us-il/manual/dhs/csmm

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us-il/manual/dhs/csmm — Axiom

(12256)PM I-01-01: Manual Organization#

(12256)(block-1)PM I-01-01: Manual Organization#

This manual consists of the Policy Manual (PM) and Workers' Action Guide (WAG). The PM (yellow pages) describes policy; the WAG (white pages) contains the procedures by which the policy is implemented.

The PM and the WAG have a parallel organization. They are divided into chapters , which cover the same subjects. For example , Chapter 01 of both the PM and the WAG covers Rights and Responsibilities; Chapter 02 of both PM and WAG covers Initial Request for Benefits, and so on.

A chapter is designated by a 2-digit number. The PM contains this Introduction and Chapters 01 through 24. The WAG contains the same chapters 01 through 24, plus:

Chapter 25, Manual Attachments . Program standards and benefit amounts; the policy development process; procedures for requesting policy clarifications; directions for use of the online manual, and other reference information.

Chapter 26, Document Handbook. Procedures for completion of various payment and authorization documents and notices of decision.

Chapter 27, Authorization of Assistance Action (Form 552) . The "green pages." Instructions for completion of the Form 552, the basic authorization and payment document for all assistance cases.

Chapter 28, Other Department Activities . Includes descriptions of the responsibilities of the Local Warrant Unit, Warrant Control Unit, and Financial Unit.

The WAG also includes the Abbreviations & Acronyms section, the Glossary, and the Index.

Each chapter is divided into sections . A section is designated by a 2-digit number following the chapter number. For example , PM 07-01-00 is section 01 of chapter 07 of the Policy Manual; WAG 03-14-00 is section 14 of chapter 03 of the Workers' Action Guide.

Sections in the PM are identical to sections in the WAG.

A section may contain one or more topics , which are designated by a third 2-digit number. A topic may contain one or more subtopics , designated by a lower-case letter. For example:

PM 07-01-04 - Chapter 07, section 01, topic 04 in the Policy Manual.

WAG 03-14-03-c - Chapter 03, section 14, topic 03, subtopic c in the Workers' Action Guide.

All topics and subtopics in the PM also appear in the WAG; in the online manual, each topic and subtopic in the PM is linked to the corresponding item in the WAG, and vice versa . Because the WAG contains detailed procedures, some WAG sections contain additional topics or subtopics not found in the PM.

(12259)PM I-01-02: Programs#

(12259)(block-1)PM I-01-02: Programs#

The Illinois Department of Human Services (IDHS) administers Cash and/or Food Assistance (SNAP/State Food) programs. Medical coverage is provided by the Illinois Department of Healthcare and Family Services (IDHFS) to people who qualify.

The programs, based on federal and state laws and court rulings, are: Temporary Assistance for Needy Families (TANF), Aid to the Aged, Blind or Disabled (AABD), Refugee and Repatriate Assistance (RRA), ACA Adult, Medical Assistance, Supplemental Nutrition Assistance Program (SNAP), State-Funded Food, and State-Funded Cash.

Note : Certain individuals who do not qualify for federal programs due to not meeting citizenship requirements may have their eligibility determined for state cash, medical and/or food assistance programs.

(12259)(block-2)Choosing a Program and Services#

A customer may choose to accept or reject any program benefit and/or services offered, even if they qualify for the benefit.

An application may be filed by completing and signing a paper application form; or an electronic application submitted through the ABE system; or a telephonic application completed over the phone by calling the ABE Customer Call Center.

When completing the application, the customer: Indicates the program request for each household member who is applying for benefits by choosing (Yes) or (No) to each program: Medical Assistance, Cash Assistance, Family Planning and/or SNAP.

For any program that is marked (Yes), the individual must meet the eligibility factors for the program and cooperate with the program requirements to qualify for the benefits.

A paper application is accepted and must be registered if: The customer completes and submits a version that does not have the updated (Yes) or (No) option; or It only contains a name, address and signature and other sections are incomplete. If received with just a name, address and signature, the application is registered for all programs (Cash, Medical and SNAP). See PM 02-04-04 , WAG 02-04-04). The customer submits an application and only selects (Yes) to one program. For example, if SNAP is (Yes) but the customer does not indicate a (Yes) or (No) for medical and/or cash. The application will be registered for all programs; or If medical is the only program selection, the application is registered for medical benefits only. This includes applications marked with a (Yes) or (No) response to a program request to indicate whether a person is applying for the benefit. This may be a hospital application, an application for long-term care, a short spenddown application, or a QMB or SLIB application or an MSP application. If additional information is needed, a Verification Checklist is sent to the customer requesting the information needed to process the medical only application. If the customer does not respond or there is an inadequate response, the application is denied; or If submitted without a program choice, but other sections of the application are completed and there is a name, address and signature, the application is registered for all programs.

If submitted without a (Yes) or (No) indicated for a program, the customer's request for benefits will be confirmed at the interview and the appropriate action will be taken to determine if all requested programs have been registered and all individuals requesting the programs have been added to the request. Other program requests may be added, if necessary. The customer's decision on benefit choices, including the decision to decline a benefit, even if eligible and all case actions taken by the FCRC are required to be documented.

(12259)(block-3)Interviews#

An interview is required for SNAP and/or Cash programs.

For Medical programs, an interview is not required. If medical is the only program selection, the application is registered for medical benefits only. If additional information is needed, issue a Verification Checklist requesting the information needed to process the medical only application. If there is no response or there is an inadequate response, the application is denied.

(12259)(block-4)Receiving Benefits on Different Cases#

A person can receive SNAP in one case and cash in another, or SNAP in one case and Medical in another. But there are only 2 situations when a person can be in more than one cash or medical case. Situation 1: A child who lives in Illinois and receives foster care/adoption cash benefits from another state can receive medical coverage from IDHFS. Situation 2: Someone who becomes an Illinois resident, and who receives cash or medical from another state, may also qualify for IDHS Cash Assistance or IDHFS Medical Assistance. If the cash they receive from the other state is at least $10.00 less than what IDHS pays, they can get a check from IDHS to make up the difference. If the other state won't pay for medical bills incurred in Illinois before their case is canceled, then IDHFS can provide medical coverage.

A person who receives TANF, AABD, RRA, or Medicare cannot receive ACA Adult.

A person who qualifies for both TANF and SSI cannot receive both. But a parent can receive one of the benefits for themselves and the other as a representative payee for a child.

A child cannot receive both Foster Care and TANF at the same time. If a child is eligible for both Foster Care and TANF, the caretaker relative must choose which program the child will receive benefits from. The Illinois Department of Children and Family Services (IDCFS) makes cash payments for children who receive Foster Care. The Family Health Plan programs provide medical coverage.

(12262)PM I-02-02: Aid to the Aged, Blind, or Disabled (AABD)#

(12262)(block-1)PM I-02-02: Aid to the Aged, Blind, or Disabled (AABD)#

AABD is a program for individuals. The AABD cash program provides money to people who qualify. The program is based on Federal guidelines. A person must prove they qualify and cooperate with program requirements.

An AABD cash person receives a MediPlan card for help with their medical needs. When they need medical service they show the MediPlan Card to the doctor, hospital, drug store, clinic, etc. A medical provider who is approved to participate in the medical program has agreed to accept payment from DPA and send the bill to DPA.

AABD(A) helps people who are at least age 65. The category designator for these cases is 01.

AABD(B) helps people who have been found blind, as defined by the Social Security Administration (SSA). The category designator for these cases is 02.

AABD(D) helps people who have been found disabled, as defined by the Social Security Administration (SSA). The category designator for these cases is 03.

A person who is financially eligible can receive AABD when they are denied SSI because of income and are at least 65 years of age or have been found blind or disabled by our Department.

AABD cash is for:

A person who received AABD cash from the State on December 31, 1973. These cases are called "grandfathered" AABD cases. The Federal cash program, Supplemental Security Income (SSI), took these cases over on January 1, 1974. "Grandfathered" people may or may not receive SSI. DHS gives them cash under the AABD program to supplement their income.

A person who meets the Social Security Administration's definition of aged, blind, or disabled. The person must be receiving SSI or have been denied SSI due to income. If they were denied SSI due to income, they must be found blind or disabled by DHS. If they don't receive enough income to meet basic needs, DHS gives them AABD cash.

A person who is a noncitizen, age 65 or older, who meets the citizenship/immigration requirements for medical assistance and was legally residing in the U.S. on 08/22/96, and who has been denied SSI due to a finding of "not disabled." If they don't receive enough income to meet basic needs, DHS gives them AABD cash.

(12277)PM I-03-00: Medical Programs#

(12277)(block-1)PM I-03-00: Medical Programs#

Medical programs include Family Health Plans (FHP), Affordable Care Act (ACA) Adults, Aid to the Aged, Blind or Disabled (AABD), Health Benefits for Persons with Disabilities (HBWD), Health Benefits for Persons with Breast or Cervical Cancer (BCC), Former Foster Care, Veterans Care (VC), Medical Benefits for Asylum Applicants and Torture Victims (AATV), Health Benefits for Immigrant Seniors (HBIS), Victims of Trafficking, Torture or Other Serious Crimes (VTTC) and Medicare Savings Programs (MSP). There are several FHP programs, i.e., Family Assist, All Kids/FamilyCare Assist, Moms & Babies and Family Health Spenddown.

Persons who qualify for TANF or AABD cash automatically qualify for medical benefits.

Persons on most HFS medical programs receive an HFS medical card. The HFS medical card lists each eligible person. When someone needs medical service, they show the medical card to the doctor, hospital, drug store, clinic, etc. A medical provider who is approved to participate in the medical program has agreed to accept payment from HFS and send the bill to HFS.

(12277)(block-2)Medical Programs#

Financial eligibility and the applicable income limits are linked for each of the medical programs listed below. See WAG 25-03-02 for a chart showing the monthly income limits based on the current federal poverty level (FPL) for medical programs. Unless otherwise noted, the income limits for the medical programs increase every year if the federal poverty level increases. When the federal poverty level increases, the eligibility system is updated each year in the spring with the new income limits which are retroactive to the first of the year.

(12277)(block-3)Family Health Plans#

Family Assist : medical benefits for families whose income is at or below the TANF Cash Payment Level. Once the family's income rises above the Family Assist income limit, the family unit may be eligible for up to a year of extended medical coverage. The Family Assist income limit is in WAG 25-03-02(2). Because the income limit is the same as the TANF Cash Payment Level, the income limit does not change annually.

All Kids Assist: medical benefits for children under age 19 whose income is above the Family Assist income limit, but equal to or less than 318% of the FPL. Children are guaranteed financial eligibility for 12 continuous months of medical coverage, dating from the last eligibility determination. The All Kids Assist income limit is in WAG 25-03-02(2).

FamilyCare Assist: medical benefits for the parent or caretaker relative (and their spouse) of dependent children under age 18, with countable income greater than the Family Assist limit, but equal to or less than 138% of the FPL. The FamilyCare Assist income limit is in WAG 25-03-02(2) .

Moms & Babies: medical benefits for pregnant women and infants under 12 months of age who are born to eligible women whose income is above the Family Assist limit, but equal to or less than 213% of the FPL. This program covers both inpatient and outpatient health care for women while they are pregnant and for the postpartum period regardless of changes in income. The Moms & Babies income limit is in WAG 25-03-02(2) .

Family Health Spenddown: medical benefits for children with income above the All Kids Assist limit and pregnant women with income above the Moms & Babies limit. A benefit unit must incur medical expenses that equal or exceed the monthly spenddown amount before medical coverage is provided for a month. The spenddown amount is the difference between a benefit unit's countable income and the Family Health Spenddown standard. The income limit for Family Health Spenddown is in PM 15-06-01-e . The income limit does not change annually.

Medicaid Presumptive Eligibility (MPE): offers immediate, temporary coverage for outpatient health care for pregnant women. If eligible, MPE covers the customer for pregnancy care starting on the date of application until the Moms & Babies application is approved. MPE eligibility is determined by an MPE provider. The income limit for MPE is in WAG 25-03-02(2) .

(12277)(block-4)ACA Adults#

A person aged 19-64 who does not qualify for FHPs or Former Foster Care, and who has countable income equal to or less than 138% of the FPL. A person who is blind or has a disability and does not have Medicare may qualify for the ACA Adult program whether living in the community or in a long-term care facility. The income limit for ACA Adult is in WAG 25-03-02(2) .

(12277)(block-5)AABD Medical#

A person who is aged (at least 65 years old) or blind or has a disability may qualify for AABD Medical whether living in the community or in a long-term care facility. A person with countable income and resources that are equal to or less than the AABD Medical income limit and AABD Medical resource limit may qualify for AABD Medical benefits without a spenddown obligation. The AABD community income limit is in WAG 25-03-02(2) . The AABD income limit for residents of long-term care facilities is in PM 15-06-02-b .

(12277)(block-6)DCFS Related#

Medical benefits are also provided to the following groups:

Foster care/adoption care children from other states who live in Illinois and qualify for the All Kids Assist program. FCRCs do not handle these cases. The Bureau of Local Office Transaction and Support Service, Springfield, approves and maintains them.

Foster care/Kinship Guardianship Assistance Program (KinGap)/subsidized adoption assistance cases administered by DCFS.

The child of a youth in foster care through DCFS is eligible for Medicaid as a 'child of ward' (newborn up to age one) based on the mother's receipt of Medicaid through DCFS.

(12277)(block-7)Former Foster Care#

Medical coverage is provided to persons aged 19 through 25 under the Former Foster Care program. Eligible individuals must have received foster care services through the Illinois Department of Children and Family Services (DCFS) and lost related Medicaid coverage when they aged out of the foster care program at age 18 or older. There is no income or resource test for these individuals.

(12277)(block-8)Health Benefits for Persons with Breast or Cervical Cancer (BCC)#

A person who needs treatment for breast or cervical cancer or a precancerous condition receives benefits through the Health Benefits for Persons with Breast or Cervical Cancer (BCC) program administered by the central BCC Unit. There is no income limit or resource test for BCC.

(12277)(block-9)Health Benefits for Workers with Disabilities (HBWD)#

A person who meets the SSA definition of disabled and is employed receives benefits through the Health Benefits for Workers with Disabilities (HBWD) program administered by the central HBWD Unit. The income limit for HBWD is in WAG 25-03-02(2) . The resource limit for HBWD is in WAG 06-24-05 .

(12277)(block-10)Medical Benefits for Asylum Applicants and Torture Victims (AATV)#

A person who has an application for asylum pending with the U.S. Bureau of Citizenship and Immigration Services (BCIS), or who receives services from a federally funded torture treatment center may receive benefits through the Medical Benefits for Asylum Applicants and Torture Victims program. The income and resource limits for AATV is in PM 06-21-01 .

(12277)(block-11)Medical Benefits for Noncitizen Victims of Trafficking, Torture or Other Serious Crimes (VTTC)#

A noncitizen victim of trafficking, torture, or other serious crimes, and their derivative family members, may receive medical benefits if they have applied for "T" Non-immigrant status, "U" Non-immigrant status, or Asylum status, or are preparing to file an application with the U.S. Citizenship and Immigration Services (USCIS) for such status. Financial and non-financial criteria for the VTTC program are in PM 06-30 .

(12277)(block-12)Health Benefits for Immigrant Adults (HBIA)#

Health Benefits for Immigrant Adults (HBIA) is for noncitizens ages 42 through 64. Eligibility is determined by using Modified Adjusted Gross Income (MAGI) budgeting for individuals who do not meet citizen requirements and are ineligible for Federal Medicaid. (See PM 06-35-00 Health Benefits for Immigrant Adults (HBIA) ).

Note: NEW Enrollment in the Health Benefits for Immigrant Adults (HBIA) program was paused effective July 1, 2023.

Program Obsoleted July 1, 2025 .

(12277)(block-13)Health Benefits for Immigrant Seniors (HBIS)#

Health Benefits for Immigrant Seniors (HBIS) is for noncitizens aged 65 years of age and older. This program follows the current AABD community eligibility criteria, for individuals who do not meet citizen requirements and are ineligible for Federal Medicaid. (See PM 06-26-00 Health Benefits for Immigrant Seniors (HBIS) ).

Note : NEW Enrollment in the Health Benefits for Immigrant Seniors (HBIS) program was paused effective end of day November 6, 2023.

(12277)(block-14)Medicare Savings Program#

Persons enrolled in Medicare Part A (hospital insurance), or Parts A and B (supplementary medical insurance) may qualify for help with Medicare premiums, coinsurance and deductibles. The amount of help available depends on the level of household income.

Qualified Medicare Beneficiary (QMB)-Coverage includes coinsurance, deductibles and payment of Medicare Part A premiums (if any) and Medicare Part B premiums. The income limit for QMB is in WAG 25-03-02-(2). The resource limit for QMB is in PM 06-12-01-a .

Specified Low Income Beneficiary (SLIB)-includes payment of Medicare Part B premiums. The income limit for SLIB is in WAG 25-03-02(2). The resource limit for SLIB is in PM 06-13-01-a .

Qualified Individual-1 (QI-1)-includes payment of Medicare Part B premiums. The income limit for QI-1 is in WAG 25-03-02(2). The resource limit for QI-1 is in PM 06-14-01-a .

(12277)(block-15)Incarcerated Individuals#

A person who applied for help and was determined eligible before being arrested and jailed by a peace officer from a county or unit of local government qualifies, even if they didn't get help before they were jailed. This special coverage pays for qualifying medical bills over the first $500.

A person who is incarcerated in an Illinois Department of Corrections (IDOC) facility may apply for medical coverage in advance of their release date. A person may also qualify for medical coverage while in an IDOC facility if they receive inpatient hospital services during their incarceration. The income limit depends on the type of medical coverage for which they qualify.

(12277)(block-16)Veterans Care (VC)#

A person who is an uninsured veteran and does not qualify under any other program listed here may receive benefits under the Veterans Care program administered by the central Veterans Care Unit.

Note : as of March 2016, new applications for Veterans Care are no longer being accepted due to lack of funding.

(12299)PM 01: Rights and Responsibilities#

(12299)(block-1)PM 01: Rights and Responsibilities#

WAG 01

PM 01-01-00: Information for Clients and the Public – 03/01/97 PM 01-01-01: Nondiscrimination – 10/01/09 MR 9.30 PM 01-01-02: Information and Referrals – 10/01/09 MR 09.30 PM 01-01-03: Freedom of Choice – 04/17/2025 MR #25.17 PM 01-01-04: Giving Out Customer Information – 04/03/19 MR #19.06 PM 01-01-04-a: Use of Case Records – 07/01/13 MR 13.16 PM 01-01-04-b: Special Conditions – 10/01/09 MR 09.30 PM 01-01-04-c Confidentiality of Earnings Records – 03/10/17 MR 17.06 PM 01-01-04-d: Viewing Case Records – 10/14/10 MR 10.28 PM 01-01-04-e: Cost to Copy Case Material – 06/08/17 MR 17.10 PM 01-01-05: Assisting Clients and the Public – 03/01/97 PM 01-01-06: Client Grievance Process – 03/01/97 PM 01-01-06-a: Filing a Grievance – 03/01/97 PM 01-01-06-b: Accepting the Grievance – 03/01/97 PM 01-01-06-c: Mediator – 03/01/97 PM 01-01-06-d: Mediator Actions – 03/01/97 PM 01-01-06-e: Action Against a Client – 03/01/97 PM 01-01-07: Voluntary Repayment of Benefits – 03/01/97

PM 01-02-00: Client Cooperation (Cash, Medical) – 12/27/17 MR 17.20 PM 01-02-01: General Cooperation – 12/27/17 MR 17.20 PM 01-02-01-a: Special Cooperation Requirements for Long Term Care – 07/01/12 MR 12.18 PM 01-02-02: Reporting Changes – 04/18/2024 #MR 24.12 PM 01-02-02-a: Cash and Medical Programs – 07/11/17 MR 17.12 PM 01-02-03: Using Available Benefits – 04/08/2025 MR #25.13 PM 01-02-03-a: Applying for Unemployment Insurance (TANF) – 07/01/97 PM 01-02-03-b: Applying for Unemployment Insurance (Assist) – 04/08/2025 MR #25.13 PM 01-02-04: Benefits Under More than One Program – 07/01/13 MR 13.16 PM 01-02-05: Referral for Rehabilitative Services (TANF) – 07/01/97 PM 01-02-06: Work Requirement (TANF) – 07/08/15 MR 15.17

PM 01-03-00: Client Cooperation (SNAP) – 10/01/09 MR 09.30 PM 01-03-01: Cooperating at Application – 10/01/09 MR 09.30 PM 01-03-01-a: Failure to Cooperate – 10/01/09 MR 09.30 PM 01-03-01-b: Refusal to Cooperate – 10/01/09 MR 09.30 PM 01-03-02: Reporting Changes – 07/11/2022 MR #22.12 PM 01-03-03: Cooperation by Active SNAP Units – 10/01/09 MR 09.30 PM 01-03-03-a: Failure to Cooperate – 10/01/09 MR 09.30 PM 01-03-03-b: Refusal to Cooperate – 10/01/09 MR 09.30

PM 01-04-00: Case Records – 03/01/97

PM 01-05-00: Reporting Abuse and Neglect – 09/01/03 PM 01-05-01: Suspected Child Abuse or Neglect – 01/05/2023 MR 23.03 PM 01-05-01-a: Child Abuse and Neglect Defined – 03/01/97 PM 01-05-01-b: Investigation by DCFS – 03/01/97 PM 01-05-01-c: Death of a Child – 01/05/2023 MR 23.03 PM 01-05-01-d: Unfit Home – 03/01/97 PM 01-05-02: Suspected Abuse and Neglect - LTC/SLF – 10/01/02 PM 01-05-02-a: Abuse and Neglect Defined – 04/17/98 PM 01-05-02-b: Investigation by DPH/HFS – 04/17/98 PM 01-05-03: Suspected Elder Abuse and Neglect - Community Cases – 12/17/99 PM 01-05-03-a: Elder Abuse and Neglect Defined – 01/01/07 MR 06.20 PM 01-05-03-b: Reporting Elder Abuse – 12/17/99 PM 01-05-03-c: DoA Investigation – 12/17/99 PM 01-05-03-d: Protection for Persons Reporting Elder Abuse – 12/17/99 PM 01-05-04: Suspected Abuse and Neglect of Disabled Adults (Age 18-59) – 09/01/03 PM 01-05-04-a:Abuse and Neglect of Disabled Adults Defined – 09/01/03 PM 01-05-04-b: Reporting Abuse and Neglect of Disabled Adults – 09/01/03 PM 01-05-04-c: OIG Investigation – 09/01/03 PM 01-05-04-d: Protection for Reporters – 09/01/03

PM 01-06-00: Customer Notices – 08/02/17 MR 17.13 PM 01-06-01: When to Give Written Notices – 07/31/18 MR #18.14 PM 01-06-01-a: What All Notices Should Contain – 03/01/97 PM 01-06-02: Notice of Approval or Denial – 07/01/12 MR 12.18 PM 01-06-03: Notices of Change – 07/11/17 MR 17.12 PM 01-06-04: Notice of Change Not Sent (SNAP) – 10/01/09 MR 09.30 PM 01-06-05: Notice of Overpayment – 03/01/00 PM 01-06-06: Notice of Missed Interview (SNAP) – 09/22/16 MR 16.15

PM 01-07-00: Appeal Rights and Fair Hearings – 05/01/02 PM 01-07-01: What May Be Appealed – 06/01/01 PM 01-07-02: How an Appeal May Be Filed – 08/24/18 MR #18.15 PM 01-07-03: Time Period to File Appeal – 08/27/2024 MR #24.17 PM 01-07-04: Continuing Benefits at the Previous Level – 10/31/2023 MR #23.31 PM 01-07-04-a: Date of Change – 10/01/09 MR 09.30 PM 01-07-04-b: Effect of Continuing Benefits – 10/01/09 MR 09.30 PM 01-07-04-c: Spenddown and SNAP Appeals – 10/01/09 MR 09.30 PM 01-07-04-d: Protective Payment Plan Appeals – 02/23/99 PM 01-07-05: Who to Notify of an Appeal – 10/20/99 PM 01-07-05-a: Appeals Involving DCSE – 02/23/99 PM 01-07-05-b: Appeal of Denial of Dental Services – 12/01/09 MR 10.09 PM 01-07-06: Pre-Hearing Review – 12/01/09 MR 10.09 PM 01-07-07: Pre-Hearing Meeting – 01/23/12 MR 12.01 PM 01-07-07-a: Statement of Facts – 10/01/09 MR 09.30 PM 01-07-07-b: Appeal of Determination of "Not Disabled" – 02/23/99 PM 01-07-07-c: Appeal of Decision on Request for Prior Approval – 06/01/01 PM 01-07-07-d: Appeal of Decision to Restrict Person to Primary Care Provider – 02/23/99 PM 01-07-07-e: Appeal of IOC Review Decision – 06/01/01 PM 01-07-07-f: Appeal of Lien on Real Property – 02/23/99 PM 01-07-07-g: Appeal of Decision of Ineligible to Participate in HIPP – 06/01/01 PM 01-07-07-h: Appeal of Decision that Health Plan Is No Longer Cost-Effective – 06/01/01 PM 01-07-07-i: Appeal of Child Care Decision – 10/20/99 PM 01-07-08: Evidence Considered Upon Appeal – 10/01/09 MR 09.30 PM 01-07-09: Withdrawing an Appeal – 02/23/99 PM 01-07-10: Appeal Hearing – 01/23/12 MR 12.01 PM 01-07-10-a: Hearing Process – 01/23/12 PM 01-07-10-b: Arrangements for Persons with Disabilities – 10/20/99 PM 01-07-10-c: Request for Hearing Delay – 10/01/09 MR 09.30 PM 01-07-10-d: Dismissal Due to Nonappearance – 06/01/01 PM 01-07-10-e: Rescheduled Hearing – 06/01/01 PM 01-07-10-f: CAU Findings – 02/23/99 PM 01-07-11: Final Hearing Decision – 10/01/09 MR 09.30 PM 01-07-11-a: Action Upheld – 10/01/09 MR 09.30 PM 01-07-11-b: Action Not Upheld – 10/20/99 PM 01-07-11-c: Lack of Jurisdiction – 02/23/99 PM 01-07-12: Authorizing Benefits Due to Hearing Decision – 02/23/99 PM 01-07-12-a: Cash Benefits – 10/20/99 PM 01-07-12-b: Medical Benefits – 02/23/99 PM 01-07-12-c: SNAP – 10/01/09 MR 09.30 PM 01-07-13: Payment of Child Care Related to Appeal (Cash) – 07/01/13 MR 13.16 PM 01-07-14: Reviewing Hearing Report – 10/20/99

PM 01-08-00: Hardship Waiver – 03/29/19 MR 19.04 PM 01-08-01: Penalty Period Due to Non-allowable Transfer – 07/01/12 MR 12.18 PM 01-08-02: Denial Due to Excess Home Equity – 03/29/19 MR 19.04

(12300)WAG 01: Rights and Responsibilities#

(12300)(block-1)WAG 01: Rights and Responsibilities#

PM 01

WAG 01-01-00: Information for Clients and the Public – 10/01/09 MR 09.30 WAG 01-01-01: Nondiscrimination – 03/01/97 WAG 01-01-01-a: Complaints of Alleged Discrimination – 10/01/09 MR 09.30 WAG 01-01-02: Information and Referrals – 10/01/09 MR 09.30 WAG 01-01-03: Freedom of Choice – 04/17/2025 MR #25.17 WAG 01-01-04: Giving Out Customer Information – 04/03/19 MR 19.06 WAG 01-01-04-a: Use of Case Records – 07/01/13 MR 13.16 WAG 01-01-04-b: Special Conditions – 10/01/09 MR 09.30 WAG 01-01-04-c: Confidentiality of Earnings Records – 03/10/17 MR 17.06 WAG 01-01-04-d: Viewing Case Records WAG 01-01-04-e: Cost to Copy Case Material – 06/08/17 MR 17.10 WAG 01-01-05: Assisting Clients and the Public – 03/01/97 WAG 01-01-05-a: Assisting Homebound Persons – 10/01/09 MR 09.30 WAG 01-01-06: Client Grievance Process – 03/01/97 WAG 01-01-06-a: Filing a Grievance – 03/01/97 WAG 01-01-06-b: Accepting the Grievance – 03/01/97 WAG 01-01-06-c: Mediator – 03/01/97 WAG 01-01-06-d: Mediator Actions – 03/01/97 WAG 01-01-06-e: Action Against a Client – 03/01/97 WAG 01-01-07: Voluntary Repayment of Benefits – 03/01/97 WAG 01-01-07-a: Partial Repayment of Cash or Medical Benefits – 11/22/13 MR 13.25 WAG 01-01-07-b: Total Repayment of Cash or Medical Benefits – 03/01/97 WAG 01-01-08: Benefit Checks Received in the Local Office – 03/01/97

WAG 01-02-00: Client Cooperation (Cash, Medical) – 03/01/97 WAG 01-02-01: General Cooperation – 03/29/12 MR 12.08 WAG 01-02-01-a: Special Cooperation Requirements for Long Term Care – 07/01/12 MR 12.18 WAG 01-02-02: Reporting Changes – 03/01/97 WAG 01-02-02-a: Cash and Medical Programs – 07/01/97 WAG 01-02-03: Using Available Benefits – 03/01/97 WAG 01-02-03-a: Applying for Unemployment Insurance (TANF) – 07/01/97 WAG 01-02-03-b: Applying for Unemployment Insurance (Assist) – 01/01/03 WAG 01-02-04: Benefits Under More than One Program – 03/01/97 WAG 01-02-05: Referral for Rehabilitative Services (TANF) – 07/01/97 WAG 01-02-06: Work Requirement (TANF) – 07/01/13 MR 13.16

WAG 01-03-00: Client Cooperation (SNAP) – 10/01/09 MR 09.30 WAG 01-03-01: Cooperating at Application – 03/01/97 WAG 01-03-01-a: Failure to Cooperate – 03/01/97 WAG 01-03-01-b: Refusal to Cooperate – 03/01/97 WAG 01-03-02: Reporting Changes – 07/11/2022 MR #22.12 WAG 01-03-03: Cooperation by Active SNAP Units – 10/01/09 MR 09.30 WAG 01-03-03-a: Failure to Cooperate – 03/01/97 WAG 01-03-03-b: Refusal to Cooperate – 03/01/97

WAG 01-04-00: Case Records – 03/01/97 WAG 01-04-01: Organization of Case Record (TANF, AABD, SNAP) – 10/01/09 MR 09.30 WAG 01-04-01-a: Denied Application – 03/01/97 WAG 01-04-01-b: Approved Application – 10/01/09 MR 09.30 WAG 01-04-02: Reserved – 01/01/05 WAG 01-04-03: Recording – 07/19/12 MR 12.20

WAG 01-05-00: Reporting Abuse and Neglect – 03/01/97 WAG 01-05-01: Suspected Child Abuse and Neglect – 01/05/2023 MR 23.03 WAG 01-05-01-a: Child Abuse and Neglect Defined – 03/01/97 WAG 01-05-01-b: Investigation by DCFS – 03/01/97 WAG 01-05-01-c: Death of a Child – 03/01/97 WAG 01-05-01-d: Unfit Home – 03/01/97 WAG 01-05-02: Suspected Abuse and Neglect - LTC/SLF – 10/01/02 WAG 01-05-02-a: Abuse and Neglect Defined – 04/17/98 WAG 01-05-02-b: Investigation by DPH/HFS – 04/17/98 WAG 01-05-03: Suspected Elder Abuse and Neglect - Community Cases – 12/17/99 WAG 01-05-03-a: Elder Abuse Defined – 12/17/99 WAG 01-05-03-b: Reporting Elder Abuse – 12/17/99 WAG 01-05-03-c: DoA Investigation – 12/17/99 WAG 01-05-03-d: Protection for Persons Reporting Elder Abuse – 12/17/99 WAG 01-05-04: Suspected Abuse and Neglect of Disabled Adults (Age 18-59) – 09/01/03 WAG 01-05-04-a: Abuse and Neglect of Disabled Adults Defined – 09/01/03 WAG 01-05-04-b: Reporting Abuse and Neglect of Disabled Adults – 09/01/03 WAG 01-05-04-c: OIG Investigation – 09/01/03 WAG 01-05-04-d: Protection for Reporters – 09/01/03

WAG 01-06-00: Client Notices – 03/01/97 WAG 01-06-01: When to Give Written Notices – 01/01/04 WAG 01-06-01-a: What All Notices Should Contain – 03/01/97 WAG 01-06-01-b: Date of Change – 03/01/97 WAG 01-06-01-c: Date of Notice – 03/01/97 WAG 01-06-01-d: Electronic Notices, Email and Mobile Phone Text Alerts – 08/02/17 MR# 17.13 WAG 01-06-02: Notice of Approval or Denial – 03/01/97 WAG 01-06-02-a: Cash Benefits – 01/26/2023 MR #23.05 WAG 01-06-02-b: Medical – 09/22/16 MR 16.15 WAG 01-06-02-c: Special Requests – 09/22/16 MR 16.15 WAG 01-06-02-d: SNAP – 09/22/16 MR 16.15 WAG 01-06-03: Notices of Changes – 09/22/16 MR 16.15 WAG 01-06-04: Notice of Change Not Sent (SNAP) – 09/22/16 MR 16.15 WAG 01-06-05: Notice of Overpayment – 09/22/16 MR 16.15 WAG 01-06-06: Notice of Missed Interview (SNAP) – 09/22/16 MR 16.15 WAG 01-06-07: Processing SNAP and TANF REDEs – 09/22/16 MR 16.15 WAG 01-06-08: Notices - Case Record Maintenance – 09/22/16 MR 16.15 WAG 01-06-09 Correspondence Module in IES – 09/22/16 MR 16.15

WAG 01-07-00: Appeal Rights and Fair Hearings – 06/01/01 WAG 01-07-01: What May Be Appealed – 03/01/97 WAG 01-07-02: How an Appeal May Be Filed – 07/15/25 MR #25.25 WAG 01-07-03: Time Period to File Appeal – 02/23/99 WAG 01-07-04: Continuing Benefits at the Previous Level – 02/23/99 WAG 01-07-04-a: Date of Change – 02/23/99 WAG 01-07-04-b: Effect of Continuing Benefits – 02/23/99 WAG 01-07-04-c: Spenddown and SNAP Appeals – 10/01/09 MR 09.30 WAG 01-07-04-d: Protective Payment Plan Appeals – 02/23/99 WAG 01-07-05: Who to Notify of an Appeal – 06/01/01 WAG 01-07-05-a: Appeals Involving DCSE – 02/23/99 WAG 01-07-05-b: Appeal of Denial of Dental Services – 12/01/09 MR 10.09 WAG 01-07-06: Pre-Hearing Review – 01/23/12 MR 12.01 WAG 01-07-07: Pre-Hearing Meeting – 01/23/12 MR 12.01 WAG 01-01-07-d: Appeal of Decision to Restrict Person to Primary Care Provider – 06/01/01 WAG 01-07-07-a: Statement of Facts – 02/23/99 WAG 01-07-07-b: Appeal of "Not Disabled" Determination – 07/18/07 MR 10.05 WAG 01-07-07-c: Appeal of Decision on Request for Prior Approval – 06/01/01 WAG 01-07-07-e: Appeal of IOC Review Decision – 06/01/01 WAG 01-07-07-f: Appeal of Lien on Real Property – 06/01/01 WAG 01-07-07-g: Appeal of Decision of Ineligible to Participate in HIPP – 06/01/01 WAG 01-07-07-h: Appeal of Decision that Health Plan No Longer Cost-Effective – 06/01/01 WAG 01-07-07-i: Appeal of Child Care Decision – 06/01/01 WAG 01-07-08: Evidence Considered Upon Appeal – 10/01/09 MR 09.30 WAG 01-07-09: Withdrawing an Appeal – 05/10/13 MR 13.12 WAG 01-07-10: Appeal Hearing – 10/20/99 WAG 01-07-10-a: Hearing Process – 04/09/19 MR #19.07 WAG 01-07-10-b: Arrangements for Persons with Disabilities – 02/23/99 WAG 01-07-10-c: Request for Hearing Delay – 10/20/99 WAG 01-07-10-d: Dismissal Due to Nonappearance – 10/20/99 WAG 01-07-10-e: Rescheduled Hearing – 10/20/99 WAG 01-07-10-f: CAU Findings – 02/23/99 WAG 01-07-11: Final Hearing Decision – 06/01/01 WAG 01-07-11-a: Action Upheld – 07/01/13 MR 13.16 WAG 01-07-11-b: Action Not Upheld – 07/01/13 MR 13.16 WAG 01-07-11-c: Lack of Jurisdiction – 02/23/99 WAG 01-07-12: Authorizing Benefits Due to Hearing Decision – 02/23/99 WAG 01-07-12-a: Cash Benefits – 07/01/13 MR 13.16 WAG 01-07-12-b: Medical Benefits – 02/23/99 WAG 01-07-12-c: SNAP – 09/17/12 MR 12.23 WAG 01-07-13: Payment of Child Care Related to Appeal (Cash) – 02/23/99 WAG 01-07-14: Reviewing Hearing Report – 10/20/99

WAG 01-08-00: Hardship Waiver – 03/29/19 MR 19.04 WAG 01-08-01: Penalty Period Due to Non-allowable Transfer – 02/06/14 MR 14.05 WAG 01-08-02: Denial Due to Excess Home Equity – 02/06/14 MR 14.05

(12305)PM 01-01-01: Nondiscrimination#

(12305)(block-1)PM 01-01-01: Nondiscrimination#

WAG 01-01-01

Consistent with the Public Aid Code, DHS does not discriminate against a person because of:

Race

Color

Religious faith

Political beliefs

Sex

Protected age group

Disability

National Origin

Give information on our nondiscrimination policy to:

clients or anyone who applies for benefits; or

any group or persons wanting to do business with DHS; or

anyone who asks about our programs or policies.

When a person applies, or when requested, explain the nondiscrimination policy to them. A person or family meeting our program rules has the right to receive benefits from us.

Staff should be careful not to intimidate or discourage anyone - citizen or noncitizen - from applying for benefits for themselves or their family members.

Nondiscrimination rules that apply to vendors receiving direct payment from the Department are contained on all direct billing payment forms. The vendor implies compliance with the Department's nondiscrimination rules when they sign the direct billing form.

Any person who believes they have been discriminated against by DHS, its employees, or any group, vendor, or person acting on behalf of DHS, may file a complaint. The complaint may be filed by a client, an applicant, a client/applicant representative, or a DHS employee. It must be filed within 180 days of the alleged discriminatory act.

A written complaint may be sent to:

Equal Employment Opportunity (EEO) Office, Department of Human Services; or

Illinois Department of Civil Rights; or

Family Community Resource Center Administrator (LOA) of the office serving that area.

In addition, SNAP clients can file a complaint with the United States Department of Agriculture (USDA). The 180-day time period for filing may be extended by USDA.

(12305)(block-2)Investigation#

The EEO investigates complaints of alleged discrimination received by DHS, and notifies the complainant of the results of the investigation.

The complainant has the right to:

present evidence, including documents and witnesses prior to the decision;

have representation;

have an impartial decision maker;

appeal the decision to a higher level;

receive a written response; and

have the complaint resolved within the established timeframes (180 days, unless an extension is needed).

The complainant is notified by EEO of any action DHS intends to take. DHS may extend the investigation period, if needed. The complainant is notified in writing of the extension.

(12305)(block-3)Appeal of Findings#

If the complainant does not agree with the findings or has added information that they feel would affect the outcome of the findings, they may file a written appeal within 10 workdays of the date they receive the notice.

The complainant files the appeal directly with the Chief EEO Officer, Springfield. The Chief EEO Officer submits the appeal to the DHS Appeals Officer (EEO). The Appeals Officer reviews the original findings and the appeal. The complainant is notified in writing of the appeal decision.

(12310)PM 01-01-03: Freedom of Choice#

(12310)(block-1)PM 01-01-03: Freedom of Choice#

WAG 01-01-03

(12310)(block-2)Freedom of Choice#

A customer may choose the program they want to apply for by answering (Yes) or (No) to each program in the Application for Benefits Eligibility (ABE) Portal or on the paper application, Request for Cash Assistance, Medical Assistance, Supplemental Nutrition Assistance Program (SNAP) .

(12310)(block-3)Cash Programs#

A person who qualifies for TANF and AABD must choose one program or the other. See Note below. Persons potentially eligible for more than one program are advised of the program differences.

An adult who qualifies for SSI cannot choose to receive TANF. Note: A person required to be in a TANF case with their child or sibling cannot choose AABD.

A caretaker relative who chooses SSI for the only child in an otherwise eligible TANF unit may receive TANF if there is insufficient income to meet the caretaker relative's needs.

(12310)(block-4)Differences in All Kids and AABD Medical Programs#

The differences between All Kids and AABD Medical which may affect a person's choice are described below.

(12310)(block-5)AABD Medical:#

If a person is included in the standard, the person's income must be considered.

A person is allowed a $25 deduction from income other than contributions and SSI (Community Cases only).

The deductions from earned income for the applicant/client are: AABD(D) and AABD(A) - the first $20 plus 1/2 of the next $60; or AABD(B) - the first $85 plus 1/2 of the remainder; and recognized expenses of employment.

