poverty law practice manual – public benefits.pdf · welcome to the poverty law practice manual....

Center for Arkansas Legal Services | (501) 376-3423 | arlegalservices.org

Legal Aid of Arkansas | 1-800-952-9243 | arlegalaid.org

Poverty Law Practice Manual Public Benefits

Contents Transitional Employment Assistance (TEA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

SNAPs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

ARKids First . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Center for Arkansas Legal Services | (501) 376-3423 | arlegalservices.org Legal Aid of Arkansas | 1-800-952-9243 | arlegalaid.org

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Introduction Welcome to the Poverty Law Practice Manual. This manual is designed to help legal aid and pro bono attorneys better understand poverty law issues in Arkansas. The Center for Arkansas Legal Services and Legal Aid of Arkansas, Inc., maintain this manual. You can learn more about free legal aid in Arkansas by visiting arlegalservices.org.


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________________________________ I ________________________________

Transitional Employment Assistance (TEA) ____________________________________________________________________

Overview The Transitional Employment Assistance (the “TEA”) program, codified at ARK. CODE ANN. § 20-76-101 et seq., provides temporary assistance to economically needy families with children under the age of eighteen who reside in Arkansas and meet specified eligibility requirements. The goal of the program is to reduce dependence on government benefits and promote economic self-sufficiency. ARK. CODE ANN. § 20-76-113(a). Central to this goal is helping adult and minor parents increase their employment potential, reducing out-of-wedlock pregnancies, and promoting family unity. TEA Manual 1010. The Arkansas Department of Human Services (the “DHS”) and the Arkansas Department of Workforce Services (the “DWS”) are charged with administering the TEA program. ARK. CODE ANN. § 20-76-401(a)(2)(A); State Plan 1.1. Specifically, the Division of County Operations of the DHS is responsible for determining TEA eligibility, and the DWS is responsible for providing case management services. TEA Manual 1020; State Plan 1.2. The Arkansas Temporary Assistance for Need Family Oversight Board oversees operations. Arkansas Act 514 of 2007. To assist needy families, the TEA program provides monthly cash assistance as well as employment and supportive services to recipients. The DHS and DWS provides services through contracts with agencies including the Department of Health, the Department of Education, the Employment Security Department, and the Office of Child Support Enforcement. They also solicit participation from private organizations, nonprofit organizations, charitable organizations, religious organizations, and institutions of education in the delivery of services. The TEA program was established on July 1, 1997 and is one of four state programs funded by federal Temporary Assistance to Needy Families (“TANF”) block grant funds and state funds claimed as maintenance of effort under the TANF program. ARK. CODE ANN. § 20-76-101(13). The TANF block grant program essentially replaced the Aid to Families with Dependent Children (the “AFDC”) Program. 42U.S.C. § 601, et seq. Since implementation, the TEA program has undergone several amendments. Specifically, the TEA program was amended in 1999, 2001, 2003, and 2007. Arkansas Act 1567 of 1999; Arkansas Act 1264 of 2001; Arkansas Act 1306 of 2003, and Arkansas Act 514 of 2007. State regulations for administering the TEA program can be found in the TEA Policy and Procedures Manual, hereinafter cited to as “TEA Manual.”

A. Eligibility Applicants for TEA benefits have the burden of proving eligibility. ARK. CODE ANN. § 20-76-401(d). The Arkansas legislature and the DHS impose the following eligibility requirements upon TEA applicants: Care of a Minor Requirement In order to be eligible for TEA benefits, applicants must be responsible for the care of a child under the age of eighteen. TEA Manual 2210. More specifically, the child must live in the home of the applicant who must be in one of the following degrees of relationship to the child:

• a blood or adoptive relative who is within the fifth degree of kinship; such relatives by degree of kinship are include: o 1st degree - parent o 2nd degree - grandparent, sibling o 3rd degree - great-grandparent, uncle, aunt, nephew, niece o 4th degree - great-great-grandparent, great-uncle, great-aunt, first cousin o 5th degree - great-great-great-grandparent, great-great-uncle, great-great-aunt, and first cousin once re-

moved (i.e., the child of one’s first cousin)


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• note: half-relationships will be considered the same as full relationships • stepfather, stepmother, stepbrother, stepsister • spouses of any persons named in the above groups. Such relatives may be considered within the scope of this provision

though the marriage is terminated by death or divorce

Residency and Citizenship Requirements In order to be eligible for assistance under the TEA program, an applicant must be a resident of the State of Arkansas (no specific duration required), intend to make Arkansas their home, and be either:

• a U.S. citizen (native born or naturalized) • an alien lawfully admitted for permanent residence prior to August 22, 1996 • an alien who entered the U.S. on or after August 22, 1996, and has been in “qualified alien” status for at least five years • a qualified alien for whom federal law requires benefits to be provided under Title IV-A of the Social Security Act TEA Manual 2220; TEA Manual 2250

Economic Need Requirement An applicant family’s “countable resources” must be equal to or below $3,000. TEA Manual 2270; State Plan 3.4. This resource limitation applies to families of all sizes. TEA Manual 2270. Resources A resource is any real or personal property available to an individual to meet his needs. TEA Manual 2271. In other words, it can be turned into cash. TEA Manual 2271. Only those resources currently available, or of which the individual has the legal ability to make available, will be considered. TEA Manual 2271. Certain items, however, are not counted in determining resources. Such items include:

• a family’s homestead • one operable motor vehicle of any value • household and personal goods • income-producing property • monies deposited in an approved Individual Development Account • funds up to $10,000 placed in an approved escrow account by an applicant who is engaged in micro-enterprise work

activity • earmarked resources such as educational grants, loans, and settlement payments that are intended and used for

purposes which preclude their use for current living costs • Earned Income Credit and other tax refunds • life insurance policies • one burial plot per family member • payments made under government disaster assistance programs • the resources of the spouse of a non-parent relative who is included in the TEA cash assistance unit • savings for Education, Entrepreneurship, and Down Payment (SEED) Applications

TEA Manual 2272; State Plan 3.4. Income A family’ “countable income” must be equal to or below $223 per month, regardless of family size, in order for the family to be eligible for initial or ongoing TEA assistance. TEA Manual 2351. This amount is twenty-five percent of the amount a full-time, forty-hour per week worker would have earned at the federal minimum wage that was effective September 1,1997 ($5.15 per hour). TEA Manual 2351; State Plan 3.3. For purposes of determining whether the “countable income” income is equal to or below the eligibility standard, the incomes of all persons in the assistance unit must be considered, including all adults, children, and minor parents. TEA Manual 2310. In addition, the income of a non-SSI parent or step-parent living in the home is always considered in determining the eligibility of children/step-children, even if such parent is not included as an eligible member. TEA Manual 2310.


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The following steps should be taken to determine whether a family’s “countable income” is equal to or below the twenty-five percent eligibility standard:

• compute the family’s countable unearned income

Unearned income is received from non-work sources such as government benefits, pensions, or child support. TEA Manual 2330. Except for those types of unearned income explicitly disregarded in TEA Manual 2331, all other unearned income received by a TEA family member is “countable.” Examples of countable sources of unearned income include pensions, annuities, insurance benefits, Social Security, Veterans’ benefits, military allotments, Teachers’ Retirement, State Retirement, Workers’ Compensation, payments received from rental producing properties, dividends, interest, and income from capital investments, estate/trust payments, and child support payments. Among the many sources of unearned income that are disregarded include SSI benefits and income of SSI recipients, bona fide loans from any source, assistance from other agencies and organizations based in whole or in part on financial need, and any cash contribution from a friend or relative. TEA Manual 2231.

• compute the family’s monthly countable gross earned income

Earned income includes wages, salaries, tips, commissions, and any other payment resulting from labor or personal service. TEAManual2340. Earned income also includes income from self-employment. Earned income may be verified by check stubs, pay slips, or collateral contacts with employer. TEA Manual 2342. Except for those types of earned income explicitly disregarded in TEA Manual 2341, all other earned income received by a TEA family member is “countable.”

• for initial eligibility determinations, apply a twenty-percent deduction to the gross amount to arrive at the monthly net

earnings

This deduction is applied to cover “work-related expenses,” such as taxes and other mandatory work-withholdings.

• for on-going eligibility determinations, apply the same twenty- percent deduction for work related expenses, then

apply a sixty-percent deduction for work-incentives

The purpose of the work-incentive deduction is to encourage recipients to find work or increase their earnings while receiving assistance. TEA2352; State Plan 3.3.

• add the net earnings to the unearned income to arrive at the monthly countable income • compare the total monthly countable income to the income eligibility standard of $223

If the income is equal to or less than $223, then the family meets the income eligibility requirement. If the income is over $223, then the family is in-eligible and the application will be denied. TEA Manual 2353.1

Drug-Related Conviction Requirement No individual who has, after July 1, 1997, been found guilty of or has pleaded guilty or nolo contendere to any state or federal offense classified as a felony by the law of the jurisdiction involved, and which has as an element of the offense, the distribution or manufacture of a controlled substance (as defined in section 102(6) of the Controlled Substances Act) is ineligible for TEA benefits. TEA Manual 2230. Such denial does not affect the eligibility of other family members, such as children. TEA Manual 2230. Family Cap Requirement The TEA Manual has a family cap provision which prohibits payment to a child who is born while the mother is receiving TEA cash assistance, either for other children or as a minor herself. According to TEA 2150.1, this provision applies equally to applicants who are pregnant and deliver after certification, and to recipients who become pregnant after certification. No exceptions.


