Mandatory Inclusion

[EAS 44-355.1]

General

Once it becomes known that a person is living with the AU, a determination must be made as to whether or not that individual is a mandatory member of the AU. The following chart is to be used to assist the EW in taking the correct action once that determination has been made:

IF...	THEN...
The person is an optional member of the AU, or has no relationship to the AU,	The EW must look at the specific case situation to determine if an overpayment may have occurred.
The EW determines that the person is a mandatory member of the AU,	The EW must notify the AU that they must apply for that individual and that the income and resources of that person will be counted in determining the AU's eligibility. The “Add Person Appointment Letter” (CSF 10) is available for this purpose.
The mandatory member affects current eligibility or is still in the home,	The case carrying EW must determine ongoing eligibility and make the overpayment calculation.
The mandatory member is no longer with the AU.	Enter information of the new member and or income in Data Collection so that the CalSAWS system computes and establishes overpayments. A referral to the DA by the Client Referral subsystem of Cal- WIN may be appropriate in this situation.

Action

When determining the CalWORKs overpayment, the EW must take the following steps:

Redetermine eligibility for the AU, based upon the presence of the individual in the AU (i.e. Does deprivation still exist for the children?) and whether the individual’s presence was a mandatory or voluntary change that should have been reported.
Review the SAR cycle to determine overpayment month (s).
Update the information in the Data Collection subsystem; Enter the income and resources of the mandatorily included person for the period the individual should have been included in the AU.
Enter the correct EBD) and the UEM accordingly. Run EDBC.
Evaluate the Capture Discrepancy Information window and identify the type of error and the Liable Individual (person responsible for repayment of the overpayment).
Document the reason for overpayment on the Journal Detail page.
Send out the appropriate overpayment NOAs from the Search/View Client Correspondence in Print Queue.
1. Note: Underpayment should not be issued, unless the client:
  1. Met all technical conditions of eligibility, and
  2. Cooperated in meeting these technical conditions, and
  3. Fulfilled their reporting requirements (made timely and accurate reports of the new person in the AU on the SAR 7).

Example

An investigator notifies the EW that the absent parent has been in the home for the last 6 months and is still there. The case-carrying EW notifies the client of the need to apply for that parent. There is no response and the case is discontinued for failing to add a mandatory AU member. A referral is made to IEVS to determine the amount of the overpayment.

It is then discovered that the parent was employed off and on during this period. The IEVS EE must attempt to determine if there was any other deprivation available to the AU during this period (such as U-parent or incapacity). The client must be contacted to provide information and/or verification, such as UIB or SDI abstracts, etc.

If it is determined that there was no other basis of deprivation for the children, the overpayment would be computed based upon that fact. However, if there was another source of deprivation, the budgets must be recomputed using the resources and income as well as the needs of the additional member.

Request for Action by IEVS

There may be situations when IEVS is investigating the circumstances surrounding a specific overpayment period. It is now required that the recipient provide information about the previously unreported person's income, resources, or other eligibility factors. As a result, IEVS may be asking the case-carrying EW to secure necessary information. The case-carrying EW must take prompt action upon receiving such a request.

If the client fails (or refuses) to provide information which they either have or can secure, and which is required in order to accurately determine current or past eligibility, the CalWORKs case may be discontinued following SAR rules with a timely and adequate NOA, for failure to provide essential information. The case record must be thoroughly documented on the Journal Detail page, providing the dates of contact, the requested verification and/or information, and the client's response or lack of response. If the client later wishes to reapply or to file a hearing based upon the county's action, the case record must contain this information to support the decisions made.

Mandatory Inclusion

General

Action

Example

Request for Action by IEVS

Related Topics