If the income of another person who is not receiving medical or cash benefits is being budgeted, only recognized expenses of employment (including child care) are deducted.

The maximum child care allowed is $160 per child for persons employed full-time and $128 per child for persons employed part-time.

(12310)(block-6)All Kids:#

A child and/or sibling can be included in the standard and their income not considered.

A $25 deduction from income is not allowed.

The deductions from earned income for the family are: $90 per person; $30 plus 1/3 of the remainder if certain conditions are met (see WAG 15-04-02-c ); and child care. (The maximum child care allowed is $200 per child under age 2 and $175 per child age 2 and over).

If the income of a responsible relative who is not receiving cash or medical is being budgeted, only $90 is deducted.

(12310)(block-7)Medical Care#

Customers can choose to see any medical vendor approved to take part in the Medicaid program. Certain programs, like HMOs, may limit their choice.

A primary care doctor and/or pharmacy is assigned to customer who overuse or abuse medical services. The client must use the primary care provider for 6 months unless special factors change this.

(12310)(block-8)Services#

Customers can accept or reject any services or programs that they may be eligible to receive. When completing an application for benefits through the ABE Portal or by the paper application, Request for Cash Assistance, Medical Assistance, Supplemental Nutrition Assistance Program (SNAP) , a customer may choose to apply for Cash Assistance, Medical Assistance, Family Planning and/or SNAP Assistance by selecting (Yes) or (No) to each program. If (Yes) is selected for a program, the individual must meet all eligibility factors and must cooperate with the program requirements to qualify for the benefits they request.

(12310)(block-9)Living Arrangements#

Customers can choose to live wherever and with whomever they want. IDHS and IDHFS cannot impose our choices on any customer. However, their choice may affect their eligibility or benefit amount.

(12310)(block-10)Family and Community Resource Center (FCRC)#

A customer, except those that live in a Long Term Care (LTC) Facility or Supportive Living Facility (SLF) and those residing in Cook County whose application is submitted by a hospital, may choose to apply at any FCRC, see PM 02-04-02 .

Once an customer is determined eligible for assistance, they have a right to choose the FCRC that will service their case and request their case be transferred, see PM 18-07-00 .

(12314)PM 01-01-04-a: Use of Case Records#

(12314)(block-1)PM 01-01-04-a: Use of Case Records#

WAG 01-01-04-a

Use case records to:

show whether or not a person qualifies for our programs;

find the amount of benefits the person or family needs;

bring services and resources to clients;

promote the health and safety of the client; and

maintain a history of the case.

Additionally, the Department cooperates with other local, state, or federal officials who:

Enforce the rules of the programs we administer and review reports of violations of our programs.

Work for the Department of Children and Family Services (DCFS) and investigate reports of child abuse and neglect.

Enforce Unemployment Insurance (UI) rules. (Case records can be used only to prove UI eligibility or benefit amount.)

Can confirm for us if a person can receive Titles II and XVI of the Social Security Act through Health and Human Services.

For a TANF case, make the case record available upon request to a law enforcement agency, to an officer of any court, and to any other person or agency a court authorizes. In particular, make the record available to a law enforcement agency to determine the current address of a client for whom they have an outstanding arrest warrant. Disclose information to the Illinois Student Assistance Commission for their investigation or audit of a delinquent student loan or monetary award. DHS, HFS, and the Department of Revenue may share information to verify sources and amounts of income and for other purposes directly related to the administration of the Illinois Public Aid Code and the Illinois Income Tax Act.

Anyone seeking information must submit proper identification that establishes their authority. When specific matters are under consideration, release only information which relates to those matters.

When possible, inform the family or client of the request to review the case record, except when the disclosure would hinder the purpose for which the request was made.

(12314)(block-2)Domestic Violence#

For the protection of the domestic violence victim, do not release any information without the person's written consent to:

any other household member;

the household's currently approved representative; or

a person acting in the household's behalf.

This includes the person's current address, workplace, work placement, school or children's school, as well as any details about the domestic violence.

(12317)PM 01-01-04-b: Special Conditions#

(12317)(block-1)PM 01-01-04-b: Special Conditions#

WAG 01-01-04-b

The DHS General Counsel's Office provides guidance for these situations:

(12317)(block-2)Courts#

Send subpoenas for case files to the Office of the General Counsel. The General Counsel tells the court our rules about disclosing client records. The General Counsel will also tell DHS staff what to do about the subpoena.

(12317)(block-3)Fugitive Felons - Other than SNAP Clients#

Before providing a law officer the address of a client who is a fugitive felon, ask the officer for:

the client's name and SSN; and

proof that the client is a fugitive felon (such as a warrant for the client's arrest); and

proof that the law officer is acting within the officer's official duties.

Do not tell the client of the request.

(12317)(block-4)Fugitive Felons - SNAP Clients#

On request, provide a law enforcement officer the address, social security number, and, if available, the photograph of a SNAP unit member (including applicants) if the officer provides the name of the person and notifies the Department that:

the member is fleeing to avoid prosecution, or custody or confinement after conviction, for a crime (or attempt to commit a crime) that, under the law of the place the member is fleeing, is a felony or is violating a condition of probation or parole imposed under Federal or State law, or has information that is necessary for the officer to conduct an official duty related to the above; and

locating or apprehending the member is an official duty; and

the request is made in the proper exercise of an official duty.

Do not tell the client of the request.

(12317)(block-5)Persons Waiting for Trial#

A person in jail may qualify for special medical coverage under certain conditions (see PM 20-02-02 ). If the person meets the conditions, provide only the following facts to law officers:

case name, address, and number;

type of benefits;

whether they were in an active case when they went to jail;

if canceled, the last date of medical coverage; and

facts about any insurance or TPL source.

(12330)WAG 01-01-01-a: Complaints of Alleged Discrimination#

(12330)(block-1)WAG 01-01-01-a: Complaints of Alleged Discrimination#

(FCRC) Give Client/Applicant Discrimination Complaint Form (Form 4026) to anyone who alleges discrimination (complainant).

(Complainant, All Programs) Sends written complaint to one of the following: Illinois Department of Human Services Bureau of Civil Affairs Attn: Kimberly Foy 100 S. Grand Ave. E. Springfield, IL 62762 (217) 782-9496 and/or Illinois Department of Human Services Equal Employment Opportunity/Affirmative Action Office 401 S. Clinton, 6th Floor Chicago, IL 60607 (312) 793-0210 and/or The Family Community Resource Center administrator (LOA).

(Complainant, All Programs) Persons who are deaf or hard of hearing and have a special device (TDD) attached to their phones can call (312) 793-5827, Chicago; or (217) 524-2182, Springfield.

(Complainant, SNAP) May also send written complaint to the United States Department of Agriculture (USDA) Director Office of Civil Rights 1400 Independence Avenue S.W. Washington, D.C. 20250-9410, or call 1-800-785-3272, TTY 1-202-720-6382

(Complainant, All Programs) In addition, a complaint may also be filed with: Illinois Department of Human Rights 100 West Randolph, Suite 10-100 Chicago, IL 60601 (312) 814-6200 Illinois Department of Human Rights 222 South College Springfield, IL 62704 (217) 785-5100 Equal Employment Opportunity Commission 500 West Madison Street - Suite 2800 Chicago, IL 60661 (312) 353-2713 U. S. Department of Health and Human Services Office of Civil Rights 233 North Michigan Avenue, Suite 240 Chicago, IL 60601 (312) 886-2359

(LOA) Take the following action if a written complaint of alleged discrimination is received by the Family Community Resource Center: Send complaint to the Equal Employment Opportunity (EEO) Office, Chicago or Springfield. Send any follow-up correspondence relating to the complaint to the EEO Office.

(EEO Coordinator) Investigates complaint when completed discrimination form is received.

(EEO Coordinator) Submits findings to Chief EEO Officer.

(Chief EEO Officer) Reviews findings. Directs EEO Coordinator to notify complainant whether or not the case has merit. Seeks more information or counsels the concerned parties, when necessary. Notifies LOA or Director of current status of the complaint. Recommends a course of action to be taken by Department.

(12331)WAG 01-01-04: Giving Out Customer Information#

(12331)(block-1)WAG 01-01-04: Giving Out Customer Information#

PM 01-01-04

(12331)(block-2)Providing Proof of Benefits Received to Customers#

(FCRC) Complete Form 3711 in its entirety and with the most recent information for any customer requesting verification of their benefits.

When a customer asks for verification of their benefits, find out from the customer the names of all persons who should be included on Proof of Receipt of Program Benefits (Form 3711). Use the Integrated Eligibility System (IES) to verify eligibility for each individual. Do not give copies of IES screens to the customer to use as their proof of benefits.

Complete Proof of Receipt of Program Benefits (Form 3711) in the following sections : Full name of the person; Enter (Yes) or (No) for the applicable program the person is receiving. Do not leave blank; and The current benefit receipt month; and Date benefit is approved; and Date benefit ends (or must be renewed).

The IDHS employee completing the form should sign and complete the name and address in the FCRC section. Affix the Family Community Resource Center stamp to the form.

Upload a copy of the Form 3711 to the customer's electronic case file in IES.

Providing accurate information on Form 3711 is important as some customers may qualify for additional services with another agency or governmental department, if they can show proof that they are eligible for a DHS program or service.

Example: A customer who is applying for a fee waiver from the Department of Homeland Security - U. S. Citizenship and Immigration Services (USCIS) may be eligible for a waiver of fees related to various applications and petitions processed by USCIS. The waiver is requested using USCIS Form I-912.

(12331)(block-3)Bureau of Customer Support and Services#

(DHS helpline) Completes Form 2160, Verification of Public Assistance Income to verify income for the Illinois Housing Authority. This form should only be used by the DHS helpline staff.

(12331)(block-4)Local, State, Federal Law Enforcement Officials#

All requests for SNAP case information from local, state, or federal law enforcement officials must be in writing. The written request must contain:

the identity and legal authority of the person making the request;

the nature of the violation being investigated and its connection to the enforcement of the SNAP Program; and

the identity of the person for whom the information is being requested.

(FCRC) Make an entry in the case record when any case information is released. Include: the name of the person requesting the information; the agency represented; the date of request and the date of the release of information; the specific information released; and the reason for the release.

(FCRC) Make an entry in the case record when any request for case information is denied. Explain the reason for denial.

(12331)(block-5)Community Outreach Partners#

A customer may complete an Outreach Partner Consent Form (IL 444-3690) allowing an outside agency to inquire about their application or case status, including help with providing verifications.

Form 3690 may be faxed, mailed or brought to the FCRC. Form 3690 is voluntary. Refusal to complete Form 3690 does not affect eligibility for SNAP outreach services provided by the Outreach Partner, or the customer's eligibility for benefits. This consent form is not valid more than 180 days beyond the date of signature. Form 3690, does not give the outside agency permission to act as an approved representative for the customer (see PM 02-04-02-a ).

(12357)PM 01-02-02-a: Cash and Medical Programs#

(12357)(block-1)PM 01-02-02-a: Cash and Medical Programs#

WAG 01-02-02-a

(12357)(block-2)What a Client Must Do#

A case not enrolled in Mid-Point Reporting (MPR) must report any change within 10 calendar days of the change. This also applies to the person who handles the income and assets of a client in an LTC or SLF. The change may be reported by phone, in person, or by mail.

A TANF family in Mid-Point Reporting is required to report changes on the interim report form and at the annual REDE.

NOTE: For medical program purposes for adults, changes must be reported within 10 days. For medical programs for children, other than for situations listed in PM 18-05-01 , an increase in income does not have to be reported until the annual REDE/renewal.

The client must cooperate in providing proof of the change when needed.

The client has the right to file a written request for increased benefits or special payments. In some cases, a written request may be required to qualify for an increase in benefits. For more information on when a written request is required for cash and medical, see PM 18 Changes.

(12357)(block-3)What a Long Term Care or Supportive Living Facility Must Do#

An LTC or SLF must report admission, discharge, death or any other change which could have an effect on a resident's eligibility within 5 workdays of the change.

(12357)(block-4)What DHS Staff Must Do#

Assist the client in preparing any written request due to a change in circumstance if it is needed to decide eligibility.

If the change results in increased benefits, approve the request so that the increased benefits are mailed no later than 45 calendar days from when the Family Community Resource Center received the request. For cash cases, any increase starts the date the change was reported, if the client was eligible on this date, or the first date of eligibility, depending on the type of change. For TANF cases, it may start before the report date if it is a filing unit change (see PM 18-03-06 ).

A delay by the client to give proof of a change extends the 45 calendar day period by the same amount of time. Depending upon the type of change, a delay in reporting the change may also affect the effective date of increase.

For clients in an LTC or SLF, complete a review of any lump sum payment within 30 days.

(12386)WAG 01-04-01-b: Approved Application#

(12386)(block-1)WAG 01-04-01-b: Approved Application#

For a TANF case , the case record is called a NERF (Numbered Expandable Removable File) record. SNAP and AABD cases may have either a NERF record or a case record. The case record has a face sheet, Form 500, with case materials fastened together and is placed in a manila folder. The NERF is an expandable pocket file with 9 labeled sections in the following order: Section 1 - Application Includes application forms, except those for only SNAP (see Section 2), attachments, requests for additional assistance, clearances, and copies of notices in response to applications or requests for additional assistance. Section 2 - SNAP/Shelter Includes applications for only SNAP, and all forms relating to SNAP, except for recovery or recoupment related forms (see Section 5), and income-related forms and worksheets (see Section 7). Section 3 - Verifications/Assets Includes forms, documentation, and notices regarding verification of assets and nonfinancial factors of eligibility, except for medical-related verifications (see Section 4). Section 4 - Miscellaneous Responsible Relatives/Medical/Referrals/Other Includes forms regarding paternity, child support, responsible relatives, medical-related issues including determinations of medical barriers, and referrals. Section 5 - Recovery/Recoupment Includes forms, notices, and documents relating to Cash/SNAP overpayments, Intentional Program Violation disqualifications, and personal injury claims. Section 6 - Redeterminations Includes all forms and notices relating to the REDE process. Includes all forms and notices relating to the Family Assessment, RSP, supportive services and referrals made to other agencies or providers. Section 7 - Income Includes all worksheets and income verifications. Section 8 - Form 157 Series/Form 514/Miscellaneous Includes all Forms 157, Notices of Change, Forms 514, Case Recordings, and Forms 3067, Case Review Findings. Include in this section all other notices, forms or material that does not belong in any other section. Section 9 - Form 552 One copy of each turnaround and pencil copy of Form 552 for the 4-year retention period.

File all information behind the appropriate section divider. File the most recent forms on top of other forms within the section. Do not write on the folders.

Enter the case name and number(s) in the upper left hand portion of the Section 1 NERF divider, or on the manila folder tab for traditional records. Case Record Sign-Out Card (Form 2952) should be the last item in the case record. NOTE: In an active case, certain packets of related information are an exception to the NERF or traditional filing system. They should be stapled together and filed in the appropriate section: Overpayment packets and verifications (TANF, AABD, SNAP) - Section 5; Duplicate warrant overpayment packets (AABD, TANF) - Section 5

Retain computer crossmatch reports for 12 months in Section 4, unless they are part of an overpayment packet which is retained permanently in Section 5. NOTE: Caseload summary reports and discrepancy or exception lists are not case record material. See "Field Report Log-Family Community Resource Center" for description of computer reports sent to the Family Community Resource Center. In active TANF cases, every department form which should be filed in a case record contains a designation which includes the: correct filing section #; and forms retention schedule. The designation is located in the upper right-hand corner of the form.

Use the Form Retention List for all case records (see WAG 25-09-00 ). NOTE: Contact the Bureau of Policy Development about forms that are not included in the list.

Destroy outdated forms and documents in the case record. Use the Form Retention List (see WAG 25-09-00 ).

Send canceled traditional case records to closed files in their original format.

Before sending a NERF record to closed files: Remove the entire contents, forms, and section dividers from the pocket file. Bind the contents together with a rubber band and place in a manila folder.

NOTE: Do not send the NERF pocket file to closed files when a case is canceled. Keep the pocket file for reuse.

(12435)PM 01-05-02: Suspected Abuse and Neglect - LTC/SLF#

(12435)(block-1)PM 01-05-02: Suspected Abuse and Neglect - LTC/SLF#

WAG 01-05-02

Call the Department of Public Health (DPH) Long Term Care/Nursing Home Hotline (1-800-252-4343) to report suspected abuse or neglect of LTC residents. The hotline operates 24 hours a day and is toll-free.

Call the Department of Healthcare and Family Services (HFS) - Bureau of Long Term Care (BLTC) (217-782-0545) to report suspected abuse or neglect of SLF residents. Follow-up in writing.

The report should include:

name of resident;

name and address of the facility at which the resident resides;

resident's age, if known;

date and time of the suspected abuse or neglect, if known;

nature of resident's condition, including any sign of previous injuries or disabilities;

any other information that might be helpful in establishing the cause of the abuse or neglect; and

identity of the person believed to have caused the abuse or neglect.

(12435)(block-2)Long Term Care#

When the BLTC nurse suspects abuse or neglect, the nurse notifies the BLTC Regional Supervisor who, in turn, notifies the Metro or Downstate Area Manager, as appropriate.

When the long term care worker suspects resident abuse or neglect, they are to notify the BLTC Regional Supervisor. Use the Problem Resolution Request form.

In emergency situations telephone the BLTC Regional Supervisor. The phone number can be obtained by calling BLTC at 217-782-0545. The Regional Supervisor notifies the BLTC nurse. The nurse follows-up on the report made to DPH and reports back to the local office.

Reports of suspected abuse or neglect may also be made to DPH in writing or in person. The person making the report is not required to give their name.

(12435)(block-3)Supportive Living Facility#

Following the report by Family Community Resource Center staff, the BLTC contacts the Metro or Downstate Area Manager, as appropriate. The Metro/Downstate Area Manager notifies the BLTC Regional Supervisor who, in turn, notifies the BLTC nurse. The BLTC nurse investigates the report and reports back to the Family Community Resource Center.

(12480)PM 01-06-01: When to Give Written Notices#

(12480)(block-1)PM 01-06-01: When to Give Written Notices#

WAG 01-06-01

Send a written notice based on the client's preference to receive electronic notices in their ABE Manage My Case (MMC) account and/or through the postal service.

Send a written notice to clients when:

approving or denying a written request for any benefits (including Crisis Assistance), or placing the request in pending status;

reducing, suspending, voiding, or canceling benefits;

setting up a protective payee plan;

making a decision on a client request for payment of medical services or items that need prior approval;

transferring a case;

increasing cash benefits when there was a written request for the increase;

taking action to recoup an overpayment;

taking a person out of the case;

making a decision on a work exemption request (does not apply to SNAP benefits); or

a Mid-Point Report is not returned by the due date.

NOTE: Inform clients orally when medical transportation is approved.

(12480)(block-2)Electronic Customer Notices, Email and Mobile Phone Text Alerts#

IES will send a written notice through the U.S. Postal Service and post an electronic PDF version of a notice in the customer's ABE Manage My Case (MMC) account. The customer must set up their MMC account in ABE to start receiving an electronic notice. Once the account is setup all notices will sync to the customer's ABE account.

The customer's notice preference can be viewed in Data Collection in the "Household Contact Information" section titled "Notice Method". The drop down contains the following options:

Electronic Only;

Electronic Only-Email and Text;

Paper Only;

Paper and Electronic-Email;

Paper and Electronic-Email and Text.

(12480)(block-3)Electronic Notice Only#

A customer with a valid email address may opt to Go Green by changing their preferred delivery method to "Electronic Only." A customer who opts to receive "Electronic Only" can only view a PDF version of the notice in their MMC account. No paper notice will be mailed to the customer.

Note: The use of electronic means only to send a written notice can only be used if the customer has agreed to receive "Electronic Only" notices.

(12480)(block-4)Email Only or Email and Mobile Phone Text Message Alerts#

A customer with a valid email address will be sent notification when a notice posts to their MMC account by:

email; or

email and mobile phone text message

Note: A customer may choose their delivery method for alerts but a customer who chooses to receive mobile text alerts must also receive an email. A customer may not choose to receive only mobile phone text alerts.

(12485)WAG 01-06-02-b: Medical#

(12485)(block-1)IES Phase 2 Process#

(FCRC) Approve or deny the application through the Integrated Eligibility System (IES).

(FCRC) Using IES, generate and mail form IL444-0360C Notice of Decision either: Centrally if the worker runs eligibility and certifies case; or Locally by: Running eligibility and certifying the case; selecting the Correspondence module in Left Navigation; and clicking the Local Print button.

(IES) Sends form IL444-360C Notice of Decision the day after the nightly batch job.

(FCRC) Generates and mails form IL-444 360C Notice of Decision if local print is chosen.

(FCRC) Reprints notices using the correspondence module in left navigation in IES.

(12485)(block-2)Features of Systematically Generated Form IL444-0360C Notice of Decision#

The IL444-360C Notice Of Decision has 5 sections. IES will generate the following fragments as appropriate:

Summary Section provides information on: notice date; date of application or date of change; What action is being taken; the policy citation for the action; information on how to use their LINK card (if applicable); and information on how to use Manage My Case in ABE.

Cash Section - see WAG 01-06-02-a.

Medical Section provides information on: who is eligible for medical assistance; what type of medical assistance each individual is eligible for; detailed information on medical assistance program requirements for each type of medical assistance being approved; medical backdate information; common services provided under the medical assistance program; any copayment requirements by program; and the calculation(s) used to determine each type of medical assistance each approved individual is eligible for.

SNAP Section - see WAG 01-06-02-d .

Additional Information Section provides information on: reporting requirements; rights and responsibilities; appeal rights; Manage My Case; and when an approved representative is named, information on approved representative policy.

(12485)(block-3)Legacy System Process (ACM and IPACS)#

(FCRC) Approve or deny the application through the Integrated Eligibility System (IES).

(System) Sends (or syncs) the approval or denial data from IES to the Client Data Base.

(System) Within 2 workdays of when an application is approved or denied, automatically issues and sends Form 360C.

(FCRC) Completes and mails Notice of Decision on Application for Medical Assistance - Regular MANG (Form 458) , when a decision is made to approve or deny an initial application as regular Medical via IPACS; or

(FCRC) Complete and mail a Notice of Decision on Application for Medical Assistance - MANG Long Term Care (HFS 458LTC) , when a decision is made to: authorize a nursing home (NH) or supportive living facility (SLF) Medical case with or without a spend down, or deny the application and a central notice is not wanted. Enter code 80 in Item 39. Send a Nursing Home/Supportive Living Facility Resource Calculation (HFS 2500) with the notice. NOTE: For a community case at application, or for backdated months that are before the case became NH or SLF, use HFS 458LTC to notify the client of the application decision and the change in case status. Send HFS 2500 with the notice.

(FCRC) Complete and mail a Notice of Limited Approval of Medical Assistance Application (Form 458D) , when: a All Kids Assist/Moms and Babies case is not eligible for the month of decision or any backdated month, and spenddown exists for each month eligibility exists.

(FCRC) Complete and mail a Notice of Decision on Applications for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M) , to inform AABD Medical applicants of: eligibility/ineligibility for Medicare cost-sharing benefits as a QMB, or payment of Medicare Part B SMIB premiums as an SLIB.

(FCRC) Complete and mail a Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP), with Form 458SPA/SPB attached, if needed, to inform an applicant they are eligible for spenddown enrollment.

(12634)WAG 01-06-02-d: SNAP#

(12634)(block-1)IES Phase 2 Process#

(FCRC) Approves or denies the application through the Integrated Eligibility System (IES).

(FCRC) Using IES, generates and mails form IL444 0360C Notice of Decision: Centrally if the worker runs eligibility and certifies case or Locally by: running eligibility and certifying the case; selecting the Correspondence module in Left Navigation: and clicking the Local Print button.

(IES) Sends form IL444-360C Notice of Decision the day after the nightly batch job.

(FCRC) Generates and mails form IL444-360C Notice of Decision if local print is chosen.

(FCRC) Reprints notices using the correspondence module in left navigation in IES.

(12634)(block-2)Features of Systematically Generated Form IL444-0360C Notice of Decision#

The IL444-360C Notice Of Decision has 5 sections:

Summary Section provides information on: notice date; date of application or date of change; What action is being taken; the policy citation for the action; information on how to use their LINK card (if applicable), and information on how to use Manage My Case in ABE.

SNAP Section provides information on: Person(s) eligible for SNAP; SNAP benefit type and amount(s); availability date of SNAP benefits; calculation of benefits; SNAP Denial, Reason and Policy Citation; SNAP sanction information (if applicable); and individual disqualification information (if applicable).

Cash Section - see WAG 01-06-02-a .

Medical Section - see WAG 01-06-02-b .

Additional Information Section provides information on: SNAP change reporting requirements; SNAP Mid-Point reporting requirements; accessing and using IL444-1978 Change Report Form; right to a Fair Hearing (Appeal); information on an appeal for a denied or approved SNAP application; continuing benefits during an appeal; and approved representative information.

(12634)(block-3)IES Phase 1 Process#

(FCRC) At Intake, approves or denies the application through the Integrated Eligibility System (IES).

(IES) Sends (or syncs) the approval or denial date from IES to the Client Data Base (CDB).

(CDB) Within 2 workdays of when the application is approved or denied, issues IL444-360C Notice of Decision .

(12634)(block-4)Legacy System Process (ACM and IPACS)#

For SNAP approvals and denials in ACM or IPACS, enter one of the following codes to identify whether a notice is centrally or locally sent:

00 - Cash or Medical with SNAP (Send both centrally)

Form 360C centrally mailed for both the SNAP and cash or Medical decision.

80 - Medical with SNAP (Suppress both)

Suppress the central notice for both the SNAP and Medical decision.

Complete and send the correct pages and sections of the locally issued notice, Form 360 series, for the SNAP decision. Complete and send the correct notice(s) for the Medical decision.

90 - Cash with SNAP (Suppress both forms)

Suppress the Central Notice for both the SNAP and Cash decision. Complete and send the correct pages and sections of the locally issued notice, Form 360 series, for the Cash and SNAP decision.

91 - Cash or Medical with SNAP (Send Cash or Medical, suppress SNAP)

Form 360C centrally mailed for the Cash or Medical decision. Complete and send the correct pages and sections of the Form 360 series for the SNAP decision.

92 - Cash or Medical with SNAP (Send SNAP, suppress Cash or Medical)

Form 360C centrally mailed for the SNAP decision and suppress the Cash or Medical form. Send the correct Cash or Medical notice.

NOTE: Enter code 92 in Item 39 when approving a Medical case as a spenddown and sending the SNAP notice centrally.

When processing SNAP approvals via IPACS, use Item 39 codes as follows:

SNAP Only (Category 08) - codes 00 or 91;

Cash - code 90; and

Medical - codes 00, 80, 91, or 92.

AABD Cash and RRA approvals must be processed through IPACS. Enter 00, 90, 91, and 92 for AABD Cash/SNAP and RRA Cash/SNAP approvals through IPACS. For RRA Medical/SNAP approvals through IPACS, enter 00, 80, 91, or 92 in Item 39.

When the central notice is suppressed, process the manual Form 360 series as follows:

Complete and send the first page (Form 360D) and the appeals rights page (Form 360P) along with any pages and sections of the Form 360 series that apply to the program(s) for which a determination was made. On Form 360D always complete:

Date of Notice;

Family Community Resource Center name, address, and telephone number; and

Date of application. Prepare 2 copies of each page of the Form 360 series and mail the original to applicant within 30 days of date of application. File copies of the Form 360 series pages in SNAP case record or SNAP section of SNAP payee's Cash or Medical case record.

(12638)WAG 01-06-03: Notices of Changes#

(12638)(block-1)IES Phase 2 Process#

(IES) centrally generates IL444-0360C Notice of Decision when there is a change in benefit amounts or case status. For more information on IL444-360C Notice of Decision , see:

Cash - WAG 01-06-02-a

Medical - WAG 01-06-02-b

SNAP - WAG 01-06-02-d

(12638)(block-2)Legacy System Process (ACM and IPACS)#

(FCRC) Submits Form 552 via IPACS or processes the transaction via ACM to reduce or stop benefits.

(System) Sends notices and supporting documents to client (when coded by caseworker to do so). Sends Form 157C, when decision is made to reduce or stop benefits. Dates/mails Form 157C no later than 2 workdays after action was transmitted. For TANF Cash cases, also sends a TANF/SNAP Computation - Work Pays (Form 553H) , and if applicable, an Attachment to Computation of Grant/SNAP (Form 553GC) . For AABD Cash cases, also sends the AABD/SNAP Computation (Form 4050C) . Prints the following message on Form 157C for a reduction in SNAP benefits "You will receive SNAP benefits through MM/YY." NOTE: The system fills in the date for specific case, based on information in Form 552 Item 24, SNAP Certification Expiration Date.

(System) Sends Form 157C when the Family Community Resource Center has sufficient information to determine ongoing SNAP eligibility and: Cash benefits are reduced or canceled; or Medical benefits are canceled. If both Cash and SNAP go down, Form 157C gives SNAP approval end date. If both Medical benefits and SNAP benefits are canceled, but for different reasons, Form 157C only contains notification and reason for the SNAP cancellation. If both Medical and SNAP benefits are canceled for the same reason, Form 157C gives the reason for both cancellations. Sends Form 157C if cash benefits go down but SNAP benefits go up. Form 157C tells increase in SNAP amount and gives SNAP approval end date.

(FCRC) Completes and sends a timely Form 157 when a decision is made to: suppress the central notice; or void an issuance. When submitting cancellation for the month following the month an issuance was voided, suppress the central notice by entering the correct code in Item 39. For AABD Cash cases, also sends the AABD/SNAP Computation (Form 4050) .

(FCRC) Completes and sends Notice of Determination of Monthly Spenddown Met/Unmet (Form 458SP-1) for a MANG community case, each month a determination of spenddown status is made.

(FCRC) Completes and sends Notice of Changes During the Enrollment Period or Eligibility Period-MANG Community Case (Form 2434A) (with Form 458SPA/SPB attached, if needed), to notify the MANG community client of a change in: Spenddown amount, case classification (i.e., regular MANG to spenddown or spenddown to regular MANG), or period of enrollment or eligibility.

(FCRC) For a long term care case, completes and sends Notice of Determination of Spenddown Met/Unmet-MANG Long Term Care Case (Form 458SP-3) each month a determination of spenddown status is made.

(FCRC) Completes and sends Notice of Change - MANG Long Term Care Case (Form 2434C) to notify a long term care client of a change in the spenddown amount and/or case classification.

(FCRC) Sends Nursing Home/Supportive Living Facility Resource Calculation (HFS 2500) , when there are changes in the credit and/or spenddown amount.

(System) Sends client Notice of Termination of Medical Enrollment/Assistance - MANG (Form 157DP) as notice of cancellation when 12-month enrollment period ends and spenddown was not met in at least one of last 3 months of enrollment period. NOTE: Application for Medical Assistance-Short Form (Form 2431) is sent with Form 157DP.

(FCRC) Completes and sends Notice to Client of Protective Payment for Mismanagement - TANF (Form 2392) when a decision is made to set up a protective payment plan based on mismanagement.

(12640)PM 01-06-03: Notices of Change#

(12640)(block-1)PM 01-06-03: Notices of Change#

WAG 01-06-03

A Notice of Change must be sent when benefits are reduced, suspended, or canceled. The Notice must contain:

the date of change;

the date of notice;

the Family Community Resource Center phone number;

a statement that the client is liable for cash and SNAP benefits received while waiting for an appeal decision, if the decision goes against them;

a clear statement of the action taken;

a clear statement of the reason for the action;

a specific policy reference which supports the action;

a clear statement of the client's right to appeal and contact information for free legal counsel;

a statement that benefits will continue in the previous amount if an appeal is filed on or before the date of change.

NOTE: The client may ask that benefits not be continued in the same amount.

For SNAP, a written notice is required for any action that affects the SNAP program status or benefit amount.

(12640)(block-2)Adequate Notice#

An adequate notice must be sent to arrive by the date of change.

For SNAP, give an adequate notice when:

stopping benefits because the client voluntarily requests that they be stopped. Fully document the request in the case record;

stopping benefits due to verified information that the client will not be residing in the Family Community Resource Center area and will not be able to obtain its next SNAP benefit.

Adequate notices must contain a statement that benefits will continue in the previous amount if an appeal is filed on or before the date of change or within 10 days of the date of notice, whichever is later, unless the client asks that benefits not be continued.

(12640)(block-3)Timely Notice#

A timely Notice of Change must be mailed or given to the client at least 10 days before the date of change. A timely notice is required when benefits are reduced, suspended, canceled, voided, withheld, or paid to a client under a protective payee plan.

Day one of the 10-day period is the day after the date of notice. Day 10 can be no later than the date of change. If the timely notice was not sent when required, do not take the action. Start over by sending another notice and waiting 10 days to take the action. Take action, if called for, for the first month a timely notice can be sent.

SNAP clients should receive a timely written notice when benefits end or are reduced during the approval period and when an approval period is shortened because the case is enrolled in Mid-Point Reporting status.

All notices are centrally issued, unless stated differently in the Workers' Action Guide, or they are withheld by the Family Community Resource Center so that a local notice can be sent.

(12640)(block-4)Notice of Hardship Waiver#

For long term care clients, a notice of cancellation or of ineligibility for payment of long term care charges due to:

a penalty period resulting from a non-allowable transfer of assets; or

the person's equity interest in his or her homestead exceeding $525,000;

must include a statement of the person's right to apply for a hardship waiver. This statement must inform the client that a written request for hardship waiver must be submitted to HFS Long Term Care - Asset Discovery Investigation (LTC-ADI), including proof that actual, not just possible, hardship exists.

For hardship waiver requests involving transfers of assets, the person must provide credible evidence that, in good faith and to the best of his or her ability, the person has taken all equitable and legal means available to recover assets transferred for less than fair market value.

See PM 01-08-00 .

(12640)(block-5)Date of Change#

For cash or SNAP cases , the date of change is the scheduled availability date of the affected benefits.

For medical cases , the date of change is the first day of the calendar month for which benefits are affected.

(12640)(block-6)Date of Notice#

The date of notice is the day the notice is mailed or given to the client.

If the client provides the envelope in which the notice of change was delivered and it contains a postmark after the date on the notice, use the postmark as the date of notice rather than the date on the notice itself.

(12661)WAG 25: Manual Attachments#

(12661)(block-1)WAG 25: Manual Attachments#

WAG 25-01-00: Policy and Procedures Process – 05/22/07 MR 07.08 WAG 25-01-01: Policy Questions – 01/04/2021 MR 21.01 WAG 25-01-02: Policy Action Coordinating Team (PACT) – 09/01/03 WAG 25-01-02-a: Terms Used – 09/01/03 WAG 25-01-02-b: Requesting a Change in Policy or Procedures – 09/01/03 WAG 25-01-02-c: Review of Change Request – 09/01/03 WAG 25-01-02-d: Circulation – 05/01/04 WAG 25-01-02-e: Policy Action Coordinating Team Meeting – 05/01/04 WAG 25-01-02-f: Publication – 09/01/03 WAG 25-01-02-g: Revising a Form – 09/01/03 WAG 25-01-03: The Online Manual – 12/17/08 WAG 25-01-03-a: Navigation – 12/02/05 MR 05.35 WAG 25-01-03-b: Finding Information – 12/02/05 MR 05.35 WAG 25-01-03-c: Updates – 12/02/05 MR 05.35

WAG 25-02-00: Program Coverage and Process – 01/01/03 WAG 25-02-01: Citizenship/INS Requirements – 03/01/97 WAG 25-02-01-a: By Citizenship/Immigration Status – 07/01/13 MR 13.16 WAG 25-02-01-b: By Program – 04/01/13 MR 13.10 WAG 25-02-03: Cash and Medical for Pregnant Women – 11/22/13 MR 13.25 WAG 25-02-04: Medical Program Coverage for TANF, FHP, AABD and ACA Adult Clients – 08/02/17 MR# 17.14 WAG 25-02-05: Coverage Groups for Part A and Part B Medicare – 04/06/98 WAG 25-02-06: Disposition Notices to Applicants – 03/01/97 WAG 25-02-06-a: Cash/Medical – 09/01/00 WAG 25-02-06-b: SNAP – 11/01/04 WAG 25-02-07: Applicants with Southeast Asian or Spanish Names – 03/01/97 WAG 25-02-07-a: SSN Applicants with Southeast Asian Names – 03/01/97 WAG 25-02-07-b: SSN Applicants with Spanish Surnames – 03/01/97 WAG 25-02-08: Medical Application Processing Schedule – 03/1/97 WAG 25-02-08-a: AABD(D) Medical Schedule – 03/01/97 WAG 25-02-08-b: AABD Medical (A or B) and FHP Schedule – 01/01/03 WAG 25-02-09: TANF Case Budgeted Through ACM – 11/22/13 MR 13.25 WAG 25-02-10: Automated Calculation of Overpayment or Underpayment – 04/01/09 MR 09.19 WAG 25-02-10-a: Income Screen – 07/01/97 WAG 25-02-10-b: Calculation Screens – 09/11/12 MR 12.23

WAG 25-03-00: Standards and Allowances – MR 10.32 01/03/11 WAG 25-03-01: County Groupings – MR 18.17 WAG 25-03-02: Standards and Allowances Overviews – 09/26/2025 MR #25.33 WAG 25-03-02 (1) SNAP – 09/26/2025 MR #25.33 WAG 25-03-02 (2) Medical FPLs – 05/20/2026 MR #26.11 WAG 25-03-02 (3) TANF – 03/17/2026 MR #26.08 WAG 25-03-02 (4) Medical - Co-Pays – 03/28/2023 MR #23.15 WAG 25-03-02 Program Standards Summary Desk Aid – 05/20/2026 MR #26.11 WAG 25-03-03: AABD Fuel and Utility Allowances by Area – 03/01/97 WAG 25-03-04: Crisis Assistance – 07/01/97 WAG 25-03-05: Table of Monthly Allowances – 10/23/2025 MR #25.39 WAG 25-03-06: Chart for Computing Amounts from Monthly Allowances – 03/01/97 WAG 25-03-07: Reserved – 11/22/13 MR 13.25 WAG 25-03-08: Prorated SNAP Benefit Amount for Initial Month – 10/23/13 MR 13.22 WAG 25-03-08-a: Proration Chart for SNAP Units of 10 or More Persons – 10/23/13 MR 13.22 WAG 25-03-09: Basis of Issuance Table (1) (01-01-21 through 09-30-21) – 04/01/2021 MR 21.10 WAG 25-03-09: Basis of Issuance Table (1) (10-01-19) – 01/22/2020 MR #20.04 WAG 25-03-09: Basis of Issuance Table (1) (10-01-21) – 11/12/2021 MR #21.24 WAG 25-03-09: Basis of Issuance Table (1) (10-01-22) – 11/09/2022 MR 22.23 WAG 25-03-09: Basis of Issuance Table (1) (10-01-23) – 10/12/2023 MR#23.28 WAG 25-03-09: Basis of Issuance Table (1) (10-01-24) – 09/23/2024 MR# 24.19 WAG 25-03-09: Basis of Issuance Table (2) (01-01-21 through 09-30-21) – 04/01/2021 MR 21.10 WAG 25-03-09: Basis of Issuance Table (2) (10-01-19) – 01/22/2020 MR #20.04 WAG 25-03-09: Basis of Issuance Table (2) (10-01-21) – 11/12/2021 MR #21.24 WAG 25-03-09: Basis of Issuance Table (2) (10-01-23) – 10/12/2023 MR#23.28 WAG 25-03-09: Basis of Issuance Table (2) (10-01-24) – 09/23/2024 MR# 24.19 WAG 25-03-09: Basis of Issuance Table (3) (01-01-21 through 09-30-21) – 04/01/2021 MR 21.10 WAG 25-03-09: Basis of Issuance Table (3) (10-01-19) – 01/22/2020 MR #20.04 WAG 25-03-09: Basis of Issuance Table (3) (10-01-21) – 11/12/2021 MR #21.24 WAG 25-03-09: Basis of Issuance Table (3) (10-01-23) – 10/12/2023 MR#23.28 WAG 25-03-09: Basis of Issuance Table (3) (10-01-24) – 09/23/2024 MR# 24.19 WAG 25-03-09: Basis of Issuance Table Effective 10/01/2025 – 09/26/2025 MR #25.33 WAG 25-03-10: Reserved – 07/12/99 WAG 25-03-11: Life Estate Table – 03/01/97 WAG 25-03-12: Life Expectancy Table – 07/01/12 MR 12.18 WAG 25-03-13: Figuring Qualifying Quarters – 04/12/18 MR #18.08 WAG 25-03-15: Federal Participation Requirements (TANF Cash) – 12/23/2020 MR #20.27

