SECTION 340:65-3-1. Determination of eligibility

(a)   Eligibility determination. The process of determining eligibility includes the applicant filing a signed application, the worker certifying or denying benefits, and all subsequent activities required to receive continuous benefits. The applicant has the right and responsibility to participate in the eligibility determination and is relied on as the first source of information.

(1)   Someone acting on the applicant's behalf, such as an authorized representative or a person with power-of-attorney, may complete the application for all programs except for Temporary Assistance for Needy Families (TANF). The applicant must complete and sign a TANF application.

(2)   When someone other than the applicant applies on behalf of the applicant, he or she must bring a signed statement from the applicant giving this person permission to act on the applicant's behalf or the applicant must have designated this person as his or her authorized representative on the signed application. The SoonerCare (Medicaid) programs allow others to apply for the applicant without a written designation.

(b)   Filing an application. A household must complete an application to apply for the Child Care Subsidy Program, Low Income Home Energy Assistance Program (LIHEAP), SoonerCare (Medicaid) Program, Supplemental Nutrition Assistance Program (SNAP), State Supplemental Payment (SSP), Supplemental Security Income Disabled Children's Program (SSI-DCP), or TANF. The applicant may request one or more benefits on the same application with the exception of LIHEAP as LIHEAP is not an ongoing benefit.

(1)   The applicant may apply for benefits in a local county office of his or her choice. When someone applies on behalf of the applicant and lives in a different county, the person may apply in his or her county of residence or in the applicant's county of residence.

(2)   When the applicant applies for TANF cash assistance in a county in which he or she does not live, the applicant's TANF Work activities are assigned in the county offering more participation opportunities for the client.

(3)   When the applicant applies online via okdhslive.org, the system auto-assigns the application based on the applicant's ZIP code.

(c)   Signature requirements. The applicant, guardian, or someone acting on the applicant's behalf, such as an authorized representative or a person with powerofattorney must sign the application, prior to benefit approval.

(1)   TANF applications must be signed by the applicant. When the TANF applicant lives with his or her spouse, both spouses must sign the application.

(2)   The applicant may voluntarily withdraw the request for benefits or services before or after signing the application.

(3)   An applicant who is:

(A)   eligible for Medicare signs the application using the name on his or her Medicare Health Insurance Benefits (HIB) card; or

(B)   not eligible for Medicare signs the application using the name shown on his or her Social Security card.

(d)   Interview requirements. Interview requirements vary by program.

(1)   Prior to benefit approval, the applicant must complete a face-to-face interview for the TANF program.

(2)   The applicant must complete a telephone or face-to-face interview for the:

(A)   Child Care Subsidy Program;

(B)   SSP Program;

(C)   SoonerCare (Medicaid) long-term care programs, such as ADvantage Waiver, nursing home care, or personal care;

(D)   SoonerCare (Medicaid) programs that categorically relate to the aged, blind, and disabled population, such as Qualified Medicare Beneficiary Plus (QMBP), Specified Low-Income Medicare Beneficiary (SLMB), or Qualified Disabled and Working Individuals (QDWI); or

(E)   SNAP.

(3)   An interview is not required when a person applies for:

(A)   LIHEAP; or

(B)   SoonerCare (Medicaid) when the Oklahoma Health Care Authority (OHCA) is responsible for determining eligibility per Oklahoma Administrative Code (OAC) 317:35-5-63.

(e)   Worker responsibilities. During the eligibility determination process, the worker is responsible for:

(1)   informing the applicant of the:

(A)   Oklahoma Department of Human Services (DHS) responsibility for reaching a decision and notifying the applicant of eligibility or ineligibility within the appropriate time limits per OAC 340:65-3-5;

(B)   applicant's right to request a fair hearing and be represented at the hearing by any person the applicant chooses per OAC 340:2-5. The applicant may request a fair hearing when there is a:

(i)   delay beyond the established time limits for determining eligibility per OAC 340:65-3-5; or

(ii)   disagreement with any action taken on the case;