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Work, Educational, and Employment Requirements At the time an application is submitted, an applicant does not have to be employed to be eligible for TEA assistance. However, if the application is approved, all able-bodied, adult family members will then be required to work or participate in work activities designed to lead to employment. TEA Manual 2400. Furthermore, all minor parents are required to participate in educational activities to fulfill their work activity requirement. TEA Manual 2400. The following persons can be exempted or temporarily deferred from work requirements:

• an individual required to care for a recipient child under the age of three months or between three and twelve months of age if childcare is not available. Parents may receive this exemption for a maximum of twelve months during his or her lifetime

• a parent or caregiver who is medically incapacitated or who possesses a disability that prevents employment • a woman in the third trimester of pregnancy • an individual who must remain at home to care for a family member who is seriously ill or incapacitated • an individual for whom support services necessary to engage in work are not available • an individual unable to participate in work activities due to effects of domestic violence • an individual unable to participate in a work activity due to extraordinary circumstances • a minor parent under eighteen years of age who resides in the home of a parent or in an approved adult-supervised

setting and who participates in full-time education or training • a teen parent under the age of twenty who maintains satisfactory attendance as a full-time student at a secondary

school are also exempt from the work requirement • in two-parent families, one parent maybe deferred from participation to care for the minor child; and the parent or

caregiver is over sixty years of age

State Plan 5 In addition to meeting work requirements, each able-bodied adult must also comply with his or her employment plan. State Plan 4.3 An employment plan is a written document, which specifies a series of actions necessary for the adult to accept and retain full time employment in the shortest amount of time. State Plan 4.3. It is developed by applicants and caseworkers after an extensive employability assessment within thirty days of application approval and must contain the following:

• the applicant’s employment goals • problems or impediments which may delay or adversely affect employment and what is needed to solve those problems • the particular TEA work activity which is most appropriate for the applicant • specific actions planned with, for, and by the customer in order to attain employment

State Plan 4.2; State Plan 4.3. During the employability assessment, the worker will present an orientation/overview of the program, gather pertinent information, and identify barriers which may prevent the applicant from becoming self-sufficient through employment. The worker may also identify the following:

• family situation/circumstances • employment history/work experience • educational attainment/ literacy level/functional educational level • skills and interests • supportive service needs, if any

State Plan 4.2. Upon completion of the assessment process, the caseworker may engage the applicant in one or more of the following work activities: Employment (Unsubsidized or Subsidized); Education; Vocational Education Training; Job Skills Training; Job Search/Job Readiness; On-the-Job Training; Community Service; Work Experience Training and Micro-Enterprise (Self-employment). State Plan 4.3. Personal Responsibility Agreement Applicants must sign and comply with a Personal Responsibility Agreement as a condition of TEA eligibility. TEA Manual 2004.1. The Personal Responsibility Agreement requires the applicant, whether an adult care taker or minor parent, to ensure that his or her school-aged children attend school regularly and that pre-school age children receive immunizations as needed. TEA Manual 2260. “School-age” is defined as five years through seventeen years of age. “Pre-school age” is defined as two months to five years of age.


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Child Support Requirement As a further condition of eligibility, applicants must agree to assign any child support rights to the state and to cooperate in obtaining child support and establishing legal paternity. TEA Manual 2140-2142. In certain circumstances, an applicant may be deemed to have “good cause” for refusing to cooperate with child support activities. TEA Manual 2143. However, good cause is limited to circumstances in which cooperation would be against the best interests of the child, such as in cases where the missing parent is violent or has abused the child or spouse. TEA Manual 2143.2. The circumstances under which “good cause” may exist and the procedures for claiming and substantiating good cause are outlined at TEA Manual 2143.1. Attorneys are sometimes called upon to represent a client whose reason for not cooperating has not been approved by the agency because a worker believes the client has not substantiated the good cause claim. Special Requirements for Minor Parents Parents under the age of eighteen must satisfy additional requirements in order to be eligible got TEA assistance. TEA Manual 2120-2122. Specifically, minor parents must attend school or engage in other education activities. TEA Manual 2120. If deemed a “head of household,” a minor parent must sign the personal responsibility agreement just as any adult parent or caregiver is required to do. However, if a minor parent is not deemed to be a head of household, then he or she must live in an adult-supervised setting and have an adult living in the home co-sign the personal responsibility agreement.

B. The Application Process 1. Complete an Application

Applications for assistance under the TEA program can be obtained in any of the following ways: • applications can be accessed online at access.arkansas.gov or at humanservices.arkansas.gov

o applications can be requested in-person at the applicant’s area DHS County Office • applications can be requested by phone at 1-800-482-8988 • applications can be requested in writing, addressed to the Arkansas Department of Human Services, Arkansas

Donaghey Plaza West, Slot S201, P.O. Box 1437, Little Rock, AR 72203-1437

Completed applications should either be submitted online or to the applicant’s area DHS County Office. TEA Manual 2003. Requests for assistance in completing a TEA application can be made by completing a DCO-215 form and submitting it to the applicant’s area DHS County Office. TEA Manual 2003. Applications for TEA benefits must contain:

• a statement of the amount of both real and personal property in which the applicant has an interest • a statement of all earned and unearned income which the applicant may have at the time of filing the application • such other information as may be required by the DHS

ARK. CODE ANN. § 20-76-403(a). The following documentation must be submitted with an application for TEA benefits:

• proof of identity and age (driver's license, birth certificate, voter registration) • Social Security numbers for all members to be included in your TEA family/unit or that numbers have been applied

for • proof of relationship to children and proof of their ages (birth certificates, school records, medical records) • for single parents, proof that the other parent is deceased or living elsewhere (divorce records, death certificate,

sworn statement) • proof of immigration status for non-U.S. citizens • proof of income (pay stubs, government checks) • proof of ineligibility for unemployment compensation • proof of housing expenses (rent receipts, mortgage) • proof of address (landlord's statement, utility records) • proof of immunization for all pre-school age children

Additional documentation other than that listed above may also be required depending upon the circumstances. Such documentation will be identified to an applicant by their assigned worker. Once all required documentation is received, TEA applications are processed within thirty calendar days from the date the application is filed. TEA Manual 2000.


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2. Attend a Face-to-Face or Telephone Interview Applications submitted to county offices require a face-to-face interview at the DHS office or at another place of convenience for those incapable of traveling to the DHS office. If the household consists of two adults, both will be interviewed. TEA Manual 2004. If the applicant family is non-head of household minor parent and his or her child or children, the adult with whom the minor parent and his or her child or children are living will also be interviewed. TEA Manual 2004. Applications submitted online do not require a face-to-face interview. TEA Manual 2004. Rather, applications submitted online are subject to a telephone interview, unless the applicant specifically requests a face-to-face interview. TEA Manual 2004. In sum, these interviews are used to gain information about applicants and determine whether regular, ongoing TEA benefits are appropriate. Information obtained from an interview may ultimately reveal that an applicant family does not necessarily need cash assistance through the TEA program or may only need one-time assistance. TEA Manual 2004. If either of these determinations is made, then the application will be terminated with the appropriate termination code. TEA Manual 2004. It is important that applicants answer interview questions truthfully because any assistance improperly paid through the TEA program is recoverable by the state as a debt due. ARK. CODE ANN. § 20-76-403(b). Furthermore, where applicable, the recipient of improperly paid assistance will be prosecuted under theft of public benefits. ARK. CODE ANN. § 20-76-403(b).

C. Determination of Cash Assistance If a family meets all of the above-described eligibility requirements, it will begin to receive monthly cash assistance under the TEA program within the month the application is approved. Monthly payment amounts vary based upon family size. All eligible TEA family members, except children who are not eligible for payment due to the family cap provision, are considered for purposes of determining the appropriate payment amount. TEA Manual 2201. The following chart reflects maximum monthly payment amounts according to family size:

Family Size

Monthly Pay

1 $81 2 $162 3 $204 4 $247 5 $286 6 $331 7 $373 8 $415 9 $457

State Plan 6.1.1.

As a general rule, once a family has received financial assistance for a period of more than twenty-four months (whether consecutive or nonconsecutive and including any time a recipient receives financial assistance from another state), it may no longer receive financial assistance under the TEA program. ARK. CODE ANN. § 20-76-404(a). However, the DWS exempts or temporarily defers the following persons from this twenty-four-month, cumulative limit on TEA financial assistance:

• individuals, as determined by the DWS, who cooperated and participated in activities, but were unable to obtain employment because of circumstances or barriers beyond their control

• child-only cases • individuals unable to obtain employment because of the lack of support services necessary to overcome barriers to

employment • parents or caregivers over sixty years of age • parents or caregivers who are caring for a disabled child relative or disabled adult relative based upon criteria set forth

in regulations issued by the DWS • parents less than eighteen years of age who reside in the home of a parent or in an approved adult-supervised setting

and who participate in full-time education or training


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• individuals, who as determined by the DWS, are unable to obtain employment due directly to the effects of domestic violence (determinations by DWS caseworkers must be reviewed by a supervisor within five (5) days of the determination)

• other individuals as determined by DWS, including, but not limited to, a child when necessary to protect the child from neglect, as defined by ARK. CODE ANN. § 12-18-103(14)

• individuals participating in education and training activities who have reached the end of their twenty-four-month cumulative limit on financial assistance, have complied with all transitional employment assistance regulations, are making satisfactory academic progress as determined by the academic institution or training program in which the individual is currently enrolled, and are expected to complete the requirements for the education or training program within a reasonable period of time as defined in regulations issued by the DWS

ARK. CODE ANN. § 20-76-404(c).

Finally, it is important to note that the twenty-four-month limit applies only to TEA cash assistance. Other support services, even if paid for with a cash reimbursement to the recipient, are usually not considered “financial assistance” with respect to the twenty-four months, lifetime limit. Payments made for other support services, however, would be subject to the federal sixty-month, lifetime limit on the receipt of assistance funded by TANF block grants. 42 U.S.C.A. § 608(a)(7)(A).

D. Determination of Support Services 1. During Program Participation

Families that meet all of the eligibility requirements for the TEA program are not necessarily entitled to support services while participating in the program. ARK.CODEANN. § 20-76-435(a). However, the TEA program’s work requirement and twenty-four-month lifetime limit on cash assistance cannot be imposed upon a family unless the support services necessary to engage in work are available. TEA Manual 4141; TEA Manual 2430. Program regulations allow for the following support services:

• transportation (TEA Manual 3410); • activity related expenses (TEA Manual 3420); • mentoring services (TEA Manual 3435); • service referrals (TEA Manual 3440); • educational expenses (TEA Manual 3422); • case management services (TEA Manual 3430); and • child care assistance (TEA Manual 3450).