WAG 25-03-09: Basis of Issuance Table (1) (10-01-2020) – 10/07/2020 MR #20.20

WAG 25-03-09: Basis of Issuance Table (2) (10-01-2020) – 10/07/2020 MR #20.20

WAG 25-03-09: Basis of Issuance Table (2) (10-01-22) – 11/09/2022 MR 22.23

WAG 25-03-09: Basis of Issuance Table (3) (10-01-2020) – 10/07/2020 MR #20.20

WAG 25-03-09: Basis of Issuance Table (3) (10-01-22) – 11/09/2022 MR 22.23

WAG 25-04-00: Coding – 03/01/97 WAG 25-04-01: SSA District Office Codes – 03/01/97 WAG 25-04-02: Types of Social Security Beneficiaries and Claim Numbers – 03/01/97 WAG 25-04-04: SOLQ Inquiry Codes – 12/01/00 WAG 25-04-05: Quarters of Coverage Codes – 07/01/98 WAG 25-04-06: Mang P Codes – 07/25/2023 MR #23.24

WAG 25-05-00: Directory – 03/01/97 WAG 25-05-01: Child Care Resource and Referral (CCR&R) Agencies – 05/23/17 MR 17.09 WAG 25-05-02: Elder Abuse Provider Agencies – 12/17/99 WAG 25-05-03: Family Community Resource Center Directory – 05/14/2024 WAG 25-05-03-a: Cook County Family Community Resource Centers by ZIP Code – 05/14/2024 WAG 25-05-04: Insurance Plans Administered Through the State of Illinois – 12/06/10 MR 10.31 WAG 25-05-04-a: State Agencies – 03/01/02 WAG 25-05-04-b: State Universities – 09/01/00 WAG 25-05-05: Federally Recognized Native American Tribes – 07/01/06 MR 11.04

WAG 25-06-00: Historical Data – 03/01/97 WAG 25-06-00-a Making Work Pay Credit – 03/01/11 MR 11.05 WAG 25-06-01: AABD Grant Adjustment Changes – 01/13/2026 MR #26.02 WAG 25-06-02: TANF Monthly Allowances - Historical – 10/23/2025 MR #25.39 WAG 25-06-03: TANF Budgeting and Asset Limits – 07/01/97 WAG 25-06-03-a: Budgeting Methods – 01/01/11 MR 11.03 WAG 25-06-03-b: Asset Limits – 11/22/13 MR 13.25 WAG 25-06-03-c: Monthly Reporting – 12/01/02 WAG 25-06-04: GA Overpayment Charts – 01/01/02 WAG 25-06-04 (2): General Assistance Fuel and Utility Allowances for the City of Chicago – 01/01/02 WAG 25-06-05: Historical SNAP Benefit Data – 04/01/2021 MR 21.10 WAG 25-06-05-a: Maximum Monthly SNAP Benefits – 10/23/2024 MR# 24.25 WAG 25-06-05-a (1) Minimum Monthly SNAP Benefit Amount for 1-2 Persons – 09/26/2025 MR #25.33 WAG 25-06-05-b (1) Maximum Gross Income Standards (200% FPL) – 09/26/2025 MR #25.33 WAG 25-06-05-b(2): Maximum Gross Income Standards (165% FPL) – 09/26/2025 MR #25.33 WAG 25-06-05-b: Maximum Gross Income Standards (130 % FPL) – 09/20/16 MR 16.14 WAG 25-06-05-c: Maximum Net Income Standards – 09/26/2025 MR #25.33 WAG 25-06-05-d: SNAP Deduction Amounts – 09/26/2025 MR #25.33 WAG 25-06-05-e: IPV Penalties – 04/01/13 MR 13.10 WAG 25-06-05-f: Assets – 11/12/2021 MR #21.24 WAG 25-06-05-g: Fair Market Value of Vehicles – 11/22/13 MR 13.25 WAG 25-06-05-h: Budgeting – 07/14/08 MR 08.15 WAG 25-06-05-i: Unreported Changes – 02/01/95 WAG 25-06-05-j: SNAP Medical Standards – 03/01/2023 MR #23.11 WAG 25-06-06: Calculating September SNAP Amount – 10/01/12 MR 12.21 WAG 25-06-07: Areas Exempt from Food Stamp Work Requirement – 01/01/00 WAG 25-06-07-a: Counties Exempt 12/96 Through 12/98 – 12/31/98 WAG 25-06-07-b: Cities Exempt 12/96 Through 12/98 – 12/31/98 WAG 25-06-07-c: State Exempt - Calendar Years 1999 through 2002 – 01/01/02 WAG 25-06-07-d: Counties Exempt Calendar Year 2003 through February 2005 – 03/01/05 WAG 25-06-07-e: Counties Nonexempt - January 2003 through February 2005 – 03/01/05 WAG 25-06-07-f: State Exempt - March 2005 through February 2007 – 03/01/06 MR 06.11 WAG 25-06-07-g Counties Nonexempt March 2007 – 03/01/07 MR 07.03 WAG 25-06-07-h Counties Nonexempt January 2008 – 03/01/08 MR 08.06 WAG 25-06-07-i Counties Nonexempt March 2008 – 03/01/08 MR 08.06 WAG 25-06-07-j Cities Exempt March 2008 – 03/01/08 MR 08.06 WAG 25-06-07-k State Exempt - January 2009 through December 2015 – 02/24/15 MR 15.08 WAG 25-06-07-l: State Exempt - January 2009 through December 2016 – 06/21/16 WAG 25-06-07-m: State Exempt January 2009 through December 2017 – 02/05/2020 MR #20.05 WAG 25-06-07-n: County Nonexempt January 2018 – 02/05/2020 MR #20.05 WAG 25-06-07-o: Counties Nonexempt January 2020 – 02/05/2020 MR #20.05 WAG 25-06-08: Federal and State Minimum Wage – 11/14/2024 MR #24.28 WAG 25-06-09: Work and Responsibility Demonstration (AFDC Cash, TANF Cash) – 12/01/02 WAG 25-06-09-a: Get a Job – 12/01/02 WAG 25-06-09-b: Quarterly Reporting/Quarterly Budgeting – 03/01/05 WAG 25-06-09-c: Self-sufficiency Plan – 12/01/02 WAG 25-06-09-d: Family Accountability – 07/01/07 MR 07.09 WAG 25-06-09-f: Job Track – 12/01/02 WAG 25-06-10: Funeral and Burial Rates – 04/13/2020 MR #20.11 WAG 25-06-11: Employment Retention & Advancement (ERA) Project – 03/14/06 MR 06.10 WAG 25-06-12: Miscellaneous Name Changes – 04/01/10 MR 10.12 WAG 25-06-14: Historical Data for Long Term Care – 07/01/12 MR 12.18 WAG 25-06-15: AABD Cash Assistance Standard for Non-Citizens Ineligible for SSI Due to 7-year Federal Limit – 01/09/2026 MR #26.01 WAG 25-06-16: SSI Payment Level - Historical – 01/13/2026 MR #26.02 WAG 25-06-17: Sheltered Care, Personal Care or Nursing Care Rates - Historical – 01/13/2026 MR #26.02 WAG 25-06-18 Historical Initial Employment Deduction (IED) – 03/17/2026 MR #26.08

WAG 25-07-00: Miscellaneous Casework Actions – 03/01/97 WAG 25-07-01: Reserved – 08/06/07 MR 07.17 WAG 25-07-02: Change of Name – 02/16/10 MR 10.01 WAG 25-07-03: Assignment of Group Number – 06/13/13 MR 13.15 WAG 25-07-04: Change or Correction of Basic Number – 03/01/97 WAG 25-07-04-a: Pending Applications – MR 10.32 01/03/11 WAG 25-07-04-b: Active Cases – 04/14/03 WAG 25-07-05: Canceling a Case – 03/01/97 WAG 25-07-05-a: TANF Case – 06/06/05 WAG 25-07-05-b: AABD Case – 03/01/97 WAG 25-07-05-c: GA Case – 03/01/97 WAG 25-07-05-d: Canceling Food Stamps – 03/01/97 WAG 25-07-06: Authorizing Zero Benefits (TANF, AABD) – 05/16/05 WAG 25-07-06-a: TANF Case – 11/22/13 MR 13.25 WAG 25-07-06-b: AABD Case – 04/22/14 MR 14.12 WAG 25-07-07: Increase or Decrease In Benefits – 03/01/97 WAG 25-07-07-a: AABD and TANF Cases – 04/22/14 MR 14.12 WAG 25-07-07-b: Food Stamps – 03/01/97 WAG 25-07-08: Authorizing An Increase - Mercury Benefits – 03/01/97 WAG 25-07-08-a: AABD, GA, and TANF Cases – 07/01/97 WAG 25-07-08-b: SNAP – 11/01/97 WAG 25-07-09: Adding A Person To The Benefit Unit (TANF) – 07/01/97 WAG 25-07-09-a: Adding Newborn or Child – 06/09/14 MR 14.15 WAG 25-07-09-b: Adding Child Born to AABD or Certain DCFS Client – 07/01/97 WAG 25-07-09-c: Temporary Addition of Adopted or Deceased Newborn – 07/01/07 MR 07.09 WAG 25-07-09-d: Adding a Child(ren) to an Active MANG Case – 07/01/97 WAG 25-07-09-e: Adding a Person to a Canceled Case for Medical Only – 01/01/03 WAG 25-07-09-f: Adding an Adult to Benefit Unit – 08/17/98 WAG 25-07-10: Computing and Issuing an IPE (TANF, GA) – 08/17/98 WAG 25-07-10-a: Central Proration – 05/14/13 MR 13.13 WAG 25-07-10-b: Regular Roll Action Only – 08/17/98 WAG 25-07-11: Deleting a Person from Benefit Unit (TANF, GA) – 08/17/98 WAG 25-07-12: Adding A Person to the SNAP Household – 07/19/2022 MR #22.13

WAG 25-08-00: Approval of Benefits Using Form 552 (IPACS) – 01/06/00 WAG 25-08-01: TANF/RRA Approvals Via Form 552 – 3/20/15 MR 15.09 WAG 25-08-01-a: TANF/RRA Cash Approvals – MR 10.32 01/03/11 WAG 25-08-01-b: Family Health Plans Approvals – 3/20/15 MR 15.09 WAG 25-08-02: AABD Approvals Via Form 552 – 03/01/97 WAG 25-08-02-a: AABD Cash Approvals – MR 10.32 01/03/11 WAG 25-08-02-b AABD Medical Approvals – MR 10.32 01/03/11 WAG 25-08-02-c: QMB Only Approvals – 03/01/97 WAG 25-08-02-d: SLIB Only Approvals – 03/01/97 WAG 25-08-03: Reserved – 04/22/14 MR 14.12 WAG 25-08-04: SNAP Approvals Via Form 552 – MR 10.32 01/03/11

WAG 25-09-00: Form Retention List – 06/24/14 MR 14.17

WAG 25-11-00: Medical Cards – 04/22/14 MR 14.12

WAG 25-13-00: IES Forms

WAG 25-14-00 360 Notices – 09/22/16 MR 16.15

WAG 25-15-00: Which Offices Certify & Maintain Which Programs – 01/22/2020 MR 20.03

(12668)WAG 25-03-03: AABD Fuel and Utility Allowances by Area#

(12668)(block-1)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $3.80 $3.80 $4.45 $5.10 $5.70 $6.40 $7.00 $7.65 $8.30 $8.90 $9.55 Electricity 5.55 5.80 6.25 6.70 7.10 7.50 7.90 8.30 8.65 9.05 9.45 Cooking Fuel 3.00 3.50 4.05 4.40 5.10 5.80 6.50 7.25 7.90 8.60 9.30 Heat - Coal 23.35 23.85 24.20 24.20 25.10 25.10 25.10 25.10 25.10 25.10 25.10 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 11.90 13.20 14.50 15.75 16.15 16.15 16.15 16.15 16.15 16.15 16.15 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-2)AREA 2 -#

Boone (13)

Carroll (17)

DeKalb (27)

DuPage (30)

Grundy (40)

Jo Daviess (51)

Kane (53) (114)

Kendall (55)

Lake (57)

LaSalle (58)

Lee (60)

McHenry (71)

Ogle (79)

Stephenson (97)

Whiteside (106)

Will (107)

Winnebago (109)

(12668)(block-3)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $3.80 $3.80 $4.45 $5.10 $5.70 $6.40 $7.00 $7.65 $8.30 $8.90 $9.55 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 20.35 21.70 21.70 24.20 25.10 25.10 25.10 25.10 25.10 25.10 25.10 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.40 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-4)AREA 3 -#

Bureau (15)

Fulton (37)

Henderson (44)

Henry (45)

Knox (56)

Marshall (67)

McDonough (70)

Mercer (74)

Peoria (80)

Putnam (86)

Rock Island (89)

Stark (95)

Tazewell (98)

Warren (102)

Woodford (110)

(12668)(block-5)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $3.80 $3.80 $4.45 $5.10 $5.70 $6.40 $7.00 $7.65 $8.30 $8.90 $9.55 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 15.75 15.75 17.80 19.48 19.48 19.48 19.48 19.48 19.48 19.48 19.48 Fuel Oil 16.55 17.40 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-6)AREA 4 -#

Adams (10)

Brown (14)

Calhoun (16)

Cass (18)

Christian (20)

Greene (39)

Hancock (42)

Jersey (50)

Logan (62)

Macoupin (64)

Mason (68)

Menard (73)

Montgomery (76)

Morgan (77)

Pike (83)

Sangamon (91)

Schuyler (92)

Scott (93)

(12668)(block-7)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $3.80 $3.80 $4.45 $5.10 $5.70 $6.40 $7.00 $7.65 $8.30 $8.90 $9.55 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 13.60 13.60 13.60 14.00 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-8)AREA 5 -#

Champaign (19)

Clark (21)

Coles (24)

Cumberland (26)

DeWitt (28)

Douglas (29)

Edgar (31)

Effingham (33)

Ford (35)

Iroquois (46)

Kankakee (54)

Livingston (61)

Macon (63)

McLean (72)

Moultrie (78)

Piatt (82)

Shelby (94)

Vermilion (100)

(12668)(block-9)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $3.80 $3.80 $4.45 $5.10 $5.70 $6.40 $ 7.00 $7.65 $ 8.30 $ 8.90 $9.55 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 15.30 15.30 15.75 16.55 17.80 17.80 17.80 17.80 17.80 17.80 17.80 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-10)AREA 6 -#

Bond (12)

Clinton (23)

Madison (65)

Monroe (75)

St. Clair (111) (112) (113)

Washington (103)

(12668)(block-11)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $5.10 $5.10 $5.70 $7.00 $7.65 $8.30 $8.90 $9.55 $10.20 $10.80 $11.45 Electricity 5.55 5.80 6.25 6.70 7.10 7.50 7.90 8.30 8.65 9.05 9.45 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 11.10 11.45 12.35 12.35 12.75 12.75 12.75 12.75 12.75 12.75 12.75 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-12)Area 7 -#

Clay (22)

Crawford (25)

Edwards (32)

Fayette (34)

Jasper (48)

Jefferson (49)

Lawrence (59)

Marion (66)

Richland (88)

Wabash (101)

Wayne (104)

(12668)(block-13)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $5.10 $5.10 $5.70 $7.00 $7.65 $8.30 $8.90 $9.55 $10.20 $10.80 $11.45 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 11.10 11.45 12.35 12.75 12.75 12.75 12.75 12.75 12.75 12.75 12.75 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12668)(block-14)AREA 8 -#

Alexander (11)

Franklin (36)

Gallatin (38)

Hamilton (41)

Hardin (43)

Jackson (47)

Johnson (52)

Massac (69)

Perry (81)

Pope (84)

Pulaski (85)

Randolph (87)

Saline (90)

Union (99)

White (105)

Williamson (108)

(12668)(block-15)NUMBER IN HOUSEHOLD#

TYPE OF UTILITY 1 2 3-4 5-6 7-8 9-10 11-12 13-14 15-16 17-18 19+ Water $5.10 $5.10 $5.70 $7.00 $7.65 $8.30 $8.90 $9.55 $10.20 $10.80 $11.45 Electricity 6.80 7.35 7.65 8.30 8.65 9.05 9.45 9.80 10.20 10.60 10.95 Cooking Fuel 3.25 4.65 6.40 7.10 7.90 8.65 9.45 10.20 10.95 11.75 12.45 Heat - Coal 8.90 8.90 9.35 9.35 9.75 9.75 9.75 9.75 9.75 9.75 9.75 Fuel Oil 16.55 17.45 17.80 19.10 19.10 19.10 19.10 19.10 19.10 19.10 19.10 Metered Gas 10.20 11.45 11.90 13.20 14.00 14.00 14.00 14.00 14.00 14.00 14.00 Bottled Gas 17.45 19.10 19.10 20.85 22.45 22.45 22.45 22.45 22.45 22.45 22.45

(12672)WAG 25-03-04: Crisis Assistance#

(12672)(block-1)Household Furnishings#

Essential furnishings are provided if the assistance unit is in need and meets the eligibility criteria.

The following items and amount of payment for each may be allowed:

Kitchen table - $50 (one per assistance unit)

Kitchen chair - $10 (one per person in assistance unit)

Beds - to ensure adequate sleeping facilities for all members of the assistance unit the following maximum amounts may be allowed: Bed frame - $ 30 Single mattress and springs - $ 70 Double mattress and springs - $100 Bunk beds (include mattresses and springs) - $130 Crib (including mattress) - $ 65

(12672)(block-2)Rent#

When the victim of a verified crisis needs a rental allowance to obtain immediate housing for the assistance unit, an amount for rent may be allowed if the prospective landlord requires payment in advance. A maximum allowance for rent of $250 may be made.

(12672)(block-3)Food#

Each person in the assistance unit may receive $5 per day until:

receipt date of the next regular TANF cash benefits or;

receipt of regular source of income or;

receipt of food stamp benefits not to exceed 30 days, minus the amount of available food stamp benefits available in the Illinois Link Account.

NOTE: The amount issued for lost/stolen cash cannot exceed the amount that was lost and cannot exceed the amount of the Payment Level.

Food cannot be authorized for replacement of lost or stolen food stamp benefits.

(12672)(block-4)Clothing, Household Supplies#

Size Assistance Unit Clothing Household Supplies 1 $ 34 $11 2 $ 58 $14 3 $ 92 $17 4 $117 $17 5 $146 $20 6 $174 $20 7 $204 $22 8 $233 $22 9 $261 $23 10 $291 $24 For each additional person: $ 29 $ 1

(12672)(block-5)Non-medical needs related to essential medical care:#

Food - $9 a day or $3 per meal per person.

Lodging - Approve lodging expenses at the least expensive rate that provides lodging adequate and available to meet the person's needs. Do not approve payment for a higher amount if lodging is available at a lower rate or free of charge.

Transportation - When transportation cannot be provided by the Medical Assistance Program, approve transportation expenses for the least expensive mode of transportation adequate to meet the person's needs. When transportation is by private automobile, the allowable rate is 14¢ per mile.

(12698)WAG 01-06-07: Processing SNAP and TANF REDEs#

(12698)(block-1)IES Phase 2 Process#

(FCRC) Processes TANF and SNAP redeterminations in the Integrated Eligibility System (IES).

(IES) Generates the appropriate sections of IL444-0360C Notice of Decision which are mailed to the customer.

NOTE: See WAG 01-06-02-d for information on the dynamic sections of the IL444-0360C Notice of Decision.

(12698)(block-2)Legacy System Process (ACM and IPACS)#

Form 360/360C tells the unit its eligibility status, new approval period, and benefit amount. It identifies persons for whom request was made and persons who are not included in the unit.

(FCRC) If the SNAP REDE is processed at Intake through IPACS, completes and sends the appropriate pages and sections of Form 360. Inform the unit of its eligibility status, new approval period, and benefit amount. Also, in Section I** (Form 360P8), advise the unit of those persons for whom application was originally made and who were not included in the approved case.

(FCRC) For income maintenance SNAP REDEs, allow the system to send Form 157C, or Form 360C, or manually send Form 360A.

(System) Sends Form 360C for SNAP REDEs when there are fewer than 45 days left in current approval period. NOTE: The following message appears on Form 360C, when code 00, 92, or 94 is used in Box 39 of Form 552 or on ACM Second Party Review/Actions To Be Taken Screen; or code F or B is used in first position of Box 44 of Form 552 or ACM Additional Entry Screen: "You have been approved for SNAP through mo/yr. You will get $ for the first month and for each remaining month unless you are notified of a different amount. The actual amount you get will be lower if your benefits are being reduced to pay back an overpayment. At a later date you will be sent information on continuing your SNAP after mo/yr."

(System) Sends Form 360A for SNAP REDEs processed in ACM or IPACS when SNAP benefits remain the same or increase, and more than 45 days remain in the current approval period.

(System) Sends Form 157C for SNAP REDEs processed in ACM or IPACS when SNAP benefits go down, and more than 45 days remain in the current approval period. NOTE: Form 157C tells the unit about a reduction in benefits and new approval period, or no longer being eligible for SNAP and case being canceled.

(System) Sends Form 360C when the SNAP REDE application is registered and denied through IPACS.

(System) Sends daily listing, IM Change Notices Issued Centrally/Intake Notices Issued Centrally, to notify Family Community Resource Center of action taken.

(12703)PM 01-07-02: How an Appeal May Be Filed#

(12703)(block-1)PM 01-07-02: How an Appeal May Be Filed#

WAG 01-07-02

A person can file an appeal:

orally;

in writing;

by using the ABE Appeals Portal;

by facsimile (fax);

by mail;

in person at the Bureau of Hearings (BAH); or

at any FCRC.

(12703)(block-2)ABE Appeals#

A client or authorized representative can access the ABE Appeals Portal to file and manage appeals. All correspondence from the Bureau of Hearings will be available in the ABE Appeals Portal including the Final Administrative Decision.

(12703)(block-3)Written Appeals#

A fax of the client's request for an appeal is the same as an original written request. A written appeal must be signed by the client or a person authorized to represent the client. If the written appeal is signed by an authorized representative, the client must give the representative written authorization to file an appeal on his or her behalf. Advise clients to send a written appeal to either the Family Community Resource Center serving that client or the DHS Bureau of Assistance Hearings (BAH).

Child Care appeals may also be filed with the Child Care Resources and Referral (CCR&R) or the Bureau of Child Care and Development.

(12703)(block-4)Faxed and Mailed Appeals#

Appeals received by a Family Community Resource Center, other Department offices, or a CCR&R must be date-stamped and uploaded in IES within 48 hours. If the client files an appeal at a FCRC that is not currently serving the client, the FCRC should upload all documents to IES and notify the servicing FCRC. Scan and upload the postmarked envelope if the request was mailed to the office or the transmittal sheet if it was faxed to the office. For appeals signed by an authorized representative, scan and upload a copy of the client's authorization (Form IL444-0960 ). Upload all documents to IES. The FCRC shall process all appeal request submitted and shall not make a determination as to the appropriateness or timeliness of the appeal request. For TANF sanction appeals, write SANCTION at the top for expedited processing. File copies of all documents in the case record.

(12703)(block-5)Phone or In Person Appeals#

A person may file an appeal by phone by calling the Bureau of Hearings' toll-free number (1-800-435-0774).

For SNAP appeals only , a person may file an appeal by telling DHS staff, by phone or in person, that they want to appeal.

(12704)WAG 01-07-02: How an Appeal May Be Filed#

(12704)(block-1)WAG 01-07-02: How an Appeal May Be Filed#

PM 01-07-02

(Customer) Asks to file an appeal.

(FCRC) Tell the customer how they can file the appeal. For cash (including child care) and medical, tell the customer they may file a written appeal by mail, fax, in person, or the customer may call DHS Bureau of Hearings (BAH) at 1-800-435-0774 between 8:30 a.m. and 4:45 p.m. on Department workdays. Give the customer the address and fax number of the FCRC. Also give the customer the address, fax number, and email for the DHS Bureau of Hearings (BAH). The address for BAH is 69 W. Washington, Suite 901, Chicago, IL 60602; Fax: 312-793-3387 and the email address is DHS.BAH@illinois.gov . For child care appeals, also provide the name and address of the appropriate CCR&R and Bureau of Child Care and Development (BCCD), 100 S. Grand Ave East, 2nd Fl., Springfield, IL 62762. Mail or give the customer a Appeals Request Form, IL444-0103 . Assist in completing the Appeals Request Form, IL444-0103 , if requested. For appeals involving only SNAP benefits, complete the Appeals Request Form IL444-0103 based on the customer's verbal request. For customers with an ABE account and login, tell the customer that they can go to https://abe.illinois.gov/abe/access/appeals . For customers without an ABE account, tell the customer that they can create an ABE account by following the prompts to link their ABE account to their IES case information and then they can file an appeal online.

(FCRC) Appeals received by a Family Community Resource Center, other Department offices, or a CCR&R must be date-stamped and uploaded in IES within 48 hours. If the customer files an appeal at a FCRC that is not currently serving the customer, the FCRC should upload the appeal into IES and notify the servicing FCRC.

(FCRC) Scan and upload Appeals Request Form IL444-0103 and the postmarked envelope if the request was mailed to the office or the transmittal sheet if it was faxed to the office. For appeals signed by an authorized representative, include a copy of the authorization, Authorized Representative Form for Appeals IL444-0960 . Upload all documents to IES. The FCRC shall process all appeal request submitted and shall not make a determination as to the appropriateness or timeliness of the appeal request. Write SANCTION on TANF sanction appeals for expedited processing. Do not mail the customer's written statement of appeal or completed Appeals Request Form IL444-0103 to BAH. Another Department office or agent that receives a customer's request for an appeal must also forward it to BAH within 2 workdays.

(FCRC) Immediately determine if the customer is entitled to continued benefits during the appeal process and restore assistance, if appropriate, unless the customer states they do not want continued benefits. Do not continue child care benefits.

(BAH) If the customer requests an appeal using the toll free number, BAH registers the appeal. Sends FCRC information on all appeal requests received directly from a customer's/representative's ABE Appeal Portal telephone, fax, or mail. Sends BCCD information on child care appeals. Forwards HFS appeals to HFS Fair Hearings Section.

(12720)PM 01-07-06: Pre-Hearing Review#

(12720)(block-1)PM 01-07-06: Pre-Hearing Review#

WAG 01-07-06

Within 7 days after the appeal is filed, the worker and supervisor must meet and review the action under appeal to decide if:

the client was sent a proper notice;

correct policy and procedures were used; and

all figures were correct and for the right periods.

If a mistake was made, stop or change the action as needed. Notify the client in writing that either:

We are dropping the action and leaving the benefits at the level they were before. Ask the client to withdraw the appeal; or

We have decided to change the action after our review, and we are taking another action.

NOTE: The client may choose not to withdraw the appeal and may also file an appeal on the new action.

If the review finds that the original action was correct, make sure that all paperwork and verifications are available for the appeal.

An appeal may be about an action taken by DHS staff who are not in the Family Community Resource Center. Contact the office responsible for the action for any directions or paperwork needed to support the action. The Family Community Resource Center Appeals Coordinator is responsible for obtaining the information from that office.

For an appeal regarding a DentaQuest decision or other HFS decision, notify the HFS Fair Hearings Section (FHS). The FHS phone number is 1-800-435-0774. FHS contacts DentaQuest or other responsible party for follow-up. The Family Community Resource Center does not conduct a pre-hearing review or pre-hearing meeting for these appeals.

For example, the HFS central office Recipient Restriction Unit schedules and conducts the pre-hearing review and meeting for appeals of decisions restricting a client to a Primary Care Provider (PCP). The Bureau of Collections (BOC) conducts the pre-hearing review on an appeal of action to file a lien on real property owned by a long-term care client.

For child care appeals, the Bureau of Child Care and Development obtains all information and evidence about the appeal from the CCR&R and/or provider and reviews it for accuracy.

When the appeal includes a determination of whether or not a signature is genuine, the FCRC Appeal Coordinator sends copies of the appeal request and evidence to the Bureau of Operations Support (BOS). BOS forwards the information to the Department's Forensic Document Examiner (FDE) and contacts BAH so they can coordinate scheduling of the hearing with the FDE. Prior to the hearing, the Family Community Resource Center receives copies of the FDE's statement of qualifications, signatures used in the determination, and conclusions in the case, to present at the hearing. The FDE keeps the originals and testifies from them by telephone during the hearing.

(12721)WAG 01-07-06: Pre-Hearing Review#

(12721)(block-1)WAG 01-07-06: Pre-Hearing Review#

PM 01-07-06

(BOC) Receives appeal request and conducts a pre-hearing review for AABD cases , when a decision to file a lien on real property owned by an AABD medical long term care client is appealed.

(FCRC) For pre-hearing review, use information on the daily list of centrally issued client notices (see WAG 01-06-00 ) to verify: that a notice was sent; the dates of the notice and change; and the specific information included on the notice. Make a copy of the list to submit as evidence at the hearing.

(FCRC) Notify the client in writing if the Department's action is reversed or modified. Send a timely corrected Notice of Change (Form 157) or an approval/denial notice, if the decision is to modify the original action. If the decision is to reverse the action on an active case, send the client a Notice of Benefit Restoration (Form 3363). Attach Request to Withdraw Appeal (Form 65) to the notice, and include a letter requesting that the client sign and return Form 65.

(FCRC) Ensure that all necessary documentation or proofs required to proceed with the appeal are in hand if the client does not withdraw the appeal.

(FCRC) Contact the appropriate bureau and attempt to get information if more documents or clarification is needed in order to proceed with the appeal. Note: For appeals related to overpayments ensure all necessary documents are included in the overpayment packet. Request any client notices from the Bureau of Collections (BOC).

(FCRC) Contact the proper central office contact person if the issue involves complex collections, cross-match, special investigations' policies or practices, or genuineness of a signature.

(Casework Supervisor) After the pre-hearing review, document the review results on Appeal Control Card and Pre-Hearing Review Quality Checklist (Form 1201), and sign the form. Use the back of the form during the pre-hearing review to document and determine if action taken was timely and appropriate. Use the front of the form to document action taken on the appeal.

(Casework Supervisor) Forward the completed Form 1201 to the Appeal Coordinator.

(12723)WAG 01-07-07: Pre-Hearing Meeting#

(12723)(block-1)WAG 01-07-07: Pre-Hearing Meeting#

PM 01-07-07

(FCRC) Prepare the Pre-Hearing Meeting Appointment Letter (Form 2491), noting date and time of the pre-hearing meeting and whether it is to be held by phone or in the office. Mail original Form 2491 to appellant. Mail copy of Form 2491 to appellant's representative if they have one. File copy of Form 2491 in case record.

(FCRC) Meet with appellant (and/or their representative).

(FCRC) Explain basis for action being appealed.

(Appellant) Presents any additional information pertaining to action being appealed.

(FCRC) Based upon information presented during the meeting, decide if it's appropriate to reverse, modify, or leave unchanged the appealed action. If a client presents the notice and envelope in which the notice was delivered, use the postmark on the envelope as the date of notice if it's later than the date of notice shown on the central notice list.

(FCRC) When the action is to be reversed or modified, authorize the revised benefits and give written notice to the appellant (or representative). Take the necessary action to authorize benefits. Complete a Notice of Benefit Restoration (Form 3363) or the appropriate notice of approval, denial, or reduction.

(FCRC) Ask the appellant to withdraw the appeal (see WAG 01-07-09 ). The withdrawal of the appeal must be in writing.

(FCRC) Complete and distribute the Statement of Facts (Form 102) if the appeal is not withdrawn after the meeting. See NOTE for exception to completion of Form 102. Use Form 102 to describe the facts supporting the Department's action or inaction.

Send the original Form 102 to the appellant and a copy to their representative. The client must receive the Form 102 at least 2 workdays before the appeal hearing. Allow 2 postal days for receipt.

File a copy of Form 102 in the case record.

Give copy of Form 102 to Hearing Officer during hearing.

NOTE: FCRC does not complete Form 102 if the appeal is about:

a prior approval request for medical service or item; or

a decision to restrict client to a primary care provider; or

an Illinois Office of the Comptroller review decision; or

a Bureau of Collections decision to file a lien on real property owned by an AABD medical long term care client; or

a child care decision; or

any other decision made by an entity other than the FCRC.

In these cases, the office responsible for the decision completes and distributes Form 102 or a Decision Summary. They send the FCRC a copy with supporting documents for the case record.

(12726)WAG 01-07-07-b: Appeal of "Not Disabled" Determination#

(12726)(block-1)WAG 01-07-07-b: Appeal of "Not Disabled" Determination#

PM 01-07-07-b

(Client) Files appeal of "Not Disabled" determination.

(FCRC) If necessary, contact other Department staff involved in the determination of "Not Disabled".

(Client or Representative) May provide medical or other information, evidence, or testimony relevant to appellant's condition.

(FCRC) Complete the original and one copy of Notice to Persons Appealing a Determination of Failure to Meet Disability Eligibility Requirements (Form 2397). Send the original Form 2397 to the appellant within 48 hours of receipt of appeal request. File a copy of Form 2397 in the case record.

(FCRC) Following the pre-hearing meeting, submit to CAU for reconsideration: medical or any other information, evidence, or testimony related to disability on which CAU based the finding (all medical reports; Medical Evaluation [Forms 183A, 183B, and 183C]) If Mail-In Application for Medical Benefits (Form HFS 2378H) is completed, Form G may be used in place of Form 183B; and any new medical or other information, evidence, or testimony related to disability submitted by the appellant/or their representative during the pre-hearing meeting.

(FCRC) Submit information to CAU, even if there's no new information. At the top of the covering memo to CAU, indicate that this is an "APPEAL". Also, indicate either "ADDITIONAL MEDICAL ATTACHED" or "NO ADDITIONAL MEDICAL ATTACHED", as applicable.

(CAU) Before the appeal hearing, reports the results of a reconsideration to the FCRC on Form 183C.

(FCRC) For AABD cases , contact CAU to determine the status of the case if the FCRC hasn't received Form 183C by 2 workdays before the date of the scheduled hearing. If CAU has again determined that the appellant is not disabled or has not made a decision in the case, contact the Assistance Hearings Section (AHS) and the appellant or appellant's representative to postpone the hearing until you receive the CAU decision. If CAU has determined that the appellant is disabled, immediately authorize benefits. Send the appropriate notice to the appellant with a copy to their representative. Include a letter and Form 65 asking the appellant and their representative to withdraw the appeal.

(FCRC) If the appeal is not withdrawn, present CAU completed Form 183C and all other reports, information, and medical information, evidence, or testimony related to the disability used by the Department at the hearing.

(12747)PM 01-07-08: Evidence Considered Upon Appeal#

(12747)(block-1)PM 01-07-08: Evidence Considered Upon Appeal#

WAG 01-07-08

When an appeal is filed timely (within 60 days for cash, medical, and child care and 90 days for SNAP), allow the client to present additional information and verifications during the appeal process. However, the client may not present evidence which they specifically refused to provide prior to the action under appeal.

If the client previously failed to provide information or verification, but did not express an intentional refusal to do so, accept the information or verification when presented during the appeal process. Reverse or modify the Department's action, if the evidence shows the client qualifies for additional benefits.

This policy also applies to applications denied because the client failed to appear for a scheduled interview. If the client appeals the denial of cash/medical/child care within 60 days or the denial of SNAP within 90 days, reschedule the interview. If the client appears for the interview and provides all required information, reopen the application with the original application date. If eligible, approve assistance and provide benefits as though all the information was available at the time of the original decision.

A client may present additional evidence when they file the timely appeal, during the pre-hearing meeting, and any time prior to and during the appeal hearing. If the client asks for more time to get further evidence before the hearing, tell them the hearing will be held as scheduled unless they request a delay from the Bureau of Assistance Hearings and it is granted. (The Bureau of Assistance Hearings will not usually grant a delay just to allow the client to obtain additional evidence.)

When additional evidence is presented during the appeal hearing, it is considered in making the Final Administrative Decision, unless:

the appeal was not filed within the specified time period or

the client previously refused to provide the evidence to the Family Community Resource Center. (Previous failure to provide such evidence is not considered refusal.)

To implement a Final Hearing Decision that upholds the FCRC and orders a new determination, the FCRC must:

make the new determination,

notify the client of the result in writing, and

authorize benefits, if the client is eligible.

(12759)PM 01-07-10-c: Request for Hearing Delay#

(12759)(block-1)PM 01-07-10-c: Request for Hearing Delay#

WAG 01-07-10-c

The client or their representative may ask for a hearing delay. Before the hearing starts, the delay is a postponement. After the hearing starts, the delay is a continuance.

A request for a postponement must be sent in writing, by mail or fax, to the Bureau of Assistance Hearings (BAH). BAH must receive the request in writing at least 2 workdays prior to the scheduled hearing date for the request to be timely. A request that is not timely must show good cause, except for the first request for postponement of a SNAP appeal.

The appellant's first request for postponement of a SNAP appeal does not have to be timely or show good cause. The appellant's first request for postponement of a non-SNAP appeal does not have to show good cause if it is timely. All other requests for postponement will be granted only if they show good cause.

Good cause includes, but is not limited to:

death in the family;

personal injury or illness that reasonably keeps the appellant from attending the hearing; and

sudden and unexpected emergency or other circumstances beyond the appellant's control, which reasonably keeps them from attending the hearing.

After the hearing starts, the appellant or their representative may verbally request that it be continued at a later time. They must have good cause, unless it is their first request for a hearing delay.

If the request for postponement or continuance is granted, BAH reschedules the hearing as soon as possible and notifies the parties of the new date, time, and place of the hearing.

Except for the first request for a postponement in a SNAP appeal, the appellant and representatives are expected to appear for the hearing unless notified that the postponement has been granted. The appeal is dismissed if they fail to appear. BAH sends a written notice of dismissal to the appellant and their representatives.

For Cash and Medical programs , the hearing may be delayed for any length of time based on the judgment of the hearing officer. If the request is allowed, extend the 90-day time limit by the same amount of time.

For SNAP cases, the client may request a delay of the hearing for up to 30 days. If the request is allowed, extend the 60-day time limit of the SNAP appeal process by the same amount of time.

Document in the case file the reason for any delay.

(12768)PM 01-07-11: Final Hearing Decision#

(12768)(block-1)PM 01-07-11: Final Hearing Decision#

WAG 01-07-11

The Final Hearing Decision is approved by the DHS Secretary, HFS Director, or both, based on the action/inaction that was the subject of the appeal. The decision applies only to the case under appeal and to no other case. A decision in an appeal is not general Department policy.

The Final Hearing Decision either:

upholds the action; or

does not uphold the action; or

determines a lack of Department jurisdiction.

The Bureau of Assistance Hearings sends a Final Decision Notice to notify the client (or their representative) of the decision. BAH sends a copy of the notice to the responsible Department office, telling them what action to take. For child care appeals, a copy of the decision is also sent to the CCR&R and/or provider and the Bureau of Child Care and Development.

The Final Hearing Decision will either uphold or not uphold the Department's action based only on the information available at the time the action was taken. The Final Hearing Decision often does not use the words "upheld" or "not upheld". Read the decision carefully and follow the directions in the decision. If the decision directs action by an entity other than the Family Community Resource Center, that entity is responsible for taking the action and reporting it.

When additional evidence is presented during the appeal hearing, it is considered in making the Final Hearing Decision, unless:

the appeal was not filed within the specified time period or

the client previously refused to provide the evidence. Previous failure to provide such evidence is not considered refusal.

There are times when the original action was right, but the decision directs you to take a different action. This may be due to additional evidence presented during the appeal or changes in the appellant's situation. When the decision directs you to take action, do it.

The decision may say to make a new determination. You must reconsider the action under appeal, using all the evidence now available. Do what you would have done if you had all the information at the time of the original action.

Barring any approved hearing delays, put the Final Hearing Decision into effect within 90 days of the date the appeal is filed for cash, medical, or child care and 60 days for SNAP.

(12772)WAG 01-07-11: Final Hearing Decision#

(12772)(block-1)WAG 01-07-11: Final Hearing Decision#

PM 01-07-11.

When the Department has jurisdiction, the Final Hearing Decision will either uphold or not uphold the Department's action based only on the information available at the time the action was taken. The Final Hearing Decision often does not use the words "upheld" or "not upheld". Read the decision carefully and follow the directions in the decision.

If the client presents evidence at the hearing which was not previously presented to the Department and the new evidence is considered, the Final Hearing Decision will also say to make a new determination based on all the evidence presented at the hearing. If the decision directs action by an entity other than the Family Community Resource Center, that entity is responsible for taking the action and reporting it.

When implementing any decision, take into account changes in the case that have happened since the original action was taken.

(LO/Other) Put the hearing decision into effect within 10 calendar days after the date the decision is received.

(LO/Other) Complete Implementation of Appeal Decision (Form 1456) when the Final Administrative Decision directs an action. Form 1456 must show all steps taken and the dates actions were taken. NOTE: Do not complete Form 1456 if all directions on the Final Administrative Decision uphold the Department's action without ordering a new determination and/or dismiss for want of jurisdiction. If the decision directs action by HFS or its agent, they complete Form 1456 and send to the HFS Fair Hearings Section.

(LO/Other) Send original Form 1456 to Bureau of Assistance Hearings with required attachments. File a copy in the case record.

(LO/Other) Whether the action is upheld or not upheld or the appeal is dismissed for lack of jurisdiction, complete the front of the Appeal Control Card and Pre-Hearing Review Quality Checklist (Form 1201).

(Appeal Coordinator) Approves and signs Form 1201.