(C)   applicant's legal responsibility for reporting all facts pertinent to eligibility;

(D)   types of changes the applicant must report within 10-calendar days;

(E)   penalty for failing to report changes;

(F)   information needed to establish eligibility. The worker uses Form 08AD092E, Client Contact and Information Request, to request an interview or verification and gives the applicant at least 10-calendar days to comply per OAC 340:65-3-2.1;

(G)   type of assistance DHS provides in establishing eligibility;

(H)   permission the applicant gives DHS to obtain information from sources other than the applicant; and

(I)   applicant's responsibility to cooperate with state and federal officials when the applicant's case is selected for a Quality Control review;

(2)   collecting information necessary for determining the applicant's initial and continuing eligibility. Information is considered verified when not questionable or inconsistent with known facts, and the information provider is the primary source of the information. The worker accepts, without further verification, the:

(A)   applicant's statement concerning:

(i)   residency;

(ii)   relationship;

(iii)   age;

(iv)   living in the home of a relative payee;

(v)   a minor parent living in the home of a relative;

(vi)   Social Security number (SSN);

(vii)   non-liquid resources;

(viii)   household members;

(ix)   school attendance; and

(x)   third party insurance;

(B)   unearned income information obtained through:

(i)   Beneficiary and Earnings Data Exchange System (BENDEX), from the Social Security Administration (SSA);

(ii)   Supplemental Security Income (SSI)/State Data Exchange System (SDX), from SSA;

(iii)   Unemployment Insurance Benefits (UIB), from the Oklahoma Employment Security Commission (OESC); and

(iv)   workers' compensation documents from Workers' Compensation Court; and

(C)   alien status information obtained through Systematic Alien Verification for Entitlements (SAVE), from the United States Citizenship and Immigration Services (USCIS);

(3)   contacting other persons who may be able to help establish eligibility when the applicant is unable to participate in the eligibility determination because of physical or mental disability, inability to speak English, or other difficulties;

(4)   determining whether the applicant is currently receiving benefits from another state when he or she has resided in Oklahoma for less than 12 months;

(5)   recognizing expressed or implied needs that include:

(A)   determining if there is a need for crisis intervention;

(B)   addressing the applicant's social services needs; and

(C)   making appropriate referrals; and

(6)   denying the application when sufficient facts are available to substantiate ineligibility.

(f)    SSN requirement. The applicant must provide a verifiable SSN or a pending SSN application for every person requesting food benefits, SSP, SSI-DCP, LIHEAP, or TANF benefits. The requirement for a verifiable SSN also applies to all persons whose needs are included for SoonerCare (Medicaid) benefits, except newborn children deemed eligible per OAC 317:35-6-60 and undocumented aliens requesting emergency medical services per OAC 317:35-5-25.

(1)   The worker accepts the applicant's statement to document each household member's SSN unless the information is inconsistent or there are other facts or observations that cause the worker to question the statement.

(A)   Persons for whom a SSN is required, but not available must be referred to the appropriate SSA office for SSN enumeration.

(i)   The worker uses Form 08AD101E, SSN Enumeration Referral, to refer persons to the SSA office for a SSN application.

(ii)   The return of Form 08AD101E to DHS validates the application(s) or indicates which persons have not provided SSA appropriate original evidence of age, identity, and citizenship.

(B)   Parents of newborns who participate in Enumeration at Birth (EAB) receive Form SSA-2853-OP3, Message From Social Security, from hospital personnel. This receipt form is verification the newborn was enumerated at birth.

(2)   When the person fails or refuses to furnish or to apply for a SSN, the worker takes action per (A) and (B) of this paragraph.

(A)   For TANF purposes, the person's needs are included; however, the worker imposes a 25 percent payment standard reduction penalty until an application for or a SSN is provided.

(B)   For food benefit and SoonerCare (Medicaid) purposes, only the needs of the person for whom a SSN is not provided or applied for are not included.