There is no provision for DHS-funded substance abuse treatment. However, referrals to other programs for more in-depth assessments are permitted. Although program regulations do guarantee access to child care and case management services while in the program (TEA Manual 3450; TEA Manual 3430), access to other support services depends on decisions by local caseworkers. According to the regulations, expenses associated with transportation, basic educational activities, or work-related activities (such as uniforms, licenses, etc.) may be paid for by TEA, but there is no requirement that DHS do so. TEAManual3410-3422. Each client is expected to make his or her own transportation arrangements. If the client does not have access to transportation, he or she is encouraged to seek rides with family members or other persons at no cost. TEA Manual 3410. If other arrangements cannot be made, recipients may receive payments or reimbursements up to a maximum of $200 per month. This assistance ends when the client has received his or her first full paycheck. This amount may be exceeded on a case-by-case basis with prior approval by the County Administrator. TEA Manual 3410.1. Clients may also receive up to $200 for one-time work-related expenses, i.e., uniforms, drug testing, etc. TEA Manual 3420. Decisions as to who qualifies for assistance with transportation and work-related expenses will be made by individual case managers. DHS and DWS must allow TEA recipients to obtain the education and training they need to obtain jobs that pay wages allowing them to be economically self-sufficient. ARK. CODE ANN. § 20- 76-443(a); TEA Manual 3250. Education and training includes Basic Education, Vocational Education Training, Job Skills Training and other Post-Secondary Training.


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TEA Manual 3250. Education and training are to be linked with other work activities to meet a client’s work participation requirement. The proportion of education, training, and other work activity hours are to be determined on an individualized basis in the best interest of the client. TEA Manual 3250. A client’s functional educational level is determined as part of the initial employability assessment. TEA clients who are assessed to have basic education deficiencies shall be allowed to combine educational activities with employment. TEA Manual 3251. Work requirements for those participating in basic education activities shall not exceed fifteen hours per week. To the extent possible, educational activities are to take place in a work context. TEA recipients who have been assessed to meet the minimum educational requirements for a particular course of vocational education shall be allowed and encouraged to pursue the training as their work activity. TEA Manual 3252. Vocational Educational Training is post-secondary education including programs at two or four year colleges, universities, technical institutes and vocational schools or training in a field directly related to a specified occupation. The vocational training must meet the requirements of a “Demand Occupation.” TEA Manual 3252; TEA Manual 3252.1. Participants in vocational education training shall not be required to work more than fifteen hours per week in order to meet their work participation requirement. TEAManual3252. TEA funds may be used to pay certain expenses (e.g., tuition, fees, and books) associated with participation in an educational activity. The conditions under which TEA funds may be used, however, does vary by type of educational activity. For example, TEA funds may be used to pay for vocational education training only when no other funding sources are available and with the approval of the County Administrator/designee. TEAManual3422.

2. Post-Employment For families that become ineligible for or choose to no longer receive TEA cash assistance due to employment and increased earnings, or who reach the state or federal time limit, extended support services are available including the following:

• one month of “Extended Support Transportation” assistance in the amount of $200 (TEAManual5140) • one year of extended child care assistance at no cost with an additional two years of child care assistance based

on a sliding fee scale. ARK. CODE ANN. § 20-76-404 (e) (TEA Manual 5110) • one year of extended Medicaid coverage for those who meet the eligibility criteria under federal law for such

coverage; (ARK. CODE ANN. § 20-76-404(e); TEA Manual 5120); families who leave TEA and have earnings that disqualify them for Medicaid shall be eligible for a new program, the ARKids First Program, that provides health care coverage for uninsured children in families with incomes up to 200 percent of the federal poverty line

o an employment bonus equal to the amount of the last regular cash assistance payment and to be received only once during a twelve-month period (TEA Manual 5130)

o a one-time payment during the twelve-month period following case closure to assist with job retention expenses. (TEA Manual 5150)

• access to the TEA post-employment information and referral program; ARK. CODE ANN. § 20-76-441; as part of the program, the Department must contact all employed TEA participants and former TEA participants, whose cases have been closed due employment, and inform about the availability of transitional supportive services such as child care, transportation, ARKids First, federal and state earned income tax credits, mentoring, financial credit counseling, Individual Development Accounts (IDAs), and other supportive services and information about education and training opportunities designed to increase participants’ future earnings and employment prospects.


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________________________________ II ________________________________

SNAPs ____________________________________________________________________

Overview Although AFDC was block granted by Congress in the 1996 Welfare Reform Law, the SNAP Program remains a federal entitlement. SNAPs are completely funded by the federal government as are approximately one-half of the administrative costs. Congress did make several major changes to the SNAP Program in the Welfare Reform Law including: denying benefits to people found guilty of distributing or manufacturing of a controlled substance; allowing unemployed able-bodied adults 18 to 50 who do not have minor children to receive SNAPs for 3 months out of 36 months; and denying SNAPs to most legal immigrants. SNAPs allow adults and children to purchase food at approved stores. Non-food items may not be purchased with SNAPs. In particular, alcoholic beverages, tobacco, household products, and pet foods are prohibited purchases. SNAPs used to be in the form of a coupon, but as of April 1998 participating households have an Electronic Benefits Transfer (EBT) card in lieu of coupons. The EBT cards are part of a computer-based system in which eligible households utilize magnetic-stripe plastic cards and have accounts maintained at the central computer. Once a household is certified, the household’s benefits are electronically loaded into a central computer account for each month during the certification period. The statutory basis for SNAPs appears at 7 U.S.C. §§ 2011-2029. Extensive federal regulations are set out at 7 C.F.R. §§ 271-274 (2003). State regulations are in the SNAP Certification Manual (SNAP.) Many changes were made to the SNAP pursuant to the new Welfare Reform Law.

A. Households—SNAP 1600 SNAPs are allotted to groups of people based on living arrangements rather than on biological or legal relationships. A household is defined as a group of people who purchase food and prepare meals together. SNAP 1600. If two individuals or groups of people share a residence but buy and prepare food separately, they can be separate households for SNAP purposes, with the following exceptions:

1. children under the age of 22 who live with a parent must be included in the same household as a parent, unless the parent is at least 60 or legally disabled; this rule applies even if the child is married and/or has children; (SNAP 1631.1); a separate household can consist of a parent and her/his minor children who purchase and prepare food separately, even if the parent's parents or the parent's siblings live in the home; 7 U.S.C. § 2012(i)(2); this is a change from prior law which required all parents, grandparents, children, grandchildren and siblings to be one household

2. the spouse of a household member (SNAP 1631) 3. siblings living in the same household, with some exceptions (SNAP 1631.1) 4. boarders (who pay the household for meals); in fact, they cannot participate in the program at all. (SNAP 1624)

Certain persons living in the home are not counted in the household, but may participate as separate households if qualified:

1. roomers (distinguished from boarders in that meals are not provided for compensation) 2. live-in attendants (nurses, servants, etc.) 3. others sharing the residence but cooking separately (with the previously mentioned exceptions still valid)

Other classifications of people may not participate either as members of the household or as separate households:

1. ineligible aliens (SNAP 1621) 2. students (basically, unless they are working or supporting the household (SNAP 1622, et seq.)


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3. disqualified persons (SNAP 1623); note: an individual who has been found guilty or pleaded guilty or no contest to any felony offense which has as an element of the offense, the distribution or manufacture of a controlled substance, as defined in Section 102(6) or the Controlled Substance Act, will not be eligible to receive SNAP benefits; this is a permanent disqualification; this provision does apply to offenses occurring on or before July 1, 1997; the disqualified individual’s income and resources will be included in its entirety in the household’s budget; (SNAP 1622.2)

4. boarders (SNAP 1624); note: as a result of recent litigation, foster children living in the home are to be considered boarders and their foster care payments are not income to the household; (SNAP 1640)

Residents of institutions are generally not eligible for SNAPs, with these exceptions (SNAP 1800):

1. residents of federally subsidized housing for the elderly (SNAP 1800.1) 2. residents of drug or alcohol rehabilitation facilities (SNAP 1800.2) 3. certain residents in disabled persons' group living facilities (SNAP 1800.3) 4. women and children in battered women's shelters (SNAP 1800.4) 5. residents of shelters for the homeless (SNAP 1800.5)

If the household contains a person who is on strike, the entire household is ineligible unless it qualified for SNAPs before the strike. See SNAP 1700 et seq.

B. Application Process—SNAP 8000

Application for SNAPs may be made by the head of the household (responsible adult), the spouse, a responsible household member, or an authorized representative. The rights of applicants are set out at SNAP 8120. The county office's responsibilities are set out at SNAP 8130. It is worthwhile to review these provisions. Basically, SNAP 8130 sets up procedures which, if working, should encourage the applicant to apply for SNAPs at her or his earliest contact with the county office. The application should be acted upon within 30 days. SNAP 8131. Eligibility is based upon financial and non-financial factors. The non-financial factors are summarized in charts found in SNAP 7200. Chart 1 describes financial eligibility factors applied to individual household members. Chart 2 describes factors applied to the household as a whole. The procedures used to determine eligibility based on the financial eligibility factors are described in SNAP 7100. The following information must be verified before the household is certified (see charts at SNAP 7200, 7410 and 7500 et seq. with cross-references for each item which needs to be verified):

1. gross non-exempt income 2. declared alien status 3. Social Security number for all household members 4. actual utility costs, if the household wants to claim more than the standard utility deduction (see SNAP 6600 et seq.) 5. actual expenses for an unoccupied home, if claimed 6. excess medical expenses of elderly or disabled (see SNAP 6500 et seq.) 7. household residency 8. identity of applicant and head of household 9. questionable information—inconsistencies, etc.