(12773)WAG 01-07-11-a: Action Upheld#

(12773)(block-1)WAG 01-07-11-a: Action Upheld#

PM 01-07-11-a

If the Department's action is upheld and benefits were continued during the appeal process, take the original action (unless it's no longer appropriate). Withhold the central notice. The Final Decision Notice is enough. Update the case record. If the case received an overpayment of cash benefits: refer the case for recovery of overpayment (see WAG 23-05-01 ); or begin recouping from the cash benefit any overpayment received while the appeal was pending (see WAG 23-05-01-a ); or impose sanction (see PM 03-22-04 , PM 03-13-04-c , or PM 24-01-03 ). See PM 15-07-01 if the decision indicates that medical must be approved for a period previously not covered.

If the Department's action is upheld and benefits were not continued during the appeal process, update the case record.

If the Department's action is upheld, but the Family Community Resource Center is told to make a new decision based on additional evidence, reconsider the action, using all the evidence now available. Do what you would have done if you had all the information at the time of the original action. Notify the client of the result in writing, and authorize benefits, if eligible. Send the appropriate notice form if benefits are reduced or canceled or an application is approved or denied. If benefits are continued or restored, send a Notice of Benefit Restoration (Form 3363). Complete Form 1456.

Do not cancel or reduce benefits, even if Family Community Resource Center action was affirmed by the appeal decision or the appeal was withdrawn, if the client is currently eligible for benefits (or increased benefits) due to changes that occurred while the appeal was pending. Calculate any overpayment based on the number of months the unit should have received reduced benefits due to the matter under appeal. Example:TANF Mrs. J receives TANF for herself and her child. Her husband and legal father of the child returns to the home in April. The father receives UI benefits greater than the cash benefit amount for a 3 person case, so the family is not eligible for TANF Cash. The caseworker takes action to cancel the case effective May. Mrs. J appeals the action before the date of change and benefits are continued. In June, while the appeal is pending, the child's father leaves the home. In August the appeal is heard and the appeal decision upholds the Family Community Resource Center action of May to cancel benefits. Complete an overpayment for the months of May and June since the family was ineligible for benefits for only that period. Since eligibility for July existed, no further overpayment is computed and the case is maintained active on the regular roll. Example:AABD Ms. J receives SSP of $75 a month. Due to an increase in her income, she is no longer eligible for cash effective September. The Family Community Resource Center takes action to cancel the case effective September. Ms. J appeals the action before the date of change and cash benefits are continued. In November, while the appeal is pending, Ms. J's rent increases. The amount of the rent increase causes Ms. J to be eligible for SSP even with her increased income. In December the appeal is heard and the appeal decision upholds the Family Community Resource Center action of September to cancel benefits. Complete an overpayment for September and October since the client was ineligible for that period. For November and December compute an overpayment based on the circumstances for those months (i.e., increased income and increased rent). Since Ms. J remains eligible for an SSP, maintain the case as active for January.

When an SNAP case receives benefits to which it is not entitled, start a claim for overissuance (see WAG 23-04-02 ).

(105287)WAG 25-15-00: Which Offices Certify & Maintain Which Programs#

(105287)(block-1)WAG 25-15-00: Which Offices Certify & Maintain Which Programs#

The Integrated Eligibility System (IES) automatically transfers pending applications and approved cases to the appropriate offices as shown in the table below. In the event that work needs to shift between offices other than described below, staff may have to transfer the cases manually.

Office New Application Routing REDE, Case Change, Case Progression Actions On-Going Maintenance DHS FCRC SNAP Cash Medical Cash (TANF, AABD cash or RRP) SNAP Medical: Family Assist Medical Extension FamilyCare Assist Moms & Babies All Kids Assist All Kids Share All Kids Premium ACA Adult Former Foster Care AABD community AABD community Spenddown Family Health Spenddown MSP (QMB, SLIB, QI-1) *AATV Cash (TANF, AABD cash or RRP) SNAP AABD community and AABD community spenddown (with or without SNAP/cash) Other medical when combined with SNAP or cash All Kids Unit Medical Marketplace Applications BCC applications from the Illinois Breast and Cervical Cancer Program (IBCCP) Medical only: Family Assist FamilyCare Assist Moms & Babies All Kids Assist All Kids Share All Kids Premium BCC ACA Adult Former Foster Care AABD community AABD community Spenddown Family Health Spenddown MSP (QMB, SLIB, QI-1) *AATV Medical only: All Kids Share All Kids Premium BCC Other Medical when combined with All Kids Share, All Kids Premium or BCC Medical Field Operations- MFO (LO 200, 244 & 163) Medical **LTC - Nursing Homes & Supportive Living Program facilities only Medical only - LTC (NH & SLP) Medical only - LTC (NH & SLP) Stroger Medical Cook County Health & Hospital Systems (CCHHS) applications Medical only: Family Assist FamilyCare Assist Moms & Babies All Kids Assist All Kids Share All Kids Premium ACA Adult Former Foster Care AABD community AABD community spenddown Family Health Spenddown MSP (QMB, SLIB, QI-1) Medical only and individual resides in Cook County: Family Assist FamilyCare Assist Moms & Babies All Kids Assist All Kids Share All Kids Premium ACA Adult Former Foster Care Family Health Spenddown MSP (QMB, SLIB, QI-1) when combined with other medical listed above Medical Management Unit No initial applications Medical only: Family Assist Medical Extension FamilyCare Assist Moms & Babies All Kids Assist All Kids Share All Kids Premium ACA Adult Former Foster Care AABD community AABD community spenddown Family Health Spenddown MSP (QMB, SLIB, QI-1) *AATV Medical only: Family Assist Medical Extension FamilyCare Assist Moms & Babies All Kids Assist ACA Adult Former Foster Care Family Health Spenddown MSP (QMB, SLIB, QI-1) *AATV HFS Special Programs Medical - HBWD Medical only: HBWD (LO 250) Veterans Care (LO 196) Other medical when combined with HBWD or VC Medical only: HBWD (LO 250) Veterans Care (LO 196) Other medical when combined with HBWD or VC

*Special Units (LO 209) continues to certify and maintain the AATV cases in Cook County.

**Department on Aging (DoA) cases are also considered to be LTC. However, they are not routed to MFO because they live in the community and may be included in an IES case with other programs and persons.

(116686)WAG 03-02-03-c: Temporary Absence (SNAP)#

(116686)(block-1)WAG 03-02-03-c: Temporary Absence (SNAP)#

PM 03-02-03-c

(116686)(block-2)Temporarily Out-of State#

A person who is active for SNAP in Illinois continues to be eligible to receive benefits while temporarily out of State. There is not a fixed time frame for the individual to be out of State. The individual continues to be eligible as long as they intend to return to Illinois. Accept the person's statement that they are temporarily out of State, unless questionable. A person who is temporarily out of state cannot receive SNAP benefits in Illinois and the other state simultaneously. See PM 02-07-01, PM 03-02-03-d on National Accuracy Clearinghouse data match with other states to prevent duplicate SNAP assistance.

Note: Temporary absence policy does not apply to students of higher education who are living apart from the SNAP household due to attending school away from home.

(116686)(block-3)Establishing Permanent Residency in Another State#

Change Reporting SNAP household is required to report changes within 10 calendar days of the date that they become aware of the change. A person who establishes permanent residency in another State does not qualify for SNAP in Illinois. If a SNAP customer reports that they have become a resident of another State, accept their statement. Verification is not required. Cancel SNAP and send Notice of Decision (IL444- 360C) to the new address with the reason, " You are no longer a resident of Illinois (Usted ya no vive en Illinois) (PM 03-02-03). If it becomes questionable that a person has established permanent residency in another State, the HSC may follow-up with a Verification Checklist (IL444-0267 VCL) and verify residency.

Mid-Point Reporting SNAP households are not required to report address changes. Unless it becomes know from the National Accuracy Clearinghouse match that the household is receiving duplicate assistance, the HSC should address questionable information at the Mid-Point Report or at the next REDE, whichever is earlier. See PM 02-07-01, PM 03-02-03-d on National Accuracy Clearinghouse data match with other states to prevent duplicate SNAP assistance.

Example 1: Ms. B receives SNAP and is a Change Reporter. She must report changes within 10 calendar days of the date she becomes aware of the change. Ms. B is planning to spend the winter months in a warmer climate and should let the FCRC know her whereabouts. Ms. B contacts the FCRC in October to report that she will be spending November, December, January, and February in Florida. She intends to return to her home in Illinois in March. Ms. B remains eligible to receive SNAP in Illinois during the winter months while she is vacationing in Florida. Ms. B should notify the FCRC when she has returned to Illinois in March.

Example 2: Ms. K receives SNAP and is in Mid-Point Reporting. Ms. K's 75 year old mother lives in Georgia and was hospitalized in November due to a fall. Ms. K goes to Georgia in November and will be staying for several months to care for her mother. In March, the FCRC learns that Ms. K's Link card has been used in Georgia for several months. As a Mid-Point Reporter, Ms. K is not required to report this information. As long as Ms. K intends to return to her home in Illinois she may continue to receive SNAP in Illinois. If residency is questionable, but is not due to a NAC match, the HSC will address it at the next Mid-Point Report or REDE, whichever is earlier. See PM 02-07-01, PM 03-02-03-d on National Accuracy Clearinghouse data match with other states to prevent duplicate SNAP assistance.

Example 3: OB is applying for SNAP in Illinois. The NAC clearance shows OB is actively receiving SNAP in Kentucky. The HSC discusses this information with OB at the interview. OB states he has only been in Illinois a few days and plans to stay permanently. He was receiving SNAP in Kentucky has requested his case be closed. The HSC issues a Verification Checklist (IL444-0267 VCL) to OB requesting proof that benefits have been closed in Kentucky. See PM 02-07-01, PM 03-02-03-d on National Accuracy Clearinghouse data match with other states to prevent duplicate SNAP assistance

Example 4: Mr. J receives SNAP and is in Change Reporting. He contacts the FCRC in May to report that he will be vacationing in South Carolina June through August. Mr. J continues to receive SNAP without interruption. At the end of July, Mr. J reports that he no longer intends to return to Illinois. The HSC cancels Mr. J's SNAP benefits per his request as he is no longer an Illinois resident and mails the notice of adverse action to his address in South Carolina.

Example 5: The SNAP household includes D and her mother. In July, D moves to Carbondale to attend school at SIU starting August. D's mother reports this information to the HSC. The HSC removes D from the SNAP and mails Form 360c, Notice of Decision informing the household that D has been removed from SNAP and the new benefit amount. D may be added back to SNAP, if she returns home for the summer and all other eligibility requirements are met, including special student eligibility requirements ( PM 03-04-03-b).

Example 6: TJ is living in the SNAP household with his parents. In January, TJ moves to Ohio to attend school at Ohio State University. TJ's mother reports this information to the HSC. The HSC removes TJ from the SNAP household and sends Form 360c, Notice of Decision indicating that TJ has been removed from SNAP and the new benefit amount. TJ may be added back to SNAP, if he returns home for the summer and all other eligibility requirements are met, including special student eligibility requirements.

(117306)PM 02-07-03-n Asset Verification System (AVS)#

(117306)(block-1)PM 02-07-03-n Asset Verification System (AVS)#

WAG 02-07-03-n

The Asset Verification System (AVS) electronically searches Financial Institutions (FIs) across the United States for assets and asset transfers of Illinois Medicaid's Aid to the Aged, Blind or Disabled (AABD) customers. A social security number (SSN) is required to initiate an AVS search. Along with the customer's SSN, AVS uses the customer's name, date of birth and physical address to determine which local banks are to be included in the AVS results.

AVS provides the first day of each month balance for each verified liquid resource.

FIs have 30 days to provide verification of resources in response to an AVS request. IES places the results in the ECR in two separate files.

The first file contains records for days 1-10 and is placed in the ECR on the 11th day (or the following business day if the 11th day falls on a weekend or holiday). This file is used to determine eligibility at application and the results are utilized in the Form A/B redetermination process.

The second file consist of records for days 11-30 and is placed in the ECR on the 31st day (or the following business day if the 31st day falls on a weekend or holiday). Caseworkers will need to review both reports as the second file may contain information that was not included with the first report. This file is used in determining ongoing eligibility.

AVS provides real property data for Illinois Medicaid Aid to the Aged, Blind or Disabled (AABD) community medical and Long-Term Care (LTC) clients. Real Property results are displayed on the AVS Report and include verification of up to 60 months of property ownership, address(es) of property, assessed and market values, purchase date, and purchase price. AVS also includes the sale dates, ownership and type of deed associated with the sale of any properties within the last 60 months.

Section 1940 of the Social Security Act requires resources to be electronically verified for certain AABD customers. AABD individuals that require an AVS search to be completed are identified by their Type of Assistance (TOA). TOAs that require an AVS search to be completed are:

Program TOA Look-Back Period Widow/Widower WDOW 30 Days DAC DAC 30 Days AABD LTC SLF SLF 60 Months AABD LTC DOA DOA 60 Months AABD LTC NH NH 60 Months AABD COMMUNITY AABD 30 Days AABD COMMUNITY SPENDDOWN SPDC 30 Days AABD LTC Spenddown SPDL 60 Months HBWD HBWD 30 Days SHELTER CARE SHLT 30 Days DOA SPENDDOWN DOAS 60 Months ACA Adult with a LTC Indicator ACA - LTC 12 Months 65+ Group (Individuals turning 65 during the REDE review period*) All 12 Months VTTC AABD Med (V) 60 Months

* Customers who turn 65 during the REDE process are required to have the resources reviewed.

The following AABD individuals are not required to have an AVS search completed:

Individuals that are only receiving Medicare Savings Program (MSP) benefits,

individuals that have countable income less than or equal to 100% of the FPL,

individuals eligible for Simplified Processing , or

MAGI EDGs: ACA, FHP, Pregnant Women.

Note: Simplified Processing does not apply to TANF and/or AABD cash cases. This policy applies to Community Medical and Long Term Supports and Services (LTSS) customers.

(117306)(block-2)AVS Search Request#

AVS inquiries will be automatically initiated by IES for all applicable TOA's during the following actions:

Application,

Program Add,

Member Add,

Redetermination, and

Program Transition.

IES systematically triggers an AVS search every time eligibility is run for AVS TOAs for the above actions. Review the ECR and case comments for recent AVS results. IES does not systematically trigger AVS searches within 60 days from a previous request.

IES considers AVS search results in the redetermination Form A/B process (See PM 19-02-04 ). An AVS search that verifies resources are under the limit for the TOA satisfies the resource check and will allow the case to be automatically redetermined with Form A, if all other eligibility criteria are met. An AVS search that verifies resources are over the limit for the TOA will result in the customer receiving Form B to complete and return. A report containing the results is placed in the ECR for staff to review.

(117306)(block-3)Case Comment#

IES systematically inserts the following case comment when it initiates an AVS search:

AVS Request has been submitted for Individuals - First/Last Name. Results will be available in the ECR after 10/30 calendar days .

Review the case comments section to view the date of the most recent AVS request. Compare the date of the case comment with the Received Date of the Document/Task in the EDM Inbox.

(117306)(block-4)AVS Report#

The AVS process includes sending requests to all national banks and pre-selected local and regional banks. Results for the head of household and their spouse are added together and the total amount of verified resources are compared to the resource limit for the assigned TOA. Results for the head of household and/or their spouse are not included with resources for 'other' individuals listed on the case. Results for 'other' individuals are included in their own section of the AVS report. The AVS report also identifies completed searches that did not identify any accounts.

AVS search results are provided in a report format and contain the following eligibility factors for liquid resources:

Name of FI;

FI address;

Type of Resource;

Account owner(s);

Individual or joint account;

Month and year;

Monthly balance; and

Date received.

Note: An indicator for either over or under the resource limit assigned to the customer's TOA will be displayed on the AVS Report.

FIs have 30 days to provide verification of resources in response to an AVS request. IES places the results in the ECR in two separate files.

The first file contains records from FIs for days 1-10 and is placed in the ECR on the 11th day (or the following business day if the 11th day falls on a weekend or holiday). Results received from the FI's are added together and the total amount of verified resources are compared to the resource limit for the assigned TOA. This file is used to determine eligibility at application and in the Form A/B REDE process.

The second file consist of records for days 11-30 and is placed in the ECR on the 31st day (or the following business day if the 31st day falls on a weekend or holiday). Caseworkers will need to review both reports as the second file contains information that is not included with the first report. This file is used in determining ongoing eligibility.

See AVS Report and Document/Task for an example.

(117306)(block-5)Liquid Resources#

AVS receives resource verifications from participating FIs which provide the total balance of verified resource(s). AVS liquid resource results contain details such as the account branch name, branch address, account owner(s), account type(s), open and closed dates, first day of the month balance and first day of the month interest earned. Enter all liquid resource information received from AVS that is needed to make an eligibility determination on the Liquid Resource page in IES.

AVS does not provide verification for the following types of resources:

Life Insurance Policies,

Bonds,

Stocks,

Investments,

Retirement Plans, and

Treasury Securities.

(117306)(block-6)Real Property#

AVS provides real property data for Illinois Medicaid Aid to the Aged, Blind or Disabled (AABD) community medical and Long-Term Care (LTC) clients. AVS responses provide up to 60 months of property ownership, address(es) of property, assessed and market values, purchase date, and purchase price. AVS also includes the sale dates, ownership and type of deed associated with the sale of any properties within the last 60 months. Verification of real property is included in the AVS report.

AVS search results contain the following eligibility factors for real property:

Address of property;

Date of transfer;

Value of property;

Sale price; and

Owner name.

(117306)(block-7)Document/Task Title#

An 'AVS Search Results (with date)' task is created when accounts are found. However, a task is only created if there is not a pending VCL task or a pending AVS task. An AVS Search Results Days 1-10 or an AVS Search Results Days 11-30 Document is added to the EMN Inbox at the end of the 10th/30th day following the request of an AVS search. If an Open or In Progress task already exist, the older task will be closed and a new task will be created for the current request. The task will be placed in the Changes/Miscellaneous queue. No task will be created if AVS does not locate and verify an account during the search. Tasks are not created during the REDE process.

AVS Results Document Title Tasks Queue Report Added to the ECR No Accounts Found AVS Search Results Days 1-10 No Task NA Yes No Accounts Found AVS Search Results Days 11-30 No Task NA Yes Accounts Found AVS Search Results Days 1-10 AVS Search Results Days 1-10 (with date) Changes/Miscellaneous Queue Yes Accounts Found AVS Search Results Days 11-30 AVS Search Results Days 11-30 (with date) Changes/Miscellaneous Queue Yes

See WAG 02-07-03-n for guidance on AVS Task and Verification Checklist (VCL).

Note: AVS results are not to be used to deny coverage.

(117306)(block-8)Definitions#

Term: Definition AdHoc Inquiries single AVS search request performed manually in the AVS Web Portal. Current Owner the owner of a liquid resource or real property. Deed an instrument that conveys ownership of real property. Direct Account Search a feature in the AVS Portal that allows the entry of an individual FI to locate and verify accounts not included in the IES initiated search. Electronic Case Record (ECR) a collection of all electronic files attached to a case in IES. Other Individuals Individuals other than the Head of Household and their spouse that have an AVS TOA. Previous Owner an individual that owned a liquid resource or real property in a lookback period.

(117306)(block-9)AVS Web Portal#

The integration of AVS with IES has replaced the need for caseworkers to visit the web portal to initiate AVS searches. The AVS Web Portal remains available for Direct Account searches and for specific case needs such as when a VCL is returned with a SSN, or for months that were not included in the initial AVS request that are required to make an eligibility determination.

Note: Check IES for an AVS related case comment prior to requesting a search in the web portal.

See WAG 02-07-03-n Asset Verification System (AVS) for how to create a Direct Account Search.

(117306)(block-10)Case Queue#

The Case Queue is the main screen of PCG's AVS Portal and stores previous search results. This screen also allows the user to assign a case to a different office, organize the case queue, provides a quick search option, verify case alerts, and more (see the AVS 2.0 User Guide (pdf) for the full list of options). The Case Queue requires each office to close cases when the eligibility decision has been made in IES (this will help users locate current results faster).

(117306)(block-11)Case Dashboard#

The Case Dashboard allows workers to view the following information:

Eligibility Decision- indicates whether a case is Pending Review, currently under review or, if the review is complete, the determination that was made,

Application Information- displays basic information regarding the request (i.e. nursing home) and case type (i.e. application or renewal),

Account Information- displays the value of current resources as of month of application,

Property Information- displays the value of the currently owned property,

AVS Summary- outlines all the suspicious transfers or properties of an individual who is likely ineligible based on available information,

Eligibility History- identifies the number of times a request has been processed through AVS for this applicant/beneficiary, and

Eligibility Bar- displays basic information regarding the applicant, spouse (if applicable), case and resources.

(117306)(block-12)AVS Support#

The AVS system provides support to its users for technical and procedural guidance. The AVS Web Portal includes the Asset Verification System Help Center located on the AVS Dashboard which includes short videos on topics such as:

Site Access and Change Password,

Case Queue,

AdHoc Request (single request),

Eligibility History,

Navigation Icons, and

Results After Decision Queue.

Select the ? icon on the top right of the AVS Dashboard to view the AVS Help Topics such as Case Dashboard and Case Queue. To report an issue or to talk to a representative from PCG concerning AVS issues, contact the AVS call center by email at ilavshelp@pcgus.com. AVS offers support to the participating FIs that are part of the AVS network. When a FI contacts a worker seeking AVS support, provide the following:

Email: avs.support@accuity.com

Phone: 1.855.807.9822, or

Fax: 1.847.763.1960.

(117323)WAG 02-07-03-n Asset Verification System (AVS)#

(117323)(block-1)WAG 02-07-03-n Asset Verification System (AVS)#

PM 02-07-03-n

IES is programmed to identify individuals in a TOA that require a verification of resources as part of their initial or ongoing medical eligibility. IES prevents AVS searches from being processed within 60 days from a previous request. Review the ECR and case comments for recent AVS results and request a search for months of eligibility needed to make a determination using the web based portal.

Note: Report searches triggered by IES requested within 60 days of a previous search to IFAST.

Staff must verify that an AVS search is requested as required for relevant AABD TOAs during:

application (Intake);

redetermination;

EDG's transitioning to an AVS relevant TOA;

member adds; and

program adds.

The AVS Web Portal remains active for special situations such as Direct Account Searches. When the AVS Portal is used and resource information is returned, upload the report to the ECR.

Refer to WAG 07-02 for guidance on how to process resources.

(117323)(block-2)Task#

An 'AVS Search Results (with date) ' task is created when accounts are found. To complete the task, review the AVS report to determine if any follow up with the customer is needed (See the Verification Checklist (VCL) section for further details).

(117323)(block-3)Verification Check List (VCL)#

Review accounts found by AVS with what the customer reported to determine if a VCL is needed.

If the AVS results match the amount the customer reported, no further action required; or

If the AVS results do not match the amount the customer reported, follow the procedures listed in the table below:

Client Statement is: AVS Results: Action: Declares Resources Under the Limit, Including 0 Over Resource Limit Send a VCL Declares Resources Over the Limit Over Resource Limit Use AVS Results Declares Resources Under the Limit, Including 0 Under Resource Limit Use AVS Results Does Not Declare Over Resource Limit Send a VCL Does Not Declare Under Resource Limit Use AVS Results Declared Resource(s) Over or Under the Limit Nothing Found Send a VCL

(117323)(block-4)Case Comment#

A worker must enter a case comment when sending a VCL requesting further verification of assets after AVS results have been received.

(117323)(block-5)Initiate an AVS search (Adhoc)#

To access the AVS Web Portal visit: il.pcgusavs.com . Review the case comments for the following entry prior to initiating a request in AVS Web Portal: AVS Request has been submitted for Individuals - First/Last Name. Results will be available . Review prior AVS search results, and the Liquid Resource page in IES for known financial information for each individual. To view previous searches:

Log on to the AVS Web Portal,

Select the magnifying glass icon,

Enter any of the following (using the SSN will help reduce the amount of search results): Social Security Number (SSN), Last Name and First Name, or Case Number.

Select 'Search',

Select the case to be reviewed, and

Select 'Eligibility History'.

Previous AVS search results will be displayed with the following information:

Name of Financial Institution (FI),

Account Type,

Account Number, and

Ending Balance.

If AVS do not have any previous search results, a zero will be displayed. See the Eligibility History help video by selecting the ? icon located on the AVS Web Portal.

If IES or AVS does not show that a search has been performed within the last 90 days, initiate the request. Users will need to allow IES to build the EDG before submitting a request for an AVS search. After IES has built the EDG, the user will enter the targeted TOA in the "Request Type" field (See PM 02-07-03-n for the list of TOAs that require an AVS search). The AVS Web Portal requires the TOA to be entered along with the following information:

Applicant Type (Application or Renewal),

Request Type (TOA), HH size (1 or 2),

District (DHS or HFS),

Name,

Social Security Number (SSN),

Gender,

Date of Birth,

Application Date, and

Physical Address.

Each AVS search may contain a maximum of 2 individuals, an additional request will be required for each additional individual(s). When a single request contains 2 individuals, the individuals need to be linked together as spouses (this field is mandatory and does not mean the individuals are actually spouses). Review AVS 2.0 User Guide (pdf) for instructions on adding a spouse. AVS requires the individual's physical address to be entered. Enter a case comment in IES for each AdHoc request.

Note : Allow 10 calendar days for search results to be returned.

Note: Verify resource transfers for all individuals applying for or receiving Long Term Care Support Services (LTSS).

(117323)(block-6)AVS Web Portal Direct Account Search - Liquid Resources#

The AVS system offers users the ability to search a specific FI that was not included in the AVS search results known as Direct Account Search. To select a FI for a direct search:

Select the individual from the AVS Case Queue,

Select the 'Account Information' tab,

Select 'Add Additional Bank(s) for Verification',

Enter the name of the bank,

Select 'Search',

Select the bank from the search results (when multiple locations for the same bank are returned, the user only needs to select 1 to conduct the search), and

Select 'Save'.

Enter a case comment in IES for each Direct Account Search.

Note: The Direct Account Search will take 10 calendar days.

(117323)(block-7)AVS Web Portal Search Results#

Select the desired case from the AVS Case Queue screen to view application, account, property, and eligibility information. Compare the results returned by AVS to reported and/or known information. Customers must verify all declared or known resources not found by AVS. Refer cases to OIG when verified resource transfer(s) are equal to or above the allowable transfer limit (see PM 07-02-20 for the resource transfer limit) or if they are questionable or unexplained.

Liquid Resources: Enter all liquid resource information received from AVS that is needed to make an eligibility determination on the Liquid Resource page in IES. See PM/WAG 07-02-00 for the policy and procedures for assets.

Real Property: Enter all real property information received from AVS that is needed to make an eligibility determination on the IES Real Property page. See PM/WAG 07-02-04 for the policy and procedures for real property.

Note: Do not rely solely on the AVS clearance to make eligibility determinations.

(117323)(block-8)Leave a Comment in the AVS Portal#

The AVS Portal includes the ability for users to leave comments for other users such as "On December 5, 2018, AVS search results verified an undisclosed resource located at Bank of America. Check to make sure that BoA is included in the search results on the next REDE".

(117323)(block-9)IES Case Comment#

Enter a case comment noting the actions taken such as:

Date of request;

Type of request: redetermination or application;

Added a FI (enter name(s) of FIs added) using the Direct Account search function;

If AVS does not locate an account, enter No Accounts Found;

If AVS returns asset account information, enter accounts found AVS pdf uploaded to ECR; and

Other information necessary to complete the review.

(117323)(block-10)Electronic Case Record (ECR)#

When the AVS Portal returns asset account information, upload the AVS pdf to the ECR.

(117323)(block-11)Passwords and Security Questions#

Use your security questions that were completed during the initial log in to help reset your password. Select the 'I forgot my password' link on the AVS log in page, enter your username and select 'Next', provide the answers to the security questions and select 'Next', enter your new password, confirm your new password and select 'Reset Password'.

(118366)WAG 01-06-09 Correspondence Module in IES#

(118366)(block-1)Navigating the Correspondence Module in IES#

The Correspondence Module is accessed through left navigation in IES. The Module allows you to:

View pending correspondence;

View history of correspondence;

Generate manual correspondence; and

Access the DHS/HFS Forms Library.

(118366)(block-2)Generating Correspondence in IES#

There are three ways to generate correspondence in IES.

System Generated Correspondence - Some correspondence is systematically generated by IES based on triggers such as certification, denials and case changes. All system generated notices are defaulted to print centrally at night, unless the caseworker chooses to locally print the correspondence. If the caseworker chooses to print the correspondence at their office prior to the overnight batch mailing, the centrally generated notice is suppressed.

Manually Generated Correspondence - Some correspondence is generated manually by FCRC staff. Staff have the option to print and mail most manually generated correspondence from their local Multi-Functional Device (MFD) or choose it to be mailed centrally by the Central Mail and Print Center based in Springfield.

Outbound Fax - The Outbound Fax functionality cannot be used for a TANF or SNAP EDG related faxes . The functionality can only be used for Medical EDG faxes. Staff have two methods to send faxes through IES. The first method is by uploading a PDF to IES on the Fax Correspondence Details page. The second method is by selecting fax through the Generate Manual page.

(118366)(block-3)Viewing Correspondence in IES#

Prior to Mailing : Staff can view pending correspondence on the View Pending Correspondence page. Unprinted correspondence shows as pending for the batch job that runs nightly. The pending correspondence includes systematically triggered notices, manually generated notices for central print or manually generated notices that are saved as a draft. Notices saved as drafts at the end of the day are not sent to central print in the nightly batch job. Another way staff can view pending correspondence is through (PC) icons on the Case - Search/Summary page.

Historical Correspondence : The FCRC can view correspondence that has been printed either locally or centrally through the View History Correspondence Page. Staff can view past notices exactly as they were printed on the print date with the historical information such as address. Another way staff can view correspondence history is through (CH) icon on the Case - Search/Summary page.

(118366)(block-4)Printing and Reprinting Correspondence in IES#

Workers can print correspondence both centrally and locally. If IES generates a notice for a customer and a worker does not print it locally during the day, it is centrally printed overnight by the Central Mail and Print Center. A notice can be reprinted from the View Correspondence History page in IES. Notices can be reprinted and mailed either centrally or locally. If the FCRC is reprinting a notice, the address information is updated to the current case information. All other information stays the same.

(118366)(block-5)Fingerprinting and Barcodes#

Fingerprinting and barcodes are both related to scanning. They are each a way to help speed up the process of scanning documents into IES. Many IES forms have a barcode in the bottom right hand corner of the document. The barcode contains a unique ID that, when scanned into IES with software called DataCap , determines what form it is and which case it belongs to. The document is then routed to the correct local office and Queue in IES. As a backup, in case the barcode is not readable, each document is also "fingerprinted". The fingerprint allows the scanning software to identify the document, even if the barcode is not readable. A scanning operator, either at the Central Scan Unit (CSU) or local office, can manually select the form number and case number if the software fails to identify either.

(118366)(block-6)Central Scanning Unit#

The Central Scanning Unit (CSU), which is located in Springfield, is created to reduce the paper handling at local offices and support the efficient, automated transfer of documents to a customer's Electronic Case Record (ECR). Many documents previously mailed to the local offices or dropped-off by customers are now mailed to the CSU for processing. CSU scans the document(s) into IES using the DataCap software. When the document has a fingerprint or a bar code, a task is created for the worker. The document is routed to the appropriate local office and placed in the correct IES queue. It is claimed by the local office through the EDM inbox and processed by the worker. The CSU will work to scan documents into IES the date they are received to allow for timely processing by the worker.

(118366)(block-7)Local Office Scanning#

Multi-Functional Devices (MFD) in the local office are equipped with the DataCap software. This enables the local office to scan documents they receive. When the document has a fingerprint or a bar code, a task is created. The document is routed to the correct EDM inbox queue in IES for claiming and processing. Additionally, if the worker does not want to create a task for a document in the EDM Inbox, they can use the Phase 1 scanning and uploading business process, the Upload Documents/Create EDM Tasks page and the Upload IES Document-DO NOT Create an Inbox Task .

(118366)(block-8)Dynamic Properties of IES Generated Forms#

Some IES generated forms are highly customized and display data entered in Data Collection into the form going to the customer. One such example is the 643 Medical Redetermination form . In the income section of the form, the following statement appears: "According to our records, you told us your household had income from _______________. Tell us below if you still have this income and the new amount." The source of the income is pulled directly from the IES Employment-Employer screen in the 'Name of Employer' field. Use care when entering the name of the employer. Do not enter unrecognizable abbreviations, nicknames or misspelled words in the Employer Name field . The customer will see this on their redetermination form.

Example 1 : Ms. A receives her Form 643 Medical Redetermination form. Last year, she reported earnings from Starlight Cleaners. The statement on her redetermination form will say: "According to our records, you told us your household had income from Starlight Cleaners. Tell us below if you still have this income and the new amount."

Example 2 : Mr. B receives his Form 643 Medical Redetermination form. Last year, he reported earnings from Shopmart Discounters, Inc. His caseworker, entered the nickname "SMD" in the Employer Name field in Data Collection. Mr. B's REDE form will say: "According to our records, you told us your household had income from SMD. Tell us below if you still have this income and the new amount."

For the first year after conversion and implementation of Phase 2, some data in the IES income screens are defaulted to a generic description of the income type. Also, a customer may receive their check through a payroll company and the actual name of the employer is unknown. Whenever a case is touched after Phase 2 Go Live, review and correct the Employer Name in IES.

(120533)WAG 25-03-09: Basis of Issuance Table (1) (10-01-19)#

(120533)(block-1)SNAP Benefit Amount By SNAP Unit Size#

0 - 100

101 - 200

201 - 300

301 - 400

401 - 500

501 - 600

601 - 700

701 - 800

801 - 900

901 - 1000

1001 - 1100

1101 - 1200

1201 - 1300

1301 - 1400

1401 - 2600

2601 - 4850

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 0 - 0 194 355 509 646 768 921 1018 1164 1310 1456 1 - 3 193 354 508 645 767 920 1017 1163 1309 1455 4 - 6 192 353 507 644 766 919 1016 1162 1308 1454 7 - 10 191 352 506 643 765 918 1015 1161 1307 1453 11 - 13 190 351 505 642 764 917 1014 1160 1306 1452 14 - 16 189 350 504 641 763 916 1013 1159 1305 1451 17 - 20 188 349 503 640 762 915 1012 1158 1304 1450 21 - 23 187 348 502 639 761 914 1011 1157 1303 1449 24 - 26 186 347 501 638 760 913 1010 1156 1302 1448 27 - 30 185 346 500 637 759 912 1009 1155 1301 1447 31 - 33 184 345 499 636 758 911 1008 1154 1300 1446 34 - 36 183 344 498 635 757 910 1007 1153 1299 1445 37 - 40 182 343 497 634 756 909 1006 1152 1298 1444 41 - 43 181 342 496 633 755 908 1005 1151 1297 1443 44 - 46 180 341 495 632 754 907 1004 1150 1296 1442 47 - 50 179 340 494 631 753 906 1003 1149 1295 1441 51 - 53 178 339 493 630 752 905 1002 1148 1294 1440 54 - 56 177 338 492 629 751 904 1001 1147 1293 1439 57 - 60 176 337 491 628 750 903 1000 1146 1292 1438 61 - 63 175 336 490 627 749 902 999 1145 1291 1437 64 - 66 174 335 489 626 748 901 998 1144 1290 1436 67 - 76 173 334 488 625 747 900 997 1143 1289 1435 71 - 73 172 333 487 624 746 899 996 1142 1288 1434 74 - 76 171 332 486 623 745 898 995 1141 1287 1433 77 - 80 170 331 485 622 744 897 994 1140 1286 1432 81 - 83 169 330 484 621 743 896 993 1139 1285 1431 84 - 86 168 329 483 620 742 895 992 1138 1284 1430 87 - 90 167 328 482 619 741 894 991 1137 1283 1429 91 - 93 166 327 481 618 740 893 990 1136 1282 1428 94 - 96 165 326 480 617 739 892 989 1135 1281 1427 97 - 100 164 325 479 616 738 891 988 1134 1280 1426

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 101 - 103 163 324 478 615 737 890 987 1133 1279 1425 104 - 106 162 323 477 614 736 889 986 1132 1278 1424 107 - 110 161 322 476 613 735 888 985 1131 1277 1423 111 - 113 160 321 475 612 734 887 984 1130 1276 1422 114 - 116 159 320 474 611 733 886 983 1129 1275 1421 117 - 120 158 319 473 610 732 885 982 1128 1274 1420 121 - 126 157 318 472 609 731 884 981 1127 1273 1419 124 - 136 156 317 471 608 730 883 980 1126 1272 1418 127 - 130 155 316 470 607 729 882 979 1125 1271 1417 131 - 133 154 315 469 606 728 881 978 1124 1270 1416 134 - 136 153 314 468 605 727 880 977 1123 1269 1415 137 - 140 152 313 467 604 726 879 976 1122 1268 1414 141 - 143 151 312 466 603 725 878 975 1121 1267 1413 144 - 146 150 311 465 602 724 877 974 1120 1266 1412 147 - 150 149 310 464 601 723 876 973 1119 1265 1411 151 - 153 148 309 463 600 722 875 972 1118 1264 1410 154 - 156 147 308 462 599 721 874 971 1117 1263 1409 157 - 160 146 307 461 598 720 873 970 1116 1262 1408 161 - 163 145 306 460 597 719 872 969 1115 1261 1407 164 - 166 144 305 459 596 718 871 968 1114 1260 1406 167 - 170 143 304 458 595 717 870 967 1113 1259 1405 171 - 173 142 303 457 594 716 869 966 1112 1258 1404 174 - 176 141 302 456 593 715 868 965 1111 1257 1403 177 - 180 140 301 455 592 714 867 964 1110 1256 1402 181 - 183 139 300 454 591 713 866 963 1109 1255 1401 184 - 186 138 299 453 590 712 865 962 1108 1254 1400 187 - 190 137 298 452 589 711 864 961 1107 1253 1399 191 - 193 136 297 451 588 710 863 960 1106 1252 1398 194 - 196 135 296 450 587 709 862 959 1105 1251 1397 197 - 200 134 295 449 586 708 861 958 1104 1250 1396

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 201 - 203 133 294 448 585 707 860 957 1103 1249 1395 204 - 206 132 293 447 584 706 859 956 1102 1248 1394 207 - 210 131 292 446 583 705 858 955 1101 1247 1393 211 - 213 130 291 445 582 704 857 954 1100 1246 1392 214 - 216 129 290 444 581 703 856 953 1099 1245 1391 217 - 220 128 289 443 580 702 855 952 1098 1244 1390 221 - 223 127 288 442 579 701 854 951 1097 1243 1389 224 - 226 126 287 441 578 700 853 950 1096 1242 1388 227 - 230 125 286 440 577 699 852 949 1095 1241 1387 231 - 233 124 285 439 576 698 851 948 1094 1240 1386 234 - 236 123 284 438 575 697 850 947 1093 1239 1385 237 - 240 122 283 437 574 696 849 946 1092 1238 1384 241 - 243 121 282 436 573 695 848 945 1091 1237 1383 244 - 246 120 281 435 572 694 847 944 1090 1236 1382 247 - 250 119 280 434 571 693 846 943 1089 1235 1381 251 - 253 118 279 433 570 692 845 942 1088 1234 1380 254 - 266 117 278 432 569 691 844 941 1087 1233 1379 257 - 263 116 277 431 568 690 843 940 1086 1232 1378 261 - 263 115 276 430 567 689 842 939 1085 1231 1377 264 - 266 114 275 429 566 688 841 938 1084 1230 1376 267 - 270 113 274 428 565 687 840 937 1083 1229 1375 271 - 273 112 273 427 564 686 839 936 1082 1228 1374 274 - 276 111 272 426 563 685 838 935 1081 1227 1373 277 - 289 110 271 425 562 684 837 934 1080 1226 1372 281 - 283 109 270 424 561 683 836 933 1079 1225 1371 284 - 286 108 269 423 560 682 835 932 1078 1224 1370 287 - 290 107 268 422 559 681 834 931 1077 1223 1369 291 - 293 106 267 421 558 680 833 930 1076 1222 1368 294 - 296 105 266 420 557 679 832 929 1075 1221 1367 297 - 300 104 265 419 556 678 831 928 1074 1220 1366

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 301 - 303 103 264 418 555 677 830 927 1073 1219 1365 304 - 306 102 263 417 554 676 829 926 1072 1218 1364 307 - 310 101 262 416 553 675 828 925 1071 1217 1363 311 - 313 100 261 415 552 674 827 924 1070 1216 1362 314 - 316 99 260 414 551 673 826 923 1069 1215 1361 317 - 320 98 259 413 550 672 825 922 1068 1214 1360 321 - 323 97 258 412 549 671 824 921 1067 1213 1359 324 - 326 96 257 411 548 670 823 920 1066 1212 1358 327 - 330 95 256 410 547 669 822 919 1065 1211 1357 331 - 333 94 255 409 546 668 821 918 1064 1210 1356 334 - 336 93 254 408 545 667 820 917 1063 1209 1355 337 - 340 92 253 407 544 666 819 916 1062 1208 1354 341 - 343 91 252 406 543 665 818 915 1061 1207 1353 344 - 346 90 251 405 542 664 817 914 1060 1206 1352 347 - 350 89 250 404 541 663 816 913 1059 1205 1351 351 - 353 88 249 403 540 662 815 912 1058 1204 1350 354 - 356 87 248 402 539 661 814 911 1057 1203 1349 357 - 360 86 247 401 538 660 813 910 1056 1202 1348 361 - 363 85 246 400 537 659 812 909 1055 1201 1347 364 - 366 84 245 399 536 658 811 908 1054 1200 1346 367 - 370 83 244 398 535 657 810 907 1053 1199 1345 371 - 373 82 243 397 534 656 809 906 1052 1198 1344 374 - 376 81 242 396 533 655 808 905 1051 1197 1343 377 - 380 80 241 395 532 654 807 904 1050 1196 1342 381 - 383 79 240 394 531 653 806 903 1049 1195 1341 384 - 386 78 239 393 530 652 805 902 1048 1194 1340 387 - 390 77 238 392 529 651 804 901 1047 1193 1339 391 - 393 76 237 391 528 650 803 900 1046 1192 1338 394 - 396 75 236 390 527 649 802 899 1045 1191 1337 397 - 400 74 235 389 526 648 801 898 1044 1190 1336

