Chapter 5101:1-5 Disability Assistance (DA) Eligibility Requirements

5101:1-5-01 The disability financial assistance program: definitions and payment standards.

(A) Definition of the disability financial assistance program

(1) Disability financial assistance (DFA) is a state and county-funded program which provides cash assistance to persons who meet DFA program requirements and who are ineligible for public assistance programs that are supported in whole or in part by federal funds (e.g., Ohio works first (OWF), supplemental security income (SSI)). No federal regulations govern the administration of the DFA program.

(2) When an assistance group is ineligible for any public assistance program supported in whole or in part by federal funds, the county department of job and family services (CDJFS) shall explore DFA eligibility. DFA shall be authorized on an ongoing basis as long as all DFA eligibility factors are met. It is not appropriate to issue DFA as temporary assistance to applicants or recipients of Ohio works first. DFA may be issued as temporary assistance to an assistance group pending federal categorical eligibility for SSI, if the individual is a member of one of the categories of covered individuals as set forth in paragraph (D) of this rule. If the assistance group is subsequently determined ineligible for SSI, DFA benefits may continue if all other DFA eligibility factors are met.

(B) Definition and formation of the DFA family group

(1) The DFA “family group” is defined as the assistance group (as set forth in paragraph (C) of this rule), and any persons related to any member of the assistance group by blood, adoption (i.e., parents and their children), or marriage who are living in the same home as the assistance group.

(a) The family group shall include all children, their siblings and half-siblings, under the age of eighteen who are living with their biological or adoptive parents. Additionally, a married individual who is living with his spouse must be included in the same family group with his spouse (the definition of marriage is set forth in rule 5101:1-3-03 of the Administrative Code). If the spouse has biological or adoptive children under age eighteen living with him, those children must also be included in the family group.

(b) A dependent child who is receiving DFA because the child is a covered individual as set forth in paragraph (D) of this rule, and who is living with an individual who is standing in place of a parent who is eligible for DFA in his own right, shall not be included in that individual’s family group.

(c) An individual who is living in a residential treatment center for substance abuse shall constitute his own family group, and shall not be in another family group while he remains in the residential treatment facility.

(d) The income and resources of all members of the family group are used in determining the eligibility of the assistance group for DFA, as set forth in rules 5101:1-5-30 and 5101:1-5-40 of the Administrative Code.

(e) The needs, income, and resources of the following individuals are excluded from the family group:

(i) OWF participants.

(ii) SSI recipients.

(iii) Individuals for whom federal, state or local foster care maintenance payments are made.

(iv) Individuals for whom federal, state or local adoption assistance payments are made.

(2) The family group is formed by selecting the following individuals:

(a) Siblings and half-siblings under the age of eighteen (including emancipated minors);

(b) The parent(s) of the children included in the family group;

(d) Any children of the spouse.

(1) The DFA “assistance group” is defined as a group of applicants for or recipients of DFA who are living together and treated as a unit for purposes of determining eligibility for DFA and establishing the amount of DFA benefits for which the group is eligible. The assistance group is formed by selecting all of the covered individuals (as set forth in paragraph (D) of this rule), from the family group (as defined in paragraph (B) of this rule). The assistance group can be the same composition as the family group, or a smaller group within the family group, depending upon the number of covered individuals within the family group.

(2) The DFA assistance group is formed by selecting the following covered individuals (defined in paragraph (D) of this rule) from the family group.

(a) When there are children, the DFA assistance group shall contain the following covered individuals (as defined in paragraph (D) of this rule):

(i) Siblings and half-siblings under the age of eighteen (including emancipated minors).

(ii) The parents of the children.

(iii) The spouse(s) of all members of the assistance group.

(iv) The spouse’s children.

(b) When there are no children, the assistance group shall contain the following covered individuals:

(i) An individual; or

(ii) A married couple.

(D) Covered individuals

(1) Eligibility for DFA is limited to the following individuals:

(a) An individual who is unable to do any substantial or gainful activity by reason of a medically determinable physical or mental impairment that can be expected to result in death or has lasted or can be expected to last for not less than nine months, as determined by the disability determination area (DDA) of the Ohio department of job and family services (ODJFS). The disability determination process is set forth in rule 5101:1-5-20 of the Administrative Code.

(b) An individual who, on June 30, 2003, was sixty years of age or older and one of the following is the case:

(i) The individual was receiving or was scheduled to begin receiving financial assistance under Chapter 5115. of the Revised Code on the basis of being sixty years of age or older;

(ii) An eligibility determination was pending regarding the individual’s application to receive financial assistance under Chapter 5115. of the Revised Code on the basis of being sixty years of age or older and, on or after July 1, 2003, the individual receives a determination of eligibility based on that application.

(2) DFA is the category of financial assistance for a minor child who meets the conditions set forth in paragraph (D) of this rule, and who is living with a nonrelated caretaker who is standing in place of the parent but does not meet the OWF living arrangement requirement set forth in rule 5101:1-3-03 of the Administrative Code. The individual standing in place of the parent must either be at least eighteen years old or emancipated. A referral to the children services agency may be appropriate in these nonrelative situations.

(E) Ineligible individuals

An individual is not eligible for DFA if any of the following conditions set forth in this paragraph apply.

(1) The individual is eligible to participate in the OWF program established under Chapter 5107. of the Revised Code. An individual who is eligible for OWF solely due to their status as a specified relative as defined in section 5107.02 of the Revised Code, has the option to participate in the OWF program or the DFA program.

(2) The individual is eligible to receive supplemental security income (SSI) pursuant to Title XVI of the “Social Security Act, ” 86 Stat. 1475 (1972), 42 USC 1383, as amended.

(3) The individual is eligible to participate in or receive assistance through another state or federal program that provides financial assistance similar to disability financial assistance, as determined by the director of ODJFS.

(4) The individual is ineligible to participate in the OWF program because of any of the following:

(a) The time limit established by section 5107.18 of the Revised Code;

(b) Failure to comply with an application or verification procedure;

(c) The fraud control provisions set forth in section 5101.83 of the Revised Code, or the fraud control program established pursuant to 45 CFR 235.112, as in effect July 1, 1996;

(d) The self-sufficiency contract and related sanction provisions set forth in sections 5107.14 and 5107.16 of the Revised Code;

(e) The minor parent provisions set forth in section 5107.24 of the Revised Code;

(f) The provisions of section 5107.26 of the Revised Code regarding termination of employment without just cause.