(g)   Citizenship requirement. All persons applying for federal or state public assistance benefits, such as Child Care Subsidy, SNAP food benefits, LIHEAP, SoonerCare (Medicaid), SSP, or TANF must declare the citizenship or alien status for each household member applying for such benefits on the application or benefit renewal. When the payee requests benefits for additional household members between application and benefit renewal, the payee completes and signs Form 08MP022E, Declaration of Citizenship Status, to declare the citizenship or alien status of the additional household members. Citizenship and alien status for persons applying for SoonerCare (Medicaid) benefits is determined using specific program requirements per OAC 317:35-5-25.

(1)   When the applicant declares that some or all of the household members applying for benefits are aliens, the worker must follow SAVE procedures per OAC 340:65-3-4 to determine the validity of documents provided to verify legal alien status.

(2)   The worker must follow each program's policy regarding citizenship and alien status requirements to determine benefit eligibility per:

(A)   OAC 340:40-7-5 for Child Care Subsidy benefits;

(B)   OAC 340:50-5-67 for SNAP food benefits;

(C)   OAC 340:20-1-8, 340:20-1-10, and 340:50-5-67 for LIHEAP;

(D)   OAC 317:35-5-25 for SSP; and

(E)   OAC 340:10-15-1 for TANF.

(3)   The citizenship requirements per (g)(3)(A) through (C) and (g)(4) of this Section are pursuant to Section 71 of Title 56 and Section 20j of Title 74 of the Oklahoma Statutes.

(A)   Lawful status in the United States (U.S.) is considered verified when:

(i)   the person applying for benefits provides a SSN or SSA completed Form 08AD101E indicating SSA accepted the person's SSN application; and

(ii)   DHS, through the automated SSN enumeration data exchange transaction with SSA, is able to verify the person's SSN.

(B)   Prior to receiving benefits, when DHS is unable to verify the SSN with SSA for a person 14 years of age or older, the person must:

(i)   provide a signed and notarized Form 08MP005E, Citizenship Affidavit, attesting to his or her U.S. citizenship or alien status; or

(ii)   provide a U.S. birth certificate, U.S. passport, a Certificate of Naturalization or other acceptable document per OAC 317:35-5-25 to verify lawful status.

(C)   When the person fails or refuses to provide a signed and notarized Form 08MP005E or one of the documents per (g)(3)B)(ii) of this Section, the worker denies or closes benefits for that person.

(4)   The application, benefit renewal, and Form 08MP022E contain a statement informing the applicant that DHS reports fraudulent claims of citizenship or lawful alien status to the U.S. Attorney and the person may be subject to criminal prosecution.

(5)   When the worker discovers a person who signed Form 08MP005E attesting to U.S. citizenship or legal alien status made a false claim:

(A)   the worker sends a memo and supporting documentation to Adult and Family Services (AFS). The memo must include:

(i)   the time frame, benefit type, and amount the person fraudulently applied for or obtained; and

(ii)   how the worker discovered the claim was false;

(B)   AFS staff in consultation with Legal Services staff, review the memo and supporting documentation; and

(C)   when AFS and Legal Services staff determine the person made a false claim, Legal Services staff files a complaint with the U.S. Attorney for the applicable district based upon the venue in which the affidavit was executed.

(h)   Eligibility determination. The worker determines eligibility after the applicant or other authorized person signs the application, completes an interview, when required, and provides required proof.

[Source: Amended at 18 Ok Reg 2096, eff 7-1-01; Amended at 20 Ok Reg 918, eff 6-1-03; Amended at 22 Ok Reg 827, eff 5-12-05; Amended at 23 Ok Reg 1907, eff 7-1-06; Amended at 25 Ok Reg 265, eff 11-1-07 (emergency); Amended at 25 Ok Reg 958, eff 6-1-08; Amended at 26 Ok Reg 1272, eff 6-1-09; Amended at 28 Ok Reg 880, eff 6-1-11; Amended at 29 Ok Reg 812, eff 7-1-12; Amended at 30 Ok Reg 686, eff 6-1-13; Amended at 33 Ok Reg 1629, eff 9-15-16]