SUBJECT:
NEW WORKER INITIATED REASON CODES FOR THE FOOD STAMP PROGRAM
DISCUSSION:
Effective July 18, 2005, the following reason codes for worker initiated rejection (WIRJ) and adverse action worker initiated closing (AAWC) actions are added to FAMIS for the Food Stamp Program:
- MGT – failure to explain management; and
- LPI – individual living in a public institution.
FAILURE TO EXPLAIN MANAGEMENT (MGT)
Prior to certification and when new information is reported on an active EU, verify any questionable information and information that affects the EU's eligibility and benefit level. Questionable information is information that is provided by the EU that is inconsistent with other available information. The exploration of management gives a clear picture of what is going on in the EU and leads to cases that are certified correctly. There may be a possible income source or someone may be paying some of the EU's expenses. Questioning management is a tool used to reduce claims, underpayments, and QC errors.
Applications
When an EU's income is less than their expenses, the situation becomes questionable. The message “Expenses exceed Income: Explore management and comment.” appears at the end of the controlled flow on the Action Authorization (FM3H) screen to remind staff to explore management. Prior to authorizing the benefit, if management is questionable, staff must ask additional questions to obtain a complete picture of the EU's situation. Document the FAMIS record noting the information in question and the verification requested. Discuss the situation in detail with the EU and enter the comment on the Eligibility Unit Member Role (FM3Z) screen. If additional verification or explanation is required, request the information from the EU. If based on information from the discussion it is not reasonable to think the EU is managing, pend for any verification that is needed. If the EU is having difficulty attaining needed verification, assist the EU whenever possible. The EU must be given sufficient time to supply the information.
If no verification is needed and management is explained, process the case. If, after a thorough discussion and sufficient time to supply the information, management is still in question, initiate the rejection action using reason code MGT. Document the FAMIS record in detail concerning what is in question and the steps taken to resolve the issue.
EXAMPLE: Mrs. White applies for food stamp benefits. She receives VA benefits of $750.00 per month. Her expenses include, rent of $400.00, health insurance premium of $250.00, and prescription co-pays of $200.00.
The message “Expenses exceed Income: Explore management and comment.” appears on the Action Authorization (FM3H) screen. The worker asks how the expenses are being paid. Mrs. White states she receives a small pension from her deceased husband.
The worker enters the additional income information in FAMIS and enters a comment about management on the Eligibility Unit Member Role (FM3Z) screen. Complete a new Eligibility Determination Resolution (EDRES), and review the budget. If all of the information in FAMIS is correct, authorize the action to approve the application.
In the above example, if the EU did not have a reasonable explanation concerning management, the worker would pend the application for any verification that is needed. FAMIS produces an FA-325 Request for Information, requesting the verification needed. The worker edits the FA-325; requesting verification of management as Mrs. White's expenses exceeds her income.
When the FA-325 expires, FAMIS recommends approving the application without the expense. To reject the application for failure to explain management the worker must go to the Action Authorization (FM3H) screen, prompt for the reason code “MGT”, select it, and enter a “U” on the command line. Press enter and repeat this for each month. FAMIS will reject the application for failure to explain management.
If additional verification other than expenses is requested and not provided, such as identity or income, FAMIS recommends rejecting the application for failure to provide requested verification.
Active Cases – not subject to Simplified Reporting
For active cases that are not subject to simplified reporting, explore management when the reported change causes the EU's situation to become questionable. Contact the EU to discuss how the EU is managing.
EXAMPLE: Mr. Apple sends in a change report saying that he has moved and his rent is now $600.00 per month. Mr. Apple's only income is $450.00 in SSA benefits and he is not subject to simplified reporting. The worker changes the EU's address but does not enter a verification code on the Shelter Expense (FMXK) screen.
FAMIS produces an FA-325 Request for Information, requesting verification of shelter expenses and residence. The worker edits the FA-325, requesting verification of management as Mr. Apple's rent exceeds his income. Mr. Apple responds that he has moved in with Mr. Peach and they are sharing the rent cost.
The worker enters the new rent amount of $300.00 (Mr. Peach and Mr. Apple share the rent) on the Shelter Expense (FMXK) screen, enters the appropriate verification code, and completes a new eligibility determination (EDRES). A comment is entered on the Eligibility Unit Member Role (FM3Z) screen explaining the new address and shelter expense arrangement.
In the above example, if the EU did not respond to the request for information, the worker would complete an Adverse Action Worker Closing (AAWC) with the reason code “MGT”, failure to explain management. An FA-510 Adverse Action Notice is generated to notify the EU of the impending action. After the expiration of the notice, FAMIS closes the case and sends the EU an FA-150 Claimant Action Notice. Staff must review the case before making the determination to close a case due to failure to explain management. If, after a thorough discussion and sufficient time to supply the information, management is still in question, initiate the closing action using reason code MGT. Document the FAMIS record in detail concerning what is in question and the steps taken to resolve the issue. If, based on information from a discussion with the EU, the EU is managing, make the indicated change on an active case.
Active Cases – subject to Simplified Reporting
Policy is not changed for simplified reporting EUs. If a simplified reporting EU reports a change, follow policy outlined in Food Stamp Manual sections 1140.005.03 through 1140.005.20.70. Verify only the information required by Simplified Reporting policy. Do not require an active case subject to simplified reporting to explain management until the next certification. Make the necessary changes and record a comment to explore management at the next certification.
LIVING IN A PUBLIC INSTITUTION (LPI)
The reason code “LPI”, living in a public institution, is added. This code is used when an individual moves to a public institution, the individual is no longer eligible to receive food stamp benefits, and the EU is either not subject to simplified reporting or it is an action that is required to be taken for EUs subject to simplified reporting.
The worker completes an Adverse Action Worker Closing (AAWC) with the reason code “LPI”, living in a public institution. An FA-510 Adverse Action Notice is generated to notify the EU of the impending action. After the expiration of the notice, FAMIS closes the case and sends the EU an FA-150 Action Notice.
The user guides Worker Initiated Closing and Worker Initiated Rejection are revised to include Temporary Assistance and the new reason codes.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.