(5) Ineligibility under paragraphs (E)(4)(c) to (E)(4)(d) of this rule applies as follows:

(a) In the case of an individual who is under eighteen years of age, the individual is ineligible only if the individual caused the assistance group to be ineligible to participate in the OWF program or resides with an individual eighteen years of age or older who was a member of the same ineligible assistance group.

(b) In the case of an individual who is eighteen years of age or older, the individual is ineligible regardless of whether the individual caused the assistance group to be ineligible to participate in OWF.

(6) Except for those individuals determined ineligible pursuant to paragraph (E)(4)(f) of this rule, a member of a DFA assistance group who has quit or refused employment or training within the past thirty days without good cause is ineligible for DFA for thirty days beginning with the date of the refusal or termination of employment or training.

(7) The individual, or any of the other individuals included in determining the individual’s eligibility for DFA, is involved in a strike, as defined in section 5107.10 of the Revised Code.

(8) The individual is an undocumented alien who fails to meet citizenship requirements.

(9) The individual became ineligible for SSI due to a failure to comply with SSI program requirements.

(10) For the purpose of avoiding consideration of property in determinations of the individual’s eligibility for DFA or a greater amount of assistance, the individual has transferred property for less than fair market value during the two years preceding application for or most recent reapplication of eligibility for DFA.

(11) The individual is a child and does not live with the child’s parents, guardians, or other persons standing in place of parents, unless the child is emancipated by being married, by serving in the armed forces, or by court order.

(12) The individual resides in a county home, city infirmary, jail or public institution.

(13) The individual is a fugitive felon as defined in section 5101.26 of the Revised Code.

(14) The individual is violating a condition of probation, a community control sanction, parole, or a post-release control sanction imposed under federal or state law.

(F) For purposes of determining eligibility for any covered individuals in the home (as set forth in paragraph (D) of this rule), the ineligible individual/family is part of the DFA family group (as defined in paragraph (B) of this rule), and the resources and income of the ineligible individual/family are countable to the family group.

(G) Need

(1) Need is defined as the deficit between the requirements of the family group according to the applicable DFA standard and the income available for immediate use.

(a) An assistance group with available countable income in excess of the appropriate DFA payment standard is not eligible regardless of whether other eligibility factors are met.

(b) An assistance group with available countable income less than the appropriate DFA payment standard is eligible for financial assistance in an amount equal to the difference between the appropriate DFA payment standard less the countable income or the state DFA payment standard for the DFA covered individual(s), whichever is the lesser amount, provided all other eligibility factors are met.

(2) The assistance group must meet all eligibility criteria set forth in Chapter 5101:1-5 of the Administrative Code and must not have its needs met by another source of financial assistance.

(3) The amount of DFA benefits to be issued depends upon the number of DFA covered individuals in the DFA assistance group. The standard for the appropriate family/assistance group size is provided in paragraph (G)(5) of this rule.

(4) The DFA payment standard is the figure used in evaluating need and in determining eligibility for the DFA program. The payment standard is the figure which is used to calculate the actual DFA payment and from which all countable income is deducted.

(5) The following chart shows the DFA payment standard.

Number in family/assistance group DA DFA payment standard

1 $ 115

2 159

3 193

4 225

5 251

6 281

7 312

8 361

9 394

10 426

11 458

12 490

13 522

14 554

15 594

for each person above 15 add 40

(H) In order to confine DFA expenditures to appropriated state funds, the director of job and family services, or his designee, may issue an order at any time suspending the approval of any new applications for DFA. The order will be distributed to all CDJFS on the same day and will remain in effect until rescinded. During a program suspension, all new applicants will be advised that a suspension is in effect. All new applications will be denied during the same time that a suspension is in effect. No waiting lists will be established during the periods of suspension.

Effective: 11/01/2007

R.C. 119.032 review dates: 08/01/2007 and 11/01/2012

Promulgated Under: 111.15

Statutory Authority: 5115.02, 5115.03

Rule Amplifies: 5115.01, 5115.02, 5115.03

Prior Effective Dates: 7/1/76, 9/1/76, 1/1/85 (Emer.), 4/1/85, 8/1/85 (Emer.), 10/17/85, 8/1/86 (Emer.), 9/15/86 (Emer.), 11/5/86, 4/1/88 (Emer.), 6/30/88, 10/1/91 (Emer.), 12/20/91, 4/1/92 (Emer.), 6/30/92, 7/1/92, 11/1/92, 7/1/93, 9/1/93, 12/30/93 (Emer.), 3/18/94, 7/1/94, 9/1/94, 8/1/95 (Emer.), 10/30/95, 7/1/96 (Emer.), 9/29/96, 10/1/96 (Emer.), 12/20/96, 9/3/97 (Emer.), 10/1/97, 7/1/98, 10/1/99, 7/1/01, 7/1/03 (Emer.), 9/30/03, 7/1/05 (Emer.), 9/29/05

5101:1-5-10 Disability financial assistance (DFA): nonfinancial eligibility requirements.

(A) Residence

(1) The individual must be physically present in the state of Ohio with the intent to remain. An individual must apply for and receive assistance from the county in which he resides.

(2) Absence from the county for more than thirty days constitutes evidence of intent to establish residence elsewhere, unless a written statement has been submitted to indicate intent to return to the county. The statement must be retained in the case record. The county department of job and family services (CDJFS) shall consider such written statement as acceptable proof of intent to return to the county if the statement includes the reason for the absence and the expected date of return. However, a written statement is not considered acceptable proof of intent to return to the county when the individual contradicts the statement by applying for public assistance in another county or state.

(B) Citizenship/alien status

The provisions as set forth in rules 5101:1-2-30 and 5101:1-2-35 of the Administrative Code regarding citizenship and sponsored aliens are applicable for DFA.

(1) DFA may be given to individuals living in their own homes or other suitable quarters, but shall not be given to individuals who reside in a county home, city infirmary, jail, or public institution.

(2) DFA shall not be given to an unemancipated child unless the child lives with his parent, guardian, or other individual standing in place of a parent and that person is at least eighteen or emancipated. Pregnant minors are subject to this requirement. A child is emancipated if he is married, serving in the armed forces, or has been emancipated by court order. Emancipation is irrevocable, unless the marriage which emancipated the minor is annulled. In order for a child to be eligible for DFA, the child must meet the condition as set forth in paragraph (D)(1)(a) of rule 5101:1-5-01 of the Administrative Code.

