Definitions

The following definitions apply when Santa Clara County is determining and notifying a recipient of recovering CAPI overpayments.

Demand for Repayment

A Demand for Repayment is a notice sent by County Collections to the client, stating that an overpayment has occurred and that the client must repay these funds. This may be sent at the same time as any other notices of overpayment and/or adjustment.

Fraud

Fraud exists when any person knowingly, willfully and with intent to defraud makes or causes a false statement to be made, conceals or misrepresents a fact and by said act eligibility status or payment amount is affected. The person need not be the claimant or anyone who is either related to, or acting on behalf of the claimant.

Full Refund

A full refund is a one time payment by grant reduction or voluntary cash payment and is always the preferred repayment method.

Month of Discovery

The Month of Discovery is the month in which the county obtained information sufficient to support a determination of the occurrence and the amount of the overpayment.

Monthly Grant Adjustment

Grant Adjustment is a method of recovering an overpayment by reducing the CAPI grant. This is normally accomplished by collecting 10% of the CAPI grant. The client may choose to have a higher amount recouped. The client may also request to have a lower amount recouped, if the overpayment will be recovered in full within 60 months, or if the person could not meet his or her ordinary and necessary living expenses if the higher rate of adjustment is applied.

Netting

Netting is the computation process used to balance overpayments against underpayments for the period under review. There is no distinction in the type of overpayments.

Overpayment

An overpayment is a payment of more than the amount entitled for any period. This includes CAPI and Conditional CAPI payments made during a period for which an individual is later determined eligible for SSI/SSP and for which the state or county does not receive federal reimbursement.

Note: Payments made on the basis of presumptive disability or blindness are not considered overpayments if an individual is later determined not to meet the definition of disabled or blind.

Any Conditional benefits received after the individual has signed the SOC 830, for which the person does not receive SSI/SSP, is NOT an overpayment, provided the person remains otherwise eligible for CAPI.

Conditional CAPI benefits for a recipient who fails to meet the eligibility requirements and client responsibilities of both regular and Conditional CAPI is an overpayment. Refer to Client Responsibilities.

ExampleExample

Mr. Tran, who is currently receiving CAPI, became a naturalized citizen on 12/15/2007. He reports his naturalization in 2/2008. Mr. Tran is then referred to SSI/SSP, requests and receives Conditional CAPI effective 3/2008. Mr. Tran fails to cooperate with SSA and his SSI/SSP application is denied in 5/2008. He now must be terminated from Conditional CAPI, and is subject to overpayment rules for:any regular CAPI received from 1/2008 to 2/2008, and any Conditional CAPI received from 3/2008 to 5/2008

Payment Adjustment

Payment Adjustment is a voluntary repayment made to the county when a recipient pays with all or a portion of a grant for which he or she is eligible. This would normally occur when a client requests more than the normal amount of 10% of the grant to be recouped.

Recoupment/Recovery

Recoupment/recovery is any method of getting back CAPI payments which were overpaid. Methods of recovery include monthly grant adjustment (recoupment), payment adjustment, voluntary cash recovery, demand for repayment.

Similar Fault

Similar fault exists when any person knowingly makes (or causes to be made) an incorrect or incomplete statement or knowingly conceals information that is material to eligibility or the payment amount. The intent to defraud is not required. The person need not be the claimant or anyone who is either related to, or acting on behalf of the claimant.

Underpayment

An underpayment is a payment of less than the amount due for any period. If an underpayment comes to the attention of the EW, reasonable steps to correct the underpayment must be taken.

Voluntary Cash Recovery

Voluntary Cash Recovery is a repayment voluntarily made to the county by a recipient who has incurred an overpayment. This would normally occur when a client makes a cash payment and chooses not to repay through grant reduction.

Waiver (of Adjustment or Recovery)

Relief from the obligation of the overpaid person and eligible spouse (and the person’s estate after his or her death) to repay the amount of the overpayment covered by the waiver.

Without Fault

The absence of fault in connection with causing or accepting the overpayment. The overpaid individual may still be at fault, even if the county or the State may have been solely at fault in causing the overpayment.