After certification, verification requirements continue. Changes occurring during the certification period must be reported, with some exceptions (see SNAP 11000 et seq.). Changes must be reported within ten days of when the change becomes known to the household. (SNAP 11100). The SNAP manual contains elaborate rules of verification, which are too complex to be repeated here. There is no longer one section on the issue of verification. Verification methods are now included in each section of the manual pertaining to an issue or fact which must be verified (e.g., earned income, see SNAP 5514). As previously stated, applications must be processed within 30 days, with the exception of expedited services (to be discussed later) and delayed cases. See generally, SNAP 8500 et seq. The consequences of delay depend on a determination of fault in causing the delay (see SNAP 8520-8530 for the complex system of determining fault). If the household is at fault, it will not be


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entitled to benefits for delay period. SNAP 8650. If the agency is at fault, the household will be entitled to benefits from the month of application. Id. After 60 days, if the household is at fault, the application will be denied; if the agency is at fault, the application will be processed even while complete information is pending. SNAP 8510. Pursuant to a consent decree in Milton v. Yamauchi, E.D., Ark. (1992), DHS is required to process 96% of initial SNAP applications within the 30-day period. The remaining 4% must be completed within 60 days of the application date. Application procedures are slightly different for households that qualify for expedited services. SNAP 9200 et seq. Households qualify if they have gross monthly income of less than $150 and liquid resources of less than $100, see SNAP 9200.1., or have income and resources which are less than their monthly rent (or mortgage payment) and utilities. See P.L. 100-77, 7 U.S.C. § 2020(e)(9)(C)). Households that qualify for expedited services can receive SNAPs within 7 days of application. SNAP PD 96-16, SNAP 9100, 9400. Verification requirements are relaxed for expedited services. Identity, residence, income, and Social Security numbers must eventually be verified, but processing of the first month's benefits will not be delayed if they cannot be verified. SNAP 9441. Homeless households are no longer entitled to expedited services unless the household meets another of the criteria listed in SNAP 9200. SNAP PD 96-16. If you have an expedited services client who is being told to provide verification or has been denied on lack of verification grounds, remind the caseworker of § 9441, and contact the caseworker's supervisor, if necessary, because the whole idea is to act as quickly as possible. The applicant is entitled to an "agency conference" within two days of denial of an expedited application, which is an informal hearing with a supervisory employee at the county office. SNAP 9323. The fair hearing process, SNAP 1600 et seq., is available, but it is not expeditious. If verification is postponed, households will have to provide verification before benefits are continued beyond the first month. SNAP 9500. There are special rules for migrant households. See SNAP 9200.2, 9446, 9447, 9448, 9600. Households in which all members have made application for SSI or in which at least one member has applied for TEA cash assistance are considered categorically eligible. SNAP 8960. If the size of the grant is so high that the household does not qualify for SNAPs, the SNAPs may be cut off without notice, provided the family was previously notified in writing of such a possibility. SNAP 8963. SSI recipients may apply for SNAPs at the Social Security office. SNAP 8920 et seq. New federal regulations also allow recertification at the Social Security office. 7 C.F.R. §§ 273.2, 273.14 (1987).

C. Recertification—SNAP 10000 Households will be given the opportunity to apply for recertification at the end of the certification period so that benefits can continue uninterrupted. SNAP 10300. The agency will issue a notice of expiration of certification no later than the last day of the month prior to the last month of certification. SNAP 10200. Households then have 15 days to submit an application for recertification. SNAP 10300. If the household fully cooperates and attends the interview, benefits can be continued, provided it is eligible. SNAP 10310. If the household fails to timely submit a recertification application, uninterrupted benefits cannot be guaranteed. SNAP 10400.

D. Residence and Citizenship—SNAP 1300, 1621 The household must apply for SNAPs in the county in which it resides. SNAP 1330. Residency need not be of any particular duration or even be with the intent of making it permanent. SNAP 1300. All members of the household must be U.S. citizens or qualified aliens. SNAP 1621. To be a qualified alien an individual must have worked 40 qualifying quarters of coverage, currently serve in the U.S. armed forces for reasons other than training, or be a veteran. SNAP 1621.1. Non-citizens may participate for no longer than 5 years if they are refugees; asylees; or aliens whose deportation have been withheld. SNAP 1621.1. Resources of ineligible aliens will be counted in their entireties when the household’s eligibility is determined. A pro rata share of the ineligible alien’s income will be counted in the SNAP budget. SNAP 1621.6. Aliens must verify their status. SNAP 1621.2.1. County offices are exhorted to report “illegal” aliens to immigrant officials. SNAP 1621.


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E. Work Requirements—SNAP 3000 Work Requirements—SNAP 3000 (See also, Project Success Manual, which includes rules for the SNAP Employment and Training program.) All able-bodied adults participating in the SNAP program must meet certain work-related requirements. Non-disabled members of the household between ages 18 and 60 will be required to register for jobs through the Arkansas Employment Security Division (ESD) and accept a suitable job if one presents itself. The following exceptions exist:

1. age (under 16, or over 60) (SNAP 3210) 2. disabled (must be verified if not obvious) (SNAP 3230—legal disability under an SSA program is not required, but such

disability will be determinative in the applicant's favor) 3. recipients of TEA cash assistance who are complying with the TEA work requirements (SNAP 3250) 4. a household member who is responsible for the care of a child under age 6 or of an incapacitated person (SNAP 3240) 5. a person who is receiving unemployment benefits or who has applied for them and has registered for work (SNAP

3260) 6. an employed person (at least 30 hours per week or the equivalent, i.e. federal minimum wage X 30) (SNAP 3280) 7. a self-employed person (SNAP 3280) 8. a student meeting the eligibility requirements of SNAP 3290 9. age 16 or 17 living with a parent or attending a school or training program on at least a half-time basis (SNAP 3220)

Household members who are required to register for work must cooperate with ESD, participate in the job search activities, and accept suitable employment if offered. SNAP 3300-3430. There are "good cause" exceptions for non-compliance. SNAP 3411. Work is not suitable if it does not pay the federal minimum wage (or its equivalent), if it either requires or prohibits membership in a union, if the job site is subject to a strike or lockout, if the worker can demonstrate that it is unsafe, if the worker can demonstrate that she/he is unfit for the job, or for other grounds. SNAP 3411. It is important to note that lack of adequate child care for children who have reached the age of six, but are under the age of 12 is no longer a “good cause” exception. (SNAP 3411). The sanction for non-compliance is severe - a three-month disqualification of the non-compliant individual for the first violation. It is no longer the case that if the non-compliant individual is the economic head of the household, the entire household will be disqualified. Instead, only the non-compliant individual will be disqualified. SNAP 3520. One of the most severe changes in the welfare reform law affects able-bodied 18-50-year-old adults who do not have minor children. If these individuals do not work or participate in a work program, they may only receive SNAPs for three months out of 36 months. (SNAP 3500) If a work program is not available to them in their county or they cannot find a job, then they will be denied SNAPs after three months. In order to receive SNAPs for more than 3 months they must:

1. work at least 20 hours per week (averaged monthly) 2. participate in and comply with Workforce Investment Act (WIA) Program for 20 hours or more per week 3. participate at least half-time in a recognized refugee training program approved, funded, or operated by the Office of

Refugee Resettlement 4. participate in a SNAP Employment and Training (E&T) Program other than a job search or job search training program 5. participate in and comply with a Workfare Program

An individual is exempt from this policy if the individual is:

1. under 18 or over 49 years of age 2. medically certified as physically or mentally unfit for employment 3. a parent or other household member responsible for the care of a dependent child 4. pregnant 5. otherwise exempt from the work registration requirements as specified in SNAP 3200-3290

The Department of Agriculture, Food and Nutrition Service, has granted permission for the State to waive the SNAP Program Requirement to Work (RTW) in certain areas where the current unemployment rate is higher than 10 %. The State has also been granted permission to waive the RTW in areas designated as labor surplus by the Department of Labor, Bureau of Labor Statistics.


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These waivers are not permanent. Any county affected by such a waiver will be notified of the terms of the waiver and will be provided with instructions for implementing the waiver. RTW waivers are applicable to individuals who actually live in an area covered by the waiver. An individual who lives in a labor surplus area but who has elected to receive services in another county will be exempt from the RTW. An individual who lives in an area where there is no RTW waiver is subject to the RTW even if he or she chooses another county as their service county. (SNAP 3501).

F. Resources—SNAP 4000 A general description of resources is contained at SNAP 4100. It should be noted that categorically eligible households (households in which all members already receive TEA or SSI—see SNAP 1920-22) are presumed to be resource eligible and don't need to go through separate verification in the SNAP program. SNAP 1921. An eligible household may not possess non-exempt resources above $2,000 unless there is at least one person over age 60. SNAP 4300. Households with at least one person over 60 may have up to $3,000 in resources. SNAP 4300. Certain resources are not counted at all. SNAP 4400. These include:

1. the household's home and lot (SNAP 4410) 2. household and personal goods (SNAP 4420) 3. one burial lot per person (SNAP 4400.11) 4. life insurance and pension funds (SNAP 4420) 5. income producing vehicles or vehicles needed for subsistence (SNAP 4430) 6. the value of a "family car" up to $4,650 (SNAP 4800 et seq.); some vehicles are evaluated for fair market value, others

for equity value, some for both; the dollar figure counted toward resources depends on the value of the vehicle and whether or not it is income producing; see SNAP 4810, SNAP PD 97-14

7. inaccessible resources (SNAP 4500) 8. resources excluded by other laws (see list at SNAP 4450) 9. resources of persons in the household but ineligible, unless the person has been disqualified because of fraud, failure

to supply a Social Security number, or illegal alien status (SNAP 4450 & 4460) 10. funds from government sources which have been earmarked for use in restoration of a home (SNAP 4460) 11. prorated income (SNAP 4460) 12. income producing property (SNAP 4440-4441) 13. Indian lands (SNAP 4460)

The SNAP Act, at 7 U.S.C. § 2014(g)(5), excludes as inaccessible, resources which, "...as a practical matter, the household is unlikely to be able to sell for any significant return because the household's interest is relatively slight or because the cost of selling the household's interest would be relatively great." That would seem to exclude any property in which the household has little or no "equity." At the present time, U.S.D.A. interprets this language as not applying to vehicles. U.S.D.A.'s position, based on arguably flimsy reasoning, is undergoing court challenges in various locations. Jointly owned resources are considered accessible to both owners unless one can prove that the resources are inaccessible (because the other joint owner refuses to subdivide or because subdivision could significantly reduce the value of the property). SNAP 4910. Note, however, that simply because a household member's name appears on a joint bank account does not mean that it is owned by the household. Her or his name may appear on the account for other reasons. See SNAP 4601. Non-recurring lump sums, unless excluded, are counted as income in the month received. (SNAP 4950). Examples of lump sum payments, include but are not limited to:

1. federal and state income tax refunds, rebates, or credits 2. child support when received as the result of the interception of a State or Federal income tax refund; other child support

payments that cover a prior period of time will be handled as explained in; (child support for a prior period that is paid in a lump sum to catch up on payments is not considered to be a non-recurring lump sum payment)

3. refunds of security deposits on rent or utilities 4. lump sum insurance payments such as, but not limited to, settlements for damages to a household member's property,

life insurance payoffs, crop insurance payments and lump sum Worker's Compensation settlements 5. loans with the exception of deferred payment student loans; see for instructions on handling student loans 6. one-time payments for damages received through a court or through an out of court settlement 7. cash gifts, awards, or prizes when received on a one-time basis; see for instructions on handling recurring payments 8. the proceeds (net) from the sale of personal property when payment is received on a one-time basis; see when

payments are received in installments


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9. work incentive payments received upon the completion of the program 10. retroactive Social Security, or Railroad Retirement payments or any other retroactive benefit payment; TEA and SSI

lump sum payments will be excluded as a resource so long as the recipient continues to be eligible for the benefit; see for instructions; if the recipient is no longer eligible for SSI or TEA, the lump sum payment will be considered a resource

11. retroactive wages (net) paid on a one-time basis to correct a previous underpayment or to otherwise adjust wages 12. vacation pay (net) when received as a one-time payment after termination or layoff 13. severance pay (net) when received as a one-time payment; see for instructions on handling severance pay received in

installments 14. salary bonuses (net) which cannot be considered to be annual bonuses; see for additional information

The SNAP program has a disqualification for illegal transfer of assets, SNAP 4970 et seq., ranging from one month to one year depending on the size of the asset(s) which was illegally transferred. SNAP 4974. Transfers are illegal if made for less than fair market value and for the purpose of qualifying for SNAPs.

G. Income—SNAP 5000 Income is defined at SNAP 5300. Income eligibility standards are based upon a household’s classification as regular or aged/disabled or categorically eligible. See SNAP 1910 for an explanation of an aged/disabled household. See SNAP 1920 for an explanation of a categorically eligible household. All other households are considered regular households. An aged/disabled household must meet only the net income eligibility standards. Net monthly income is computed by adding all non-excluded income for all household members and subtracting all allowable deductions. A regular household must meet both the net income eligibility standards and the gross income eligibility standards. Gross monthly income is all non-excluded gross earned and unearned income for all households’ members. Net income is the household’s income after subtracting all allowable deductions. A categorically eligible household does not have to meet either the gross or net income eligibility standards. SNAP 5200. There are some items excluded from income. See SNAP 5400. These include:

1. certain recoupments being made because of a prior overpayment of benefits (SNAP 5410); 2. child support payments obligated to OCSE to maintain eligibility (SNAP 5401); 3. in-kind benefits (SNAP 5406); 4. vendor payments (there are extensive definitions and qualifications see SNAP 5413) The energy assistance exclusion

is limited to federal energy assistance except energy assistance provided under Low-Income Energy Assistance Act. SNAP P.L. 99-425;

5. irregular income, defined as not capable of being reasonably anticipated nor greater than $30 per quarter (SNAP 5407); 6. loans (SNAP 5408); 7. educational income (SNAP 5404; SNAP 1622.3); 8. reimbursement for past or future expenses as long as the household does not make a profit (SNAP 5411 - note the

specific exclusions and inclusions); 9. money received for and actually used for care of a non-household member (SNAP 5412); 10. by federal statute (SNAP 5405 - e.g. VISTA stipends); 11. earnings of a child who attends school (SNAP 5403, SNAP PD 96-16); 12. non-recurring lump sum payment (counted as resources in the month received, unless specifically excluded as a

resource by federal statute or regulation) (SNAP 5409); 13. costs of producing self-employment income (SNAP 5402; 5630); 14. earned income tax credit (SNAP 5414).

There are several allowable deductions from income (see generally SNAP 6100):

1. a standard $134 (SNAP 6300); 2. 20% of the household's gross countable earned income. (SNAP 6200). (Congress recently enacted legislation that

denies the earned income deduction to any income that the household willfully and fraudulently fails to report, as proven in court or an administrative fraud hearing. See P.L. 100-77, §805; 7 U.S.C. §2014(3));

3. actual child care costs (there is no maximum deduction amount), necessary for the parent to work or to train for work (SNAP 6400-6410);

4. medical expenses over $35 for all aged/disabled persons in the household (SNAP 6500-6528); 5. excess shelter costs above 50% of the household's income after all other deductions (unless there is an aged or

disabled household member, the shelter deduction cannot exceed a maximum allowable figure (SNAP 6600-6628) (Take particular note of how to include utility costs in the shelter allowance);


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6. child support payments made by a household member to an individual who is not a household member (SNAP 6550-6552); and

7. losses from a farming enterprise (SNAP 6210). The amounts of the above deductions are readjusted every October 1 for inflation. 7 U.S.C. § 2014(g)(B)(i).

H. Budgeting and Calculations—SNAP 8600 and SNAP 7000 Initial eligibility is determined based on the circumstances in the entire month of application. That first month's allotment is prorated. SNAP 8610. Households are certified to receive SNAPs for differing periods of time, depending on the predictability of the household's circumstances. SNAP 8700 et seq. Eligibility determinations begin with determining resources and income of the household. See SNAP 7000 et seq. for a description of prospective budgeting and various examples. All households other than categorically eligible households and aged/disabled households must meet gross income limits to participate in the Supplemental Nutrition Assistance Program. A household's total gross income is calculated by adding together all gross monthly income as calculated from each non-excluded source including annualized income. Prorated income will be included if the month for which eligibility is being determined is included in the period of intended use. Excluded income will not be used to determine gross income. Except for the farm loss deduction explained in SNAP 5670, no deductions will be allowed in the calculation of total gross income. The farm loss deduction will be applied to the household's gross income before the gross income pretest is applied. A household is classified as "regular" or "aged/disabled.” See SNAP Appendix B—Glossary for definitions. Households containing elderly or disabled members receive certain advantages in calculating income and benefits and are not subject to the gross income pretest. The gross income pretest figures as of October 1, 2015 are set out in part below: Number in Household Gross Monthly Income Standard 1 $1,276 2 $1,726 3 $2,177 4 $2,628 5 $3,078 6 $3,529 7 $3,980 etc. etc. Gross income is then transformed into net income by subtracting all deductions discussed above. Almost all households then must pass a maximum net income test. As of October 1, 2015, the maximum net income figures are: Number in Household Net Income Maximum 1 $981 2 $1,328 3 $1,675 4 $2,021 5 $2,368 6 $2,715 7 $3,061 etc. etc. If the household's income is above the net income maximum, the household is ineligible. However, categorically eligible households (households in which all members receive SSI or TEA—see SNAP 1920-23) are not subject to the gross income pretest but must meet the net income eligibility. SNAP 1910.


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Net income is then compared to a chart that correlates household size and net income and renders the household supplemental nutrition assistance program allotment. The allotment equals the household's net income multiplied by .3. § 7 U.S.C. §2017(a). If an elderly or disabled individual(s) lives in a household with non-elderly or disabled individuals, she/he can be a separate household even if she/he does not purchase or prepare food separately. However, the entire household must pass a "165% income pretest" before the elderly or disabled individual(s) can be eligible for SNAPs. The entire household's income may not exceed 165% of the net income maximum. SNAP 1630 # 4. If this test is passed, then she/he is treated like any aged/disabled household and does not need to pass the gross income pretest at SNAP 7600-7610. The various pretest maximums are set out as Exhibit A to the SNAP manual, followed by the allotment chart described above.

I. Replacing Lost or Stolen Coupons Households may request a full or partial replacement of food purchased with SNAP benefits and subsequently destroyed in a household misfortune such as, but not limited to, a fire, flood or tornado. (SNAP 14132)

J. Overpayments Welfare agencies are being encouraged to pursue all claims for overpayments of benefits and fraud. This is as true in SNAP benefits as it is in TEA. Claims are classified as either inadvertent household error, administrative error, or intentional program violation. The most obvious difference is the criminal penalties attached to fraud charges. Fraud claims are discussed at SNAP 15600; non-fraud claims at SNAP 15100-15535. Official agency policy mandates the collection of non-fraud overpayments regardless of fault, unless the claim is classified as an administrative error and more than 12 months have elapsed between the month the overpayment occurred, and the caseworker discovered an overpayment might exist. Additionally, no claim will be prepared for overpayments that occurred more than six years before the agency became aware of the overpayment. No claim will be prepared for any months in excess of three years from the month the agency discovered a possible overpayment if the county office has purged its files and has no record of issuance for those months. Finally, no claim will be prepared for any months in excess of three years from the month the worker discovered a possible overpayment if the household’s circumstances for that month cannot be established because an employer or other source of verification has purged the records for the month of possible overpayment. SNAP 15200. Uncollected overpayments can also be recovered in offsets against future benefits. SNAP 15530; 15700-15800. Fraud is adjudicated either as a result of an administrative fraud hearing or a court action. Fraud, known administratively as "intentional program violation," occurs when an individual intentionally:

1. makes false or misleading statements to qualify for the Program or to obtain benefits to which the household was not entitled

2. misrepresents, conceals or withholds facts to qualify for the Program or to obtain benefits to which the household was not entitled

3. commits any act that constitutes a violation to the federal regulations or any state statute relating to the use, presentation, transfer, acquisition, receipt or possession of Supplemental Nutrition Assistance Program benefits; SNAP 15110

Claims that are "believed" to involve fraud follow a complex procedure through the agency's fraud unit, the prosecuting attorney's office, and the county office. See SNAP 15620, 16700 et seq. Cases in which the client is ultimately found innocent of fraud are still subject to collection as non-fraud claims. SNAP 15600. Collection of claims may be accomplished by lump sums from the household, allotment reduction, offset of EBT SNAP benefits, and tax refund intercepts. SNAP 15530-15533, 15700, 15800, 15900-15940. The household's current level of benefits is not affected by failure to live up to a collection plan, except in the case of allotment reduction following a fraud verdict. SNAP 15700.