(3) An individual residing in a residential treatment center meets the living arrangement requirement.

(4) An individual residing in an Ohio department of mental health or Ohio department of mental retardation and developmental disabilities licensed or supervised home is eligible for DFA provided that all other eligibility requirements are met.

(5) An individual residing in a mental health institution, with an anticipated date of release, is potentially eligible. The CDJFS processes the application, even though the living arrangement requirement is not met at the time of application.

(a) The application for assistance is filed in the county in which the applicant will reside upon release from the mental health facility. The applicant will be assisted through the application process by a social worker in a mental health institution or a case manager from a community mental health agency.

(b) If all eligibility factors for DFA, with the exception of living arrangements, have been met, the CDJFS shall approve the DFA, but have the check directed to the CDJFS, pending release of the applicant from the mental health facility.

(c) The beginning date of cash assistance will be the date of release from the mental health facility, as all eligibility factors will be met on that date. The mental health workers are being instructed to provide the CDJFS with the latest possible date of release for the individual. If the release occurs earlier than the given date, any underpayment will be provided to the individual.

(d) The initial DFA warrant shall be picked up at the CDJFS upon the individual’s release from the mental health facility. If the individual so chooses, the warrant may be mailed to the residence upon the notification of the individual’s release. Subsequent warrants shall be forwarded to the assistance group’s residence as is done with all other DFA assistance groups.

(e) If during the application process, the CDJFS determines that the individual will not be released into the community, the CDJFS shall terminate the DFA and cancel the warrant.

(f) Many of the individuals applying for DFA will also be applying for supplemental security income (SSI). For those individuals, the interim assistance provisions as set forth in rule 5101:1-5-70 of the Administrative Code must be followed.

Effective: 11/01/2007

R.C. 119.032 review dates: 08/01/2007 and 11/01/2012

Promulgated Under: 111.15

Statutory Authority: 5115.03

Rule Amplifies: 5115.03

Prior Effective Dates: 7/1/76, 10/10/83 (Temp), 12/22/83, 9/15/84 (Emer.), 12/15/84, 8/1/85 (Emer.), 10/17/85, 4/1/86, 1/1/89, 1/3/89 (Emer.), 4/1/89, 5/28/89, 4/1/90, 10/1/91 (Emer.), 12/20/91, 12/30/93 (Emer.), 3/18/94, 8/1/95 (Emer.), 10/30/95, 3/1/96 (Emer.), 5/30/96, 10/1/96 (Emer.), 12/15/96, 7/1/98, 7/1/99, 1/1/03, 7/1/03 (Emer.), 9/30/03, 7/1/05 (Emer.), 9/29/05

5101:1-5-20 DFA: disability and the determination of disability.

(A) Definition of disability

This rule addresses the eligibility criterion of disability for the DFA program.

“Disability” for purposes of the DFA program is defined in section 5115.01 of the Revised Code, as an individual who is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or that has lasted or can be expected to last for a continuous period of not less than nine months. The determination of disability is made by the county medical services (CMS) unit, and is based on SSI disability criteria except for the twelve-month SSI disability requirement.

(B) Disability determination process

Except as provided in paragraph (B)(1)(a)(i) of this rule, if an individual has, appears to have or alleges to have a disability as defined in paragraph (A) of this rule, the CDJFS must develop the medical information necessary for submission to the CMS unit for a determination of disability. The determination of disability by the CMS unit for potential medicaid may be used to meet the disability determination requirement for the DFA program.

(1) CDJFS responsibilities

(a) The CDJFS must determine that the criterion of disability is met when:

(i) an individual has been approved for SSA disability benefits for the individual’s own disability or blindness. “SSA disability benefits” are disability benefits provided to an individual and authorized by the SSA through Title II and Title XVI of the Social Security Act [42 U.S.C. 402 (4/7/2000) and 42 U.S.C. 416 (8/15/1994)]. The CDJFS does not have to develop and submit a CMS packet for a CMS disability determination in this circumstance; or

(ii) an individual is determined to have a presumptive disability by the SSA, and the individual has an application for SSA disability benefits pending. However, the CDJFS must also submit a CMS packet to the CMS unit in this circumstance.

(b) The CDJFS cannot make its own determination of disability based upon the contents of the JFS 07302, “Basic Medical Form”.

(i) An individual has, alleges to have, or appears to have a physical or mental impairment, or combination of impairments that may limit his or her ability to work;

(ii) An individual is, alleges being, or appears to be blind;

(iii) An individual has a pending application for SSA disability benefits under Title II of the Social Security Act, and/or SSI benefits under Title XVI of the Social Security Act (42 U.S.C. 402 and 42 U.S.C. 416 respectively); or

(iv) An individual has, alleges having, or appears to have a physical or mental impairment, blindness, or combination of impairments, but is eligible for medicaid under a category other than disability or blindness.

(d) As a condition of DFA eligibility, the CDJFS must require individuals to apply for SSA disability benefits under Title II of the Social Security Act, and/or SSI benefits under Title XVI of the Social Security Act, to which they are or may be entitled.

(e) Upon request, the CDJFS must assist the individual in obtaining medical documentation to support the disability or blindness claim. Upon request, the CDJFS must utilize administrative funds to assist the individual in receiving an eye examination or medical/psychological examination to determine whether an individual is blind or disabled.

(f) The CDJFS must obtain all available current medical information as well as any other information requested by the CMS unit and submit it in the CMS packet.

(i) The CDJFS must include in the CMS packet all available current medical information for all alleged impairment(s) or combination of impairments.

(ii) The CDJFS must assist the individual in obtaining existing medical information, tests, services or records from other entities, such as the SSA, Ohio rehabilitation services commission, workers’ compensation, etc.

(g) The CDJFS must give the forms listed in this paragraph to the individual, the individual’s legal representative, another person applying on behalf of the individual, or the treating physician(s).

(i) JFS 07302, “Basic Medical Form”. This form must be signed by a licensed physician (M.D. or D.O.);

(ii) JFS 07308, “Mental Functional Capacity Assessment” when the individual has or appears to have a mental impairment. This form must be signed by a licensed physician/psychiatrist (M.D. or D.O.), or licensed psychologist.

(h) The CDJFS or SSI case manager must complete the JFS 07004, “Social Summary Report for Disability Determination”.

(i) The CDJFS must complete the JFS 03605, “Administrative Agency Referral to the CMS Unit” using the current medical information..

(j) The CDJFS must submit the CMS packet to the CMS unit for a disability determination.

