Fraud and similar fault redetermination of Social Security claims

The Social Security Administration has issued rulings about redetermining eligibility for disability benefits based on fraud or similar fault

Social Security must disregard evidence if there a reason to believe fraud or similar fault was involved in providing that evidence.  For claims that have already been granted, Social Security will redetermine eligibility and will disregard the evidence for which there is a reason to believe fraud or similar fault was involved.  Fraud is defined as “when a person, with the intent to defraud, either makes or causes to be made, a false statement or misrepresentation of a material fact for use in determining rights under the Act; or conceals or fails to disclose a material fact for use in determining rights under the Act.” Similar fault is defined as “an incorrect or incomplete statement that is material to the determination is knowingly made or information that is material to the determination is knowingly concealed.”

Social Security reevaluates the case based on the remaining evidence in the record to determine eligibility.  This includes evidence in the record at the time of the original favorable decision, and evidence provided during the redetermination process.  If the individual is found ineligible after the redetermination, benefits are terminated and the benefits paid are an overpayment.

In determining whether there a reason to believe there has been fraud or similar fault, adjudicators can make inferences based on the totality of the circumstances such as facts or case characteristics common to known or suspected patterns of fraud.  This can include disregarding evidence provided by someone who has not committed fraud or similar fault, but whose evidence relies on other evidence involving fraud or similar fault.

At a hearing, the administrative law judge considers objections to disregarding the evidence and then decides whether there is reason to believe that fraud or similar fault was involved in providing the evidence.

Initiation of a redetermination for alleged fraud or similar fault is not a determination subject to an administrative hearing or judicial review.  After redetermination, an appeal of the redetermination decision can include objections to the finding to disregard evidence.  (SSR 22-1p, May 17, 2022.)

 

Posted in SSI

Treatment of CalKIDS accounts

In 2019, the passage of SB 77 provided one-time state funding to create CalKIDS, a qualified scholarship program. It opens a college savings account for every newborn child in California regardless of income. CalKIDS will provide an initial seed deposit of at least $25 in each savings account and other potential financial awards to participants. In 2021, the passage of the American Rescue Plan Act significantly expanded the program to include an additional 3.7 million low-income public school students in grades 1 through 12 who qualify for free or reduced lunch, are homeless, or are in foster care. Eligible students receive an initial seed deposit of $500. Later in 2021, CalKIDS clarified eligibility to include students attending state special schools.  The CalKIDS expansion was implemented on July 1, 2022. 

College Savings and CalKIDS Accounts allow families to save and invest money for their children’s future higher education expenses. Savings withdrawn from a CSA program that utilizes a 529 college savings account, such as CalKIDS, are not subject to federal or state taxes if they are used for qualified higher education expenses. 

Because CalKIDS Accounts are owned by the State and are not available to the Assistance Unit (AU) are not counted as income or resources for CalWORKs purposes. Any funds, including funds deposited and investment returns, originating from a CalKIDS account will not be considered in the eligibility determination or grant calculation for CalWORKs applicants or recipients. 

CalKIDS Accounts are entirely excluded as income or resources for the CalFresh and California Food Assistance Program CalKIDS shows accounts must be excluded from income and resources entirely. 

CalKIDS does not count as income for CalWORKs Homeless Assistance Program (HA) and the CalWORKs Housing Support Program (HSP) because they are CalWORKs programs.  CalKIDS also does not count as income when determining eligibility for assistance provided by other Housing and Homelessness Programs, including Project Roomkey/Homelessness COVID Response, Bringing Families Home, and the Housing and Disability Advocacy Program.

CalKIDS accounts do not count as income for CalWORKs Stage 1 Child Care.  For other child care programs,  CalKIDS accounts are not considered countable income because they are owned by the state.. CalKIDS funds that are withdrawn and not utilized for educational purposes may be considered countable income if not excluded on some other basis.

The impact of CalKIDS on RCA/ECA and TCVAP follows the income and assets eligibility and administration rules of the CalWORKs program unless specifically superseded by RCA regulations. The eligibility criteria for ECA and TCVAP Cash Assistance states benefits shall be the same as those for RCA, with certain exceptions. These CalWORKs regulations regarding the treatment of CalKIDS accounts and funds also apply to RCA, ECA, and TCVAP recipients.

