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reduce benefits, even if Family Community Resource Center action was affirmed by the appeal decision or the appeal was withdrawn, if the client is currently eligible for benefits (or increased benefits) due to changes that occurred while the appeal was pending.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 ).