K. Fair Hearings—SNAP 16000

SNAP clients have 90 days to request a fair hearing. SNAP 16330. A hearing may be requested at any time the household believes an action has adversely affected its SNAP participation. Further, household may appeal when an application for SNAP is denied, when SNAP benefits are decreased, when a SNAP case is closed, when SNAP benefits are believed to be inadequate, or when a request for restored benefits is denied. SNAP 16300.


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Goldberg v. Kelly, 397 U.S. 254 (1970), protections apply to SNAP benefits fair hearings - the right to timely and adequate notice, the right to appear, the right to see one's file, the right to confront and cross-examine one's accusers. 7 C.F.R. § 273.15 (2003). Either the household or the county office has the right to subpoena witnesses. SNAP 16513. Judicial review in circuit court is available for 30 days after an adverse decision of the agency's fair hearing committee. SNAP 16537. There are separate procedures for tax intercepts (SNAP 16550), and fraud (SNAP 16700 et seq.).

L. Issuance—SNAP 1900 Issuance of SNAP benefits in the State of Arkansas operates in the following sequence:

• The county office authorizes issuance of SNAP benefits. • Benefits for initial applicants are authorized on a daily basis. Monthly benefits for currently certified cases are authorized

at the end of each calendar month for the following calendar month. • Benefits are issued through an Electronic Benefits Transfer (EBT) system utilizing a device similar to a debit card. • When a household applies for the first time or when an applicant needs a new EBT card, the card is mailed to the

household. After the EBT card is received, the SNAP household must contact the Customer Service Help Desk at 1-800-997-9999 to select the personal identification number (PIN) that must be used with the EBT card.

• To purchase food with the EBT card, the SNAP household takes the card to any grocery store authorized by the Department of Agriculture, Food and Nutrition Service (FNS) to accept SNAP benefits. At the grocery store, the EBT card is swiped through a point of sale (POS) device.

• When the card is swiped, the EBT contractor electronically credits to the merchant's bank account an amount equivalent to the SNAP purchase, and the household's SNAP EBT account is electronically debited for the amount of the purchase.

There are also procedures for replacing SNAPs when the recipient has received only a partial allotment, but the recipient must go to the county office immediately after receipt to report the shortage and request replacement SNAP households must call the Arkansas EBT Help Desk at 1-800-997-9999 to report lost, stolen or damaged cards. There is no charge to the cardholder for replacement of lost, stolen or damaged cards. (SNAP 14400).


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________________________________ III ________________________________

Medicare ____________________________________________________________________

Overview Medicare is federally funded health insurance for the elderly and certain handicapped people. Eligibility is not tied to income guidelines. Part A provides coverage for hospital and nursing home care, home health care and hospice care, and is available to most Social Security recipients. Part B provides coverage for other services (physicians' services, clinics, etc.) and requires a monthly premium, payment of an annual deductible, and co-insurance. Beginning with expenses for services furnished during calendar year 2006, and for all succeeding years, the annual deductible is the previous year's deductible plus the annual percentage increase in the monthly actuarial rate for Medicare enrollees age 65 and over, rounded to the nearest dollar. 42 C.F.R. § 410.160. Neither Part A nor Part B pays the recipient's entire medical costs. Administration of Medicare is controlled by federal law but is performed primarily by private insurance companies under contract with the federal government. In Arkansas, the insurance carrier is Blue Cross/Blue Shield. The statutory authority for Medicare is 42 U.S.C.A. § 1395-1395lll. Regulations appear at 42 C.F.R. § 405 et seq. For Medicare issues, advocates may find Legal Counsel for the Elderly (a project of the AARP) especially helpful. In particular, they publish an updated Medicare Practice Manual. LCE's address is 601 E Street, N.W., Washington, D.C. 20049 or call 202-434-2120.

A. Eligibility 1. Part A

There are four categories of eligible persons: 1. Persons age 65 or over and eligible for either Social Security retirement benefits, Social Security survivor's benefits,

or Railroad Retirement benefits (even if the person is not actually receiving any of those benefits), 42 C.F.R. § 406.10 (2003).

2. Persons not eligible for Social Security or Railroad Retirement, but who attained age 65 before 1968, or who attained 65 after 1967 and have a certain number of quarters of coverage, 42 C.F.R. § 406.11 (2003).

3. Certain individuals who have qualified for Social Security disability benefits for 25 months as an insured individual, child, widow, or widower who is “under a disability” or is a disabled qualified beneficiary certified under Section 7(d) of the Railroad Retirement Act, 42 C.F.R. §406.12, and victims of end stage renal disease, §406.13;

4. Persons age 65 or greater who do not qualify for Social Security, but who voluntarily pay a premium for Medicare coverage, 42 C.F.R. § 406.20 et seq. (2003).

2. Part B

Persons age 65 or greater who are eligible for Part A. See 42 C.F.R. §407.10. The person must either pay the Part B premium or have it deducted from Social Security benefits. AR Seniors consist of individuals aged 65 or over whose income is equal to or below 80% of FPL. If the individual is entitled to Medicare he/she must receive Medicare. AR Seniors provides full Medicaid coverage. M.S. B-321. In Arkansas, persons on Medicaid who are “Exceptional Medically Needy” will have their premiums paid by Medicaid. See Arkansas Medical Services Manual (M.S. O-131). Medicaid will also pay the Medicare premium, deductibles, and co-payments for people (not receiving Medicaid benefits) whose income is up to 100% of the Federal Poverty Level. See M.S. B-322, et seq. The eligible are referred to as "Qualified Medicare Beneficiaries." (QMBs). Under a new program, Medicaid also pays the Part B premium for persons with income between 100% and 120% of the Federal Poverty Level (SMBs). M.S. B-323. Qualified Individuals 1 consists of individuals who would be eligible for SMB except that their income exceeds the SMB level. QI-1’s must have income of at least 120% but less that 135% of the FPL. QI-1 pays only the Medicare Part B premium. M.S. B-324. Finally, Qualified Disabled and Working Individuals consist of


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individuals who are aged, blind or have a disability who lost Medicare Part A entitlement solely due to the individual’s earning that reached or exceeded the Substantial Gainful Activity (SGA) amount. QDWI income limit is 200% of the FPL. QDWI’s are eligible only for payment of their Medicare Part A-Hospital Insurance premium. M.S. b-325.

B. Coverage

1. Exclusions As a preliminary note, some items are never covered by Medicare, (see 42 C.F.R. § 411.15 (2003)).

• Services that are not "reasonable and necessary" (see 42 C.F.R. § 411.15(k)); • Services that are offered free of charge (see 42 C.F.R. § 411.4); • "Frills", such as TV's, radios, and air conditioners (called "personal comfort services") (see 42 C.F.R. §411.15(j)); • Routine exams (unless in treatment of a specific illness), eyeglasses, and immunizations (unless directly related

to treatment of an illness, such as rabies) (see 42 C.F.R. § 411.15(a)-(c)&(e)); • Foot care (see 42 C.F.R. § 411.15(l)); • Personal care services, such as aid in feeding, clothing, or bathing oneself (unless needed to facilitate treatment

or to prevent deterioration of health where the beneficiary is confined to the home, 42 C.F.R. § 409.45 (b)(1)(i); or necessary for the palliation or management of terminal illness 42 C.F.R. § 418.202);

• Cosmetic surgery, unless it also has a therapeutic effect, such as after a severe burn (see 42 C.F.R. § 411.15(h));

• Dental treatment, unless the condition is severe enough to warrant hospitalization (see 42 C.F.R. § 411.15(i)); • Services paid by workers' compensation (see 42 C.F.R. § 411.40 et seq.); • Exams required by insurance companies, business establishments, government agencies, or other third parties

(see 42 C.F.R. § 411.15(a)(2)); • Orthopedic shoes or other supportive devices, except when shoes are integral parts of leg braces (see 42 C.F.R.

§ 411.15(f)); • Custodial care, except as necessary for the palliation or management of terminal illness, as provided in part 418

of this chapter. (Custodial care is any care that does not meet the requirements for coverage as SNF care as set forth in §§ 409.31 through 409.35 of this chapter.) (see 42 C.F.R. § 411.15(g));

• Services to hospital patients (note exceptions) (see 42 C.F.R. § 411.15(m)); • Assisted suicide (see 42 C.F.R. § 411.15(q); • A home health service as defined in section 1861(m) of the Act furnished to an individual who is under a plan of

care of an HHA, unless that HHA has submitted a claim for payment for such services (see 42 C.F.R. § 411.15(r));

• Certain services of an assistant-at-surgery (see 42 C.F.R. § 411.15(n)); • Experimental or investigational devices, except for certain devices (see 42 C.F.R. § 411.15(o)); • Services furnished to SNF residents (see 42 C.F.R. § 411.15(p)); • Hearing aids (see 42 C.F.R. § 411.15(d)); and • Services covered by other insurance (see 42 C.F.R. § 411.20 et seq.).

2. Covered Items

Part A Generally, Part A covers inpatient services, subject to an annual deductible. The deductible is adjusted annually for inflation.