CalKIDS accounts are not counted as a resource for SSI/SSP or CAPI because they are owned by the state.  Distributions that are used for educational expenses of the designated beneficiary are excluded as a resource in the month received, and if retained beyond the month of receipt, they are excluded for 9 months beginning with the month of receipt. However, since the funds will be distributed directly to the higher education institutions on behalf of the participants to pay for qualifying higher education expenses and not retained by the beneficiary, the distributions will likewise not be considered a resource to the beneficiary.  (ACL 22-79, October 4, 2022.)

Cuban and Haitian Entrant eligibility for benefits programs

The California Department of Social Services has issued information regarding eligibility of Cuban/Haitian entrants for public benefits programs. 

Cuban/Haitian entrants may be eligible for Entrant Cash Assistance (ECA),. This refers to federally funded cash assistance available to those who do not meet the categorical requirements of other state/federal cash assistance programs. ECA follows the rules of the Refugee Resettlement Program. ECA applicants are not required to have a Social Security Number.

Cuban/Haitian entrants can be eligible for CalWORKs upon entry into the United States.  They must submit proof of applying for a Social Security Number within 30 days or have good cause for not applying for a Social Security Number.  Cuban/ Haitian Entrants who apply for or receive CalWORKs must be eligible for Homeless Assistance or the Housing Support Program (HSP). Cuban/Haitian Entrants can be eligible for Project Roomkey, the Bringing Families Home (BFH) program, the Housing and Disability Advocacy Program (HDAP), and/or the Home Safe program if they otherwise meet the eligibility requirements for each program.”

Cuban/Haitian entrants can be eligible for CalFresh immediately without a waiting period. Non-citizens who are eligible based on immigration status must meet all other requirements. These individuals are not eligible for the California Food Assistance Program while Entrant status is in effect because they are eligible for CalFresh.. 

Cuban/Haitian Entrants who are aged, blind, or disabled and meet income limits, may be eligible for SSI/SSP. Entrants are eligible for SSI for seven years. A Cuban/Haitian Entrant who is found ineligible for SSI because of their immigration status can be eligible for CAPI.

Cuban/Haitian Entrants who become eligible for ECA must meet work registration requirements.  Cuban/Haitian Entrants who do not have work authorization should be enrolled in services to help achieve self sufficiency.   (ACIN I-63-22, September 20, 2022.)

Eligibility for federal benefits for Humanitarian Parolees from Ukraine

The California Department of Social Services has issued new guidance about eligibility for federal benefits for Humanitarian Parolees from Ukraine.  This guidance supersedes ACIN I-40-22 for federal benefits.

Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 are eligible for CalWORKs, CalFresh, MediCal, SSI, and Refugee Cash Assistance and Office of Refugee Resettlement programs.

A spouse, or child of an Ukranian or Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 is eligible for CalWORKs, CalFresh, MediCal, SSI, and Office of Refugee Resettlement programs.

A parent, legal guardian, or primary caregiver of an unaccompanied refugee minor or an unaccompanied child who is an Ukranian or Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 is eligible for CalWORKs, CalFresh, MediCal, SSI, and Office of Refugee Resettlement programs.

These individual are eligible for benefits until the end of their parole term.

People who adjust their status from humanitarian parolee to Temporary Protected Status are eligible for Refugee Cash Assistance and Office of Refugee Resettlement programs until the end of their parole term after they have exhausted 12 months of Refugee Cash Assistance, whichever is first.  People who enter as Temporary Protected Status without humanitarian parole are ineligible for benefits.

For Refugee Cash Assistance, Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023, the state date for Refugee Cash Assistance is May 21, 2022 or the date of parole, whichever is later. Eligibility for Refugee Cash Assistance is extended to 12 months.

For CalWORKs, submitting the Form I-765 is sufficient verification that the client has met their obligation to apply for a Social Security Number.  If the applicant does not complete the application for a Social Security Number within 30 days of applying, the county will determine if the client has good cause for not having a Social Security Number.  Counties must help the client get verification.