(k) When the CMS unit has deferred a disability determination, and the CDJFS is unable to obtain all of the requested additional medical information, the CDJFS must resubmit the initial CMS packet and any additional information to the CMS for a final disability decision.

(l) The CDJFS must maintain case records in accordance with rule 5101-9-21 of the Administrative Code.

(m) If the CMS unit determines that the individual meets the disability requirement for DFA, the CDJFS must approve DFA if all other DFA eligibility requirements are met.

(n) The CDJFS must issue proper notice and hearing rights as outlined in division-level designation 5101:6 of the Administrative Code.

(o) All individuals who appear to meet the aged, blind or disabled criteria as set forth in rule 5101:1-39-03 of the Administrative Code, must be referred to the SSA to apply for SSI. Additionally, all individuals applying for or in receipt of DFA who appear to meet the blind or disabled criteria set forth in rule 5101:1-39-03 of the Administrative Code must be referred to the SSI case management program. DFA may be authorized for an individual whose SSI application is pending, provided that the individual meets all of the following:

(i) The individual meets all DFA eligibility requirements; and,

(ii) The individual is not eligible for an interim or advance payment from SSI; and,

(iii) The individual complies with the requirements of DFA interim assistance as set forth in rule 5101:1-5-70 of the Administrative Code.

(p) The CDJFS must submit the following information to the CMS unit prior to the disability review date. The disability review date is the date that the CMS unit enters into CRIS-E as the date on which the CMS unit determines that the current CMS approval will expire. The CDJFS must not terminate DFA assistance based solely on the expiration of the current CMS approval without a new CMS determination of disability. The CDJFS must submit:

(i) A new CMS packet. The CMS packet must contain all required forms specified in paragraph (B)(1) of this rule and all available current medical information to support the disability claim;

(ii) The previously approved CMS packet; and

(iii) Any other information requested by the CMS unit.

(2) Responsibilities of the individual

(a) When the individual alleges a disability or blindness, the individual must provide documentation from an appropriate medical professional knowledgeable about the individual’s current medical status to support the existence of the impairment or condition.

(b) Each applicant for or recipient of DFA who, in the judgment of the ODJFS or the CDJFS might be eligible for SSI, must, as a condition of eligibility for DFA, apply for SSI if directed by the ODJFS or the CDJFS. The CDJFS must also require the applicant or recipient, as a condition of eligibility for DFA, to pursue reconsiderations and appeals of the social security administration decisions that deny the individual SSI benefits.

(3) County medical services (CMS) unit responsibilities

(a) The CMS unit will approve, deny or defer disability determinations submitted by the CDJFS. The CMS unit will notify the CDJFS upon approving, denying or deferring a disability determination via CRIS-E and the JFS 03600, “County Medical Services Disability Determination”.

(b) When the CMS unit approves a disability, the CMS unit will determine the disability begin date and the disability review date. The CMS unit will inform the CDJFS via CRIS-E and the JFS 03600, “County Medical Services Disability Determination”.

(c) The CMS unit will approve, deny or defer disability reviews submitted by the CDJFS. The CMS unit will notify the CDJFS upon approving, denying or deferring a disability review via CRIS-E and the JFS 03600.

(d) In accordance with paragraph (B)(1)(k) of this rule, when the CDJFS is unable to obtain all of the requested additional medical information in a deferred case, the CDJFS must submit the initial CMS packet to the CMS unit. The CMS unit must make a final decision on the case. The CMS unit will notify the CDJFS of the decision via CRIS-E and the JFS 03600.

(e) Any decision made by the CMS unit is subject to all hearing and appeal rights in accordance with division level designation 5101:6 of the Administrative Code.

(1) As set forth in paragraph (B)(3)(b) of this rule, when the CMS unit approves a disability, the CMS unit will determine the disability begin date and the disability review date.

(2) As set forth in paragraph (B)(1)(p) of this rule, the CDJFS must submit a CMS packet to the CMS unit before the disability review date.

(3) If the individual continues to meet all other DFA eligibility requirements as provided in Chapter 5101:1-5 of the Administrative Code, the CDJFS must continue DFA eligibility for the individual while the CMS unit is conducting the disability review.

(D) When DFA benefits are terminated, and the individual reapplies for DFA

(1) Within twelve months after the disability begin date, the disability criterion is met. The CDJFS must not submit a new CMS packet to the CMS unit. The CDJFS must apply the existing disability review date, in accordance with paragraph (B)(3)(b) of this rule. However, the CDJFS must submit a CMS packet to the CMS unit before the disability review date originally established by the CMS unit.

(2) Beyond twelve months of the disability begin date, the disability criterion is not met. The CDJFS must submit a new CMS packet to the CMS unit for a disability determination, in accordance with paragraph (B)(1) of this rule.

HISTORY: Eff 9-3-77; 1-1-81; 6-1-84; 9-6-84; 8-1-85; 7-1-87 (Emer.); 8-3-87; 1-1-88; 3-28-88; 4-1-89 (Emer.); 4-24-89; 4-1-90; 10-1-90; 10-1-91 (Emer.); 12-20-91; 4-1-92 (Emer.); 6-30-92; 12-22-92 (Emer.); 3-20-93; 10-30-95; 7-1-98; 7-1-03 (Emer.); 9-30-03; Rescinded and reenacted eff. 1-1-05

Rule promulgated under: RC 111.15

Rule authorized by: RC 5115.03

Rule amplifies: RC 5115.01, 5115.03

R.C. 119.032 review dates: 01/01/2010

5101:1-5-30 Disability financial assistance (DFA): resources.

(A) Definition of resources

(1) “Resources” are those possessions belonging to members of the family which may be used for their support. Resources include personal property, real property, and liquid assets as well as assets not in liquid form. All resources of all members of the family group, as defined in rule 5101:1-5-01 of the Administrative Code, must be evaluated in terms of value and availability.

(2) The total equity value of all countable real property, personal property, and liquid assets owned by the members of the family group cannot exceed one-thousand dollars. All resources are evaluated according to equity value. “Equity value” is defined as fair market value minus liens or encumbrances. “Fair market value” is defined as the price for which an item of a particular make, model, size, material, or condition will sell on the open market in the geographic area involved. “Geographic area” means the area covered by radio, television, newspaper, and other media serving the area where the family group lives and/or the property is located.