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 401 - 403 73 234 388 525 647 800 897 1043 1189 1335 404 - 406 72 233 387 524 646 799 896 1042 1188 1334 407 - 410 71 232 386 523 645 798 895 1041 1187 1333 411 - 413 70 231 385 522 644 797 894 1040 1186 1332 414 - 416 69 230 384 521 643 796 893 1039 1185 1331 417 - 420 68 229 383 520 642 795 892 1038 1184 1330 421 - 423 67 228 382 519 641 794 891 1037 1183 1329 424 - 426 66 227 381 518 640 793 890 1036 1182 1328 427 - 430 65 226 380 517 639 792 889 1035 1181 1327 431 - 433 64 225 379 516 638 791 888 1034 1180 1326 434 - 436 63 224 378 515 637 790 887 1033 1179 1325 437 - 440 62 223 377 514 636 789 886 1032 1178 1324 441 - 443 61 222 376 513 635 788 885 1031 1177 1323 444 - 446 60 221 375 512 634 787 884 1030 1176 1322 447 - 450 59 220 374 511 633 786 883 1029 1175 1321 451 - 453 58 219 373 510 632 785 882 1028 1174 1320 454 - 456 57 218 372 509 631 784 881 1027 1173 1319 457 - 460 56 217 371 508 630 783 880 1026 1172 1318 461 - 463 55 216 370 507 629 782 879 1025 1171 1317 464 - 470 54 215 369 506 628 781 878 1024 1170 1316 467 - 470 53 214 368 505 627 780 877 1023 1169 1315 471 - 473 52 213 367 504 626 779 876 1022 1168 1314 474 - 476 51 212 366 503 625 778 875 1021 1167 1313 477 - 480 50 211 365 502 624 777 874 1020 1166 1312 481 - 483 49 210 364 501 623 776 873 1019 1165 1311 484 - 486 48 209 363 500 622 775 872 1018 1164 1310 487 - 490 47 208 362 499 621 774 871 1017 1163 1309 491 - 495 46 207 361 498 620 773 870 1016 1162 1308 494 - 496 45 206 360 497 619 772 869 1015 1161 1307 497 - 500 44 205 359 496 618 771 868 1014 1160 1306

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 501 - 503 43 204 358 495 617 770 867 1013 1159 1305 504 - 506 42 203 357 494 616 769 866 1012 1158 1304 507 - 510 41 202 356 493 615 768 865 1011 1157 1303 511 - 513 40 201 355 492 614 767 864 1010 1156 1302 514 - 516 39 200 354 491 613 766 863 1009 1155 1301 517 - 520 38 199 353 490 612 765 862 1008 1154 1300 521 - 523 37 198 352 489 611 764 861 1007 1153 1299 524 - 526 36 197 351 488 610 763 860 1006 1152 1298 527 - 530 35 196 350 487 609 762 859 1005 1151 1297 531 - 533 34 195 349 486 608 761 858 1004 1150 1296 534 - 536 33 194 348 485 607 760 857 1003 1149 1295 537 - 450 32 193 347 484 606 759 856 1002 1148 1294 541 - 543 31 192 346 483 605 758 855 1001 1147 1293 544 - 546 30 191 345 482 604 757 854 1000 1146 1292 547 - 558 29 190 344 481 603 756 853 999 1145 1291 551 - 553 28 189 343 480 602 755 852 998 1144 1290 554 - 556 27 188 342 479 601 754 851 997 1143 1289 557 - 560 26 187 341 478 600 753 850 996 1142 1288 561 - 563 25 186 340 477 599 752 849 995 1141 1287 564 - 566 24 185 339 476 598 751 848 994 1140 1286 567 - 576 23 184 338 475 597 750 847 993 1139 1285 571 - 573 22 183 337 474 596 749 846 992 1138 1284 574 - 576 21 182 336 473 595 748 845 991 1137 1283 577 - 580 20 181 335 472 594 747 844 990 1136 1282 581 - 583 19 180 334 471 593 746 843 989 1135 1281 584 - 586 18 179 333 470 592 745 842 988 1134 1280 587 - 590 17 178 332 469 591 744 841 987 1133 1279 591 - 593 16 177 331 468 590 743 840 986 1132 1278 594 - 596 16 176 330 467 589 742 839 985 1131 1277 597 - 600 16 175 329 466 588 741 838 984 1130 1276

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 601 - 603 16 174 328 465 587 740 837 983 1129 1275 604 - 606 16 173 327 464 586 739 836 982 1128 1274 607 - 610 16 172 326 463 585 738 835 981 1127 1273 611 - 613 16 171 325 462 584 737 834 980 1126 1272 614 - 616 16 170 324 461 583 736 833 979 1125 1271 617 - 620 16 169 323 460 582 735 832 978 1124 1270 621 - 623 16 168 322 459 581 734 831 977 1123 1269 624 - 626 16 167 321 458 580 733 830 976 1122 1268 627 - 630 16 166 320 457 579 732 829 975 1121 1267 631 - 633 16 165 319 456 578 731 828 974 1120 1266 634 - 636 16 164 318 455 577 730 827 973 1119 1265 637 - 640 16 163 317 454 576 729 826 972 1118 1264 641 - 643 16 162 316 453 575 728 825 971 1117 1263 644 - 646 16 161 315 452 574 727 824 970 1116 1262 647 - 650 16 160 314 451 573 726 823 969 1115 1261 651 - 653 16 159 313 450 572 725 822 968 1114 1260 654 - 656 16 158 312 449 571 724 821 967 1113 1259 657 - 660 16 157 311 448 570 723 820 966 1112 1258 661 - 663 16 156 310 447 569 722 819 965 1111 1257 664 - 666 16 155 309 446 568 721 818 964 1110 1256 667 - 670 16 154 308 445 567 720 817 963 1109 1255 671 - 673 16 153 307 444 566 719 816 962 1108 1254 674 - 676 16 152 306 443 565 718 815 961 1107 1253 677 - 680 16 151 305 442 564 717 814 960 1106 1252 681 - 683 16 150 304 441 563 716 813 959 1105 1251 684 - 686 16 149 303 440 562 715 812 958 1104 1250 687 - 690 16 148 302 439 561 714 811 957 1103 1249 691 - 693 16 147 301 438 560 713 810 956 1102 1248 694 - 696 16 146 300 437 559 712 809 955 1101 1247 697 - 700 16 145 299 436 558 711 808 954 1100 1246

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 701 - 703 16 144 298 435 557 710 807 953 1099 1245 704 - 706 16 143 297 434 556 709 806 952 1098 1244 707 - 710 16 142 296 433 555 708 805 951 1097 1243 711 - 713 16 141 295 432 554 707 804 950 1096 1242 714 - 716 16 140 294 431 553 706 803 949 1095 1241 717 - 720 16 139 293 430 552 705 802 948 1094 1240 721 - 726 16 138 292 429 551 704 801 947 1093 1239 724 - 726 16 137 291 428 550 703 800 946 1092 1238 727 - 730 16 136 290 427 549 702 799 945 1091 1237 731 - 735 16 135 289 426 548 701 798 944 1090 1236 734 - 736 16 134 288 425 547 700 797 943 1089 1235 737 - 740 16 133 287 424 546 699 796 942 1088 1234 741 - 743 16 132 286 423 545 698 795 941 1087 1233 744 - 746 16 131 285 422 544 697 794 940 1086 1232 747 - 750 16 130 284 421 543 696 793 939 1085 1231 751 - 753 16 129 283 420 542 695 792 938 1084 1230 754 - 756 16 128 282 419 541 694 791 937 1083 1229 757 - 760 16 127 281 418 540 693 790 936 1082 1228 761 - 763 16 126 280 417 539 692 789 935 1081 1227 764 - 766 16 125 279 416 538 691 788 934 1080 1226 767 - 770 16 124 278 415 537 690 787 933 1079 1225 771 - 773 16 123 277 414 536 689 786 932 1078 1224 774 - 776 16 122 276 413 535 688 785 931 1077 1223 777 - 780 16 121 275 412 534 687 784 930 1076 1222 781 - 783 16 120 274 411 533 686 783 929 1075 1221 784 - 786 16 119 273 410 532 685 782 928 1074 1220 787 - 790 16 118 272 409 531 684 781 927 1073 1219 791 - 793 16 117 271 408 530 683 780 926 1072 1218 794 - 796 16 116 270 407 529 682 779 925 1071 1217 797 - 800 16 115 269 406 528 681 778 924 1070 1216

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 801 - 803 16 114 268 405 527 680 777 923 1069 1215 804 - 806 16 113 267 404 526 679 776 922 1068 1214 807 - 810 16 112 266 403 525 678 775 921 1067 1213 811 - 813 16 111 265 402 524 677 774 920 1066 1212 814 - 816 16 110 264 401 523 676 773 919 1065 1211 817 - 820 16 109 263 400 522 675 772 918 1064 1210 821 - 823 16 108 262 399 521 674 771 917 1063 1209 824 - 826 16 107 261 398 520 673 770 916 1062 1208 827 - 830 16 106 260 397 519 672 769 915 1061 1207 831 - 833 16 105 259 396 518 671 768 914 1060 1206 834 - 836 16 104 258 395 517 670 767 913 1059 1205 837 - 840 16 103 257 394 516 669 766 912 1058 1204 841 - 843 16 102 256 393 515 668 765 911 1057 1203 844 - 846 16 101 255 392 514 667 764 910 1056 1202 847 - 850 16 100 254 391 513 666 763 909 1055 1201 851 - 853 16 99 253 390 512 665 762 908 1054 1200 854 - 856 16 98 252 389 511 664 761 907 1053 1199 857 - 860 16 97 251 388 510 663 760 906 1052 1198 861 - 863 16 96 250 387 509 662 759 905 1051 1197 864 - 866 16 95 249 386 508 661 758 904 1050 1196 867 - 876 16 94 248 385 507 660 757 903 1049 1195 871 - 873 16 93 247 384 506 659 756 902 1048 1194 874 - 876 16 92 246 383 505 658 755 901 1047 1193 877 - 880 16 91 245 382 504 657 754 900 1046 1192 881 - 883 16 90 244 381 503 656 753 899 1045 1191 884 - 888 16 89 243 380 502 655 752 898 1044 1190 887 - 890 16 88 242 379 501 654 751 897 1043 1189 891 - 893 16 87 241 378 500 653 750 896 1042 1188 894 - 896 16 86 240 377 499 652 749 895 1041 1187 897 - 900 16 85 239 376 498 651 748 894 1040 1186

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 901 - 903 16 84 238 375 497 650 747 893 1039 1185 904 - 906 16 83 237 374 496 649 746 892 1038 1184 907 - 910 16 82 236 373 495 648 745 891 1037 1183 911 - 913 16 81 235 372 494 647 744 890 1036 1182 914 - 916 16 80 234 371 493 646 743 889 1035 1181 917 - 920 16 79 233 370 492 645 742 888 1034 1180 921 - 923 16 78 232 369 491 644 741 887 1033 1179 924 - 926 16 77 231 368 490 643 740 886 1032 1178 927 - 930 16 76 230 367 489 642 739 885 1031 1177 931 - 933 16 75 229 366 488 641 738 884 1030 1176 934 - 936 16 74 228 365 487 640 737 883 1029 1175 937 - 940 16 73 227 364 486 639 736 882 1028 1174 941 - 943 16 72 226 363 485 638 735 881 1027 1173 944 - 946 16 71 225 362 484 637 734 880 1026 1172 947 - 950 16 70 224 361 483 636 733 879 1025 1171 951 - 953 16 69 223 360 482 635 732 878 1024 1170 954 - 956 16 68 222 359 481 634 731 877 1023 1169 957 - 960 16 67 221 358 480 633 730 876 1022 1168 961 - 963 16 66 220 357 479 632 729 875 1021 1167 964 - 966 16 65 219 356 478 631 728 874 1020 1166 967 - 970 16 64 218 355 477 630 727 873 1019 1165 971 - 978 16 63 217 354 476 629 726 872 1018 1164 974 - 978 16 62 216 353 475 628 725 871 1017 1163 977 - 980 16 61 215 352 474 627 724 870 1016 1162 981 - 983 16 60 214 351 473 626 723 869 1015 1161 984 - 986 16 59 213 350 472 625 722 868 1014 1160 987 - 990 16 58 212 349 471 624 721 867 1013 1159 991 - 993 16 57 211 348 470 623 720 866 1012 1158 994 - 998 16 56 210 347 469 622 719 865 1011 1157 997 - 1000 16 55 209 346 468 621 718 864 1010 1156

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1001 - 1003 16 54 208 345 467 620 717 863 1009 1155 1004 - 1006 16 53 207 344 466 619 716 862 1008 1154 1007 - 1010 16 52 206 343 465 618 715 861 1007 1153 1011 - 1013 16 51 205 342 464 617 714 860 1006 1152 1014 - 1016 16 50 204 341 463 616 713 859 1005 1151 1017 - 1020 16 49 203 340 462 615 712 858 1004 1150 1021 - 1023 16 48 202 339 461 614 711 857 1003 1149 1024 - 1026 16 47 201 338 460 613 710 856 1002 1148 1027 - 1030 16 46 200 337 459 612 709 855 1001 1147 1031 - 1033 16 45 199 336 458 611 708 854 1000 1146 1034 - 1036 16 44 198 335 457 610 707 853 999 1145 1037 - 1040 16 43 197 334 456 609 706 852 998 1144 1041 - 1043 16 42 196 333 455 608 705 851 997 1143 1044 - 1046 16 41 195 332 454 607 704 850 996 1142 1047 - 1050 16 40 194 331 453 606 703 849 995 1141 1051 - 1053 16 39 193 330 452 605 702 848 994 1140 1054 - 1058 16 38 192 329 451 604 701 847 993 1139 1057 - 1060 16 37 191 328 450 603 700 846 992 1138 1061 - 1063 16 36 190 327 449 602 699 845 991 1137 1064 - 1086 16 35 189 326 448 601 698 844 990 1136 1067 - 1070 16 34 188 325 447 600 697 843 989 1135 1071 - 1073 16 33 187 324 446 599 696 842 988 1134 1074 - 1076 16 32 186 323 445 598 695 841 987 1133 1077 - 1080 16 31 185 322 444 597 694 840 986 1132 1081 - 1083 16 30 184 321 443 596 693 839 985 1131 1084 - 1086 16 29 183 320 442 595 692 838 984 1130 1087 - 1090 16 28 182 319 441 594 691 837 983 1129 1091 - 1093 16 27 181 318 440 593 690 836 982 1128 1094 - 1098 16 26 180 317 439 592 689 835 981 1127 1097 - 1100 16 25 179 316 438 591 688 834 980 1126

Maximum net income for a 1-person non-categorically eligible SNAP unit is $1,041.

Minimum monthly SNAP benefit for an eligible 1-person SNAP unit is $16.

If a categorically eligible SNAP unit of 1- person has net income of more than $1,041, authorize a $16 SNAP benefit.

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1101 - 1103 16 24 178 315 437 590 687 833 979 1125 1104 - 1106 16 23 177 314 436 589 686 832 978 1124 1107 - 1110 16 22 176 313 435 588 685 831 977 1123 1111 - 1113 16 21 175 312 434 587 684 830 976 1122 1114 - 1116 16 20 174 311 433 586 683 829 975 1121 1117 - 1120 16 19 173 310 432 585 682 828 974 1120 1121 - 1123 16 18 172 309 431 584 681 827 973 1119 1124 - 1126 16 17 171 308 430 583 680 826 972 1118 1127 - 1130 16 16 170 307 429 582 679 825 971 1117 1131 - 1133 16 16 169 306 428 581 678 824 970 1116 1134 - 1136 16 16 168 305 427 580 677 823 969 1115 1137 - 1140 16 16 167 304 426 579 676 822 968 1114 1141 - 1143 16 16 166 303 425 578 675 821 967 1113 1144 - 1146 16 16 165 302 424 577 674 820 966 1112 1147 - 1150 16 16 164 301 423 576 673 819 965 1111 1151 - 1153 16 16 163 300 422 575 672 818 964 1110 1154 - 1156 16 16 162 299 421 574 671 817 963 1109 1157 - 1160 16 16 161 298 420 573 670 816 962 1108 1161 - 1163 16 16 160 297 419 572 669 815 961 1107 1164 - 1166 16 16 159 296 418 571 668 814 960 1106 1167 - 1170 16 16 158 295 417 570 667 813 959 1105 1171 - 1173 16 16 157 294 416 569 666 812 958 1104 1174 - 1176 16 16 156 293 415 568 665 811 957 1103 1177 - 1180 16 16 155 292 414 567 664 810 956 1102 1181 - 1183 16 16 154 291 413 566 663 809 955 1101 1184 - 1186 16 16 153 290 412 565 662 808 954 1100 1187 - 1190 16 16 152 289 411 564 661 807 953 1099 1191 - 1193 16 16 151 288 410 563 660 806 952 1098 1194 - 1196 16 16 150 287 409 562 659 805 951 1097 1197 - 1200 16 16 149 286 408 561 658 804 950 1096

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1201 - 1203 16 16 148 285 407 560 657 803 949 1095 1204 - 1206 16 16 147 284 406 559 656 802 948 1094 1207 - 1210 16 16 146 283 405 558 655 801 947 1093 1211 - 1213 16 16 145 282 404 557 654 800 946 1092 1214 - 1216 16 16 144 281 403 556 653 799 945 1091 1217 - 1220 16 16 143 280 402 555 652 798 944 1090 1221 - 1223 16 16 142 279 401 554 651 797 943 1089 1224 - 1226 16 16 141 278 400 553 650 796 942 1088 1227 - 1230 16 16 140 277 399 552 649 795 941 1087 1231 - 1233 16 16 139 276 398 551 648 794 940 1086 1234 - 1236 16 16 138 275 397 550 647 793 939 1085 1237 - 1240 16 16 137 274 396 549 646 792 938 1084 1241 - 1243 16 16 136 273 395 548 645 791 937 1083 1244 - 1246 16 16 135 272 394 547 644 790 936 1082 1247 - 1250 16 16 134 271 393 546 643 789 935 1081 1251 - 1253 16 16 133 270 392 545 642 788 934 1080 1254 - 1256 16 16 132 269 391 544 641 787 933 1079 1257 - 1260 16 16 131 268 390 543 640 786 932 1078 1261 - 1263 16 16 130 267 389 542 639 785 931 1077 1264 - 1266 16 16 129 266 388 541 638 784 930 1076 1267 - 1270 16 16 128 265 387 540 637 783 929 1075 1271 - 1273 16 16 127 264 386 539 636 782 928 1074 1274 - 1276 16 16 126 263 385 538 635 781 927 1073 1277 - 1280 16 16 125 262 384 537 634 780 926 1072 1281 - 1283 16 16 124 261 383 536 633 779 925 1071 1284 - 1286 16 16 123 260 382 535 632 778 924 1070 1287 - 1290 16 16 122 259 381 534 631 777 923 1069 1291 - 1293 16 16 121 258 380 533 630 776 922 1068 1294 - 1296 16 16 120 257 379 532 629 775 921 1067 1297 - 1300 16 16 119 256 378 531 628 774 920 1066

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1301 - 1303 16 16 118 255 377 530 627 773 919 1065 1304 - 1306 16 16 117 254 376 529 626 772 918 1064 1307 - 1310 16 16 116 253 375 528 625 771 917 1063 1311 - 1313 16 16 115 252 374 527 624 770 916 1062 1314 - 1316 16 16 114 251 373 526 623 769 915 1061 1317 - 1320 16 16 113 250 372 525 622 768 914 1060 1321 - 1323 16 16 112 249 371 524 621 767 913 1059 1324 - 1326 16 16 111 248 370 523 620 766 912 1058 1327 - 1330 16 16 110 247 369 522 619 765 911 1057 1331 - 1333 16 16 109 246 368 521 618 764 910 1056 1334 - 1336 16 16 108 245 367 520 617 763 909 1055 1337 - 1340 16 16 107 244 366 519 616 762 908 1054 1341 - 1343 16 16 106 243 365 518 615 761 907 1053 1344 - 1346 16 16 105 242 364 517 614 760 906 1052 1347 - 1350 16 16 104 241 363 516 613 759 905 1051 1351 - 1353 16 16 103 240 362 515 612 758 904 1050 1354 - 1356 16 16 102 239 361 514 611 757 903 1049 1357 - 1360 16 16 101 238 360 513 610 756 902 1048 1361 - 1363 16 16 100 237 359 512 609 755 901 1047 1364 - 1366 16 16 99 236 358 511 608 754 900 1046 1367 - 1370 16 16 98 235 357 510 607 753 899 1045 1371 - 1373 16 16 97 234 356 509 606 752 898 1044 1374 - 1376 16 16 96 233 355 508 605 751 897 1043 1377 - 1380 16 16 95 232 354 507 604 750 896 1042 1381 - 1383 16 16 94 231 353 506 603 749 895 1041 1384 - 1386 16 16 93 230 352 505 602 748 894 1040 1387 - 1390 16 16 92 229 351 504 601 747 893 1039 1391 - 1393 16 16 91 228 350 503 600 746 892 1038 1394 - 1396 16 16 90 227 349 502 599 745 891 1037 1397 - 1400 16 16 89 226 348 501 598 744 890 1036

Bold areas refer to categorically eligible units only.

(120534)WAG 25-03-09: Basis of Issuance Table (2) (10-01-19)#

(120534)(block-1)SNAP Benefit Amount By SNAP Unit Size#

0 - 1400

1401 - 1500

1501 - 1600

1601 - 1700

1701 - 1800

1801 - 1900

1901 - 2000

2001 - 2100

2101 - 2200

2201 - 2300

2301 - 2400

2401 - 2500

2501 - 2600

2601 - 4850

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1401 - 1403 16 16 88 225 347 500 597 743 889 1035 1404 - 1406 16 16 87 224 346 499 596 742 888 1034 1407 - 1410 16 16 86 223 345 498 595 741 887 1033 1411 - 1413 16 16 85 222 344 497 594 740 886 1032 1414 - 1416 16 16 84 221 343 496 593 739 885 1031 1417 - 1420 16 16 83 220 342 495 592 738 884 1030 1421 - 1423 16 16 82 219 341 494 591 737 883 1029 1424 - 1426 16 16 81 218 340 493 590 736 882 1028 1427 - 1430 16 16 80 217 339 492 589 735 881 1027 1431 - 1433 16 16 79 216 338 491 588 734 880 1026 1434 - 1436 16 16 78 215 337 490 587 733 879 1025 1437 - 1440 16 16 77 214 336 489 586 732 878 1024 1441 - 1443 16 16 76 213 335 488 585 731 877 1023 1444 - 1446 16 16 75 212 334 487 584 730 876 1022 1447 - 1450 16 16 74 211 333 486 583 729 875 1021 1451 - 1453 16 16 73 210 332 485 582 728 874 1020 1454 - 1456 16 16 72 209 331 484 581 727 873 1019 1457 - 1460 16 16 71 208 330 483 580 726 872 1018 1461 - 1463 16 16 70 207 329 482 579 725 871 1017 1464 - 1466 16 16 69 206 328 481 578 724 870 1016 1467 - 1470 16 16 68 205 327 480 577 723 869 1015 1471 - 1473 16 16 67 204 326 479 576 722 868 1014 1474 - 1476 16 16 66 203 325 478 575 721 867 1013 1477 - 1480 16 16 65 202 324 477 574 720 866 1012 1481 - 1483 16 16 64 201 323 476 573 719 865 1011 1484 - 1486 16 16 63 200 322 475 572 718 864 1010 1487 - 1490 16 16 62 199 321 474 571 717 863 1009 1491 - 1493 16 16 61 198 320 473 570 716 862 1008 1494 - 1496 16 16 60 197 319 472 569 715 861 1007 1497 - 1500 16 16 59 196 318 471 568 714 860 1006

Minimum monthly SNAP benefit for an eligible 2-person SNAP unit is $16.

If a categorically eligible SNAP unit of 2 has net income of more than $1,410, authorize a $16 SNAP benefit.

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1501 - 1503 16 16 58 195 317 470 567 713 859 1005 1504 - 1506 16 16 57 194 316 469 566 712 858 1004 1507 - 1510 16 16 56 193 315 468 565 711 857 1003 1511 - 1513 16 16 55 192 314 467 564 710 856 1002 1514 - 1516 16 16 54 191 313 466 563 709 855 1001 1517 - 1520 16 16 53 190 312 465 562 708 854 1000 1521 - 1523 16 16 52 189 311 464 561 707 853 999 1524 - 1526 16 16 51 188 310 463 560 706 852 998 1527 - 1530 16 16 50 187 309 462 559 705 851 997 1531 - 1533 16 16 49 186 308 461 558 704 850 996 1534 - 1536 16 16 48 185 307 460 557 703 849 995 1537 - 1540 16 16 47 184 306 459 556 702 848 994 1541 - 1543 16 16 46 183 305 458 555 701 847 993 1544 - 1546 16 16 45 182 304 457 554 700 846 992 1547 - 1550 16 16 44 181 303 456 553 699 845 991 1551 - 1553 16 16 43 180 302 455 552 698 844 990 1554 - 1556 16 16 42 179 301 454 551 697 843 989 1557 - 1560 16 16 41 178 300 453 550 696 842 988 1561 - 1563 16 16 40 177 299 452 549 695 841 987 1564 - 1566 16 16 39 176 298 451 548 694 840 986 1567 - 1570 16 16 38 175 297 450 547 693 839 985 1571 - 1573 16 16 37 174 296 449 546 692 838 984 1574 - 1576 16 16 36 173 295 448 545 691 837 983 1577 - 1580 16 16 35 172 294 447 544 690 836 982 1581 - 1583 16 16 34 171 293 446 543 689 835 981 1584 - 1586 16 16 33 170 292 445 542 688 834 980 1587 - 1590 16 16 32 169 291 444 541 687 833 979 1591 - 1593 16 16 31 168 290 443 540 686 832 978 1594 - 1596 16 16 30 167 289 442 539 685 831 977 1597 - 1600 16 16 29 166 288 441 538 684 830 976

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1601 - 1603 16 16 28 165 287 440 537 683 829 975 1604 - 1606 16 16 27 164 286 439 536 682 828 974 1607 - 1610 16 16 26 163 285 438 535 681 827 973 1611 - 1613 16 16 25 162 284 437 534 680 826 972 1614 - 1616 16 16 24 161 283 436 533 679 825 971 1617 - 1620 16 16 23 160 282 435 532 678 824 970 1621 - 1623 16 16 22 159 281 434 531 677 823 969 1624 - 1626 16 16 21 158 280 433 530 676 822 968 1627 - 1630 16 16 20 157 279 432 529 675 821 967 1631 - 1633 16 16 19 156 278 431 528 674 820 966 1634 - 1636 16 16 18 155 277 430 527 673 819 965 1637 - 1640 16 16 17 154 276 429 526 672 818 964 1641 - 1643 16 16 16 153 275 428 525 671 817 963 1644 - 1646 16 16 15 152 274 427 524 670 816 962 1647 - 1650 16 16 14 151 273 426 523 669 815 961 1651 - 1653 16 16 13 150 272 425 522 668 814 960 1654 - 1656 16 16 12 149 271 424 521 667 813 959 1657 - 1650 16 16 11 148 270 423 520 666 812 958 1661 - 1663 16 16 10 147 269 422 519 665 811 957 1664 - 1666 16 16 9 146 268 421 518 664 810 956 1667 - 1670 16 16 8 145 267 420 517 663 809 955 1671 - 1673 16 16 7 144 266 419 516 662 808 954 1674 - 1676 16 16 6 143 265 418 515 661 807 953 1677 - 1680 16 16 5 142 264 417 514 660 806 952 1681 - 1683 16 16 4 141 263 416 513 659 805 951 1684 - 1686 16 16 3 140 262 415 512 658 804 950 1687 - 1690 16 16 2 139 261 414 511 657 803 949 1691 - 1693 16 16 1 138 260 413 510 656 802 948 *1694 - 1696 16 16 137 259 412 509 655 801 947 1697 - 1700 16 16 136 258 411 508 654 800 946

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1701 - 1703 16 16 135 257 410 507 653 799 945 1704 - 1706 16 16 134 256 409 506 652 798 944 1707 - 1710 16 16 133 255 408 505 651 797 943 1711 - 1713 16 16 132 254 407 504 650 796 942 1714 - 1716 16 16 131 253 406 503 649 795 941 1717 - 1720 16 16 130 252 405 502 648 794 940 1721 - 1723 16 129 251 404 501 647 793 939 1724 - 1726 16 128 250 403 500 646 792 938 1727 - 1730 16 127 249 402 499 645 791 937 1731 - 1733 16 126 248 401 498 644 790 936 1734 - 1736 16 125 247 400 497 643 789 935 1737 - 1740 16 124 246 399 496 642 788 934 1741 - 1743 16 123 245 398 495 641 787 933 1744 - 1746 16 122 244 397 494 640 786 932 1747 - 1750 16 121 243 396 493 639 785 931 1751 - 1753 16 120 242 395 492 638 784 930 1754 - 1756 16 119 241 394 491 637 783 929 1757 - 1760 16 118 240 393 490 636 782 928 1761 - 1763 16 117 239 392 489 635 781 927 1764 - 1766 16 116 238 391 488 634 780 926 1767 - 1770 16 115 237 390 487 633 779 925 1771 - 1773 16 114 236 389 486 632 778 924 1774 - 1776 16 113 235 388 485 631 777 923 1777 - 1780 16 112 234 387 484 630 776 922 1781 - 1783 16 111 233 386 483 629 775 921 1784 - 1786 16 110 232 385 482 628 774 920 1787 - 1790 16 109 231 384 481 627 773 919 1791 - 1793 16 108 230 383 480 626 772 918 1794 - 1796 16 107 229 382 479 625 771 917 1797 - 1800 16 106 228 381 478 624 770 916

Maximum net income for a 3-person non-categorically eligible SNAP unit is $1,778.

*Note : Net income starting at $1,694 exceeds the level at which benefits are issued for 3-person SNAP unit.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1801 - 1803 16 105 227 380 477 623 769 915 1804 - 1806 16 104 226 379 476 622 768 914 1807 - 1810 16 103 225 378 475 621 767 913 1811 - 1813 16 102 224 377 474 620 766 912 1814 - 1816 16 101 223 376 473 619 765 911 1817 - 1820 16 100 222 375 472 618 764 910 1821 - 1823 16 99 221 374 471 617 763 909 1824 - 1826 16 98 220 373 470 616 762 908 1827 - 1830 16 97 219 372 469 615 761 907 1831 - 1833 16 96 218 371 468 614 760 906 1834 - 1836 16 95 217 370 467 613 759 905 1837 - 1840 16 94 216 369 466 612 758 904 1841 - 1843 16 93 215 368 465 611 757 903 1844 - 1846 16 92 214 367 464 610 756 902 1847 - 1850 16 91 213 366 463 609 755 901 1851 - 1853 16 90 212 365 462 608 754 900 1854 - 1856 16 89 211 364 461 607 753 899 1857 - 1860 16 88 210 363 460 606 752 898 1861 - 1863 16 87 209 362 459 605 751 897 1864 - 1866 16 86 208 361 458 604 750 896 1867 - 1870 16 85 207 360 457 603 749 895 1871 - 1873 16 84 206 359 456 602 748 894 1874 - 1876 16 83 205 358 455 601 747 893 1877 - 1880 16 82 204 357 454 600 746 892 1881 - 1883 16 81 203 356 453 599 745 891 1884 - 1886 16 80 202 355 452 598 744 890 1887 - 1890 16 79 201 354 451 597 743 889 1891 - 1893 16 78 200 353 450 596 742 888 1894 - 1896 16 77 199 352 449 595 741 887 1897 - 1900 16 76 198 351 448 594 740 886

Bold areas refer to categorically eligible SNAP units only.

Numbers of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1901 - 1903 16 75 197 350 447 593 739 885 1904 - 1906 16 74 196 349 446 592 738 884 1907 - 1910 16 73 195 348 445 591 737 883 1911 - 1913 16 72 194 347 444 590 736 882 1914 - 1916 16 71 193 346 443 589 735 881 1917 - 1920 16 70 192 345 442 588 734 880 1921 - 1923 16 69 191 344 441 587 733 879 1924 - 1926 16 68 190 343 440 586 732 878 1927 - 1930 16 67 189 342 439 585 731 877 1931 - 1933 16 66 188 341 438 584 730 876 1934 - 1936 16 65 187 340 437 583 729 875 1937 - 1940 16 64 186 339 436 582 728 874 1941 - 1943 16 63 185 338 435 581 727 873 1944 - 1946 16 62 184 337 434 580 726 872 1947 - 1950 16 61 183 336 433 579 725 871 1951 - 1953 16 60 182 335 432 578 724 870 1954 - 1956 16 59 181 334 431 577 723 869 1957 - 1960 16 58 180 333 430 576 722 868 1961 - 1963 16 57 179 332 429 575 721 867 1964 - 1966 16 56 178 331 428 574 720 866 1967 - 1970 16 55 177 330 427 573 719 865 1971 - 1973 16 54 176 329 426 572 718 864 1974 - 1976 16 53 175 328 425 571 717 863 1977 - 1980 16 52 174 327 424 570 716 862 1981 - 1983 16 51 173 326 423 569 715 861 1984 - 1986 16 50 172 325 422 568 714 860 1987 - 1990 16 49 171 324 421 567 713 859 1991 - 1993 16 48 170 323 420 566 712 858 1994 - 1996 16 47 169 322 419 565 711 857 1997 - 2000 16 46 168 321 418 564 710 856

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2001 - 2003 16 45 167 320 417 563 709 855 2004 - 2006 16 44 166 319 416 562 708 854 2007 - 2010 16 43 165 318 415 561 707 853 2011 - 2013 16 42 164 317 414 560 706 852 2014 - 2016 16 41 163 316 413 559 705 851 2017 - 2020 16 40 162 315 412 558 704 850 2021 - 2023 16 39 161 314 411 557 703 849 2024 - 2026 16 38 160 313 410 556 702 848 2027 - 2030 16 37 159 312 409 555 701 847 2031 - 2033 16 36 158 311 408 554 700 846 2034 - 2036 16 35 157 310 407 553 699 845 2037 - 2040 16 34 156 309 406 552 698 844 2041 - 2043 16 33 155 308 405 551 697 843 2044 - 2046 16 32 154 307 404 550 696 842 2047 - 2050 16 31 153 306 403 549 695 841 2051 - 2053 16 30 152 305 402 548 694 840 2054 - 2056 16 29 151 304 401 547 693 839 2057 - 2060 16 28 150 303 400 546 692 838 2061 - 2063 16 27 149 302 399 545 691 837 2064 - 2066 16 26 148 301 398 544 690 836 2067 - 2070 16 25 147 300 397 543 689 835 2071 - 2073 16 24 146 299 396 542 688 834 2074 - 2076 16 23 145 298 395 541 687 833 2077 - 2080 16 22 144 297 394 540 686 832 2081 - 2083 16 21 143 296 393 539 685 831 2084 - 2086 16 20 142 295 392 538 684 830 2087 - 2090 16 19 141 294 391 537 683 829 2091 - 2093 16 18 140 293 390 536 682 828 2094 - 2096 16 17 139 292 389 535 681 827 2097 - 2100 16 16 138 291 388 534 680 826

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Net Monthly Income 1 2 3 4 5 6 7 8 9 10 2101 - 2103 16 15 137 290 387 533 679 825 2104 - 2106 16 14 136 289 386 532 678 824 2107 - 2110 16 13 135 288 385 531 677 823 2111 - 2113 16 12 134 287 384 530 676 822 2114 - 2116 16 11 133 286 383 529 675 821 2117 - 2120 16 10 132 285 382 528 674 820 2121 - 2123 16 9 131 284 381 527 673 819 2124 - 2126 16 8 130 283 380 526 672 818 2127 - 2130 16 7 129 282 379 525 671 817 2131 - 2133 16 6 128 281 378 524 670 816 2134 - 2136 16 5 127 280 377 523 669 815 2137 - 2140 16 4 126 279 376 522 668 814 2141 - 2143 16 3 125 278 375 521 667 813 2144 - 2146 16 2 124 277 374 520 666 812 2147 - 2150 16 1 123 276 373 519 665 811 2151 - 2153 16 122 275 372 518 664 810 2154 - 2156 16 121 274 371 517 663 809 2157 - 2160 16 120 273 370 516 662 808 2161 - 2163 16 119 272 369 515 661 807 2164 - 2166 16 118 271 368 514 660 806 2167 - 2170 16 117 270 367 513 659 805 2171 - 2173 16 116 269 366 512 658 804 2174 - 2176 16 115 268 365 511 657 803 2177 - 2180 16 114 267 364 510 656 802 2181 - 2183 16 113 266 363 509 655 801 2184 - 2186 16 112 265 362 508 654 800 2187 - 2190 16 111 264 361 507 653 799 2191 - 2193 16 110 263 360 506 652 798 2194 - 2196 16 109 262 359 505 651 797 2197 - 2200 16 108 261 358 504 650 796

Maximum Net Income for a 4-person non-categorically eligible SNAP unit is $2,146.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2201 - 2203 16 107 260 357 503 649 795 2204 - 2206 16 106 259 356 502 648 794 2207 - 2210 16 105 258 355 501 647 793 2211 - 2213 16 104 257 354 500 646 792 2214 - 2216 16 103 256 353 499 645 791 2217 - 2220 16 102 255 352 498 644 790 2221 - 2223 16 101 254 351 497 643 789 2224 - 2226 16 100 253 350 496 642 788 2227 - 2230 16 99 252 349 495 641 787 2231 - 2233 16 98 251 348 494 640 786 2234 - 2236 16 97 250 347 493 639 785 2237 - 2240 16 96 249 346 492 638 784 2241 - 2243 16 95 248 345 491 637 783 2244 - 2246 16 94 247 344 490 636 782 2247 - 2250 16 93 246 343 489 635 781 2251 - 2253 16 92 245 342 488 634 780 2254 - 2256 16 91 244 341 487 633 779 2257 - 2260 16 90 243 340 486 632 778 2261 - 2263 16 89 242 339 485 631 777 2264 - 2266 16 88 241 338 484 630 776 2267 - 2270 16 87 240 337 483 629 775 2271 - 2273 16 86 239 336 482 628 774 2274 - 2276 16 85 238 335 481 627 773 2277 - 2280 16 84 237 334 480 626 772 2281 - 2283 16 83 236 333 479 625 771 2284 - 2286 16 82 235 332 478 624 770 2287 - 2290 16 81 234 331 477 623 769 2291 - 2293 16 80 233 330 476 622 768 2294 - 2296 16 79 232 329 475 621 767 2297 - 2300 16 78 231 328 474 620 766

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2301 - 2303 16 77 230 327 473 619 765 2304 - 2306 16 76 229 326 472 618 764 2307 - 2310 16 75 228 325 471 617 763 2311 - 2313 16 74 227 324 470 616 762 2314 - 2316 16 73 226 323 469 615 761 2317 - 2320 16 72 225 322 468 614 760 2321 - 2323 16 71 224 321 467 613 759 2324 - 2326 16 70 223 320 466 612 758 2327 - 2330 69 222 319 465 611 757 2331 - 2333 68 221 318 464 610 756 2334 - 2336 67 220 317 463 609 755 2337 - 2340 66 219 316 462 608 754 2341 - 2343 65 218 315 461 607 753 2344 - 2346 64 217 314 460 606 752 2347 - 2350 63 216 313 459 605 751 2351 - 2353 62 215 312 458 604 750 2354 - 2356 61 214 311 457 603 749 2357 - 2360 60 213 310 456 602 748 2361 - 2363 59 212 309 455 601 747 2364 - 2366 58 211 308 454 600 746 2367 - 2370 57 210 307 453 599 745 2371 - 2373 56 209 306 452 598 744 2374 - 2376 55 208 305 451 597 743 2377 - 2380 54 207 304 450 596 742 2381 - 2383 53 206 303 449 595 741 2384 - 2386 52 205 302 448 594 740 2387 - 2390 51 204 301 447 593 739 2391 - 2393 50 203 300 446 592 738 2394 - 2396 49 202 299 445 591 737 2397 - 2400 48 201 298 444 590 736

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2401 - 2403 47 200 297 443 589 735 2404 - 2406 46 199 296 442 588 734 2407 - 2410 45 198 295 441 587 733 2411 - 2413 44 197 294 440 586 732 2414 - 2416 43 196 293 439 585 731 2417 - 2420 42 195 292 438 584 730 2421 - 2423 41 194 291 437 583 729 2424 - 2426 40 193 290 436 582 728 2427 - 2430 39 192 289 435 581 727 2431 - 2433 38 191 288 434 580 726 2434 - 2436 37 190 287 433 579 725 2437 - 2440 36 189 286 432 578 724 2441 - 2443 35 188 285 431 577 723 2444 - 2446 34 187 284 430 576 722 2447 - 2450 33 186 283 429 575 721 2451 - 2453 32 185 282 428 574 720 2454 - 2456 31 184 281 427 573 719 2457 - 2460 30 183 280 426 572 718 2461 - 2463 29 182 279 425 571 717 2464 - 2466 28 181 278 424 570 716 2467 - 2470 27 180 277 423 569 715 2471 - 2473 26 179 276 422 568 714 2474 - 2476 25 178 275 421 567 713 2477 - 2480 24 177 274 420 566 712 2481 - 2483 23 176 273 419 565 711 2484 - 2486 22 175 272 418 564 710 2487 - 2490 21 174 271 417 563 709 2491 - 2493 20 173 270 416 562 708 2494 - 2496 19 172 269 415 561 707 2497 - 2500 18 171 268 414 560 706

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2501 - 2503 17 170 267 413 559 705 2504 - 2506 16 169 266 412 558 704 2507 - 2510 15 168 265 411 557 703 2511 - 2513 14 167 264 410 556 702 2514 - 2516 13 166 263 409 555 701 2517 - 2520 12 165 262 408 554 700 2521 - 2523 11 164 261 407 553 699 2524 - 2526 10 163 260 406 552 698 2527 - 2530 9 162 259 405 551 697 2531 - 2533 8 161 258 404 550 696 2534 - 2536 7 160 257 403 549 695 2537 - 2540 6 159 256 402 548 694 2541 - 2543 5 158 255 401 547 693 2544 - 2546 4 157 254 400 546 692 2547 - 2550 3 156 253 399 545 691 2551 - 2553 2 155 252 398 544 690 2554 - 2556 1 154 251 397 543 689 2557 - 2560 153 250 396 542 688 2561 - 2563 152 249 395 541 687 2564 - 2566 151 248 394 540 686 2567 - 2570 150 247 393 539 685 2571 - 2573 149 246 392 538 684 2574 - 2576 148 245 391 537 683 2577 - 2580 147 244 390 536 682 2581 - 2583 146 243 389 535 681 2584 - 2586 145 242 388 534 680 2587 - 2590 144 241 387 533 679 2591 - 2593 143 240 386 532 678 2594 - 2596 142 239 385 531 677 2597 - 2600 141 238 384 530 676

Maximum Net Income for a 5-person non-categorically eligible SNAP unit is $2,515.

