligibility.

(f)SSN requirement. The applicant must provide a verifiable SSN or a pending SSN application for every person requesting food benefits, SSP, SSI-DCP, LIHEAP, or TANF benefits. The requirement for a verifiable SSN also applies to all persons whose needs are included for SoonerCare (Medicaid) benefits, except newborn children deemed eligible, per OAC 317:35-6-60, and undocumented aliens requesting emergency medical services, per OAC 317:35-5-25.

(1) The applicant's statement regarding each household member's SSN is sufficient unless the information is inconsistent or other facts or observations cause the worker to question the statement.

(A) The OKDHS worker refers persons for whom an SSN is required, but not available, to the appropriate SSA office for SSN enumeration using Form 08AD101E, SSN Enumeration Referral. The return of Form 08AD101E to OKDHS validates the application(s) or indicates which persons have not provided SSA-appropriate original evidence of age, identity, and citizenship.

(B) Parents of newborns who participate in Enumeration at Birth receive Form SSA-2853-OP3, Message From Social Security, from hospital personnel. This receipt form is verification the newborn was enumerated at birth.

(2) When the person fails or refuses to furnish or to apply for an SSN, the worker takes action per (A) and (B) of this paragraph.

(A) For TANF purposes, the person's needs are included; however, the worker imposes a 25 percent payment standard reduction penalty until an application for or an SSN is provided.

(B) For SNAP, LIHEAP, and SoonerCare (Medicaid) purposes, only the person's needs for whom an SSN is not provided or applied for are not included.

(g)Citizenship requirement. All persons applying for federal or state public assistance benefits, such as Child Care Subsidy, SNAP food benefits, LIHEAP, SoonerCare (Medicaid), SSP, or TANF must declare the citizenship or alien status for each household member applying for such benefits on the application or benefit renewal. When the payee requests benefits for additional household members between application and benefit renewal, the payee completes and signs Form 08MP022E, Declaration of Citizenship Status, to declare the citizenship or alien status of the additional household members. Refer to OAC 317:35-5-25 for citizenship and alien status requirements for persons applying for SoonerCare (Medicaid) benefits.

(1) When the applicant declares that some or all the household members applying for benefits are aliens, the worker follows SAVE procedures, per OAC 340:65-3-4, to determine the validity of documents provided to verify legal alien status.

(2) The worker follows each program's rules regarding citizenship and alien status requirements to determine benefit eligibility, per:

(A) OAC 340:40-7-5 for Child Care Subsidy benefits;

(B) OAC 340:50-5-67 for SNAP food benefits;

(C) OAC 340:20-1-8, 340:20-1-10, and 340:50-5-67 for LIHEAP;

(D) OAC 317:35-5-25 for SSP; and

(E) OAC 340:10-15-1 for TANF.

(3) The citizenship requirements per (g)(3)(A) through (C) and (g)(4) of this Section are pursuant to Section 71 of Title 56 of the Oklahoma Statutes (56 O.S. § 71) and 74 O.S. § 20j.

(A) Lawful status in the United States (U.S.) is verified when:

(i) the person applying for benefits provides an SSN or SSA completed Form 08AD101E indicating SSA accepted the person's SSN application; and

(ii) OKDHS, through the automated SSN enumeration data exchange transaction with SSA, is able to verify the person's SSN.

(B) Prior to receiving benefits, when OKDHS is unable to verify the SSN with SSA for a person 14 years of age or older, the person must provide a:

(i) signed and notarized Form 08MP005E, Citizenship Affidavit, attesting to his or her U.S. citizenship or alien status; or

(ii) U.S. birth certificate, U.S. passport, a Certificate of Naturalization or other acceptable document, per OAC 317:35-5-25 to verify lawful status.

(C) When the person fails or refuses to provide a signed and notarized Form 08MP005E or one of the documents per (g)(3)B)(ii) of this Section, the worker denies or closes benefits for that person.

(4) The application, benefit renewal, and Form 08MP022E contain a statement informing the applicant that OKDHS reports fraudulent claims of citizenship or lawful alien status to the U.S. Attorney and, when a fraudulent claim is made, the person may be subject to criminal prosecution.

(5) When the worker discovers a person who signed Form 08MP005E attesting to U.S. citizenship or legal alien status made a false claim:

(A) the worker sends a memo and supporting documentation to the appropriate AFS Program. The memo must include:

(i) the time frame, benefit type, and amount the person fraudulently applied for or obtained; and

(ii) how the worker discovered the claim was false;

(B) AFS Program staff, in consultation with Legal Services (LS) staff, reviews the memo and supporting documentation to determine if the person made a false claim. LS staff files a complaint with the U.S. Attorney for the applicable district based upon the venue in which the affidavit was executed when appropriate.

(h)Eligibility determination. The worker determines eligibility after the applicant or other authorized person signs the application, completes an interview, when required, and provides required proof.

Okla. Admin. Code § 340:65-3-1

Amended at 18 Ok Reg 2096, eff 7-1-01; Amended at 20 Ok Reg 918, eff 6-1-03; Amended at 22 Ok Reg 827, eff 5-12-05; Amended at 23 Ok Reg 1907, eff 7-1-06; Amended at 25 Ok Reg 265, eff 11-1-07 (emergency); Amended at 25 Ok Reg 958, eff 6-1-08; Amended at 26 Ok Reg 1272, eff 6-1-09; Amended at 28 Ok Reg 880, eff 6-1-11; Amended at 29 Ok Reg 812, eff 7-1-12; Amended at 30 Ok Reg 686, eff 6-1-13

Amended by Oklahoma Register, Volume 33, Issue 24, September 1, 2016, eff. 9/15/2016

Amended by Oklahoma Register, Volume 38, Issue 24, September 1, 2021, eff. 9/15/2021

Amended by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/15/2022

Amended by Oklahoma Register, Volume 41, Issue 23, August 15, 2024, eff. 9/16/2024