For child support cooperation, counties must inform families of their right to request good cause for non-cooperation.  The circumstances of people from Ukraine may be good cause for non-cooperation.

For Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023, income and resources of a sponsor and a sponsor’s spouse who lives with the sponsor do not count in determining CalWORKs eligibility.

For Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 can be eligible for Homeless Assistance and Housing Support Program.  Homeless Assistance and Housing Support Program can be used to supplement federal refugee resettlement funds.

For CalFresh, Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 are eligible for CalFresh to the same extent as refugees.  They are eligible effective May 21, 2022.  Counties should reach out to people denied under prior policy to inform them that they now may be eligible.  For CalFresh, the household must verify that they have applied for a Social Security Number or show good cause for failure to provide a Social Security Number.

Ukranians and Non-Ukranian individuals paroled into the United States because of the war between February 24, 2022 and September 30, 2023 may be eligible for SSI.  Counties should issue Refugee Cash Assistance until SSI is granted.

Ukranian Humanitarian Parolees who entered the United States prior to February 24, 2022 are not eligible for Refugee Case Assistance or SSI.  (ACWDL, July 6, 2022, chart corrected by ACWDL, July 22, 2022.)

 

Eligibility of Ukranian nationals for federal and state benefits

THIS LETTER HAS BEEN SUPERCEEDED FOR FEDERAL BENEFITS.  SEE ACWDL, July 6, 2022, summarized here.

The California Department of Social Services (CDSS) has provided guidance regarding eligibility of Ukranian nationals for various public benefits programs.

Ukranian arrivals who have refugee or asylee status qualify for CalWORKs, CalFresh, SSI, and Refugee Cash Assistance (RCA).

Ukranian refugees and asylees are eligible for RCA. Persons with Temporary Protected Status are not eligible for RCA.  Counties must accept a declaration under penalty of perjury of the applicant’s immigration status while documentary verification is pending.

Ukranian nationals who have Temporary Protected Status are not eligible for most federal or state public benefits.

Ukranian humanitarian parolees can be eligible for CalWORKs with state funds.  This is because humanitarian parolees have Permanent Residence Under Color of Law (PRUCOL).  This includes eligibility for Homeless Assistance and Housing Support Program, both of which can supplement federal refugee resettlement funding.

Ukranian humanitarian parolees are eligible for the Cash Assistance Program for Immigrants (CAPI).  They are not eligible for SSI.

Ukranian humanitarian parolees are eligible for CalFresh or California Food Assistance Program (CFAP) if they have been paroled into the United States for at least one year.  Paroled for at least one year means the duration of parole.  A humanitarian parolee is eligible for CalFresh or CFAP from the day they are paroled into the United States if their parole will last at least one year.  Ukranian humanitarian parolees for less than one year are not eligible for CalFresh or CFAP.

Public interest parolees must be admitted to the United States for at least one year and must meet two additional criteria to be eligible for CalFresh, including five years of residence, working 40 quarters, children under age 18, elderly or disabled as defined.  People who do not meet two of the additional criteria can be eligible for CFAP.

Ukranians with refugee, asylee or humanitarian parolee status are eligible for Project Roomkey, Bringing Families Home, Housing and Disability Advocacy Program, and Home Safe.

Ukranian arrivals, including humanitarian parolees, can be eligible for Medi-Cal.

Regardless of the documentation presented, counties must verify immigration status with the SAVE system.  (ACIN I-40-22, April 22, 2022, ACIN I-40-22E, May 24, 2022.)

Social Security protective filing tool

The Social Security Administration (SSA) has implemented its Online Protective Filing Too.   It allows submitting a request for an appointment to file for benefits and record a protective filing date online.  A protective filing date is established upon submission from the Tool.  The Tool collects responses to initial screening questions, determines applicable Title II and Title XVI claim types, and establishes Title II and Title XVI protective filing dates.  The individual must complete all required fields and submit the inquiry to establish a protective filing date.

The Tool gives a confirmation message onscreen and sends an email confirmation that Social Security will schedule an appointment within 7-14 business days.

The Tool is located at https://www.ssa.gov/benefits/ssi/start.html.

(EM-22015, March 19, 2022.)

Posted in SSI