(B) Availability of resources

(1) When evaluating any resource, the county department of job and family services (CDJFS) must determine availability of the resource to the family group as defined in paragraph (A) of this rule. For a resource to be considered in determining eligibility, the resource must be available or accessible to the family group. The family group must have the legal right to control and dispose of the property for it to be counted as a resource. The family group’s interest in the resource can be determined by checking the deed, mortgage, purchase agreement, contract, county records, etc.

(2) The basic principle in determining the value of the family group’s resources in the determination of eligibility for DFA assistance groups within the family group, is that property owned by a member of the family group is regarded as available to all members of the family group.

(3) A resource is considered to be available to the family group as long as the owner of the resource (who is a member of the family group), or any other member of the family group is aware, or has reason to be aware of the resource. If the recipient convinces the CDJFS that all members of the family group were unaware of the resource and had no reason to be aware of the resource, then the resource shall be considered to have been unavailable. The family group has the burden of proving that each member of the family group was unaware of, and had no reason to be aware of the resource. The resource will be considered to have been unavailable only for the period of time the family group can demonstrate that they had no reason to be aware of the resource. Once any member of the family group becomes, or has reason to become aware of the existence of the resource, the resource will be considered available to the family group.

(4) If a family group member shares ownership of a resource with an individual who is not a member of the family group, or one of the excluded individuals identified in rule 5101:1-5-01 of the Administrative Code, and that individual indicates the intention of blocking the family group’s use or disposal of the resource, the family group should be referred to available legal services. If legal means of pursuit are available, the family group is required to take any and all necessary action to make the resource available. If the family group is unwilling to take action to make the resource available, the assistance group is ineligible for DFA. If the family group is unable to make the resource available because one of the owners cannot be located, the cost of legal action is prohibitive, etc., the resource is not considered to be available to the family group. Availability shall be reviewed at each reapplication.

(1) The home which is the usual residence of the family group. The homestead includes one home and all adjoining land.

(a) The family group must use the homestead property as their home on a permanent basis. In case of temporary absence, they must return to live in the home within a reasonable amount of time, not to exceed six months.

(b) A mobile home or trailer owned by a member of the family group is exempt as a resource if it is used by the family group as theirits residence. If a mobile home or trailer is owned by a member of the family group and is not used as the home, it is a resource. Its value must be assessed toward the resource limitation.

(2) Real property that is owned by a family group member but is not used by the family group as the residence may be exempt if it is used to produce income to support the family group. It is exempt if the annual net income produced equals at least six per cent of the current market value as determined by the county auditor and the monthly net income is used to support the family group.

(3) Nonhomestead property pending a sale, provided it is listed for sale at a value not less than the value determined by the county auditor as the current market value and no offer is refused that is at least ninety per cent of the value determined by the county auditor as the current market value.

(4) The entire value of all vehicles owned by any family group member shall be excluded.

(5) Basic maintenance items essential to day-to-day living such as clothes, furniture, appliances, televisions, stereos, and other similarly essential items of limited value.

(6) Bona fide loans from any source.

(7) Educational grants and scholarships from any source for undergraduate and graduate college expenses.

(8) Payments received by individuals of Japanese ancestry under Section 105 of Public Law 100-383 (08/10/88), and payments received by the Aleuts under Section 206 of Public Law 100-383.

(9) Payments made on or after January 1, 1989, from the “Agent Orange Settlement Fund” or any other fund established pursuant to the settlement in the “In Re Agent Orange” product liability litigation, M.D.L. No. 381 (E.D.N.Y.) under Public Law 101-201 (103 Stat. 1795) (December 6, 1989) and section 10405 of Public Law 101-239 (103 Stat. 2489) (December 19, 1989).

(10) One burial space for each member of the family group.

(11) Payments received under the provisions of the Maine Indian Claims Settlement Act of 1980 (Public Law 96-420, 10/10/80) received on or after October 10, 1980.

(12) Payments received under the provisions of the Radiation Exposure Compensation Act (Public Law 101-426, 10/15/90) received on or after October 15, 1990.

(13) Payments received under the provisions of Aroostook Band of Micmacs Act (Public Law 102-171, 11/26/91) received on or after November 26, 1991.

(14) Payments received under the provisions of the Child Care and Development Block Grant (Section 5082 of Public Law 101-508, 11/05/90).

(15) Escrow accounts established and credited as the direct result of the assistance group’s involvement in the family self-sufficiency program on or after May 13, 1992. These escrow accounts are only considered available when the assistance group is no longer receiving any federal, state, or other public assistance for housing.

(16) Payments received under the provision of the Seneca Nation Settlement Act of 1990 (Public Law 101-503, 11/03/90) received on or after November 3, 1990.

(17) The resources of an individual on whose behalf federal, state or local foster care maintenance payments are made.

(18) The resources of an individual on whose behalf federal, state or local adoption assistance payments are made.

(19) The resources of an SSI recipient.

(20) Earned income tax credit (EITC) payments in the form of a refund of federal income taxes or in the form of an advance payment by an employer must be disregarded in the month of receipt of such payment and in the month following. When an applicant has received the EITC refund in the month prior to application, any remaining portion of the EITC payment will be considered an exempt resource in the month of application.

(21) Funeral arrangements with equity value of one thousand five hundred dollars or less for each family group member. If the equity value of funeral arrangements exceeds one thousand five hundred dollars, the excess value shall be counted toward the resource limitation.

(22) Assistance received in accordance with a federal statute (e.g., the Federal Disaster Relief Act of 1974) and in conjunction with a catastrophe declared by the president of the United States to be a disaster.

(23) A payment of disaster assistance, casualty insurance, or other settlement specifically designated to replace a resource lost due to a disaster is considered as a resource in the same manner as the exempt resource for a period of six months. When the family group intends to replace or repair the exempt resource but circumstances beyond his control prevent replacement or repair within the six-month period, an extension of up to six additional months may be granted. Any portion of the payment not used within the applicable period to make replacement or repair of the item is considered to be a liquid asset subject to the resource limitation.

(24) Child support payment distributions made by the Ohio department of job and family services (ODJFS) pursuant to division (C) of Section 1 of Am. S.B. 170 of the 124th General Assembly and rules 5101:1-29-31.1 and 5101:1-29-31.2 of the Administrative Code.

(25) As set forth in section 5115.03 of the Revised Code, the value of any tuition payment contract entered into under section 3334.09 of the Revised Code or any scholarship awarded under section 3334.18 of the Revised Code and the amount of payments made by the Ohio tuition trust authority under section 3334.09 of the Revised Code pursuant to the contract or scholarship. The CDJFS shall not require any individual to terminate a tuition payment contract entered into under Chapter 3334. of the Revised Code as a condition of eligibility for DFA.