Inpatient Hospital Care, 42 C.F.R. § 409.10 et seq. (2003) The regulations contain a number of criteria that the facility must meet in order to qualify as a "hospital." See Id. at § 409.3. In a covered hospital, the following items are covered by Medicare:

• room and board (semi-private) • nursing and other services (but not the services of a private nurse) • use of normal hospital facilities • drugs, supplies, and equipment for use in the hospital • other therapies • medical social services • medical or surgical services provided by certain interns or residents in training


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• transportation services, including transport by ambulance • services related to kidney transplants • services of interns and residents at a teaching hospital (the services of other physicians are covered under Part B) See 42 C.F.R. §§ 409.10-409.18

Post Hospital Care in an Inpatient Skilled Nursing Facility For up to 100 days, 42 U.S.C. 1395a(2)(A)

Home Health Care, 42 U.S.C. § 1395d(a)(3)

Hospice Care, Under Limited Conditions, 42 U.S.C. § 1395d(a)(4) Part B Medical and Other Services, 42 C.F.R. §§ 410.10-410.78 These items include physicians' services, supplies and services incident to a physician's services, diagnostic services, therapeutic services, equipment rental, ambulance service, etc. Part B Coverage Requires an Annual Deductible and Coinsurance on Some Services After the Deductible. § 410.3(b)(1). This is in addition to the monthly premium already mentioned.

C. Claims Because the beneficiary can be held liable for services not covered by Medicare, advocates need to be familiar with the claims procedure. Medicare coverage is often tied to "medical necessity" related to the person's diagnosis upon first entering a facility. Advocates should check the records and be sure that complete and correct diagnoses are entered in the claims record. For example, if a patient is admitted to the hospital for treatment of pneumonia and arthritis, but the claims forms mention only the pneumonia, then services and supplies necessary for treatment of the arthritis alone will not be picked up by the insurance carrier. Part A The provider submits a bill to a private insurance organization also called a “Medicare intermediary,” which grants or denies the claim. The intermediary notifies the beneficiary, who may appeal (see below) a denied claim or the amount of payment. 42 C.F.R. § 421.51 (2003). Part B Providers send claims to the carrier for the area where the service was provided. Physicians either may take an assignment of the patient's bill and agree to accept the reimbursement as at least 80% of the bill (and therefore charge the patient no more than 20%), or may let the patient submit the claim and pay the physician directly. There is no limitation on the amount the patient may be billed in the second procedure. 42 C.F.R. § 410.152. When a provider is overpaid for a service, the beneficiary may be liable for recoupment. An inquiry into fault, similar to that under SSI, is instituted. The Social Security overpayment regulations are specifically incorporated as the relevant fault standard when the Medicare recipient is also a Title II (Social Security) recipient. See 42 C.F.R. § 405.354 (2003). The provider or the government can be held liable if unnecessary or excluded services were paid, unless it is shown that the beneficiary knew or should have known that the services were not covered. In such a case, the beneficiary can be sued in state court by the provider in a regular debt collection action. §§ 405.350-405.379.

D. Appeals Appeals are conducted by the Social Security Administration in a manner similar to Social Security Disability appeals (reconsideration, hearing, Appeals Council review). Part A Coverage, 42 C.F.R. §§ 405.701-.753 (2003) An adverse decision can be appealed the same as disability appeals, except that not all appeals are entitled to the complete process. For claims of less than $100, only appeals through the reconsideration stage are allowed. § 405.720(d). Claims of $100 or more merit appeal through Departmental Appeals Board review. Only claims of $1,000 or more are entitled to judicial review. § 405.730.


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Part B Coverage, 42 C.F.R. §§ 405.801-.877 (2003) All appeals are initially handled by the insurance carrier. Persons with Part B claims of $500 or more may have a hearing with a Social Security ALJ. Furthermore, claims for $1,000 or more are entitled to judicial review. The U.S. Supreme Court has also approved judicial review of challenges to the interpretation and validity of Part B regulations under the federal A.P.A. Bowen v. Michigan Academy of Family Physicians, Inc., 106 S. Ct. 2133 (1986).

E. Medicare-Approved Drug Discount Cards If an individual is enrolled in Medicare, he/she is eligible to enroll in a Medicare-approved drug discount card, unless he/she receives outpatient prescription drugs through Medicaid. If the individual has a limited income and does not have drug coverage, he/she can receive assistance. If the individual’s monthly income in 2004 is no more than $1,048, if single or no more than $1,406, if married, the individual might qualify for a $600 credit on the Medicare-approved drug discount card. Another $600.00 credit may also be available for 2005. In addition, the individual might qualify for additional, larger discounts from many drug manufacturers. Signing up for a Medicare-approved drug discount card is voluntary. An individual may sign up any time in 2004 and there is no deadline or late enrollment penalty. Enrollment began May 3, 2004, and benefits will begin in June 2004. Enrollment forms for the Medicare-approved drug discount cards are available on medicare.gov or by calling 1-800-MEDICARE. The individual will be mailed an enrollment form and if he/she qualifies, he/she will be sent the enrollment form to apply for the $600 credit.


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________________________________ IV ________________________________

Medicaid ____________________________________________________________________

Overview Medicaid is a needs-based program of assistance to the poor. Persons must have low income and either be "categorically needy" (usually meaning receiving SSI) or "medically needy" (ineligible for a federal aid program, but without income enough to pay for medical expenses). Medicaid reimburses the providers directly for covered services. Medicaid is strictly voluntary for Arkansas Health care providers, except for hospitals and nursing homes which received funds under the Hill-Burton Act. Until 1994, recipients were able to select their own physicians, or other providers from a list of Medicaid participating providers. In 1994, Arkansas Medicaid instituted a managed care program for Medicaid recipients. Under this program, each Medicaid recipient must select a primary care physician (PCP) who will provide primary care services and refer the recipient for all necessary specialty services, hospital care, and other services. The recipient is restricted to receive services from the PCP or from a provider to whom the recipient was referred by the PCP. This program is mandatory, with some exceptions. Those exceptions include:

• recipients who have Medicare as their primary insurance • children's Medical Services recipients • nursing facility residents • residents of an intermediate care facility for the mentally retarded • medically needy spend down recipients

In Arkansas, claims for Medicaid reimbursement must be filed within twelve months of the date of service. MS 1400. Upon being found eligible, a person's medical bills for the three prior months must be covered (assuming the person was eligible during those months). 42 C.F.R. § 435.914 (2003). Medicaid funds come from both the state and federal government. The state agency that operates the Medicaid program in Arkansas is the Department of Human Services (DHS). The federal statute creating Medicaid is codified at 42 U.S.C.A. §§ 1396-1396u. Regulations appear at 42 C.F.R. §§ 430-456 (2003) (see particularly § 435 (eligibility); § 440 (services covered—general); § 441 (services covered—specific requirements and limitations)); and in the Arkansas Medical Services Manual (MS). Medicaid law is wildly complex, and what appears below is only intended to give a general outline of the most important Medicaid programs. The National Health Law Program (healthlaw.org) has published a soft bound book on Medicaid that goes into more detail. See An Advocate's Guide to the Medicaid Program (2001).

A. Eligibility 1. Categorical Eligibility—MS 2000

Categorical eligibility refers to individuals who are automatically eligible to receive a Medicaid card because they fall into a certain category of poor persons. The largest categories are SSI recipients and individuals eligible for TEA related Medicaid. The following categories of individuals are eligible for Medicaid:

1. individuals eligible for Supplemental Security Income (SSI); MS 2010 2. blind or disabled individuals with converted cases who are not considered to be blind or disabled under SSI criteria;

MS 2020 3. individuals eligible for Medicaid as essential spouses in December 1973 and who continue to meet that eligibility

criteria; MS 2025 4. disabled widows and widowers; MS 2045, 2046, 2049 5. Qualified Medicare Beneficiaries who qualify under the Medicare Catastrophic Coverage Act of 1988, and whose

benefits are limited to Medicare cost sharing. MS 2047, MS 2073, MS 2074 6. Specified Low Income Medicare Beneficiaries; MS 2051 7. Qualified Disabled and Working Individuals; MS 2048


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8. Disabled Adult Children (DAC); MS 2050 9. individuals who were eligible for Medicaid in Title XIX institutions in December 1973; MS 2044.3 10. families who lose TEA related Medicaid eligibility due to increased wages and who qualify for up to 12 months of

transitional Medicaid; MS 2061 11. families who lose TEA related Medicaid eligibility due to the collection of child support payments and who qualify

for up to 3 months of extended Medicaid; MS 2063 12. certain individuals receiving inpatient psychiatric care in Arkansas State Hospital; MS 2070 13. Developmentally Disabled Individuals who qualify for Home and Community Based Services; MS 2075 14. Aged Individuals who qualify for Home and Community Based Waiver Services; MS2076 15. newborn infants born to women determined to be Medicaid eligible when the infant was born; MS 2080 16. individuals who qualify for services under the Alternatives for Adults with Physical Disabilities Waiver; MS 2078 17. disabled children eligible for Medicaid under TEFRA; MS 2090 18. illegal aliens who are eligible for emergency services only; MS 1095 19. individuals who qualify for retroactive Medicaid eligibility; MS 2100 20. certain individuals in Title XIX Long Term Care Facilities; MS 3000 21. women eligible as Pregnant Women who meet the AFDC or Medically Needy standards of need; MS 5000, MS

7000 22. individuals eligible for the under 18 (U-18) category; MS 6000 23. Title IV-E and other Foster Children; MS 6000, MS 7000 24. Non-Title IV-E Adoptive Children with Special Needs; MS 6590 25. individuals eligible for the medically needy program; MS 7000 26. certain refugees 27. individuals found eligible for TEA related Medicaid; MS 2085 28. children who lost their SSI eligibility because they did not meet the new definition of disability; MS 2036

Note: Effective January 1, 1997, the Social Security Administration terminated all SSI and Social Security Disability recipients who were receiving benefits because drug addiction or alcoholism was material to the finding of disability. These individuals are no longer considered categorically eligible as disabled individuals for Medicaid. Individuals whose disability status has been terminated due to the finding of SSA or MRT may apply for Medicaid at the county office. However, unless the individual alleges a new and different disabling condition, he/she cannot be found eligible in a category in which disability is and eligibility requirement. (see MS 2055)

2. Medically Needy Eligibility

Arkansas is one of about 30 states that have a medically needy Medicaid program. This is also commonly referred to as "spend-down" Medicaid. Eligible applicants have too much income to qualify for categorical eligibility. They would qualify for Medicaid as being AFDC recipients, SSI recipients, or under 18, if their income was not so great (see MS 7000). This is known as "categorical relatedness." However, they have such high medical bills that, when those bills are subtracted from their income ("spending down"), the income is reduced to the eligibility guidelines. This eligibility guideline is known as the Medically Needy Income Level (MNIL). MS 7061. Medicaid will then generally pay the part of their bills which is left after "spend-down." To be determined medically needy, applicants must fit the AFDC, SSI, or under 18 categories and have income (after spend-down) and resources below maximum limits. Resource Limitations Household Size Resource Limit 1: $2,000 2: $3,000 3: $3,100 MS 7500. See MS 3330-3338.12 to see how to compute countable resources.