Bold areas refer to categorically eligible SNAP units only.

(120535)WAG 25-03-09: Basis of Issuance Table (3) (10-01-19)#

(120535)(block-1)SNAP Benefit Amount By SNAP Unit Size#

0-1400

1401 - 2600

2601 - 2700

2701 - 2800

2801 - 2900

2901 - 3000

3001 - 3100

3101 - 3200

3201 - 3300

3301 - 3400

3401 - 3500

3501 - 3600

3601 - 3700

3701 - 3800

3801 - 3900

3901 - 4000

4001 - 4100

4101 - 4200

4201 - 4300

4301 - 4400

4401 - 4500

4501 - 4600

4601 - 4700

4701 - 4800

4801 - 4850

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2601 - 2603 140 237 383 529 675 2604 - 2606 139 236 382 528 674 2607 - 2610 138 235 381 527 673 2611 - 2613 137 234 380 526 672 2614 - 2616 136 233 379 525 671 2617 - 2620 135 232 378 524 670 2621 - 2623 134 231 377 523 669 2624 - 2626 133 230 376 522 668 2627 - 2630 132 229 375 521 667 2631 - 2633 131 228 374 520 666 2634 - 2636 130 227 373 519 665 2637 - 2640 129 226 372 518 664 2641 - 2643 128 225 371 517 663 2644 - 2646 127 224 370 516 662 2647 - 2650 126 223 369 515 661 2651 - 2653 125 222 368 514 660 2654 - 2656 124 221 367 513 659 2657 - 2660 123 220 366 512 658 2661 - 2663 122 219 365 511 657 2664 - 2666 121 218 364 510 656 2667 - 2670 120 217 363 509 655 2671 - 2673 119 216 362 508 654 2674 - 2676 118 215 361 507 653 2677 - 2680 117 214 360 506 652 2681 - 2683 116 213 359 505 651 2684 - 2686 115 212 358 504 650 2687 - 2690 114 211 357 503 649 2691 - 2693 113 210 356 502 648 2694 - 2696 112 209 355 501 647 2697 - 2700 111 208 354 500 646

Number of Persons Monthly Net income 1 2 3 4 5 6 7 8 9 10 2701 - 2703 110 207 353 499 645 2704 - 2706 109 206 352 498 644 2707 - 2710 108 205 351 497 643 2711 - 2713 107 204 350 496 642 2714 - 2716 106 203 349 495 641 2717 - 2720 105 202 348 494 640 2721 - 2723 104 201 347 493 639 2724 - 2726 103 200 346 492 638 2727 - 2730 102 199 345 491 637 2731 - 2733 101 198 344 490 636 2734 - 2736 100 197 343 489 635 2737 - 2740 99 196 342 488 634 2741 - 2743 98 195 341 487 633 2744 - 2746 97 194 340 486 632 2747 - 2750 96 193 339 485 631 2751 - 2753 95 192 338 484 630 2754 - 2756 94 191 337 483 629 2757 - 2760 93 190 336 482 628 2761 - 2763 92 189 335 481 627 2764 - 2765 91 188 334 480 626 2767 - 2770 90 187 333 479 625 2771 - 2773 89 186 332 478 624 2774 - 2776 88 185 331 477 623 2777 - 2780 87 184 330 476 622 2781 - 2783 86 183 329 475 621 2784 - 2786 85 182 328 474 620 2787 - 2790 84 181 327 473 619 2791 - 2793 83 180 326 472 618 2794 - 2796 82 179 325 471 617 2797 - 2800 81 178 324 470 616

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2801 - 2803 80 177 323 469 615 2804 - 2806 79 176 322 468 614 2807 - 2810 78 175 321 467 613 2811 - 2813 77 174 320 466 612 2814 - 2816 76 173 319 465 611 2817 - 2820 75 172 318 464 610 2821 - 2820 74 171 317 463 609 2824 - 2826 73 170 316 462 608 2827 - 2830 72 169 315 461 607 2831 - 2833 71 168 314 460 606 2834 - 2836 70 167 313 459 605 2837 - 2840 69 166 312 458 604 2841 - 2843 68 165 311 457 603 2844 - 2846 67 164 310 456 602 2847 - 2850 66 163 309 455 601 2851 - 2853 65 162 308 454 600 2854 - 2856 64 161 307 453 599 2857 - 2860 63 160 306 452 598 2861 - 2863 62 159 305 451 597 2864 - 2866 61 158 304 450 596 2867 - 2870 60 157 303 449 595 2871 - 2873 59 156 302 448 594 2874 - 2876 58 155 301 447 593 2877 - 2880 57 154 300 446 592 2881 - 2883 56 153 299 445 591 2884 - 2886 55 152 298 444 590 2887 - 2890 54 151 297 443 589 2891 - 2893 53 150 296 442 588 2894 - 2896 52 149 295 441 587 2897 - 2900 51 148 294 440 586

Maximum Net Income for a 6-person non-categorically eligible SNAP unit is $2,883.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2901 - 2903 50 147 293 439 585 2904 - 2906 49 146 292 438 584 2907 - 2910 48 145 291 437 583 2911 - 2913 47 144 290 436 582 2914 - 2916 46 143 289 435 581 2917 - 2920 45 142 288 434 580 2921 - 2923 44 141 287 433 579 2924 - 2926 43 140 286 432 578 2927 - 2930 42 139 285 431 577 2931 - 2933 41 138 284 430 576 2934 - 2936 40 137 283 429 575 2937 - 2940 39 136 282 428 574 2941 - 2943 38 135 281 427 573 2944 - 2946 37 134 280 426 572 2947 - 2950 36 133 279 425 571 2951 - 2953 35 132 278 424 570 2954 - 2956 34 131 277 423 569 2957 - 2960 33 130 276 422 568 2961 - 2963 32 129 275 421 567 2964 - 2966 31 128 274 420 566 2967 - 2970 30 127 273 419 565 2971 - 2973 29 126 272 418 564 2974 - 2976 28 125 271 417 563 2977 - 2980 27 124 270 416 562 2981 - 2983 26 123 269 415 561 2984 - 2986 25 122 268 414 560 2987 - 2990 24 121 267 413 559 2991 - 2993 23 120 266 412 558 2994 - 2996 22 119 265 411 557 2997 - 3000 21 118 264 410 556

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3001 - 3003 20 117 263 409 555 3004 - 3006 19 116 262 408 554 3007 - 3010 18 115 261 407 553 3011 - 3013 17 114 260 406 552 3014 - 3016 16 113 259 405 551 3017 - 3020 15 112 258 404 550 3021 - 3023 14 111 257 403 549 3024 - 3026 13 110 256 402 548 3027 - 3030 12 109 255 401 547 3031 - 3033 11 108 254 400 546 3034 - 3036 10 107 253 399 545 3037 - 3040 9 106 252 398 544 3041 - 3043 8 105 251 397 543 3044 - 3046 7 104 250 396 542 3047 - 3050 6 103 249 395 541 3051 - 3093 5 102 248 394 540 3054 - 3056 4 101 247 393 539 3057 - 3060 3 100 246 392 538 3061 - 3063 2 99 245 391 537 3064 - 3066 1 98 244 390 536 3067 - 3070 97 243 389 535 3071 - 3073 96 242 388 534 3074 - 3076 95 241 387 533 3077 - 3080 94 240 386 532 3081 - 3083 93 239 385 531 3084 - 3086 92 238 384 530 3087 - 3090 91 237 383 529 3091 - 3093 90 236 382 528 3094 - 3096 89 235 381 527 3097 - 3100 88 234 380 526

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3101 - 3103 87 233 379 525 3104 - 3106 86 232 378 524 3107 - 3110 85 231 377 523 3111 - 3113 84 230 376 522 3114 - 3116 83 229 375 521 3117 - 3120 82 228 374 520 3121 - 3123 81 227 373 519 3124 - 3126 80 226 372 518 3127 - 3130 79 225 371 517 3131 - 3133 78 224 370 516 3134 - 3136 77 223 369 515 3137 - 3140 76 222 368 514 3141 - 3143 75 221 367 513 3144 - 3146 74 220 366 512 3147 - 3150 73 219 365 511 3151 - 3453 72 218 364 510 3154 - 3156 71 217 363 509 3157 - 3160 70 216 362 508 3161 - 3163 69 215 361 507 3164 - 3166 68 214 360 506 3167 - 3170 67 213 359 505 3171 - 3173 66 212 358 504 3174 - 3176 65 211 357 503 3177 - 3180 64 210 356 502 3181 - 3183 63 209 355 501 3184 - 3186 62 208 354 500 3187 - 3190 61 207 353 499 3191 - 3193 60 206 352 498 3194 - 3196 59 205 351 497 3197 - 3200 58 204 350 496

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3201 - 3203 57 203 349 495 3204 - 3206 56 202 348 494 3207 - 3210 55 201 347 493 3211 - 3213 54 200 346 492 3214 - 3216 53 199 345 491 3217 - 3220 52 198 344 490 3221 - 3223 51 197 343 489 3224 - 3226 50 196 342 488 3227 - 3230 49 195 341 487 3231 - 3231 48 194 340 486 3234 - 3236 47 193 339 485 3237 - 3240 46 192 338 484 3241 - 3243 45 191 337 483 3244 - 3246 44 190 336 482 3247 - 3250 43 189 335 481 3251 - 3253 42 188 334 480 3254 - 3256 41 187 333 479 3257 - 3260 40 186 332 478 3261 - 3263 39 185 331 477 3264 - 3266 38 184 330 476 3267 - 3270 37 183 329 475 3271 - 3273 36 182 328 474 3274 - 3276 35 181 327 473 3277 - 3280 34 180 326 472 3281 - 3283 33 179 325 471 3284 - 3286 32 178 324 470 3287 - 3290 31 177 323 469 3291 - 3293 30 176 322 468 3294 - 3296 29 175 321 467 3297 - 3300 28 174 320 466

Maximum Net Income for a 7-person non-categorically eligible SNAP unit is $3,251.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3301 - 3303 27 173 319 465 3304 - 3306 26 172 318 464 3307 - 3310 25 171 317 463 3311 - 3313 24 170 316 462 3314 - 3316 23 169 315 461 3317 - 3320 22 168 314 460 3321 - 3323 21 167 313 459 3324 - 3326 20 166 312 458 3327 - 3330 19 165 311 457 3331 - 3333 18 164 310 456 3334 - 3336 17 163 309 455 3337 - 3340 16 162 308 454 3341 - 3343 15 161 307 453 3344 - 3346 14 160 306 452 3347 - 3350 13 159 305 451 3351 - 3353 12 158 304 450 3354 - 3356 11 157 303 449 3357 - 3360 10 156 302 448 3361 - 3363 9 155 301 447 3364 - 3366 8 154 300 446 3367 - 3370 7 153 299 445 3371 - 3373 6 152 298 444 3374 - 3376 5 151 297 443 3377 - 3380 4 150 296 442 3381 - 3383 3 149 295 441 3384 - 3386 2 148 294 440 3387 - 3390 1 147 293 439 3391 - 3393 146 292 438 3394 - 3396 145 291 437 3397 - 3400 144 290 436

Bold areas refer to categorically eligible SNAP units only.

Number if Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3401 - 3403 143 289 435 3404 - 3406 142 288 434 3407 - 3410 141 287 433 3411 - 3413 140 286 432 3414 - 3416 139 285 431 3417 - 3420 138 284 430 3421 - 3423 137 283 429 3424 - 3420 136 282 428 3427 - 3130 135 281 427 3431 - 3433 134 280 426 3434 - 3436 133 279 425 3437 - 3440 132 278 424 3441 - 3443 131 277 423 3444 - 3446 130 276 422 3447 - 3450 129 275 421 3451 - 3453 128 274 420 3454 - 3456 127 273 419 3457 - 3460 126 272 418 3461 - 3463 125 271 417 3464 - 3466 124 270 416 3467 - 3470 123 269 415 3471 - 3473 122 268 414 3474 - 3476 121 267 413 3477 - 3480 120 266 412 3481 - 3483 119 265 411 3484 - 3486 118 264 410 3487 - 3490 117 263 409 3491 - 3493 116 262 408 3494 - 3496 115 261 407 3497 - 3500 114 260 406

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3501 - 3503 113 259 405 3504 - 3506 112 258 404 3507 - 3510 111 257 403 3511 - 3513 110 256 402 3514 - 3516 109 255 401 3517 - 3520 108 254 400 3521 - 3523 107 253 399 3524 - 3526 106 252 398 3527 - 3530 105 251 397 3531 - 3533 104 250 396 3534 - 3536 103 249 395 3537 - 3540 102 248 394 3541 - 3543 101 247 393 3544 - 3540 100 246 392 3547 - 3550 99 245 391 3551 - 3553 98 244 390 3554 - 3556 97 243 389 3557 - 3560 96 242 388 3561 - 3563 95 241 387 3564 - 3566 94 240 386 3567 - 3570 93 239 385 3571 - 3573 92 238 384 3574 - 3576 91 237 383 3577 - 3580 90 236 382 3581 - 3583 89 235 381 3584 - 3586 88 234 380 3587 - 3590 87 233 379 3591 - 3593 86 232 378 3594 - 3596 85 231 377 3597 - 3600 84 230 376

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3601 - 3603 83 229 375 3604 - 3606 82 228 374 3607 - 3610 81 227 373 3611 - 3613 80 226 372 3614 - 3616 79 225 371 3617 - 3620 78 224 370 3621 - 3623 77 223 369 3624 - 3626 76 222 368 3627 - 3630 75 221 367 3631 - 3633 74 220 366 3634 - 3636 73 219 365 3637 - 3640 72 218 364 3641 - 3643 71 217 363 3644 - 3646 70 216 362 3647 - 3650 69 215 361 3651 - 3653 68 214 360 3654 - 3656 67 213 359 3657 - 3660 66 212 358 3661 - 3663 65 211 357 3664 - 3666 64 210 356 3667 - 3670 63 209 355 3671 - 3673 62 208 354 3674 - 3676 61 207 353 3677 - 3680 60 206 352 3681 - 3683 59 205 351 3684 - 3686 58 204 350 3687 - 3690 57 203 349 3691 - 3693 56 202 348 3694 - 3696 55 201 347 3697 - 3700 54 200 346

Minimum Net Income for an 8-person non-categorically eligible SNAP unit is $3,620.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3701 - 3703 53 200 345 3704 - 3706 52 198 344 3707 - 3710 51 197 343 3711 - 3713 50 196 342 3714 - 3716 49 195 341 3717 - 3720 48 194 340 3721 - 3723 47 193 339 3724 - 3726 46 192 338 3727 - 3730 45 191 337 3731 - 3733 44 190 336 3734 - 3730 43 189 335 3737 - 3740 42 188 334 3741 - 3743 41 187 333 3744 - 3746 40 186 332 3747 - 3750 39 185 331 3751 - 3753 38 184 330 3754 - 3756 37 183 329 3757 - 3760 36 182 328 3761 - 3763 35 181 327 3764 - 3766 34 180 326 3767 - 3770 33 179 325 3771 - 3773 32 178 324 3774 - 3776 31 177 323 3777 - 3780 30 176 322 3781 - 3783 29 175 321 3784 - 3789 28 174 320 3787 - 3790 27 173 319 3791 - 3793 26 172 318 3794 - 3796 25 171 317 3797 - 3800 24 170 316

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3801 - 3803 23 169 315 3804 - 3806 22 168 314 3807 - 3810 21 167 313 3811 - 3813 20 166 312 3814 - 3816 19 165 311 3817 - 3820 18 164 310 3821 - 3823 17 163 309 3824 - 3826 16 162 308 3827 - 3830 15 161 307 3831 - 3833 14 160 306 3834 - 3836 13 159 305 3837 - 3840 12 158 304 3841 - 3843 11 157 303 3844 - 3846 10 156 302 3847 - 3850 9 155 301 3851 - 3853 8 154 300 3854 - 3856 7 153 299 3857 - 3860 6 152 298 3861 - 3863 5 151 297 3864 - 3866 4 150 296 3867 - 3870 3 149 295 3871 - 3873 2 148 294 3874 - 3876 1 147 293 3877 - 3880 146 292 3881 - 3883 145 291 3884 - 3886 144 290 3887 - 3890 143 289 3891 - 3893 142 288 3894 - 3896 141 287 3897 - 3900 140 286

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3901 - 3903 139 285 3904 - 3906 138 284 3907 - 3910 137 283 3911 - 3913 136 282 3914 - 3916 135 281 3917 - 3920 134 280 3921 - 3923 133 279 3924 - 2926 132 278 3927 - 2930 131 277 3931 - 3933 130 276 3934 - 3936 129 275 3937 - 3940 128 274 3941 - 3943 127 273 3944 - 3946 126 272 3947 - 3950 125 271 3951 - 3953 124 270 3954 - 3956 123 269 3957 - 3980 122 268 3961 - 3903 121 267 3964 - 3966 120 266 3967 - 3970 119 265 3971 - 3973 118 264 3974 - 3976 117 263 3977 - 3980 116 262 3981 - 3983 115 261 3984 - 3986 114 260 3987 - 3996 113 259 3991 - 3993 112 258 3994 - 3996 111 257 3997 - 4000 110 256

Maximum Net Income for a 9-person non-categorically eligible SNAP unit is $3,989.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4001 - 4003 109 255 4004 - 4006 108 254 4007 - 4010 107 253 4011 - 4013 106 252 4014 - 4018 105 251 4017 - 4020 104 250 4021 - 4023 103 249 4024 - 4026 102 248 4027 - 4030 101 247 4031 - 4033 100 246 4034 - 4036 99 245 4037 - 4040 98 244 4041 - 4043 97 243 4044 - 4046 96 242 4047 - 4050 95 241 4051 - 4053 94 240 4054 - 4056 93 239 4057 - 4060 92 238 4061 - 4063 91 237 4064 - 4066 90 236 4067 - 4070 89 235 4071 - 4073 88 234 4074 - 4076 87 233 4077 - 4080 86 232 4081 - 4083 85 231 4084 - 4086 84 230 4087 - 4090 83 229 4091 - 4093 82 228 4094 - 4096 81 227 4097 - 4100 80 226

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4101 - 4103 79 225 4104 - 4106 78 224 4107 - 4110 77 223 4111 - 4113 76 222 4114 - 4116 75 221 4117 - 4120 74 220 4121 - 4123 73 219 4124 - 4126 72 218 4127 - 4130 71 217 4131 - 4133 70 216 4134 - 4136 69 215 4137 - 4140 68 214 4141 - 4143 67 213 4144 - 4146 66 212 4147 - 4150 65 211 4151 - 4153 64 210 4154 - 4156 63 209 4157 - 4160 62 208 4161 - 4163 61 207 4164 - 4166 60 206 4167 - 4170 59 205 4171 - 4173 58 204 4174 -4176 57 203 4177 - 4180 56 202 4181 - 4183 55 201 4184 - 4186 54 200 4187 - 4190 53 199 4191 - 4193 52 198 4194 - 4196 51 197 4197 - 4200 50 196

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4201 - 4203 49 195 4204 - 4206 48 194 4207 - 4210 47 193 4211 - 4213 46 192 4214 - 4216 45 191 4217 - 4220 44 190 4221 - 4223 43 189 4224 - 4226 42 188 4227 - 4250 41 187 4231 - 4233 40 186 4234 - 4236 39 185 4237 - 4240 38 184 4241 - 4243 37 183 4244 - 4246 36 182 4247 - 4250 35 181 4251 - 4253 34 180 4254 - 4256 33 179 4257 - 4260 32 178 4261 - 4263 31 177 4264 - 4266 30 176 4267 - 4270 29 175 4271 - 4273 28 174 4274 - 4276 27 173 4277 - 4280 26 172 4281 - 4283 25 171 4284 - 4286 24 170 4287 - 4290 23 169 4291 - 4293 22 168 4294 - 4296 21 167 4297 - 4300 20 166

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4301 - 4303 19 165 4304 - 4306 18 164 4307 - 4310 17 163 4311 - 4313 16 162 4314 - 4316 15 161 4317 - 4320 14 160 4321 - 4323 13 159 4324 - 4326 12 158 4327 - 4330 11 157 4331 - 4333 10 156 4334 - 4336 9 155 4337 - 4340 8 154 4341 - 4343 7 153 4344 - 4346 6 152 4347 - 4350 5 151 4351 - 4353 4 150 4354 - 4356 3 149 4357- 4360 2 148 4361 - 4363 1 147 4364 - 4366 146 4367 - 4370 145 4371 - 4373 144 4374 - 4376 143 4377 - 4380 142 4381 - 4383 141 4384 - 4386 140 4387 - 4390 139 4391 - 4393 138 4394 - 4396 137 4397 - 4400 136

Maximum Net Income for a 10-person non-categorically eligible SNAP unit is $4,358.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4401 - 4403 135 4404 - 4406 134 4407 - 4410 133 4411 - 4413 132 4414 - 4416 131 4417 - 4420 130 4421 - 4423 129 4424 - 4426 128 4427 - 4430 127 4431 - 4433 126 4434 - 4436 125 4437 - 4440 124 4441 - 4443 123 4444 - 4446 122 4447 - 4450 121 4451 - 4453 120 4454 - 4456 119 4457 - 4460 118 4461 - 4463 117 4464 - 4466 116 4467 - 4470 115 4471 - 4473 114 4474 - 4470 113 4477 - 4480 112 4481 - 4483 111 4484 - 4486 110 4487 - 4490 109 4491 - 4493 108 4494 - 4496 107 4497 - 4500 106

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4501 - 4503 105 4504 - 4506 104 4507 - 4510 103 4511 - 4513 102 4514 - 4516 101 4517 - 4520 100 4521 - 4523 99 4524 - 4526 98 4527 - 4530 97 4531 - 4533 96 4534 - 4536 95 4537 - 4536 94 4541 - 4543 93 4544 - 4546 92 4547 -4550 91 4551 - 4553 90 4554 - 4556 89 4557 - 4560 88 4561 - 4563 87 4564 - 4566 86 4567 - 4570 85 4571 - 4573 84 4574 - 4576 83 4577 - 4580 82 4581 - 4583 81 4584 - 4586 80 4587 - 4590 79 4591 - 4596 78 4594 - 4596 77 4597 - 4600 76

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4601 - 4603 75 4604 - 4606 74 4607 - 4610 73 4611 - 4613 72 4614 - 4616 71 4617 - 4620 70 4621 - 4623 69 4624 - 4626 68 4627- 4630 67 4631 - 4633 66 4634 - 4636 65 4637 - 4640 64 4641 - 4643 63 4644 - 4646 62 4647 - 4650 61 4651 - 4653 60 4654 - 4656 59 4657 - 4660 58 4661 - 4663 57 4664 - 4666 56 4667 - 4670 55 4671 - 4673 54 4674 - 4676 53 4677 - 4680 52 4681 - 4683 51 4684 - 4686 50 4687 - 4690 49 4691 - 4693 48 4694 - 4696 47 4697 - 4700 46

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4701 - 4703 45 4704 - 4706 44 4707 - 4710 43 4711 - 4713 42 4714 - 4716 41 4717 - 4720 40 4721 - 4723 39 4724 - 4726 38 4727 - 4730 37 4731 - 4733 36 4734 - 4736 35 4737 - 4740 34 4741 - 4743 33 4744 - 4746 32 4747 - 4750 31 4751 - 4753 30 4754 - 4756 29 4757 - 4760 28 4761 - 4763 27 4764 - 4766 26 4767 - 4770 25 4771 - 4773 24 4774 - 4776 23 4777 - 4780 22 4781 - 4783 21 4784 - 4786 20 4787 - 4790 19 4791 - 4793 18 4794 - 4796 17 4797 - 4800 16

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4801 - 4803 15 4804 - 4806 14 4807 - 4810 13 4811 - 1013 12 4814 -4 816 11 4817 - 4820 10 4821 - 4823 9 4824 - 4826 8 4827 - 4830 7 4831 - 4833 6 4834 - 4836 5 4837 - 4840 4 4841 - 4843 3 4844 - 4846 2 4847 - 4850 1

Bold areas refer to categorically eligible SNAP units only.

(121576)PM 02-07-03-l: Special Verifications for SNAP#

(121576)(block-1)PM 02-07-03-l: Special Verifications for SNAP#

WAG 02-07-03-l

(121576)(block-2)Verify Identity#

Verify the identity of the person filing the application. When an approved representative applies for a SNAP household, verify the identity of the payee for the SNAP household and of the approved representative. It is not necessary to verify the identity of each person listed on the application.

(121576)(block-3)Housing Costs#

Verification of housing costs must be provided at initial application, at redeterminations when a change of address and/or housing cost is reported, at the Mid-Point Report when a change of address and/or housing cost is reported, and during the certification period when a change of address and/or housing cost is reported.

(121576)(block-4)Housing Costs for an Unoccupied Home#

SNAP customers may claim expenses for a home in which they temporarily do not live. A SNAP household that has both an occupied home and an unoccupied home is only entitled to one utility standard. The appropriate standard may be used for the home the SNAP household chooses.

(121576)(block-5)Child Support Income Exclusion from Gross Monthly Income#

All verified court ordered child support payments are treated as an income exclusion from the SNAP household's total gross monthly income when comparing to the Maximum Monthly Gross Income Standard for the household size. If eligible after the exclusion is allowed, the household's total gross income (include the child support payment amount) is used to calculate the 20% Earned Income Deduction. Child support payments are not allowed as an income deduction in the net SNAP benefit calculation.

When a SNAP household requests to have child support payments excluded from their gross monthly income, the support order and the actual support payments made in the most recent 30 days must be verified to determine the amount to exclude. Individual payments are converted to a monthly amount. The support order may be a court order, an administrative order, or a legal separation document. Voluntary support payments are not an allowable expense for SNAP.

(121576)(block-6)Qualifying Member Medical Expenses#

For SNAP households with a qualifying member verify that total medical costs for all qualifying members are more than $35, prior to allowing a Standard Medical Deduction. Verify all medical expenses for SNAP households choosing actual medical expenses instead of a Standard Medical Deduction. See PM 05-06-01 for qualifying member definition. A qualifying member SNAP household entitled to expedited service is entitled to a medical expense deduction, if they list medical expense amounts, even if verification of those expenses is postponed. See WAG 13-01-05-a .

(121576)(block-7)Verification of the Expenses#

If getting needed verification for an expense delays approving a SNAP household's application, figure the household's eligibility and benefit level without a deduction for the expense which was reported but not verified. If, after the SNAP household is approved for benefits, the household provides verification of the expense, treat the information like the SNAP household reported a change in circumstances (see PM 18-04-00).

(121576)(block-8)Accepting Verifications via the Customer's Cell Phone#

Documentary evidence is used as the primary source of verification when possible. Documentary evidence is the actual item itself, such as a driver's license or paystubs. When a customer is claiming not to have the actual item, the Family Community Resource Center (FCRC) must accept any reasonable documentary evidence provided by the household that adequately proves the statements on the application and can be identified as belonging to customer.

(121576)(block-9)Work Requirement#

When a member of the SNAP household must meet the SNAP Work Requirement, anticipate the Work Requirement will be met. A statement that the customer expects to meet the Work Requirement is verification that the Work Requirement is met. Verification does not need to be provided monthly. The customer is in Change Reporting status and is responsible for reporting a change within 10 calendar days of the date they learn about the change (PM 18-04-00 ). The statement may be from an employer, a local governmental unit, SNAP Employment and Training staff, or a community organization.

(121576)(block-10)Financial Management#

If a SNAP household's monthly SNAP related expenses exceed the household's known monthly income and resources, discuss financial management with the customer. Ask the customer how they pay the expenses. They must explain financial management before SNAP benefits are issued. But they do not have to provide verification to prove it before expedited benefits are issued.

Document the customer's statements and explanation of their financial management.

If explaining financial management requires that the customer provide verification, request the verification (see PM 02-07-02 ). Deny the application if the customer does not provide the verification within 10 calendar days and has not asked for more time or help in getting the information.

(121600)PM 13-01-05-a: Allowable Medical Expenses#

(121600)(block-1)PM 13-01-05-a: Allowable Medical Expenses#

WAG 13-01-05-a

Medical expenses are not allowed if:

reimbursable by insurance or a third party, or

paid by a vendor payment, or

paid by a non Food Assistance household member unless the amount paid is counted as income.

(121600)(block-2)Allowable Medical Expenses#

Regardless of intent to pay, allowable medical expenses include, but are not limited to, bills received or expected to be received for the following services:

Medical and dental care.

Psychotherapy and rehabilitation services provided by a state licensed practitioner or other qualified health professional.

The cost for acupuncture, massage therapy, or herbs prescribed for therapeutic purposes, if a state licensed practitioner or other qualified health professional prescribes or approves as an alternative therapy or medicine. The cost for the practitioner and the therapy or medicine may be allowed as a medical expense, if it cannot be otherwise purchased with Food Assistance benefits and is not prescribed as a part of a special diet.

Hospitalization or outpatient treatment.

Nursing care or nursing home care including bills received by the household for a person who was a household member immediately before entering the hospital or nursing home.

Prescribed drugs, including insulin and other over the counter medications when approved by a physician or other qualified health professional.

Postage for mail order prescription drugs is an allowable medical expense.

Cost of medical supplies, sickroom equipment, including rental, or other prescribed equipment.

Adaptive equipment in vehicles and homes as well as monthly telephone fees for amplifiers and warning signals for elderly or disabled individuals ( PM 05-06-01) and the costs of telecommunications devices for the elderly or disabled.

Health and hospitalization insurance policy premiums. NOTE: Do not allow for the costs of: health and accident policies such as those payable in a lump sum for death or dismemberment, or income maintenance policies such as those that make mortgage or loan payments while the beneficiary is disabled, or health insurance premiums paid by the Health Insurance Premium Payment (HIPP) Program.

Insurance premiums for policies intended to cover cancer treatments.

Insurance premiums for ambulance insurance policies.

Payments made on a conventional loan when the loan is used to pay a one-time only medical expense, but loan expenses such as interest are not allowed as part of the deduction. If a mortgage is obtained for the purpose of financing a large medical expense, the mortgage payment should be allowed as a shelter cost and is not allowed as a medical expense.

Medicare premiums, Supplementary Medical Insurance Benefits (SMIB), and/or the Hospital Insurance Benefits (HIB), regardless of whether the qualifying member pays the premium directly or has it deducted from their Social Security check. Do not allow costs for Medicare SMIB and/or HIB premiums, if the person is enrolled in the Department of Healthcare and Family Service (HFS) SMIB/HIB buy-in agreement, or in the QMB or SLIB program.

Pay-in Spenddown payments. Pay-in Spenddown payments are centrally entered by the system see ( PM 13-01-05-f and WAG 13-01-05-f ).

Dentures, hearing aids, and prosthetics.

Cost of securing and maintaining an animal specially trained to serve the needs of a disabled person. When determining the cost, include the cost of food, veterinary bills, and other maintenance costs.

Contact lens or eyeglasses prescribed by an optometrist or a physician trained in eye disease.

Physician's charges to complete medical or insurance reports.

Reasonable cost of transportation and/or lodging to obtain needed medical treatment or services. If the household's automobile is used for medical transportation, the allowable rate is $.24 per mile. Transportation and lodging costs must be verified.

Costs of maintaining an attendant, homemaker, home health aide, housekeeper, or childcare provider, when needed due to age, infirmity, or illness of a household member. In order to allow the costs, the provider cannot be a Food Assistance household member. If a Food Assistance household incurs attendant care costs for an incapacitated person of any age that could qualify as either a medical care deduction or as a dependent care deduction, allow the household the option to choose how the costs will be deducted. The household may choose to deduct the entire attendant care cost as a dependent care deduction or as a medical expense deduction but not both. Discuss with the customer and determine the option that would be most beneficial for them. Incapacitation is:

any permanent or temporary condition that prevents an individual from participating fully in normal activities without supervision (including, but not limited to, work or school); and

that requires the care of another person to ensure the health and safety of the individual, or condition or situation that makes a lack of supervision risky to the health and safety of that individual. Do not refer to the Client Assessment Unit (CAU).

In addition to other costs, if the household provides the attendant with a majority of their meals, allow an amount equal to the maximum benefit amount for a one-person Food Assistance household as a medical expense.

Group home services, such as Community Integrated Living Arrangement (CILA) services, for persons living in group homes. See PM 06-11-02-b for an explanation of CILAs. CILA services are allowable medical expenses, even when the customer resides in their own home. Accept the group home's statement of what portion of the customer's income the group home keeps for shelter expenses, also allow the telephone standard as a utility expense if the household pays for their own private telephone. CILA customers keep a portion of their income as a Personal Needs Allowance (PNA). NOTE: The PNA is not a medical expense. See PM 05-08-09 for information on the current amount of the PNA. Effective January 1, 2026, the PNA will increase annually at the same rate as the Social Security cost-of-living adjustment. After the shelter expenses, PNA, and medical expenses the customer pays out of pocket are accounted for, the remainder of the income is retained by the group home as a medical expense. See WAG 13-01-05 . NOTE: Before deducting additional out of pocket medical expenses from the CILA customer's income, these must be verified.

Supportive Living Facility (SLF) services. If the resident receives medical assistance, the amount of the medical expense is the SLF credit amount. See WAG 05-11-05 .

Hemp derived CBD (cannabidiol) Oil may be allowed as a medical deduction only if verification is provided that specifically indicates: a State licensed practitioner or qualifying health professional has approved or prescribed the product; and certifies that the product contains a delta-9 tetrahydrocannabinol (THC) concentration in an amount that does not exceed 3% on a dry weight basis. When requesting verification from a customer claiming CBD oil as a medical expense, make sure the customer understands what needs to be provided as proof of their usage. Specifically state what is needed on the 267 VCL. If the customer's verification does not specifically include #1 and #2 above, do not allow a medical deduction. There is no exception to this requirement.

NOTE: See PM 13-01-05-e for Medical Expenses not allowed.

(121616)WAG 13-01-05-c: Nonreimbursable Medical Expenses#

(121616)(block-1)WAG 13-01-05-c: Nonreimbursable Medical Expenses#

PM 13-01-05-c

(121616)(block-2)Expense Incurred More Than Once#

When a SNAP unit, using actual medical expenses instead of a Standard Medical Deduction, is billed for a medical expense more often than monthly, convert the cost to a monthly amount. Multiply weekly amounts by 4.3 , bi weekly amounts by 2.15 , and semi monthly amounts by 2.

(121616)(block-3)One Time Only Expenses#

If a unit, using actual medical expenses instead of a Standard Medical Deduction, wants to average a one time only medical expense over the remaining months of the approval period, take the action effective for the month the Family Community Resource Center (FCRC) is required to take action on the change (see PM 18-04-07 ) . At initial approval and at SNAP REDE, begin averaging with the first month of the new approval period.

If a unit is making installment payments on a bill, allow a deduction for the payment if the payment plan was set up when the expense was first billed or came due.

NOTE: To allow a medical expense, the amount must be over $35. When averaging medical expenses, if the averaged amount is $35 or less, the expense must be used on a one time only basis.

(121616)(block-4)Installment Payments#

If a SNAP unit, using actual medical expenses instead of a Standard Medical Deduction, verifies installment payments, allow the current billing for installment payments when a payment plan for an allowable medical expense is established. Do not allow past due amounts.

Example 1: Ms. M verified that she is billed $300 per month because a payment plan was set up to pay for outpatient surgery that was not covered by insurance. Allow $300 per month as an actual medical expense.

Example 2: Mr. T verified a monthly billing of $250 for a payment plan for dental work. His most recent statement verified that he only paid $100. Add $100 per month to his other medical expenses. Allow the $185 Standard Medical Deduction if the total of all his expenses are less than $185. If expenses are greater than $185 allow actual medical expenses.