(26) The cash value of pension plans or funds shall be excluded, including public employees retirement system (PERS) and Ohio public employees deferred compensation program funds as long as the funds remain in PERS or Ohio deferred compensation, respectively, individual retirement accounts (IRAs), Keogh plans that involve no contractual obligation with anyone who is not a family group member and simplified employer pension plans (often referred to as SEP-IRAs), which are operated like IRAs and in which employers make direct deposits in IRA-like retirement accounts for workers.

(27) Individual development accounts (IDAs) are excluded regardless of their funding source.

(D) Countable resources

All liquid assets owned by the family group are countable resources. “Liquid assets” are those resources which are in cash or payable in cash upon demand. The most common types of liquid assets are cash on hand, savings accounts, checking accounts, trusts, stocks, and mortgages. The value of such items must be assessed, combined with the value of all of the family group’s other countable resources, and counted toward the one-thousand-dollar family group resource limitation.

“Personal property” consists of those resources that are available for the support or maintenance of a family group’s needs. Personal property includes property owned separately by the family group or the family group’s prorated share of property owned jointly. It consists of those items which are easily transported and stored, such as cash, bonds, life insurance, etc.

(1) Stocks

The “value of stock” is the closing price in a newspaper. The value of stocks traded over the counter is expressed on a “bid” and “asked” basis. The bid price is used to determine the value of a stock. If the closing or bid price of a stock is not shown, a local securities firm must determine its value. If the ownership of the stock is shared, i.e., more than one name is on the face of the stock certificate, it is jointly owned and each person’s share is equal. Shares of stock in an Alaskan native regional or village corporation are exempted from resources.

(2) U.S. savings bonds

(a) A “U.S. savings bond” is an obligation of the federal government but unlike other government bonds, it is not transferable; that is, it can only be sold back to the government. Several series of U.S. savings bonds, e.g., I, J, H, can be quickly converted into cash at local banks. Some bonds, including series e bonds, must be held at least sixty days from the date of issuance before they can be cashed. Other than those bonds, most savings bonds are convertible within one to two days.

(b) U.S. savings bonds are usually registered in the name of the owner(s) shown on the front of the bond and may be redeemed by the owner by completing a form on the back of the bond. If ownership of the bond is shared (more than one name is on the face of the bond), each person’s share is equal, but any one of them can dispose of the bond.

(c) In establishing the value of a U.S. savings bond, the date of issuance on the face of the bond is controlling. The value of the bond depends on the time elapsed from the date of issue. Although many U.S. savings bonds have a table of values on the reverse of the bond, this table is often inaccurate since the interest rate on U.S. bonds may have changed since the bond was issued.

(3) Mortgages

A “mortgage” is a pledge of a particular property for the payment of a debt or the performance of some other obligation within a prescribed time period. A mortgage may generally be discounted or sold. The amount for which the mortgage could be discounted or sold is the amount of the countable resources.

(4) Preneed funeral contracts

(a) A “preneed (prepaid) funeral contract” is a written agreement, contract, or series of contracts to provide funeral services and/or funeral goods to be used in connection with the funeral or final disposition of human remains.

(b) If the equity value of funeral agreements exceeds one thousand five hundred dollars, the excess value is counted toward the resource limitation. Prior to determining whether the excess value is available to the family group, the contract will have to be reviewed to determine whether it is revocable or irrevocable.

(c) All payments for funeral goods and services made under a preneed funeral contract remain intact as a fund held by a financial institution or in a common or pooled trust fund until the death of the person for whose benefit the agreement is made or until the goods or services are delivered.

(d) Any deposit may be released upon demand of the person for whose benefit such deposit was made or upon the demand of the seller for its share of the deposited funds and earned interest if the contract has been canceled.

(5) Checking and savings accounts

(a) Having a checking or savings account is virtually like having cash on hand because deposits are payable on demand. An individual should be able to withdraw money from a checking account or savings account on the same day he requests it. The balance(s) of savings and/or checking accounts belonging to the family group member must be combined with the value of all of the family group’s other countable resources and counted toward the resource limitation.

(b) If the checking or savings account documentation shows deposit and withdrawal activity inconsistent with the family group’s stated financial situation, the case shall be investigated fully to establish the source of the income. If the checkbook or bank statement is not available or there is some reason to doubt the accuracy of the record, verification shall be obtained from the bank, with the family group’s written authorization.

(c) All funds in a joint account are a resource of the family group member if he has unrestricted access to the funds. In joint account situations which affect the eligibility of the DFA assistance groups within the family group, the family group shall be advised of the responsibility to provide documentation to support the contention that access to the joint account is restricted. The family group member may support the contention by submitting the contract (depository account/signature card) with the financial institution or a statement from the financial institution or by documenting that a substantial portion of the account was contributed by another person who is not a member of the family group. If the family group member’s signature is all that is necessary to access the account, then the account shall be considered in its entirety, unless documentation is provided that indicates the other person deposited a substantial portion of the funds.

(d) When the family group provides documentation that shows the other person has a substantial interest in the account, only the portion that the family group contributed shall be considered as a resource in determining eligibility for the DFA assistance groups within the family group. Interest accrued on the account shall be allocated according to the portions of ownership. Documentation to show that the family group member does not own all the funds in the account include:

(i) A statement of the family group member listing the reason for establishing the joint account, who made deposits to and withdrawals from the account, how withdrawals were spent, etc.;

(ii) Corroborating statements from other account holder(s); and

(iii) Where ownership for prior periods needs to be established, the evidence must include a financial institution record, income statement or work record.

(e) If the coholder of the joint account is incompetent or a minor, it is not necessary to obtain a corroborating statement from that individual. That person’s incompetency or age may be the reason why the family group member is listed as a joint account holder. The CDJFS shall obtain a corroborating statement from a third party who has knowledge of the circumstances surrounding the establishment of the joint account. If there is no third party, then the CDJFS shall make the decision without a corroborating statement and document the basis for the decision.

(6) Life insurance

In order for the value of any life insurance policy to be considered in the total amount of resources, it is necessary that the policy be owned by the family group or a member of the family group. The cash value of any life insurance must be assessed, combined with the value of all other countable resources, and counted toward the resource limitation.

(7) Trusts

(a) A “trust” is a right of property held by one party for the benefit of another. The person who holds the legal title to property for the benefit or use of another is the “trustee”.