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Income Limitations (MNIL) Household Size Monthly Income Limit 1: $108.33 2: $216.66 3: $275 4: $333.33 5: $383.33 6: $441.66 7: $500 8: $558.33 9: $616.66 10: $675 Add $58.33 to monthly income level for each additional family member after 10. See MS 7610. Eligibility for spend down is calculated on a quarterly basis. Therefore, to be eligible, one must be categorically related and his or her income for the quarter must, after deduction for allowable medical expenses for the quarter, fall below the quarterly MNIL. For instance, Avram, an SSI-related family of one, has income of $1,200 for the quarter August 1-October 31. The quarterly MNIL is a whopping $325 (see MS 7610). Therefore, Avram needs to "spend down" $875 to become eligible for any payments. He incurs bills as follows:

Aug. 5 $100 (X-Ray) Sept. 6 $85 (Dr. Visit) Sept. 10 $65 (ER Visit) Sept. 13 $75 (ER Visit) Sept. 19 $550 (Outpatient Surgery) Sept. 22 $80 (ER Visit)

Avram "spent down" his last dollar on Sept. 19 and, therefore, he will receive a Medicaid card dated September 20-October 31, 1991. All items otherwise covered by Medicaid during this time period should be covered. Two things should be noted: 1) Avram does not have to pay the $875 to his providers, it is only necessary that the bills be incurred (i.e., the applicant needs to bring the bills to Human Services); 2) Avram needs to reapply on November 1 for the next quarter if he has more bills. A recipient can only receive three months of eligibility on any one application. See generally MS 7631-7633 regarding chronological spend down. It is crucial to understand that the spend down quarter chosen does not have to be the three months following the date of application. See MS 7065. It can be any continuous three calendar months beginning with the three months prior to the month in which the application was made and ending with the last day of the three-month period beginning with the month in which application was made. See MS 7065 (example given). It is important to choose the quarter, based on the bills the client has, or anticipates, which will maximize benefits. In fact, DHS is supposed to choose the applicant's best quarter, MS 7065, but caseworkers don't always do so either because they don't understand the provision precisely or it is far easier to always count retroactively from the date of application rather than to anticipate expenses (i.e., choose a period which goes somewhat or completely into the future).

B. Covered Services

Available services are listed at MS 1040, and are too complex to be duplicated here. Services must be adequate to achieve their purposes. The state may set limits on certain procedures to be uniformly applied. According to the regulations, the state may grant fewer services to the medically needy than to the categorically needy, but somehow the services it offers both groups must be equal in amount, duration, and scope. See §§ 440.220-440.240 (1997). This is known as comparability. Id at § 440.240. Even after a careful reading of these regulations, the concept of comparability appears self-contradictory.


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Medicaid recipients are responsible for paying a coinsurance amount equal to 20% of the per diem charge for the first Medicaid covered day per inpatient hospital admission. Medicaid recipients are also responsible for paying a co-payment amount per prescription based on a graduated payment scale, not to exceed $3 per prescription. The coinsurance and co-payment policy does not apply to the following recipients and/or services: (1) Individuals under the age of 18 (2) Pregnant Women (3) Individuals residing in a nursing or ICF/MR facility who are approved for vendor payment (4) Emergency services (5) Family planning services and supplies (6) Health Maintenance Organization (HMO) enrollees and (7) Services provided to individuals receiving hospice care. (MS 1151)

C. Application Process Application is made through the Arkansas Department of Human Services. As in other benefit programs, federal law requires that the state agency allow anyone to apply for Medicaid. 42 C.F.R. § 435.906. Generally, Medicaid applications must be disposed of within 45 days of receipt; 90 days if disability is at issue. 42 C.F.R § 435.911. The eligibility categories that require a finding of disability necessitate (if one is not already receiving funds from a "disability" program) submission of evidence of disability to the agency's "Medical Review Team." That body analyzes the evidence and makes a decision on disability. The medical review team's standards are the same as disability standards under Social Security law. But see Williams v. Scott, 278 Ark. 453, 647 S.W.2d 115 (1983); Arkansas Department of Human Services v. Simes, 281 Ark. 81, 661 S.W.2d 378 (1983) (regarding burdens of proof and evidence necessary to show disability). In most cases the applicant, if disabled, is eligible either for SSI or SSD. Therefore, a claimant who is turned down for Medicaid should apply for SSI and pursue his or her appeal to the hearing level. If the claimant is awarded SSI, he or she will also get Medicaid. Several eligibility categories, i.e. Elder Choices, Independent Choices, Adults with Physical Disabilities, require that the applicant be determined functionally disabled. The elderly individual must meet at least one of the following three criteria as determined by a licensed medical professional:

1. The individual is unable to perform either of the following: a. at least one of the three activities of daily living (ADL) of transferring/locomotion, eating or toileting without

extensive assistance from or total dependence upon another person b. at least two of the three activities of daily living (ADL) of transferring/locomotion, eating or toileting without

limited assistance from another person 2. The individual has a primary or secondary diagnosis of Alzheimer’s disease or elated dementia and is cognitively

impaired so as to require substantial supervision from another individual because he or she engages in inappropriate behaviors which pose serious health or safety hazards to himself or others.

3. The individual has a diagnosed medical condition which requires monitoring or assessment at least once a day by a licensed medical professional and the condition, if untreated, would be life-threatening. 42 U.S.C. 1396t(c).

D. Appeals

The Medicaid appeals process is similar to that used for SNAPs. See 42 C.F.R. § 431.200 -.250; MS 9300 et seq. A request for a fair hearing must be received in the Appeals and Hearings Office no later than 30 days from the date of the advance notice. If the hearing results in another adverse ruling, the person can petition the circuit court for judicial review within 30 days. See Williams v. Scott, supra.; MS 9317. Basic due process rights must be preserved at the hearing. 42 C.F.R. § 431.205(d). If the issue is disability (which frequently it is), the advocate should prepare exactly as in a Social Security proceeding, gathering evidence to show that the client cannot engage in substantial gainful activity.


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If the issue is functional disability, as in Elder Choices cases, the petitioner has the burden of proving continued disability and continued entitlement to benefits. If the petitioner meets this burden, the burden shifts to DHS to articulate the reason the petitioner no longer has a disability and is no longer entitle to Elder Choices services. DHS will meet its burden and may terminate an Elder Choices recipient’s benefits if there is substantial evidence of any of the following:

• clear and specific error in the prior Elder Choices determination • the petitioner’s medical condition has improved • the petitioner’s condition is not so disabling as originally believed

However, in medical improvement cases, the evidence must suggest the petitioner’s condition is less severe than first believed due to new or improved diagnostic techniques or evaluations.[Social Security Disability Benefits Reform Act of 1984; Pub. L. No. 98-460, 98 Stat. 1794; Weber v. Harris, 640 F.2d 176 (8th Cir. 1981); Rush v. Secretary of Health and Human Services, 738 F.2d 909 (8th Cir. 1984); Polaski v. Heckler, 751 F.2d 943 (8th Cir. 1984; and Steele v. Heckler, 748 F.2d 492 (8th Cir. 1984)


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________________________________ V ________________________________

ARKids First ____________________________________________________________________

A. ARKids First The ARKids First program was implemented by Arkansas on September 1, 1997. It is designed to provide Medicaid eligibility for Arkansas children from birth through age 18. There are two categories of ARKids First; ARKids A, which includes Poverty Level Infants and Children (Category 61), commonly referred to as SOBRA, Newborn Medicaid; and ARKids B (Category 01) the ARKids First Demonstration Waiver Program. Participants in ARKids A are covered for a full range of Medicaid services (MS 16020). Participants must select a Primary Care Physician (PCP) before most benefits will be paid. The income limits for ARKids A are set at 133% of the Federal Poverty Level (FPL) for children under 6 and at 100% of FPL for children 6 and older. There are no income limits for newborns. If the mother was eligible for Medicaid the day the baby was born, the baby is eligible with no look-back. Specific income deductions may be taken for poverty children - $90 from earned income, child care deductions, and $50 for child support. There are no resource limits and the participant may have insurance and still be eligible; however, the insurance pays before ARKids A. Children under age 19 are covered. (MS 16010-16180 poverty level child; MS 16200 newborn). Participants in ARKids B are not eligible for the full range of Medicaid services. Co-payments and coinsurance apply for all services except immunizations, preventative health screening, family planning, and prenatal care. (MS 16020) Participants must select a Primary Care Physician (PCP) before their application can be certified. The income limits for ARKids B are set at 200% of the Federal Poverty Level. A $50 income deduction for child support is allowed and there are no resource limits. A child is not eligible if he/she has comprehensive group or employer-based insurance. If the group or employer based insurance is dropped, there is a 6-month waiting period before coverage can begin except when insurance was terminated involuntarily. (MS 16015-16180)

This manual is a collaboration of the Center for Arkansas Legal Services and Legal Aid of Arkansas, Inc. These nonprofit organizations provide free legal assistance to eligible Arkansans who meet income, asset, and other guidelines. Legal assistance may also include advice and counsel, brief services, or full representation depending on the situation. For more information about civil legal aid in Arkansas, please visit arlegalservices.org. For information specific to Legal Aid of Arkansas, Inc., visit arlegalaid.org. Apply for services online or by calling 1-800-9-LAW-AID (1-800-952-9243). The information and statements of law in this manual should not be considered legal advice. This manual is provided as a broad guide to help you understand how certain legal matters are handled in general. Courts may interpret the law differently. Always do what the court tells you to do.

Center for Arkansas Legal Services & Legal Aid of Arkansas

Updated December 2017

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