(126584)WAG 25-03-09: Basis of Issuance Table (1) (10-01-2020)#

(126584)(block-1)SNAP Benefit Amount By Unit Size#

0 - 100

101 - 200

201 - 300

301 - 400

401 - 500

501 - 600

601 - 700

701 - 800

801 - 900

901 - 1000

1001 - 1100

1101 - 1200

1201 - 1300

1301 - 1400

1401 - 2600

2601 - 5106

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 0 - 0 204 374 535 680 807 969 1071 1224 1377 1530 1 - 3 203 373 534 679 806 968 1070 1223 1376 1529 4 - 6 202 372 533 678 805 967 1069 1222 1375 1528 7 - 10 201 371 532 677 804 966 1068 1221 1374 1527 11 - 13 200 370 531 676 803 965 1067 1220 1373 1526 14 - 16 199 369 530 675 802 964 1066 1219 1372 1525 17 - 20 198 368 529 674 801 963 1065 1218 1371 1524 21 - 23 197 367 528 673 800 962 1064 1217 1370 1523 24 - 26 196 366 527 672 799 961 1063 1216 1369 1522 27 - 30 195 365 526 671 798 960 1062 1215 1368 1521 31 - 33 194 364 525 670 797 959 1061 1214 1367 1520 34 - 36 193 363 524 669 796 958 1060 1213 1366 1519 37 - 40 192 362 523 668 795 957 1059 1212 1365 1518 41 - 43 191 361 522 667 794 956 1058 1211 1364 1517 44 - 46 190 360 521 666 793 955 1057 1210 1363 1516 47 - 50 189 359 520 665 792 954 1056 1209 1362 1515 51 - 53 188 358 519 664 791 953 1055 1208 1361 1514 54 - 56 187 357 518 663 790 952 1054 1207 1360 1513 57 - 60 186 356 517 662 789 951 1053 1206 1359 1512 61 - 63 185 355 516 661 788 950 1052 1205 1358 1511 64 - 64 184 354 515 660 787 949 1051 1204 1357 1510 67 - 70 183 353 514 659 786 948 1050 1203 1356 1509 71 - 73 182 352 513 658 785 947 1049 1202 1355 1508 74 - 76 181 351 512 657 784 946 1048 1201 1354 1507 77 - 80 180 350 511 656 783 945 1047 1200 1353 1506 81 - 83 179 349 510 655 782 944 1046 1199 1352 1505 84 - 86 178 348 509 654 781 943 1045 1198 1351 1504 87 - 90 177 347 508 653 780 942 1044 1197 1350 1503 91 - 93 176 346 507 652 779 941 1043 1196 1349 1502 94 - 96 175 345 506 651 778 940 1042 1195 1348 1501 97 - 100 174 344 505 650 777 939 1041 1194 1347 1500

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 101 - 103 173 343 504 649 776 938 1040 1193 1346 1499 104 - 106 172 342 503 648 775 937 1039 1192 1345 1498 107 - 110 171 341 502 647 774 936 1038 1191 1344 1497 111 - 113 170 340 501 646 773 935 1037 1190 1343 1496 114 - 116 169 339 500 645 772 934 1036 1189 1342 1495 117 - 120 168 338 499 644 771 933 1035 1188 1341 1494 121 - 123 167 337 498 643 770 932 1034 1187 1340 1493 124 - 126 166 336 497 642 769 931 1033 1186 1339 1492 127 - 130 165 335 496 641 768 930 1032 1185 1338 1491 131 - 133 164 334 495 640 767 929 1031 1184 1337 1490 134 - 136 163 333 494 639 766 928 1030 1183 1336 1489 137 - 140 162 332 493 638 765 927 1029 1182 1335 1488 141 - 143 161 331 492 637 764 926 1028 1181 1334 1487 144 - 146 160 330 491 636 763 925 1027 1180 1333 1486 147 - 150 159 329 490 635 762 924 1026 1179 1332 1485 151 - 153 158 328 489 634 761 923 1025 1178 1331 1484 154 - 156 157 327 488 633 760 922 1024 1177 1330 1483 157 - 160 156 326 487 632 759 921 1023 1176 1329 1482 161 - 163 155 325 486 631 758 920 1022 1175 1328 1481 164 - 166 154 324 485 630 757 919 1021 1174 1327 1480 167 - 170 153 323 484 629 756 918 1020 1173 1326 1479 171 - 173 152 322 483 628 755 917 1019 1172 1325 1478 174- 176 151 321 482 627 754 916 1018 1171 1324 1477 177 - 180 150 320 481 626 753 915 1017 1170 1323 1476 181 - 183 149 319 480 625 752 914 1016 1169 1322 1475 184 - 186 148 318 479 624 751 913 1015 1168 1321 1474 187 - 190 147 317 478 623 750 912 1014 1167 1320 1473 191 - 193 146 316 477 622 749 911 1013 1166 1319 1472 194 - 196 145 315 476 621 748 910 1012 1165 1318 1471 197 - 200 144 314 475 620 747 909 1011 1164 1317 1470

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 201 - 203 143 313 474 619 746 908 1010 1163 1316 1469 204 - 206 142 312 473 618 745 907 1009 1162 1315 1468 207 - 210 141 311 472 617 744 906 1008 1161 1314 1467 211 - 213 140 310 471 616 743 905 1007 1160 1313 1466 214 - 216 139 309 470 615 742 904 1006 1159 1312 1465 217 - 220 138 308 469 614 741 903 1005 1158 1311 1464 221 - 223 137 307 468 613 740 902 1004 1157 1310 1463 224 - 226 136 306 467 612 739 901 1003 1156 1309 1462 227 - 230 135 305 466 611 738 900 1002 1155 1308 1461 231 - 233 134 304 465 610 737 899 1001 1154 1307 1460 234 - 236 133 303 464 609 736 898 1000 1153 1306 1459 237 - 240 132 302 463 608 735 897 999 1152 1305 1458 241 - 243 131 301 462 607 734 896 998 1151 1304 1457 244 - 246 130 300 461 606 733 895 997 1150 1303 1456 247 - 250 129 299 460 605 732 894 996 1149 1302 1455 251 - 253 128 298 459 604 731 893 995 1148 1301 1454 254 - 256 127 297 458 603 730 892 994 1147 1300 1453 257 - 260 126 296 457 602 729 891 993 1146 1299 1452 261 - 263 125 295 456 601 728 890 992 1145 1298 1451 264 - 266 124 294 455 600 727 889 991 1144 1297 1450 267 - 270 123 293 454 599 726 888 990 1143 1296 1449 271- 273 122 292 453 598 725 887 989 1142 1295 1448 274 - 276 121 291 452 597 724 886 988 1141 1294 1447 277 - 280 120 290 451 596 723 885 987 1140 1293 1446 281 - 283 119 289 450 595 722 884 986 1139 1292 1445 284 - 286 118 288 449 594 721 883 985 1138 1291 1444 287 - 290 117 287 448 593 720 882 984 1137 1290 1443 291 - 293 116 286 447 592 719 881 983 1136 1289 1442 294 - 296 115 285 446 591 718 880 982 1135 1288 1441 297 - 300 114 284 445 590 717 879 981 1134 1287 1440

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 301 - 303 113 283 444 589 716 878 980 1133 1286 1439 304 - 306 112 282 443 588 715 877 979 1132 1285 1438 307 - 310 111 281 442 587 714 876 978 1131 1284 1437 311 - 313 110 280 441 586 713 875 977 1130 1283 1436 314 - 316 109 279 440 585 712 874 976 1129 1282 1435 317 - 320 108 278 439 584 711 873 975 1128 1281 1434 321 - 323 107 277 438 583 710 872 974 1127 1280 1433 324 - 326 106 276 437 582 709 871 973 1126 1279 1432 327 - 330 105 275 436 581 708 870 972 1125 1278 1431 331 - 333 104 274 435 580 707 869 971 1124 1277 1430 334 - 336 103 273 434 579 706 868 970 1123 1276 1429 337 - 340 102 272 433 578 705 867 969 1122 1275 1428 341 - 343 101 271 432 577 704 866 968 1121 1274 1427 344 - 346 100 270 431 576 703 865 967 1120 1273 1426 347 - 350 99 269 430 575 702 864 966 1119 1272 1425 351 - 353 98 268 429 574 701 863 965 1118 1271 1424 354 - 358 97 267 428 573 700 862 964 1117 1270 1423 357 - 360 96 266 427 572 699 861 963 1116 1269 1422 361 - 363 95 265 426 571 698 860 962 1115 1268 1421 364 - 366 94 264 425 570 697 859 961 1114 1267 1420 367 - 370 93 263 424 569 696 858 960 1113 1266 1419 371 - 373 92 262 423 568 695 857 959 1112 1265 1418 374 - 376 91 261 422 567 694 856 958 1111 1264 1417 377 - 380 90 260 421 566 693 855 957 1110 1263 1416 381 - 383 89 259 420 565 692 854 956 1109 1262 1415 384 - 386 88 258 419 564 691 853 955 1108 1261 1414 387 - 390 87 257 418 563 690 852 954 1107 1260 1413 391 - 393 86 256 417 562 689 851 953 1106 1259 1412 394 - 396 85 255 416 561 688 850 952 1105 1258 1411 397 - 400 84 254 415 560 687 849 951 1104 1257 1410

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 401 - 403 83 253 414 559 686 848 950 1103 1256 1409 404 - 406 82 252 413 558 685 847 949 1102 1255 1408 407 - 410 81 251 412 557 684 846 948 1101 1254 1407 411 - 413 80 250 411 556 683 845 947 1100 1253 1406 414 - 416 79 249 410 555 682 844 946 1099 1252 1405 417 - 420 78 248 409 554 681 843 945 1098 1251 1404 421 - 423 77 247 408 553 680 842 944 1097 1250 1403 424 - 426 76 246 407 552 679 841 943 1096 1249 1402 427 - 430 75 245 406 551 678 840 942 1095 1248 1401 431 - 433 74 244 405 550 677 839 941 1094 1247 1400 434 - 436 73 243 404 549 676 838 940 1093 1246 1399 437 - 440 72 242 403 548 675 837 939 1092 1245 1398 441 - 443 71 241 402 547 674 836 938 1091 1244 1397 444 - 446 70 240 401 546 673 835 937 1090 1243 1396 447 - 450 69 239 400 545 672 834 936 1089 1242 1395 451 - 453 68 238 399 544 671 833 935 1088 1241 1394 454 - 456 67 237 398 543 670 832 934 1087 1240 1393 457 - 460 66 236 397 542 669 831 933 1086 1239 1392 461 - 463 65 235 396 541 668 830 932 1085 1238 1391 464 - 466 64 234 395 540 667 829 931 1084 1237 1390 467 - 470 63 233 394 539 666 828 930 1083 1236 1389 471 - 473 62 232 393 538 665 827 929 1082 1235 1388 474 - 476 61 231 392 537 664 826 928 1081 1234 1387 477 - 480 60 230 391 536 663 825 927 1080 1233 1386 481 - 483 59 229 390 535 662 824 926 1079 1232 1385 484 - 486 58 228 389 534 661 823 925 1078 1231 1384 487 - 490 57 227 388 533 660 822 924 1077 1230 1383 491 - 493 56 226 387 532 659 821 923 1076 1229 1382 494 - 496 55 225 386 531 658 820 922 1075 1228 1381 497 - 500 54 224 385 530 657 819 921 1074 1227 1380

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 501 - 503 53 223 384 529 656 818 920 1073 1226 1379 504 - 506 52 222 383 528 655 817 919 1072 1225 1378 507 - 510 51 221 382 527 654 816 918 1071 1224 1377 511 - 513 50 220 381 526 653 815 917 1070 1223 1376 514 - 516 49 219 380 525 652 814 916 1069 1222 1375 517 - 520 48 218 379 524 651 813 915 1068 1221 1374 521 - 523 47 217 378 523 650 812 914 1067 1220 1373 524 - 526 46 216 377 522 649 811 913 1066 1219 1372 527 - 530 45 215 376 521 648 810 912 1065 1218 1371 531 - 533 44 214 375 520 647 809 911 1064 1217 1370 534 - 536 43 213 374 519 646 808 910 1063 1216 1369 537 - 540 42 212 373 518 645 807 909 1062 1215 1368 541 - 543 41 211 372 517 644 806 908 1061 1214 1367 544 - 546 40 210 371 516 643 805 907 1060 1213 1366 547 - 550 39 209 370 515 642 804 906 1059 1212 1365 551 - 553 38 208 369 514 641 803 905 1058 1211 1364 554 - 556 37 207 368 513 640 802 904 1057 1210 1363 557 - 560 36 206 367 512 639 801 903 1056 1209 1362 561 - 563 35 205 366 511 638 800 902 1055 1208 1361 564 - 566 34 204 365 510 637 799 901 1054 1207 1360 567 - 570 33 203 364 509 636 798 900 1053 1206 1359 571 - 573 32 202 363 508 635 797 899 1052 1205 1358 574 - 576 31 201 362 507 634 796 898 1051 1204 1357 577 - 580 30 200 361 506 633 795 897 1050 1203 1356 581 - 583 29 199 360 505 632 794 896 1049 1202 1355 584 - 586 28 198 359 504 631 793 895 1048 1201 1354 587 - 590 27 197 358 503 630 792 894 1047 1200 1353 591 - 593 26 196 357 502 629 791 893 1046 1199 1352 594 - 596 25 195 356 501 628 790 892 1045 1198 1351 597 - 600 24 194 355 500 627 789 891 1044 1197 1350

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 601 - 603 23 193 354 499 626 788 890 1043 1196 1349 604 - 606 22 192 353 498 625 787 889 1042 1195 1348 607 - 610 21 191 352 497 624 786 888 1041 1194 1347 611 - 613 20 190 351 496 623 785 887 1040 1193 1346 614 - 616 19 189 350 495 622 784 886 1039 1192 1345 617 - 620 18 188 349 494 621 783 885 1038 1191 1344 621 - 623 17 187 348 493 620 782 884 1037 1190 1343 624 - 626 16 186 347 492 619 781 883 1036 1189 1342 627 - 630 16 185 346 491 618 780 882 1035 1188 1341 631 - 633 16 184 345 490 617 779 881 1034 1187 1340 634 - 636 16 183 344 489 616 778 880 1033 1186 1339 637 - 640 16 182 343 488 615 777 879 1032 1185 1338 641 - 643 16 181 342 487 614 776 878 1031 1184 1337 644 - 646 16 180 341 486 613 775 877 1030 1183 1336 647 - 650 16 179 340 485 612 774 876 1029 1182 1335 651 - 653 16 178 339 484 611 773 875 1028 1181 1334 624 - 656 16 177 338 483 610 772 874 1027 1180 1333 657 - 660 16 176 337 482 609 771 873 1026 1179 1332 661 - 663 16 175 336 481 608 770 872 1025 1178 1331 664 - 666 16 174 335 480 607 769 871 1024 1177 1330 667 - 670 16 173 334 479 606 768 870 1023 1176 1329 671 - 673 16 172 333 478 605 767 869 1022 1175 1328 674 - 676 16 171 332 477 604 766 868 1021 1174 1327 677 - 680 16 170 331 476 603 765 867 1020 1173 1326 681 - 683 16 169 330 475 602 764 866 1019 1172 1325 684 - 686 16 168 329 474 601 763 865 1018 1171 1324 687 - 690 16 167 328 473 600 762 864 1017 1170 1323 691 - 693 16 166 327 472 599 761 863 1016 1169 1322 694 - 696 16 165 326 471 598 760 862 1015 1168 1321 697 - 700 16 164 325 470 597 759 861 1014 1167 1320

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 701 - 703 16 163 324 469 596 758 860 1013 1166 1319 704 - 706 16 162 323 468 595 757 859 1012 1165 1318 707 - 710 16 161 322 467 594 756 858 1011 1164 1317 711 - 713 16 160 321 466 593 755 857 1010 1163 1316 714 - 716 16 159 320 465 592 754 856 1009 1162 1315 717 - 720 16 158 319 464 591 753 855 1008 1161 1314 721 - 723 16 157 318 463 590 752 854 1007 1160 1313 724 - 726 16 156 317 462 589 751 853 1006 1159 1312 727 - 730 16 155 316 461 588 750 852 1005 1158 1311 731 - 733 16 154 315 460 587 749 851 1004 1157 1310 734 - 736 16 153 314 459 586 748 850 1003 1156 1309 737 - 740 16 152 313 458 585 747 849 1002 1155 1308 741 - 743 16 151 312 457 584 746 848 1001 1154 1307 744 - 746 16 150 311 456 583 745 847 1000 1153 1306 747 - 750 16 149 310 455 582 744 846 999 1152 1305 751 - 753 16 148 309 454 581 743 845 998 1151 1304 754 - 756 16 147 308 453 580 742 844 997 1150 1303 757 - 760 16 146 307 452 579 741 843 996 1149 1302 761 - 763 16 145 306 451 578 740 842 995 1148 1301 764 - 766 16 144 305 450 577 739 841 994 1147 1300 767 - 770 16 143 304 449 576 738 840 993 1146 1299 771 - 773 16 142 303 448 575 737 839 992 1145 1298 774 - 776 16 141 302 447 574 736 838 991 1144 1297 777 - 780 16 140 301 446 573 735 837 990 1143 1296 781 - 783 16 139 300 445 572 734 836 989 1142 1295 784 - 786 16 138 299 444 571 733 835 988 1141 1294 787 - 790 16 137 298 443 570 732 834 987 1140 1293 791 - 793 16 136 297 442 569 731 833 986 1139 1292 794 - 796 16 135 296 441 568 730 832 985 1138 1291 797 - 800 16 134 295 440 567 729 831 984 1137 1290

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 801 - 803 16 133 294 439 566 728 830 983 1136 1289 804 - 806 16 132 293 438 565 727 829 982 1135 1288 807 - 810 16 131 292 437 564 726 828 981 1134 1287 811 - 813 16 130 291 436 563 725 827 980 1133 1286 814 - 816 16 129 290 435 562 724 826 979 1132 1285 817 - 820 16 128 289 434 561 723 825 978 1131 1284 821 - 823 16 127 288 433 560 722 824 977 1130 1283 824 - 826 16 126 287 432 559 721 823 976 1129 1282 827 - 830 16 125 286 431 558 720 822 975 1128 1281 831 - 833 16 124 285 430 557 719 821 974 1127 1280 834 - 836 16 123 284 429 556 718 820 973 1126 1279 837 - 840 16 122 283 428 555 717 819 972 1125 1278 841 - 843 16 121 282 427 554 716 818 971 1124 1277 844 - 846 16 120 281 426 553 715 817 970 1123 1276 847 - 850 16 119 280 425 552 714 816 969 1122 1275 851 - 853 16 118 279 424 551 713 815 968 1121 1274 854 - 856 16 117 278 423 550 712 814 967 1120 1273 857 - 860 16 116 277 422 549 711 813 966 1119 1272 861 - 863 16 115 276 421 548 710 812 965 1118 1271 864 - 866 16 114 275 420 547 709 811 964 1117 1270 867 - 870 16 113 274 419 546 708 810 963 1116 1269 871 - 873 16 112 273 418 545 707 809 962 1115 1268 874 - 876 16 111 272 417 544 706 808 961 1114 1267 877 - 880 16 110 271 416 543 705 807 960 1113 1266 881 - 883 16 109 270 415 542 704 806 959 1112 1265 884 - 886 16 108 269 414 541 703 805 958 1111 1264 887 - 890 16 107 268 413 540 702 804 957 1110 1263 891 - 893 16 106 267 412 539 701 803 956 1109 1262 894 - 896 16 105 266 411 538 700 802 955 1108 1261 897 - 900 16 104 265 410 537 699 801 954 1107 1260

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 901 - 903 16 103 264 409 536 698 800 953 1106 1259 904 - 906 16 102 263 408 535 697 799 952 1105 1258 907 - 910 16 101 262 407 534 696 798 951 1104 1257 911 - 913 16 100 261 406 533 695 797 950 1103 1256 914 - 916 16 99 260 405 532 694 796 949 1102 1255 917 - 920 16 98 259 404 531 693 795 948 1101 1254 921 - 923 16 97 258 403 530 692 794 947 1100 1253 924 - 926 16 96 257 402 529 691 793 946 1099 1252 927 - 930 16 95 256 401 528 690 792 945 1098 1251 931 - 933 16 94 255 400 527 689 791 944 1097 1250 934 - 936 16 93 254 399 526 688 790 943 1096 1249 937 - 940 16 92 253 398 525 687 789 942 1095 1248 941 - 943 16 91 252 397 524 686 788 941 1094 1247 944 - 946 16 90 251 396 523 685 787 940 1093 1246 947 - 950 16 89 250 395 522 684 786 939 1092 1245 951 - 953 16 88 249 394 521 683 785 938 1091 1244 954 - 956 16 87 248 393 520 682 784 937 1090 1243 957 - 960 16 86 247 392 519 681 783 936 1089 1242 961 - 963 16 85 246 391 518 680 782 935 1088 1241 964 - 966 16 84 245 390 517 679 781 934 1087 1240 967 - 970 16 83 244 389 516 678 780 933 1086 1239 971 - 973 16 82 243 388 515 677 779 932 1085 1238 974 - 976 16 81 242 387 514 676 778 931 1084 1237 977 - 980 16 80 241 386 513 675 777 930 1083 1236 981 - 983 16 79 240 385 512 674 776 929 1082 1235 984 - 986 16 78 239 384 511 673 775 928 1081 1234 987 - 990 16 77 238 383 510 672 774 927 1080 1233 991 - 993 16 76 237 382 509 671 773 926 1079 1232 994 - 996 16 75 236 381 508 670 772 925 1078 1231 997 - 1000 16 74 235 380 507 669 771 924 1077 1230

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1001 - 1003 16 73 234 379 506 668 770 923 1076 1229 1004 - 1006 16 72 233 378 505 667 769 922 1075 1228 1007 - 1010 16 71 232 377 504 666 768 921 1074 1227 1011 - 1013 16 70 231 376 503 665 767 920 1073 1226 1014 -1016 16 69 230 375 502 664 766 919 1072 1225 1017 - 1020 16 68 229 374 501 663 765 918 1071 1224 1021 - 1023 16 67 228 373 500 662 764 917 1070 1223 1024 - 1026 16 66 227 372 499 661 763 916 1069 1222 1027 - 1030 16 65 226 371 498 660 762 915 1068 1221 1031 - 1033 16 64 225 370 497 659 761 914 1067 1220 1034 - 1036 16 63 224 369 496 658 760 913 1066 1219 1037 - 1040 16 62 223 368 495 657 759 912 1065 1218 1041 - 1043 16 61 222 367 494 656 758 911 1064 1217 1044 - 1046 16 60 221 366 493 655 757 910 1063 1216 1047 - 1050 16 59 220 365 492 654 756 909 1062 1215 1051 - 1053 16 58 219 364 491 653 755 908 1061 1214 1054 - 1056 16 57 218 363 490 652 754 907 1060 1213 1057 - 1060 16 56 217 362 489 651 753 906 1059 1212 1061 - 1063 16 55 216 361 488 650 752 905 1058 1211 1064 - 1066 16 54 215 360 487 649 751 904 1057 1210 1067 - 1070 16 53 214 359 486 648 750 903 1056 1209 1071 - 1073 16 52 213 358 485 647 749 902 1055 1208 1074 - 1076 16 51 212 357 484 646 748 901 1054 1207 1077 - 1080 16 50 211 356 483 645 747 900 1053 1206 1081 - 1083 16 49 210 355 482 644 746 899 1052 1205 1084 - 1086 16 48 209 354 481 643 745 898 1051 1204 1087 - 1090 16 47 208 353 480 642 744 897 1050 1203 1091 - 1093 16 46 207 352 479 641 743 896 1049 1202 1094 - 1096 16 45 206 351 478 640 742 895 1048 1201 1097 - 1100 16 44 205 350 477 639 741 894 1047 1200

Maximum net income for a one-person non-categorically eligible SNAP unit is $1,064.

Minimum monthly SNAP benefit for an eligible one-person SNAP unit is $16.

If a categorically eligible SNAP unit of one has net income of more than $1,064,

authorize a $16 SNAP benefit.

Bold areas refer to categorically eligible units only

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1101 -1 103 16 43 204 349 476 638 740 893 1046 1199 1104 - 1106 16 42 203 348 475 637 739 892 1045 1198 1107 - 1110 16 41 202 347 474 636 738 891 1044 1197 1111 - 1113 16 40 201 346 473 635 737 890 1043 1196 1114 - 1116 16 39 200 345 472 634 736 889 1042 1195 1117 - 1120 16 38 199 344 471 633 735 888 1041 1194 1121 - 1123 16 37 198 343 470 632 734 887 1040 1193 1124 - 1126 16 36 197 342 469 631 733 886 1039 1192 1127 - 1130 16 35 196 341 468 630 732 885 1038 1191 1131 - 1133 16 34 195 340 467 629 731 884 1037 1190 1134 - 1136 16 33 194 339 466 628 730 883 1036 1189 1137 - 1140 16 32 193 338 465 627 729 882 1035 1188 1141 - 1143 16 31 192 337 464 626 728 881 1034 1187 1144 - 1146 16 30 191 336 463 625 727 880 1033 1186 1147 - 1150 16 29 190 335 462 624 726 879 1032 1185 1151 - 1153 16 28 189 334 461 623 725 878 1031 1184 1154 - 1156 16 27 188 333 460 622 724 877 1030 1183 1157 - 1160 16 26 187 332 459 621 723 876 1029 1182 1161 - 1163 16 25 186 331 458 620 722 875 1028 1181 1164 - 1166 16 24 185 330 457 619 721 874 1027 1180 1167 - 1170 16 23 184 329 456 618 720 873 1026 1179 1171 - 1173 16 22 183 328 455 617 719 872 1025 1178 1174 - 1176 16 21 182 327 454 616 718 871 1024 1177 1177 - 1180 16 20 181 326 453 615 717 870 1023 1176 1181 - 1183 16 19 180 325 452 614 716 869 1022 1175 1184 - 1186 16 18 179 324 451 613 715 868 1021 1174 1187 - 1190 16 17 178 323 450 612 714 867 1020 1173 1191 - 1193 16 16 177 322 449 611 713 866 1019 1172 1194 - 1196 16 16 176 321 448 610 712 865 1018 1171 1197 - 1200 16 16 175 320 447 609 711 864 1017 1170

Bold areas refer to categorically eligible units only

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1201 - 1 203 16 16 174 319 446 608 710 863 1016 1169 1204 - 1206 16 16 173 318 445 607 709 862 1015 1168 1207 - 1210 16 16 172 317 444 606 708 861 1014 1167 1211 - 1213 16 16 171 316 443 605 707 860 1013 1166 1214 - 1216 16 16 170 315 442 604 706 859 1012 1165 1217 - 1220 16 16 169 314 441 603 705 858 1011 1164 1221 -1 223 16 16 168 313 440 602 704 857 1010 1163 1224 - 1226 16 16 167 312 439 601 703 856 1009 1162 1227 - 1230 16 16 166 311 438 600 702 855 1008 1161 1231 - 1233 16 16 165 310 437 599 701 854 1007 1160 1234 - 1236 16 16 164 309 436 598 700 853 1006 1159 1237 - 1240 16 16 163 308 435 597 699 852 1005 1158 1241 - 1243 16 16 162 307 434 596 698 851 1004 1157 1244 - 1246 16 16 161 306 433 595 697 850 1003 1156 1247 - 1250 16 16 160 305 432 594 696 849 1002 1155 1251 - 1253 16 16 159 304 431 593 695 848 1001 1154 1254 - 1256 16 16 158 303 430 592 694 847 1000 1153 1257 - 1260 16 16 157 302 429 591 693 846 999 1152 1261 - 1263 16 16 156 301 428 590 692 845 998 1151 1264 - 1266 16 16 155 300 427 589 691 844 997 1150 1267 - 1270 16 16 154 299 426 588 690 843 996 1149 1271 - 1273 16 16 153 298 425 587 689 842 995 1148 1274 - 1276 16 16 152 297 424 586 688 841 994 1147 1277 - 1280 16 16 151 296 423 585 687 840 993 1146 1281 - 1283 16 16 150 295 422 584 686 839 992 1145 1284 - 1286 16 16 149 294 421 583 685 838 991 1144 1287 - 1290 16 16 148 293 420 582 684 837 990 1143 1291 - 1293 16 16 147 292 419 581 683 836 989 1142 1294 - 1296 16 16 146 291 418 580 682 835 988 1141 1297 - 1300 16 16 145 290 417 579 681 834 987 1140

Bold areas refer to categorically eligible units only

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1301 - 1303 16 16 144 289 416 578 680 833 986 1139 1304 - 1306 16 16 143 288 415 577 679 832 985 1138 1307 - 1310 16 16 142 287 414 576 678 831 984 1137 1311 - 1313 16 16 141 286 413 575 677 830 983 1136 1314 - 1316 16 16 140 285 412 574 676 829 982 1135 1317 - 1320 16 16 139 284 411 573 675 828 981 1134 1321 - 1323 16 16 138 283 410 572 674 827 980 1133 1324 - 1326 16 16 137 282 409 571 673 826 979 1132 1327 - 1330 16 16 136 281 408 570 672 825 978 1131 1331 - 1333 16 16 135 280 407 569 671 824 977 1130 1334 - 1336 16 16 134 279 406 568 670 823 976 1129 1337 - 1340 16 16 133 278 405 567 669 822 975 1128 1341 - 1343 16 16 132 277 404 566 668 821 974 1127 1344 - 1346 16 16 131 276 403 565 667 820 973 1126 1347 - 1350 16 16 130 275 402 564 666 819 972 1125 1351 - 1353 16 16 129 274 401 563 665 818 971 1124 1354 - 1356 16 16 128 273 400 562 664 817 970 1123 1357 - 1360 16 16 127 272 399 561 663 816 969 1122 1361 - 1363 16 16 126 271 398 560 662 815 968 1121 1364 - 1366 16 16 125 270 397 559 661 814 967 1120 1367 - 1370 16 16 124 269 396 558 660 813 966 1119 1371 - 1373 16 16 123 268 395 557 659 812 965 1118 1374 - 1376 16 16 122 267 394 556 658 811 964 1117 1377 - 1380 16 16 121 266 393 555 657 810 963 1116 1381 - 1383 16 16 120 265 392 554 656 809 962 1115 1384 - 1386 16 16 119 264 391 553 655 808 961 1114 1387 - 1390 16 16 118 263 390 552 654 807 960 1113 1391 - 1393 16 16 117 262 389 551 653 806 959 1112 1394 - 1396 16 16 116 261 388 550 652 805 958 1111 1397 - 1400 16 16 115 260 387 549 651 804 957 1110

Bold areas refer to categorically eligible units only

(126585)WAG 25-03-09: Basis of Issuance Table (2) (10-01-2020)#

(126585)(block-1)SNAP Benefit Amount by SNAP Unit Size#

0 - 1400

1401 - 1500

1501 - 1600

1601 - 1700

1701 - 1800

1801 - 1900

1901 - 2000

2001 - 2100

2101 - 2200

2201 - 2300

2301 - 2400

2401 - 2500

2501 - 2600

2601 - 5106

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1401 - 1403 16 16 114 259 386 548 650 803 956 1109 1404 - 1406 16 16 113 258 385 547 649 802 955 1108 1407 - 1410 16 16 112 257 384 546 648 801 954 1107 1411 - 1413 16 16 111 256 383 545 647 800 953 1106 1414 - 1416 16 16 110 255 382 544 646 799 952 1105 1417 - 1420 16 16 109 254 381 543 645 798 951 1104 1421 - 1423 16 16 108 253 380 542 644 797 950 1103 1424 - 1426 16 16 107 252 379 541 643 796 949 1102 1427 - 1430 16 16 106 251 378 540 642 795 948 1101 1431 - 1433 16 16 105 250 377 539 641 794 947 1100 1434 - 1436 16 16 104 249 376 538 640 793 946 1099 1437 - 1440 16 16 103 248 375 537 639 792 945 1098 1441 - 1443 16 16 102 247 374 536 638 791 944 1097 1444 - 1446 16 16 101 246 373 535 637 790 943 1096 1447 - 1450 16 16 100 245 372 534 636 789 942 1095 1451 - 1453 16 16 99 244 371 533 635 788 941 1094 1454 - 1456 16 16 98 243 370 532 634 787 940 1093 1457 - 1460 16 16 97 242 369 531 633 786 939 1092 1461 - 1463 16 16 96 241 368 530 632 785 938 1091 1464 - 1466 16 16 95 240 367 529 631 784 937 1090 1467 - 1470 16 16 94 239 366 528 630 783 936 1089 1471 - 1473 16 16 93 238 365 527 629 782 935 1088 1474 - 1476 16 16 92 237 364 526 628 781 934 1087 1477 - 1480 16 16 91 236 363 525 627 780 933 1086 1481 - 1483 16 16 90 235 362 524 626 779 932 1085 1484 - 1486 16 16 89 234 361 523 625 778 931 1084 1487 - 1490 16 16 88 233 360 522 624 777 930 1083 1491 - 1493 16 16 87 232 359 521 623 776 929 1082 1494 - 1496 16 16 86 231 358 520 622 775 928 1081 1497 - 1500 16 16 85 230 357 519 621 774 927 1080

Maximum net income for a 2-person non-categorically eligible SNAP unit is $1,437.

Minimum monthly SNAP benefit for an eligible 2-person SNAP unit is $16.

If a categorically eligible SNAP unit of two has net income of more than $1,437, authorize a $16 SNAP benefit amount.

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1501 - 1503 16 16 84 229 356 518 620 773 926 1079 1504 - 1506 16 16 83 228 355 517 619 772 925 1078 1507 - 1510 16 16 82 227 354 516 618 771 924 1077 1511 - 1513 16 16 81 226 353 515 617 770 923 1076 1514 - 1516 16 16 80 225 352 514 616 769 922 1075 1517 - 1520 16 16 79 224 351 513 615 768 921 1074 1521 - 1523 16 16 78 223 350 512 614 767 920 1073 1524 - 1526 16 16 77 222 349 511 613 766 919 1072 1527 - 1530 16 16 76 221 348 510 612 765 918 1071 1531 - 1533 16 16 75 220 347 509 611 764 917 1070 1534 - 1536 16 16 74 219 346 508 610 763 916 1069 1537 - 1540 16 16 73 218 345 507 609 762 915 1068 1541 - 1543 16 16 72 217 344 506 608 761 914 1067 1544 - 1546 16 16 71 216 343 505 607 760 913 1066 1547 - 1550 16 16 70 215 342 504 606 759 912 1065 1551 - 1553 16 16 69 214 341 503 605 758 911 1064 1554 - 1556 16 16 68 213 340 502 604 757 910 1063 1557 - 1560 16 16 67 212 339 501 603 756 909 1062 1561 - 1563 16 16 66 211 338 500 602 755 908 1061 1564 - 1566 16 16 65 210 337 499 601 754 907 1060 1567 - 1570 16 16 64 209 336 498 600 753 906 1059 1571 - 1573 16 16 63 208 335 497 599 752 905 1058 1574 - 1576 16 16 62 207 334 496 598 751 904 1057 1577 - 1580 16 16 61 206 333 495 597 750 903 1056 1581 - 1583 16 16 60 205 332 494 596 749 902 1055 1584 - 1586 16 16 59 204 331 493 595 748 901 1054 1587 - 1590 16 16 58 203 330 492 594 747 900 1053 1591 - 1593 16 16 57 202 329 491 593 746 899 1052 1594 - 1596 16 16 56 201 328 490 592 745 898 1051 1597- 1600 16 16 55 200 327 489 591 744 897 1050

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1601 - 1603 16 16 54 199 326 488 590 743 896 1049 1604 - 1606 16 16 53 198 325 487 589 742 895 1048 1607 - 1610 16 16 52 197 324 486 588 741 894 1047 1611 - 1613 16 16 51 196 323 485 587 740 893 1046 1614 - 1616 16 16 50 195 322 484 586 739 892 1045 1617 - 1620 16 16 49 194 321 483 585 738 891 1044 1621 - 1623 16 16 48 193 320 482 584 737 890 1043 1624 - 1626 16 16 47 192 319 481 583 736 889 1042 1627 - 1630 16 16 46 191 318 480 582 735 888 1041 1631 - 1633 16 16 45 190 317 479 581 734 887 1040 1634 - 1636 16 16 44 189 316 478 580 733 886 1039 1637 - 1640 16 16 43 188 315 477 579 732 885 1038 1641 - 1643 16 16 42 187 314 476 578 731 884 1037 1644 - 1646 16 16 41 186 313 475 577 730 883 1036 1647 - 1650 16 16 40 185 312 474 576 729 882 1035 1651 - 1653 16 16 39 184 311 473 575 728 881 1034 1654 - 1656 16 16 38 183 310 472 574 727 880 1033 1657 - 1660 16 16 37 182 309 471 573 726 879 1032 1661 - 1663 16 16 36 181 308 470 572 725 878 1031 1664 - 1666 16 16 35 180 307 469 571 724 877 1030 1667 - 1670 16 16 34 179 306 468 570 723 876 1029 1671 - 1673 16 16 33 178 305 467 569 722 875 1028 1674 - 1676 16 16 32 177 304 466 568 721 874 1027 1677 - 1680 16 16 31 176 303 465 567 720 873 1026 1681 - 1683 16 16 30 175 302 464 566 719 872 1025 1684 - 1686 16 16 29 174 301 463 565 718 871 1024 1687 - 1690 16 16 28 173 300 462 564 717 870 1023 1691 - 1693 16 16 27 172 299 461 563 716 869 1022 1694 - 1696 16 16 26 171 298 460 562 715 868 1021 1697 - 1700 16 16 25 170 297 459 561 714 867 1020

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1701 - 1703 16 16 24 169 296 458 560 713 866 1019 1704 - 1706 16 16 23 168 295 457 559 712 865 1018 1707 - 1710 16 16 22 167 294 456 558 711 864 1017 1711 - 1713 16 16 21 166 293 455 557 710 863 1016 1714 - 1716 16 16 20 165 292 454 556 709 862 1015 1717 - 1720 16 16 19 164 291 453 555 708 861 1014 1721 - 1723 16 16 18 163 290 452 554 707 860 1013 1724 - 1726 16 16 17 162 289 451 553 706 859 1012 1727 - 1730 16 16 16 161 288 450 552 705 858 1011 1731 - 1733 16 16 15 160 287 449 551 704 857 1010 1734 - 1736 16 16 14 159 286 448 550 703 856 1009 1737 - 1740 16 16 13 158 285 447 549 702 855 1008 1741 - 1743 16 16 12 157 284 446 548 701 854 1007 1744 - 1746 16 16 11 156 283 445 547 700 853 1006 1747 - 1750 16 16 10 155 282 444 546 699 852 1005 1751 - 1753 16 16 9 154 281 443 545 698 851 1004 1754 - 1756 16 16 8 153 280 442 544 697 850 1003 1757 - 1760 16 7 152 279 441 543 696 849 1002 1761 - 1763 16 6 151 278 440 542 695 848 1001 1764 - 1766 16 5 150 277 439 541 694 847 1000 1767 - 1770 16 4 149 276 438 540 693 846 999 1771 - 1773 16 3 148 275 437 539 692 845 998 1774 - 1776 16 2 147 274 436 538 691 844 997 1777 - 1780 16 1 146 273 435 537 690 843 996 1781 - 1783 16 145 272 434 536 689 842 995 1784 - 1786 16 144 271 433 535 688 841 994 1787 - 1790 16 143 270 432 534 687 840 993 1791 - 1793 16 142 269 431 533 686 839 992 1794 - 1796 16 141 268 430 532 685 838 991 1797 - 1800 16 140 267 429 531 684 837 990

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1801 - 1803 16 139 266 428 530 683 836 989 1804 - 1806 16 138 265 427 529 682 835 988 1807 - 1810 16 137 264 426 528 681 834 987 1811 - 1813 16 136 263 425 527 680 833 986 1814 - 1816 16 135 262 424 526 679 832 985 1817 - 1820 16 134 261 423 525 678 831 984 1821 - 1823 16 133 260 422 524 677 830 983 1824 -1 826 16 132 259 421 523 676 829 982 1827 - 1830 16 131 258 420 522 675 828 981 1831 - 1833 16 130 257 419 521 674 827 980 1834 - 1836 16 129 256 418 520 673 826 979 1837 - 1840 16 128 255 417 519 672 825 978 1841 - 1843 16 127 254 416 518 671 824 977 1844 - 1846 16 126 253 415 517 670 823 976 1847 - 1850 16 125 252 414 516 669 822 975 1851 - 1853 16 124 251 413 515 668 821 974 1854 - 1856 16 123 250 412 514 667 820 973 1857 - 1860 16 122 249 411 513 666 819 972 1861 - 1863 16 121 248 410 512 665 818 971 1864 - 1866 16 120 247 409 511 664 817 970 1867 - 1870 16 119 246 408 510 663 816 969 1871 - 1873 16 118 245 407 509 662 815 968 1874 - 1876 16 117 244 406 508 661 814 967 1877 - 1880 16 116 243 405 507 660 813 966 1881 - 1883 16 115 242 404 506 659 812 965 1884 - 1886 16 114 241 403 505 658 811 964 1887 - 1890 16 113 240 402 504 657 810 963 1891 - 1893 16 112 239 401 503 656 809 962 1894 - 1896 16 111 238 400 502 655 808 961 1897 - 1900 16 110 237 399 501 654 807 960

Maximum net income for a 3-person noncateg0rically eligible SNAP unit is $1810.

Net income must be at a level where benefits are issued.