(b) The CDJFS should not automatically consider a trust owned by or created for a member of the family group unavailable. In some instances the beneficiary may petition the court to have funds released early in order to meet current needs. The family group member must attempt to make the resource available by consulting a legal aid service or the county prosecutor’s office. If the family group member is unable to make the resource available or the cost of legal action is prohibitive, the trust is considered unavailable. Unavailability must be reviewed at each reapplication.

(c) If the person who created the trust is a family group member, the trust shall be considered a resource as the family group has the legal ability to dissolve it and to use the money. If a family group member is a beneficiary of a trust, the trust shall not be considered as a resource to the family group when the family group cannot convert it to cash. Any payment the family group receives from the trust is unearned income and shall be treated in accordance with the provisions set forth in rule 5101:1-5-40 of the Administrative Code.

(d) A person who is appointed a trustee generally cannot use any of the funds within the trust for his own benefit. Therefore, an individual may be a trustee of a valuable trust and not be able to receive money from it since he has no access to the funds for his personal use. Under such circumstances, it is not a resource to him. If a family group member is acting as a trustee for a trust he created, the trust is a resource as provided in paragraph (D)(7)(c) of this rule.

(8) Real property

(a) The term “real property” includes all rights in land and objects affixed to the land, such as buildings, fences, crops, trees, etc. Real property shall only be counted when the family group has a legal interest in, and the legal ability to use or dispose of, the property.

(b) Real property retained by the family group, which is not exempt according to one of the criteria set forth in paragraphs (C)(1) and (C)(2) of this rule, is a countable resource. The amount of the countable resource of nonexempt real property is its equity value, the current market value minus liens and encumbrances. This equity value is counted toward the resource limitation.

(i) The current market value of all types of real property including homestead is calculated by determining the assessed value used for property taxes. The CDJFS shall determine the assessed value by using the local county auditor’s procedures.

(ii) County auditor’s assessment of value is presumed to be reasonably accurate as the market value. If the county auditor’s value is unreasonable or inaccurate to a prudent person, an appraisal secured from a licensed real estate broker may be submitted as the market value of the real property.

(c) Real property that is owned by the family group but is not used as the family group’s residence or used to produce income for the family group, as set forth in paragraph (C)(2) of this rule, must be sold and the proceeds used for the support of the family group. The family group must provide verification that the property is listed for sale with a real estate agency or firm. Real property pending a sale may be exempt, provided the provisions set forth in paragraph (C)(3) of this rule are met.

(d) For all nonhomestead real property which an assistance group owns or is part owner, the current market value and equity value of nonhomestead real property is a countable resource.

(E) Transfer of property

(1) Property, real or personal, constitutes a resource and is subject to the basic public assistance principle that resources which are actually available to the family group must be considered in evaluating need and in determining eligibility. The transfer or assignment of property for less than the fair market value must be examined to determine if the transfer was done to qualify for aid, or for a greater amount of aid, or to avoid utilization of the property. Such transfers, if during the two years preceding application for or most recent redetermination of eligibility for DFA, shall result in ineligibility for any/all DFA assistance groups within the family group.

(2) Circumstances under which ineligibility is presumed to exist as a result of property transfer are:

(a) A transfer of property to reduce the family group’s remaining holdings to within the maximum family group resource limit results in ineligibility. If the transfer occurred more than two years prior to the date of application or most recent redetermination for DFA, there is a presumption that the transfer was made in good faith and not for the purpose of qualifying for DFA.

(b) Even though the county assessed value of real property owned by the family group is within the maximum, a transfer of all or a portion of such property results in ineligibility if the transfer is made:

(i) To avoid utilization of the property; or

(ii) To safeguard future eligibility status by divesting the family group of proceeds which the family group would receive if the property were sold.

(c) There is a presumption that a transfer of income producing property is for the purpose of qualifying for a greater amount of aid. Unless this presumption is overcome, ineligibility for all DFA assistance groups within the family group results.

(d) The reason that a family group transferred property, i.e., the actual intent in doing so, is the single most essential element to be considered in determining the effect of the transfer upon the eligibility of the assistance groups within the family group. A transfer of property is, in itself, disqualifying only when the family group’s reason for making the transfer was to qualify the assistance groups within the family group for aid, for a greater amount of aid, or to avoid utilization.

(e) In determining the family group’s intent, it is necessary to evaluate the stated reason for the transfer and the consistency of such statement with the known facts. The consideration received for the transferred property may not have been adequate, the transfer may have been ill-advised, and/or the family group, in making the transfer may have exercised poor judgment. However, these facts alone do not automatically establish that a transfer was disqualifying. The family group’s motives must be carefully scrutinized, the important determination being the family group’s actual reason for the transfer and the relationship of that reason to the application for or continued receipt of aid.

(f) The transfer of property to qualify for aid, for a greater amount of aid, or to avoid utilization results in ineligibility for the assistance groups within the family group beginning the first day of the month subsequent to the month the transfer was made and continues either:

(i) For a period which would have supported the family group member at the rate of three hundred twenty-four dollars a month for the individual and an additional one hundred six dollars for each family group member until the difference between the fair market value and the resource limitation was reduced to zero.

(ii) Until the property was reconveyed to the family group member.

(F) Exchange, replacement, sale or transfer of resources

(1) If an exempt resource is exchanged by the family group for another exempt resource of equal value, the resulting resource is exempt. If an exempt resource is exchanged for a nonexempt resource of any value, the nonexempt resource is a countable resource.

(2) If an exempt resource is sold, the resulting cash is an exempt resource for six months only if it will be used to purchase an exempt resource.

(3) If a nonexempt resource is exchanged for another nonexempt resource of the same type and of equal value, the new resource is nonexempt.

(4) If a nonexempt resource is replaced because of loss due to theft, accident, or disaster, the replacement amount or the replacement item is considered to be a nonexempt resource.

(5) If a nonexempt resource is sold, the amount received can be considered as a nonexempt resource only if it is used to purchase the same type of resource of equal value within a thirty-day period of the sale. Otherwise, the amount received from the sale of the nonexempt resource is considered as income.