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 1901 - 1903 16 109 236 398 500 653 806 959 1904 - 1906 16 108 235 397 499 652 805 958 1907 - 1910 16 107 234 396 498 651 804 957 1911 - 1913 16 106 233 395 497 650 803 956 1914 - 1916 16 105 232 394 496 649 802 955 1917 - 1920 16 104 231 393 495 648 801 954 1921 - 1923 16 103 230 392 494 647 800 953 1924 - 1926 16 102 229 391 493 646 799 952 1927 - 1930 16 101 228 390 492 645 798 951 1931 - 1933 16 100 227 389 491 644 797 950 1934 - 1936 16 99 226 388 490 643 796 949 1937 - 1940 16 98 225 387 489 642 795 948 1941 - 1943 16 97 224 386 488 641 794 947 1944 - 1946 16 96 223 385 487 640 793 946 1947 - 1950 16 95 222 384 486 639 792 945 1951 - 1953 16 94 221 383 485 638 791 944 1954 - 1956 16 93 220 382 484 637 790 943 1957 - 1960 16 92 219 381 483 636 789 942 1961 - 1963 16 91 218 380 482 635 788 941 1964 - 1966 16 90 217 379 481 634 787 940 1967 - 1970 16 89 216 378 480 633 786 939 1971 - 1973 16 88 215 377 479 632 785 938 1974 - 1976 16 87 214 376 478 631 784 937 1977 - 1980 16 86 213 375 477 630 783 936 1981 - 1983 16 85 212 374 476 629 782 935 1984 - 1986 16 84 211 373 475 628 781 934 1987 - 1990 16 83 210 372 474 627 780 933 1991 - 1993 16 82 209 371 473 626 779 932 1994 - 1996 16 81 208 370 472 625 778 931 1997 - 2000 16 80 207 369 471 624 777 930

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2001 - 2003 16 79 206 368 470 623 776 929 2004 - 2006 16 78 205 367 469 622 775 928 2007 - 2010 16 77 204 366 468 621 774 927 2011 - 2013 16 76 203 365 467 620 773 926 2014 - 2016 16 75 202 364 466 619 772 925 2017 - 2020 16 74 201 363 465 618 771 924 2021 - 2023 16 73 200 362 464 617 770 923 2024 - 2026 16 72 199 361 463 616 769 922 2027 - 2030 16 71 198 360 462 615 768 921 2031 - 2033 16 70 197 359 461 614 767 920 2034 - 2036 16 69 196 358 460 613 766 919 2037 - 2040 16 68 195 357 459 612 765 918 2041 - 2043 16 67 194 356 458 611 764 917 2044 - 2046 16 66 193 355 457 610 763 916 2047 - 2050 16 65 192 354 456 609 762 915 2051 - 2053 16 64 191 353 455 608 761 914 2054 - 2056 16 63 190 352 454 607 760 913 2057 - 2060 16 62 189 351 453 606 759 912 2061 - 2063 16 61 188 350 452 605 758 911 2064 - 2066 16 60 187 349 451 604 757 910 2067 - 2070 16 59 186 348 450 603 756 909 2071 - 2075 16 58 185 347 449 602 755 908 2074 - 2076 16 57 184 346 448 601 754 907 2077 - 2080 16 56 183 345 447 600 753 906 2081 - 2083 16 55 182 344 446 599 752 905 2084 - 2086 16 54 181 343 445 598 751 904 2087 - 2090 16 53 180 342 444 597 750 903 2091 - 2093 16 52 179 341 443 596 749 902 2094 - 2096 16 51 178 340 442 595 748 901 2097 - 2100 16 50 177 339 441 594 747 900

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2101 - 2103 16 49 176 338 440 593 746 899 2104 - 2106 16 48 175 337 439 592 745 898 2107 - 2110 16 47 174 336 438 591 744 897 2111 - 2113 16 46 173 335 437 590 743 896 2114 - 2116 16 45 172 334 436 589 742 895 2117 - 2120 16 44 171 333 435 588 741 894 2121 - 2123 16 43 170 332 434 587 740 893 2124 - 2126 16 42 169 331 433 586 739 892 2127 - 2130 16 41 168 330 432 585 738 891 2131 - 2133 16 40 167 329 431 584 737 890 2134 - 2136 16 39 166 328 430 583 736 889 2137 - 2140 16 38 165 327 429 582 735 888 2141- 2143 16 37 164 326 428 581 734 887 2144 - 2146 16 36 163 325 427 580 733 886 2147 - 2150 16 35 162 324 426 579 732 885 2151 - 2153 16 34 161 323 425 578 731 884 2154 - 2156 16 33 160 322 424 577 730 883 2157 - 2160 16 32 159 321 423 576 729 882 2161 - 2163 16 31 158 320 422 575 728 881 2164 - 2166 16 30 157 319 421 574 727 880 2167 - 2170 16 29 156 318 420 573 726 879 2171 - 2173 16 28 155 317 419 572 725 878 2174 - 2176 16 27 154 316 418 571 724 877 2177 - 2180 16 26 153 315 417 570 723 876 2181 - 2183 16 25 152 314 416 569 722 875 2184 - 2186 16 24 151 313 415 568 721 874 2187 - 2190 16 23 150 312 414 567 720 873 2191 - 2193 16 22 149 311 413 566 719 872 2194 - 2196 16 21 148 310 412 565 718 871 2197 - 2200 16 20 147 309 411 564 717 870

Maximum Net Income for a 4-person non-categorically eligible SNAP unit is $2,184.

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2201 - 2203 16 19 146 308 410 563 716 869 2204 - 2206 16 18 145 307 409 562 715 868 2207 - 2210 16 17 144 306 408 561 714 867 2211 - 2213 16 16 143 305 407 560 713 866 2214 - 2216 16 15 142 304 406 559 712 865 2217 - 2220 16 14 141 303 405 558 711 864 2221 - 2223 16 13 140 302 404 557 710 863 2224 - 2226 16 12 139 301 403 556 709 862 2227 - 2230 16 11 138 300 402 555 708 861 2231 - 2233 16 10 137 299 401 554 707 860 2234 - 2236 16 9 136 298 400 553 706 859 2237 - 2240 16 8 135 297 399 552 705 858 2241 - 2243 16 7 134 296 398 551 704 857 2244 - 2246 16 6 133 295 397 550 703 856 2247 - 2250 16 5 132 294 396 549 702 855 2251 - 2253 16 4 131 293 395 548 701 854 2254 - 2256 16 3 130 292 394 547 700 853 2257 - 2260 16 2 129 291 393 546 699 852 2261 - 2263 16 1 128 290 392 545 698 851 2264 - 2266 16 127 289 391 544 697 850 2267 - 2270 16 126 288 390 543 696 849 2271 - 2273 16 125 287 389 542 695 848 2274 - 2276 16 124 286 388 541 694 847 2277 - 2280 16 123 285 387 540 693 846 2281 - 2283 16 122 284 386 539 692 845 2284 - 2286 16 121 283 385 538 691 844 2287 - 2290 16 120 282 384 537 690 843 2291 - 2293 16 119 281 383 536 689 842 2294 - 2296 16 118 280 382 535 688 841 2297 - 2300 16 117 279 381 534 687 840

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2301 - 2303 16 116 278 380 533 686 839 2304 - 2306 16 115 277 379 532 685 838 2307 - 2310 16 114 276 378 531 684 837 2311 - 2313 16 113 275 377 530 683 836 2314 - 2316 16 112 274 376 529 682 835 2317 - 2320 16 111 273 375 528 681 834 2321 - 2323 16 110 272 374 527 680 833 2324 - 2326 16 109 271 373 526 679 832 2327 - 2330 16 108 270 372 525 678 831 2331 - 2333 16 107 269 371 524 677 830 2334 - 2336 16 106 268 370 523 676 829 2337 - 2340 16 105 267 369 522 675 828 2341 - 2343 16 104 266 368 521 674 827 2344 - 2346 16 103 265 367 520 673 826 2347 - 2350 16 102 264 366 519 672 825 2351 - 2353 16 101 263 365 518 671 824 2354 - 2356 16 100 262 364 517 670 823 2357 - 2360 16 99 261 363 516 669 822 2361 - 2363 16 98 260 362 515 668 821 2364 - 2366 16 97 259 361 514 667 820 2367 - 2370 16 96 258 360 513 666 819 2371 - 2373 16 95 257 359 512 665 818 2374 - 2376 94 256 358 511 664 817 2377 - 2380 93 255 357 510 663 816 2381 - 2383 92 254 356 509 662 815 2384 - 2386 91 253 355 508 661 814 2387 - 2390 90 252 354 507 660 813 2391 - 2393 89 251 353 506 659 812 2394 - 2396 88 250 352 505 658 811 2397 - 2400 87 249 351 504 657 810

Bold areas refer to categorically eligible units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2401 - 2403 86 248 350 503 656 809 2404 - 2406 85 247 349 502 655 808 2407 - 2410 84 246 348 501 654 807 2411 - 2413 83 245 347 500 653 806 2414 - 2416 82 244 346 499 652 805 2417 - 2420 81 243 345 498 651 804 2421 - 2423 80 242 344 497 650 803 2424 - 2426 79 241 343 496 649 802 2427 - 2430 78 240 342 495 648 801 2431 - 2433 77 239 341 494 647 800 2434 - 2436 76 238 340 493 646 799 2437 - 2440 75 237 339 492 645 798 2441 - 2443 74 236 338 491 644 797 2444 - 2446 73 235 337 490 643 796 2447 - 2450 72 234 336 489 642 795 2451 - 2453 71 233 335 488 641 794 2454 - 2456 70 232 334 487 640 793 2457 - 2460 69 231 333 486 639 792 2461 - 2463 68 230 332 485 638 791 2464 - 2466 67 229 331 484 637 790 2467 - 2470 66 228 330 483 636 789 2471 - 2473 65 227 329 482 635 788 2474 - 2476 64 226 328 481 634 787 2477 - 2480 63 225 327 480 633 786 2481 - 2483 62 224 326 479 632 785 2484 - 2486 61 223 325 478 631 784 2487 - 2490 60 222 324 477 630 783 2491 - 2493 59 221 323 476 629 782 2494 - 2496 58 220 322 475 628 781 2497 - 2500 57 219 321 474 627 780

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2501 - 2503 56 218 320 473 626 779 2504 - 2506 55 217 319 472 625 778 2507 - 2510 54 216 318 471 624 777 2511 - 2513 53 215 317 470 623 776 2514 - 2516 52 214 316 469 622 775 2517 - 2520 51 213 315 468 621 774 2521 - 2523 50 212 314 467 620 773 2524 - 2526 49 211 313 466 619 772 2527 - 2530 48 210 312 465 618 771 2531 - 2533 47 209 311 464 617 770 2534 - 2536 46 208 310 463 616 769 2537 - 2540 45 207 309 462 615 768 2541 - 2543 44 206 308 461 614 767 2544 - 2546 43 205 307 460 613 766 2547 - 2550 42 204 306 459 612 765 2551 - 2553 41 203 305 458 611 764 2554 - 2556 40 202 304 457 610 763 2557 - 2560 39 201 303 456 609 762 2561 - 2563 38 200 302 455 608 761 2564 - 2566 37 199 301 454 607 760 2567 - 2570 36 198 300 453 606 759 2571 - 2573 35 197 299 452 605 758 2574 - 2576 34 196 298 451 604 757 2577 - 2580 33 195 297 450 603 756 2581 - 2583 32 194 296 449 602 755 2584 - 2586 31 193 295 448 601 754 2587 - 2590 30 192 294 447 600 753 2591 - 2593 29 191 293 446 599 752 2594 - 2596 28 190 292 445 598 751 2597 - 2600 27 189 291 444 597 750

Maximum Net Income for a 5-person non-categorically eligible SNAP unit is $2,557.

Bold areas refer to categorically eligible units only.

(126586)WAG 25-03-09: Basis of Issuance Table (3) (10-01-2020)#

(126586)(block-1)SNAP Benefit Amount by SNAP Unit Size#

0 - 1400

1401 - 2600

2601 - 2700

2701 - 2800

2801 - 2900

2901 - 3000

3001 - 3100

3101 - 3200

3201 - 3300

3301 - 3400

3401 - 3500

3501 - 3600

3601 - 3700

3701 - 3800

3801 - 3900

3901 - 4000

4001 - 4100

4101 - 4200

4201 - 4300

4301 - 4400

4401 - 4500

4501 - 4600

4601 - 4700

4701 - 4800

4801 - 4900

4901 - 5000

5001 - 5106

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2601 - 2603 26 188 290 443 596 749 2604 - 2606 25 187 289 442 595 748 2607 - 2610 24 186 288 441 594 747 2611 - 2613 23 185 287 440 593 746 2614 - 2616 22 184 286 439 592 745 2617 - 2620 21 183 285 438 591 744 2621 - 2623 20 182 284 437 590 743 2624 - 2626 19 181 283 436 589 742 2627 - 2630 18 180 282 435 588 741 2631 - 2633 17 179 281 434 587 740 2634 - 2636 16 178 280 433 586 739 2637 - 2640 15 177 279 432 585 738 2641 - 2643 14 176 278 431 584 737 2644 - 2646 13 175 277 430 583 736 2647 - 2650 12 174 276 429 582 735 2651 - 2653 11 173 275 428 581 734 2654 - 2656 10 172 274 427 580 733 2657 - 2660 9 171 273 426 579 732 2661 - 2663 8 170 272 425 578 731 2664 - 2666 7 169 271 424 577 730 2667 - 2670 6 168 270 423 576 729 2671 - 2673 5 167 269 422 575 728 2674 - 2676 4 166 268 421 574 727 2677 - 2680 3 165 267 420 573 726 2681 - 2683 2 164 266 419 572 725 2684 - 2686 1 163 265 418 571 724 2687 - 2690 162 264 417 570 723 2691 - 2693 161 263 416 569 722 2694 - 2696 160 262 415 568 721 2697 - 2700 159 261 414 567 720

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2701 - 2703 158 260 413 566 719 2704 - 2706 157 259 412 565 718 2707 - 2710 156 258 411 564 717 2711 - 2713 155 257 410 563 716 2714 - 2716 154 256 409 562 715 2717 - 2720 153 255 408 561 714 2721 - 2723 152 254 407 560 713 2724 - 2726 151 253 406 559 712 2727 - 2730 150 252 405 558 711 2731 - 2733 149 251 404 557 710 2734 - 2736 148 250 403 556 709 2737 - 2740 147 249 402 555 708 2741 - 2743 146 248 401 554 707 2744 - 2746 145 247 400 553 706 2747 - 2750 144 246 399 552 705 2751 - 2753 143 245 398 551 704 2754 - 2756 142 244 397 550 703 2757 - 2760 141 243 396 549 702 2761 - 2763 140 242 395 548 701 2764 - 2766 139 241 394 547 700 2767 - 2770 138 240 393 546 699 2771 - 2773 137 239 392 545 698 2774 - 2776 136 238 391 544 697 2777 - 2780 135 237 390 543 696 2781 - 2783 134 236 389 542 695 2784 - 2786 133 235 388 541 694 2787 - 2790 132 234 387 540 693 2791 - 2793 131 233 386 539 692 2794 - 2796 130 232 385 538 691 2797 - 2800 129 231 384 537 690

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2801 - 2803 128 230 383 536 689 2804 - 2806 127 229 382 535 688 2807 - 2810 126 228 381 534 687 2811 - 2813 125 227 380 533 686 2814 - 2816 124 226 379 532 685 2817 - 2820 123 225 378 531 684 2821 - 2823 122 224 377 530 683 2824 - 2826 121 223 376 529 682 2827 - 2830 120 222 375 528 681 2831 - 2833 119 221 374 527 680 2834 - 2836 118 220 373 526 679 2837 - 2840 117 219 372 525 678 2841 - 2843 116 218 371 524 677 2844 - 2846 115 217 370 523 676 2847 - 2850 114 216 369 522 675 2851 - 2853 113 215 368 521 674 2854 - 2856 112 214 367 520 673 2857 - 2860 111 213 366 519 672 2861 - 2863 110 212 365 518 671 2864 - 2866 109 211 364 517 670 2867 - 2870 108 210 363 516 669 2871 - 2873 107 209 362 515 668 2874 - 2876 106 208 361 514 667 2877 - 2880 105 207 360 513 666 2881 - 2883 104 206 359 512 665 2884 - 2886 103 205 358 511 664 2887 - 2890 102 204 357 510 663 2891 - 2893 101 203 356 509 662 2894 - 2896 100 202 355 508 661 2897 - 2900 99 201 354 507 660

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 2901 - 2903 98 200 353 506 659 2904 - 2906 97 199 352 505 658 2907 - 2910 96 198 351 504 657 2911 - 2913 95 197 350 503 656 2914 - 2916 94 196 349 502 655 2917 - 2920 93 195 348 501 654 2921 - 2923 92 194 347 500 653 2924 - 2926 91 193 346 499 652 2927 - 2930 90 192 345 498 651 2931 - 2933 89 191 344 497 650 2934 - 2936 88 190 343 496 649 2937 - 2940 87 189 342 495 648 2941 - 2943 86 188 341 494 647 2944 - 2946 85 187 340 493 646 2947 - 2950 84 186 339 492 645 2951 - 2953 83 185 338 491 644 2954 - 2956 82 184 337 490 643 2957 - 2960 81 183 336 489 642 2961 - 2963 80 182 335 488 641 2964 - 2966 79 181 334 487 640 2967 - 2970 78 180 333 486 639 2971 - 2973 77 179 332 485 638 2974 - 2976 76 178 331 484 637 2977 - 2980 75 177 330 483 636 2981 - 2983 74 176 329 482 635 2984 - 2986 73 175 328 481 634 2987 - 2890 72 174 327 480 633 2991 - 2993 71 173 326 479 632 2994 - 2996 70 172 325 478 631 2997 - 3000 69 171 324 477 630

Maximum Net Income for a 6-person non-categorically eligible SNAP unit is $2,930.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3001 - 3003 68 170 323 476 629 3004 - 3006 67 169 322 475 628 3007 - 3010 66 168 321 474 627 3011 - 3013 65 167 320 473 626 3014 - 3016 64 166 319 472 625 3017 - 3020 63 165 318 471 624 3021 - 3023 62 164 317 470 623 3024 - 3026 61 163 316 469 622 3027 - 3030 60 162 315 468 621 3031 - 3033 59 161 314 467 620 3034 - 3036 58 160 313 466 619 3037 - 3040 57 159 312 465 618 3041 - 3043 56 158 311 464 617 3044 - 3046 55 157 310 463 616 3047 - 3050 54 156 309 462 615 3051 - 3053 53 155 308 461 614 3054 - 3056 52 154 307 460 613 3057 - 3060 51 153 306 459 612 3061 - 3063 50 152 305 458 611 3064 - 3066 49 151 304 457 610 3067 - 3070 48 150 303 456 609 3071 - 3073 47 149 302 455 608 3074 - 3076 46 148 301 454 607 3077 - 3080 45 147 300 453 606 3081 - 3083 44 146 299 452 605 3084 - 3086 43 145 298 451 604 3087 - 3090 42 144 297 450 603 3091 - 3093 41 143 296 449 602 3094 - 3096 40 142 295 448 601 3097 - 3100 39 141 294 447 600

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3101 - 3103 38 140 293 446 599 3104 - 3106 37 139 292 445 598 3107 - 3110 36 138 291 444 597 3111 - 3113 35 137 290 443 596 3114 - 3116 34 136 289 442 595 3117 - 3120 33 135 288 441 594 3121 - 3123 32 134 287 440 593 3124 - 3126 31 133 286 439 592 3127 - 3130 30 132 285 438 591 3131 - 3133 29 131 284 437 590 3134 - 3136 28 130 283 436 589 3137 - 3140 27 129 282 435 588 3141 - 3143 26 128 281 434 587 3144 - 3146 25 127 280 433 586 3147 - 3150 24 126 279 432 585 3151 - 3153 23 125 278 431 584 3154 - 3156 22 124 277 430 583 3157 - 3160 21 123 276 429 582 3161 - 3163 20 122 275 428 581 3164 - 3166 19 121 274 427 580 3167 - 3170 18 120 273 426 579 3171 - 3173 17 119 272 425 578 3174 - 3176 16 118 271 424 577 3177 - 3180 15 117 270 423 576 3181 - 3183 14 116 269 422 575 3184 - 3186 13 115 268 421 574 3187 - 3190 12 114 267 420 573 3191 - 3193 11 113 266 419 572 3194 - 3196 10 112 265 418 571 3197 - 3200 9 111 264 417 570

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3201 - 3203 8 110 263 416 569 3204 - 3206 7 109 262 415 568 3207 - 3210 6 108 261 414 567 3211 - 3213 5 107 260 413 566 3214 - 3216 4 106 259 412 565 3217 - 3220 3 105 258 411 564 3221 - 3223 2 104 257 410 563 3224 - 3226 1 103 256 409 562 3227 - 3230 102 255 408 561 3231 - 3233 101 254 407 560 3234 - 3236 100 253 406 559 3237 - 3240 99 252 405 558 3241 - 3243 98 251 404 557 3244 - 3246 97 250 403 556 3247 - 3250 96 249 402 555 3251 - 3253 95 248 401 554 3254 - 3256 94 247 400 553 3257 - 3260 93 246 399 552 3261 - 3263 92 245 398 551 3264 - 3266 91 244 397 550 3267 - 3270 90 243 396 549 3271 - 3273 89 242 395 548 3274 - 3276 88 241 394 547 3277 - 3280 87 240 393 546 3281 - 3283 86 239 392 545 3284 - 3286 85 238 391 544 3287 - 3290 84 237 390 543 3291 - 3293 83 236 389 542 3294 - 3296 82 235 388 541 3297 - 3000 81 234 387 540

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3301 - 3303 80 233 386 539 3304 - 3306 79 232 385 538 3307 - 3310 78 231 384 537 3311 - 3313 77 230 383 536 3314 - 3316 76 229 382 535 3317 - 3320 75 228 381 534 3321 - 3323 74 227 380 533 3324 - 3326 73 226 379 532 3327 - 3330 72 225 378 531 3331 - 3333 71 224 377 530 3334 - 3336 70 223 376 529 3337 - 3340 69 222 375 528 3341 - 3343 68 221 374 527 3344 - 3346 67 220 373 526 3347 - 3350 66 219 372 525 3351 - 3353 65 218 371 524 3354 - 3356 64 217 370 523 3357 - 3360 63 216 369 522 3361 - 3363 62 215 368 521 3364 - 3366 61 214 367 520 3367 - 3370 60 213 366 519 3371 - 3373 59 212 365 518 3374 - 3376 58 211 364 517 3377 - 3380 57 210 363 516 3381 - 3383 56 209 362 515 3384 - 3386 55 208 361 514 3387 - 3390 54 207 360 513 3391 - 3393 53 206 359 512 3394 - 3396 52 205 358 511 3397 - 3400 51 204 357 510

Maximum Net Income for a 7-person non-categorically eligible SNAP unit is $3,304.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3401 - 3403 50 203 356 509 3404 - 3406 49 202 355 508 3407 - 3410 48 201 354 507 3411 - 3413 47 200 353 506 3414 - 3416 46 199 352 505 3417 - 3420 45 198 351 504 3421 - 3423 44 197 350 503 3424 - 3426 43 196 349 502 3427 - 3430 42 195 348 501 3431 - 3433 41 194 347 500 3434 - 3436 40 193 346 499 3437 - 3440 39 192 345 498 3441 - 3443 38 191 344 497 3444 - 3446 37 190 343 496 3447 - 3450 36 189 342 495 3451 - 3453 35 188 341 494 3454 - 3456 34 187 340 493 3457 - 3460 33 186 339 492 3461 - 3463 32 185 338 491 3464 - 3466 31 184 337 490 3467 - 3470 30 183 336 489 3471 - 3473 29 182 335 488 3474 - 3476 28 181 334 487 3477 - 3480 27 180 333 486 3481 - 3483 26 179 332 485 3484 - 3486 25 178 331 484 3487 - 3490 24 177 330 483 3491 - 3493 23 176 329 482 3494 - 3496 22 175 328 481 3497 - 3500 21 174 327 480

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3501 - 3503 20 173 326 479 3504 - 3506 19 172 325 478 3507 - 3510 18 171 324 477 3511 - 3513 17 170 323 476 3514 - 3516 16 169 322 475 3517 - 3520 15 168 321 474 3521 - 3523 14 167 320 473 3524 - 3526 13 166 319 472 3527 - 3530 12 165 318 471 3531 - 3533 11 164 317 470 3534 - 3536 10 163 316 469 3537 - 3540 9 162 315 468 3541 - 3543 8 161 314 467 3544 - 3546 7 160 313 466 3547 - 3550 6 159 312 465 3551 - 3553 5 158 311 464 3554 - 3556 4 157 310 463 3557 - 3560 3 156 309 462 3561 - 3563 2 155 308 461 3564 - 3566 1 154 307 460 3567 - 3570 153 306 459 3571 - 3573 152 305 458 3574 - 3576 151 304 457 3577 - 3580 150 303 456 3581 - 3583 149 302 455 3584 - 3586 148 301 454 3587 - 3590 147 300 453 3591 - 3593 146 299 452 3594 - 3596 145 298 451 3597 - 3600 144 297 450

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3601 - 3603 143 296 449 3604 - 3606 142 295 448 3607 - 3610 141 294 447 3611 - 3613 140 293 446 3614 - 3616 139 292 445 3617 - 3620 138 291 444 3621 - 3623 137 290 443 3624 - 3626 136 289 442 3627 - 3630 135 288 441 3631 - 3633 134 287 440 3634 - 3636 133 286 439 3637 - 3640 132 285 438 3641 - 3643 131 284 437 3644 - 3646 130 283 436 3647 - 3650 129 282 435 3651 - 3653 128 281 434 3654 - 3656 127 280 433 3657 - 3660 126 279 432 3661 - 3663 125 278 431 3664 - 3666 124 277 430 3667 - 3670 123 276 429 3671 - 3673 122 275 428 3674 - 3676 121 274 427 3677 - 3680 120 273 426 3681 - 3683 119 272 425 3684 - 3686 118 271 424 3687 - 3690 117 270 423 3691 - 3693 116 269 422 3694 - 3696 115 268 421 3697 - 3700 114 267 420

Maximum Net Income for 8-person non-categorically eligible SNAP unit is $3,677.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3701 - 3703 113 266 419 3704 - 3706 112 265 418 3707 - 3710 111 264 417 3711 - 3713 110 263 416 3714 - 3716 109 262 415 3717 - 3720 108 261 414 3721 - 3723 107 260 413 3724 - 3726 106 259 412 3727 - 3730 105 258 411 3731 - 3733 104 257 410 3734 - 3736 103 256 409 3737 - 3740 102 255 408 3741 - 3743 101 254 407 3744 - 3746 100 253 406 3747 - 3750 99 252 405 3751 - 3753 98 251 404 3754 - 3756 97 250 403 3757 - 3760 96 249 402 3761 - 3763 95 248 401 3764 - 3766 94 247 400 3767 - 3770 93 246 399 3771 - 3773 92 245 398 3774 - 3776 91 244 397 3777 - 3780 90 243 396 3781 - 3783 89 242 395 3784 - 3786 88 241 394 3787 - 3790 87 240 393 3791 - 3793 86 239 392 3794 - 3796 85 238 391 3797 - 3800 84 237 390

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3801 - 3803 83 236 389 3804 - 3806 82 235 388 3807 - 3810 81 234 387 3811 - 3813 80 233 386 3814 - 3816 79 232 385 3817 - 3820 78 231 384 3821 - 3823 77 230 383 3824 - 3826 76 229 382 3827 - 3830 75 228 381 3831 - 3833 74 227 380 3834 - 3836 73 226 379 3837 - 3840 72 225 378 3841 - 3843 71 224 377 3844 - 3846 70 223 376 3847 - 3850 69 222 375 3851 - 3853 68 221 374 3854 - 3856 67 220 373 3857 - 3860 66 219 372 3861 - 3863 65 218 371 3864 - 3866 64 217 370 3867 - 3870 63 216 369 3871 - 3873 62 215 368 3874 - 3876 61 214 367 3877 - 3880 60 213 366 3881 - 3883 59 212 365 3884 - 3886 58 211 364 3887 - 3890 57 210 363 3891 - 3893 56 209 362 3894 - 3896 55 208 361 3897 - 3900 54 207 360

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 3901 - 3903 53 206 359 3904 - 3906 52 205 358 3907 - 3910 51 204 357 3911 - 3913 50 203 356 3914 - 3916 49 202 355 3917 - 3920 48 201 354 3921 - 3923 47 200 353 3924 - 3926 46 199 352 3927 - 3930 45 198 351 3931 - 3933 44 197 350 3934 - 3936 43 196 349 3937 - 3940 42 195 348 3941 - 3943 41 194 347 3944 - 3946 40 193 346 3947 - 3950 39 192 345 3951 - 3953 38 191 344 3954 - 3956 37 190 343 3957 - 3960 36 189 342 3961 - 3963 35 188 341 3964 - 3966 34 187 340 3967 - 3970 33 186 339 3971 - 3973 32 185 338 3974 - 3976 31 184 337 3977 - 3980 30 183 336 3981 - 3983 29 182 335 3984 - 3986 28 181 334 3987 - 3990 27 180 333 3991 - 3993 26 179 332 3994 - 3996 25 178 331 3997 - 4000 24 177 330

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4001 - 4003 23 176 329 4004 - 4006 22 175 328 4007 - 4010 21 174 327 4011 - 4013 20 173 326 4014 - 4016 19 172 325 4017 - 4020 18 171 324 4021 - 4023 17 170 323 4024 -4 026 16 169 322 4027 - 4030 15 168 321 4031 - 4033 14 167 320 4034 - 4036 13 166 319 4037 - 4040 12 165 318 4041 - 4043 11 164 317 4044 - 4046 10 163 316 4047 - 4050 9 162 315 4051 - 4053 8 161 314 4054 - 4056 7 160 313 4057 - 4060 6 159 312 4061 - 4063 5 158 311 4064 - 4066 4 157 310 4067 - 4070 3 156 309 4071 - 4073 2 155 308 4074 - 4076 1 154 307 4077 - 4080 153 306 4081 - 4083 152 305 4084 - 4086 151 304 4087 - 4090 150 303 4091 - 4093 149 302 4094 - 4096 148 301 4097 - 4100 147 300

Maximum Net Income for a 9-person non-categorically eligible SNAP unit is $4,051.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4101 - 4103 146 299 4104 - 4106 145 298 4107 - 4110 144 297 4111 - 4113 143 296 4114 - 4116 142 295 4117 - 4120 141 294 4121 - 4123 140 293 4124 - 4126 139 292 4127 - 4130 138 291 4131 - 4133 137 290 4134 - 4136 136 289 4137 - 4140 135 288 4141 - 4143 134 287 4144 - 4146 133 286 4147 - 4150 132 285 4151 - 4153 131 284 4154 - 4153 130 283 4157 - 4160 129 282 4161 - 4163 128 281 4164 - 4166 127 280 4167 - 4170 126 279 4171 - 4173 125 278 4174 - 4176 124 277 4177 - 4180 123 276 4181 - 4183 122 275 4184 - 4186 121 274 4187 - 4190 120 273 4191 - 4193 119 272 4194 - 4196 118 271 4197 - 4200 117 270

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4201 - 4203 116 269 4204 - 4206 115 268 4207 - 4210 114 267 4211 - 4213 113 266 4214 - 4216 112 265 4217 - 4220 111 264 4221 - 4223 110 263 4224 - 4226 109 262 4227 - 4230 108 261 4231 - 4233 107 260 4234 - 4236 106 259 4237 - 4240 105 258 4241 - 4243 104 257 4244 - 4246 103 256 4247 - 4250 102 255 4251 - 4253 101 254 4254 - 4256 100 253 4257 - 4260 99 252 4261 - 4263 98 251 4264 - 4266 97 250 4267 - 4270 96 249 4271 - 4273 95 248 4274 - 4276 94 247 4277 - 4280 93 246 4281 - 4283 92 245 4284 - 4286 91 244 4287 - 4290 90 243 4291 - 4293 89 242 4294 - 4296 88 241 4297 - 4300 87 240

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4301 - 4303 86 239 4304 - 4306 85 238 4307 - 4310 84 237 4311 - 4313 83 236 4314 - 4316 82 235 4317 - 4320 81 234 4321 - 4323 80 233 4324 - 4326 79 232 4327 - 4330 78 231 4331 - 4333 77 230 4334 - 4336 76 229 4337 - 4340 75 228 4341 - 4343 74 227 4344 - 4346 73 226 4347 - 4350 72 225 4351 - 4353 71 224 4354 - 4356 70 223 4357 - 4360 69 222 4361 - 4363 68 221 4364 - 4366 67 220 4367 - 4370 66 219 4371 - 4373 65 218 4374 - 4376 64 217 4377 - 4380 63 216 4381 - 4383 62 215 4384 - 4386 61 214 4387 - 4390 60 213 4391 - 4393 59 212 4394 - 4396 58 211 4397 - 4400 57 210

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4401 - 4403 56 209 4404 - 4406 55 208 4407 - 4410 54 207 4411 - 4413 53 206 4414 - 4416 52 205 4417 - 4420 51 204 4421 - 4423 50 203 4424 - 4426 49 202 4427 - 4430 48 201 4431 - 4433 47 200 4434 - 4436 46 199 4437 - 4440 45 198 4441 - 4443 44 197 4444 - 4446 43 196 4447 - 4450 42 195 4451 - 4453 41 194 4454 - 4456 40 193 4457 - 4460 39 192 4461 - 4463 38 191 4464 - 4466 37 190 4467 - 4470 36 189 4471 - 4473 35 188 4474 - 4476 34 187 4477 - 4480 33 186 4481 - 4483 32 185 4484 - 4486 31 184 4487 - 4490 30 183 4491 - 4493 29 182 4494 - 4496 28 181 4497 - 4500 27 180

Maximum Net Income for a 10-person non-categorically eligible SNAP unit is $4,425.

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4501 - 4503 26 179 4504 - 4506 25 178 4507 - 4510 24 177 4511 - 4513 23 176 4514 - 4516 22 175 4517 - 4520 21 174 4521 - 4523 20 173 4524 - 4526 19 172 4527 - 4530 18 171 4531 - 4533 17 170 4534 - 4536 16 169 4537 - 4540 15 168 4541 - 4543 14 167 4544 - 4546 13 166 4547 - 4550 12 165 4551 - 4553 11 164 4554 - 4556 10 163 4557 - 4560 9 162 4561 - 4563 8 161 4564 - 4566 7 160 4567 - 4570 6 159 4571 - 4573 5 158 4574 - 4576 4 157 4577 - 4580 3 156 4581 - 4581 2 155 4584 - 4586 1 154 4587 - 4590 153 4591 - 4593 152 4594 - 4596 151 4597 - 4600 150

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4601 - 4603 149 4604 - 4606 148 4607 - 4610 147 4611 - 4613 146 4614 - 4616 145 4617 - 4620 144 4621 - 4623 143 4624 - 4626 142 4627 - 4630 141 4631 - 4633 140 4634 - 4336 139 4637 - 4640 138 4641 - 4643 137 4644 - 4646 136 4647 - 4650 135 4651 - 4653 134 4654 - 4656 133 4657 - 4660 132 4661 - 4663 131 4664 - 4666 130 4667 - 4670 129 4671 - 4673 128 4674 - 4676 127 4677 - 4680 126 4681 - 4683 125 4684 - 4686 124 4687 - 4690 123 4691 - 4693 122 4694 - 4696 121 4697 - 4700 120

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4701 - 4703 119 4704 - 4706 118 4707 - 4710 117 4711 - 4713 116 4714 - 4716 115 4717 - 4720 114 4721 - 4723 113 4724 - 4726 112 4727 - 4730 111 4731 - 4733 110 4734 - 4736 109 4737 - 4740 108 4741 - 4743 107 4744 - 4746 106 4747 - 4750 105 4751 - 4753 104 4754 - 4756 103 4757 - 4760 102 4761 - 4763 101 4764 - 4766 100 4767 - 4770 99 4771 - 4773 98 4774 - 4776 97 4777 - 4780 96 4781 - 4783 95 4784 - 4786 94 4787 - 4790 93 4791 - 4793 92 4794 - 4796 91 4797 - 4800 90

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4801 - 4803 89 4804 - 4806 88 4807 - 4810 87 4811 - 4813 86 4814 - 4816 85 4817 - 4820 84 4821 - 4823 83 4824 - 4826 82 4827 - 4830 81 4831 - 4833 80 4834 - 4836 79 4837 - 4840 78 4841 - 4843 77 4844 - 4846 76 4847 - 4850 75 4851 - 4853 74 4854 - 4856 73 4857 - 4860 72 4861 - 4863 71 4864 - 4866 70 4867 - 4870 69 4871 - 4873 68 4874 - 4876 67 4877 - 4880 66 4881 - 4883 65 4884 - 4886 64 4887 - 4890 63 4891 - 4893 62 4894 - 4896 61 4897 - 4900 60

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 4901 - 4903 59 4904 - 4906 58 4907 - 4910 57 4911 - 4913 56 4914 - 4916 55 4917 - 4920 54 4921 - 4923 53 4924 - 4926 52 4927 - 4930 51 4931 - 4933 50 4934 - 4936 49 4937 - 4940 48 4941 - 4943 47 4944 - 4946 46 4947 - 4950 45 4951 - 4953 44 4954 - 4956 43 4957 - 4960 42 4961 - 4963 41 4964 - 4966 40 4967 - 4970 39 4971 - 4973 38 4974 - 4976 37 4977 - 4980 36 4981 - 4983 35 4984 - 4986 34 4987 - 4990 33 4991 - 4993 32 4994 - 4996 31 4997 - 5000 30

Bold areas refer to categorically eligible SNAP units only.

Number of Persons Monthly Net Income 1 2 3 4 5 6 7 8 9 10 5001 - 5003 29 5004 - 5006 28 5007 - 5010 27 5011 - 5013 26 5014 - 5016 25 5017 - 5020 24 5021 - 5023 23 5024 - 5026 22 5027 - 5030 21 5031 - 5033 20 5034 -5 036 19 5037 - 5040 18 5041 - 5043 17 5044 - 5046 16 5047 - 5050 15 5051 - 5053 14 5054 - 5056 13 5057 - 5060 12 5061 - 5063 11 5064 - 5066 10 5067 - 5070 9 5071 - 5073 8 5074 - 5076 7 5077 - 5080 6 5081 - 5083 5 5084 - 5086 4 5087 - 5090 3 5091 - 5093 2 5094 - 5096 1 5097 - 5100 5101 - 5103 5104 - 5106

Bold areas refer to categorically eligible SNAP units only.

(12254)Introduction#

(12254)(block-1)Introduction#

(12254)Introduction#

(12254)(block-1)Introduction#

(12255)PM I-01-00: Overview#

(12256)PM I-01-01: Manual Organization#

(12256)(block-1)PM I-01-01: Manual Organization#

(12259)PM I-01-02: Programs#

(12259)(block-1)PM I-01-02: Programs#

(12259)(block-2)Choosing a Program and Services#

(12259)(block-3)Interviews#

(12259)(block-4)Receiving Benefits on Different Cases#

(12260)PM I-02-00: Cash Programs#

(12260)(block-1)PM I-02-00: Cash Programs#

(12261)PM I-02-01: Temporary Assistance for Needy Families (TANF)#

(12261)(block-1)PM I-02-01: Temporary Assistance for Needy Families (TANF)#

(12262)PM I-02-02: Aid to the Aged, Blind, or Disabled (AABD)#

(12262)(block-1)PM I-02-02: Aid to the Aged, Blind, or Disabled (AABD)#

(12263)PM I-02-03: Refugee and Repatriate Assistance (RRA)#

(12263)(block-1)PM I-02-03: Refugee and Repatriate Assistance (RRA)#

(12264)PM I-02-03-a: Refugee Resettlement Program (RRP)#

(12264)(block-1)PM I-02-03-a: Refugee Resettlement Program (RRP)#

(12265)PM I-02-03-b: Repatriate Program#

(12265)(block-1)PM I-02-03-b: Repatriate Program#

(12277)PM I-03-00: Medical Programs#

(12277)(block-1)PM I-03-00: Medical Programs#

(12277)(block-2)Medical Programs#

(12277)(block-3)Family Health Plans#

(12277)(block-4)ACA Adults#

(12277)(block-5)AABD Medical#

(12277)(block-6)DCFS Related#

(12277)(block-7)Former Foster Care#

(12277)(block-8)Health Benefits for Persons with Breast or Cervical Cancer (BCC)#

(12277)(block-9)Health Benefits for Workers with Disabilities (HBWD)#

(12277)(block-10)Medical Benefits for Asylum Applicants and Torture Victims (AATV)#

(12277)(block-11)Medical Benefits for Noncitizen Victims of Trafficking, Torture or Other Serious Crimes (VTTC)#

(12277)(block-12)Health Benefits for Immigrant Adults (HBIA)#

(12277)(block-13)Health Benefits for Immigrant Seniors (HBIS)#

(12277)(block-14)Medicare Savings Program#

(12277)(block-15)Incarcerated Individuals#

(12277)(block-16)Veterans Care (VC)#

(12282)PM I-03-01: Spenddown#

(12282)(block-1)PM I-03-01: Spenddown#

(12285)PM I-03-02: Pregnant Women Programs (Moms & Babies, MPE)#

(12285)(block-1)PM I-03-02: Pregnant Women Programs (Moms & Babies, MPE)#

(12286)PM I-03-03: Adult Programs (AABD)#

(12286)(block-1)PM I-03-03: Adult Programs (AABD)#

(12287)PM I-03-04: Emergency Medical for Noncitizens#

(12287)(block-1)PM I-03-04: Emergency Medical for Noncitizens#

(12288)PM I-03-05: Programs for Children#

(12288)(block-1)PM I-03-05: Programs for Children#

(12288)(block-2)Presumptive Eligibility Coverage#

(12289)PM I-04-00: Special Medicare Payment Programs#

(12289)(block-1)PM I-04-00: Special Medicare Payment Programs#

(12290)PM I-05-00: Food Programs#

(12291)PM I-05-01: Supplemental Nutrition Assistance Program (SNAP)#

(12291)(block-1)PM I-05-01: Supplemental Nutrition Assistance Program (SNAP)#

(12292)PM I-05-02: Summer EBT#

(12292)(block-1)PM I-05-02: Summer EBT#

(12294)PM I-06-00: Earnfare#

(12294)(block-1)Earnfare#

(12299)PM 01: Rights and Responsibilities#

(12299)(block-1)PM 01: Rights and Responsibilities#

(12300)WAG 01: Rights and Responsibilities#

(12300)(block-1)WAG 01: Rights and Responsibilities#

(12301)PM 01-01-00: Information for Clients and the Public#

(12301)(block-1)PM 01-01-00: Information for Clients and the Public#

(12302)WAG 01-01-00: Information for Clients and the Public#

(12302)(block-1)WAG 01-01-00: Information for Clients and the Public#

(12305)PM 01-01-01: Nondiscrimination#

(12305)(block-1)PM 01-01-01: Nondiscrimination#

(12305)(block-2)Investigation#

(12305)(block-3)Appeal of Findings#

(12307)PM 01-01-02: Information and Referrals#

(12307)(block-1)PM 01-01-02: Information and Referrals#

(12310)PM 01-01-03: Freedom of Choice#

(12310)(block-1)PM 01-01-03: Freedom of Choice#

(12310)(block-2)Freedom of Choice#

(12310)(block-3)Cash Programs#

(12310)(block-4)Differences in All Kids and AABD Medical Programs#