Effective: 11/01/2007

R.C. 119.032 review dates: 08/17/2007 and 11/01/2012

Promulgated Under: 111.15

Statutory Authority: 5115.03

Rule Amplifies: 5115.02, 5115.03

Prior Effective Dates: 7/1/76, 9/1/76, 5/1/80, 10/1/83, 5/1/84, 7/1/84 (Emer.), 7/15/84, 9/10/84, 10/1/84 (Emer.), 12/17/84, 12/27/84, 8/1/85 (Emer.), 10/17/85, 11/1/87, 10/1/89 (Emer.), 12/1/89 (Emer.), 12/6/89, 3/2/90, 3/20/90, 6/1/90, 7/12/91 (Emer.), 4/1/92, 9/1/92, 10/1/92 (Emer.), 12/21/92, 7/30/93 (Emer.), 10/23/93, 5/1/94, 9/1/94, 8/1/95 (Emer.), 10/30/95, 10/1/97 (Emer.), 12/30/97, 7/1/98, 7/1/00, 7/1/01, 7/1/02, 7/1/03 (Emer.), 9/30/03

5101:1-5-40 Disability financial assistance (DFA): income.

(A) General definition

(1) Income is earned or unearned payments received by a member of the family group during a calendar month. Income can be received as a result of current or past labor or services, business activities, interest in real or personal property, or as a benefit or contribution from persons, organizations, or assistance agencies.

(2) Income received by all members of the family group (as defined in rule 5101:1-5-01 of the Administrative Code) shall be included in determining whether an assistance group (as defined in rule 5101:1-5-01 of the Administrative Code) is eligible for DFA. The income of the family group shall also be included in determining the amount of DFA benefits for which the DFA assistance group is eligible. To be considered in determining the amount of the DFA payment, income must be received or reasonably anticipated to be received by the family group during the budget period.

(3) Certain types of income are excluded from consideration as set forth in paragraph (B) of this rule. In addition, earned income disregards are deducted from each employed family group member’s gross monthly earnings. The earned income disregards are set forth in paragraph (G) of this rule.

(4) The determination of eligibility for the DFA assistance group is dependent upon the amount of income received by the family group. Only available income received by the family group is considered in determining eligibility for the DFA assistance groups within the family group. Availability depends upon the date of receipt, and the number of months the income is intended to cover. Sometimes, it may be necessary to apportion income to future months. Such income is current income in the month to which it is apportioned. An employee under an annual employment contract shall have the income from such contract apportioned over the year provided the contract is for at least eight months.

(a) The county department of job and family services (CDJFS) must explore with each family group the potential development of monthly income. The CDJFS is responsible for:

(i) Reviewing with the DFA assistance group all of the family group’s resources, current and future, in light of their income-producing potential.

(ii) Encouraging the production of income within the DFA assistance group’s capabilities.

(iii) Determining whether income is actually received, the regularity of receipt, the net amount of the family group’s share, and whether it is excluded or exempt from consideration as income.

(b) The family group is responsible for giving information necessary to income determinations and for taking all actions necessary to obtain unconditionally available income.

(i) The family group must apply for any monthly benefits to which any of the family group members are entitled, including family group members who have potential coverage for unemployment compensation benefits. When these benefits are actually received, they are counted as unearned income in the determination of eligibility for DFA.

(ii) Income shall be considered unconditionally available if the family group has only to apply, claim, or accept the income.

(iii) Ineligibility for the DFA assistance groups within the family group results if a family group member refuses to accept unconditionally available income.

(B) Exempt income

Certain types of payments or benefits received by family group members are exempt from consideration as income in the determination of eligibility and level of benefits for the DFA assistance groups within the family group. Paragraphs (B)(1) to (B)(6) of this rule set forth the types of exempt income in the DFA program.

(1) The earnings of an individual who is under the age of sixteen.

(2) All income excluded under the food assistance program regulations as set forth in rule 5101:4-4-13 of the Administrative Code.

(3) The value of any tuition payment contract entered into under section 3334.09 of the Revised Code, or any scholarship awarded under section 3334.18 of the Revised Code and the amount of payments made by the Ohio tuition trust authority under section 3334.09 of the Revised Code pursuant to the contract or scholarship. The individual shall not be required to terminate a tuition payment contract entered into under Chapter 3334. of the Revised Code as a condition of eligibility for DFA. However, any refund paid under section 3334.10 of the Revised Code is considered to be income in the month received for DFA.

(4) Court ordered child support payments made by a member of the family group for a child outside the family group. The amount paid, up to the amount ordered, is exempt.

(5) Income tax refunds received by any of the family group members.

(6) Any other income amounts that federal statutes or regulations require be excluded.

(7) All income excluded under the Ohio works first (OWF) program regulations as set forth in rule 5101:1-23-20 of the Administrative Code.

(1) Unless specifically listed as exempt income in paragraph (B) of this rule, all earned income (less appropriate earned income disregards and child care deduction) and unearned income is considered as nonexempt income and is to be deducted from the payment standard. All nonexempt monthly income shall reduce the payment standard dollar for dollar.

(2) In calculating gross nonexempt income, the amount shall be rounded down to the nearest whole dollar by dropping all cents. All cents in gross weekly, biweekly, or semimonthly income shall be dropped prior to applying the conversion factors to convert the income into a standard month. All cents shall be dropped before and after multiplying by the appropriate conversion factor, and prior to the application of the earned income disregards and the child care deduction, if applicable. Hourly rates which contain cents are not rounded but are converted in the exact amount.

(3) Gross nonexempt income which is received in a frequency other than monthly must be converted to a standard month rather than adjusting income each month.

Conversion shall be performed using the following factors:

(a) Income received on a weekly basis is multiplied by 4.3.

(b) Income received biweekly (every two weeks) is multiplied by 2.15.

(4) In situations in which an individual has fluctuating income, the income must first be averaged (as set forth in rule 5101:1-23-20 of the Administrative Code) to arrive at a figure to be converted into monthly income.

(5) In calculating the expenses which may be subtracted from gross nonexempt income, the actual amount of each expense shall be used in the calculation. The sum of these expenses shall be deducted from the individual’s rounded-down monthly income prior to rounding down in the determination of countable income.

(6) If there are different categories of allowable expenses, the actual amount of the expenses are added by category. The sum of each category of expenses shall be deducted from the corresponding category of rounded-down gross monthly income.

(D) Unearned income

(1) Unearned income is all income that is not wages or net earnings from self-employment. Unearned income includes any tuition refund paid under section 3334.10 of the Revised Code. Unearned income also includes non-recurring lump-sum payments. A non-recurring lump-sum payment is income that is not anticipated or expected to be received again. Receipt of a non-recurring lump-sum payment is income in the month received, and a resource beginning with the month following receipt and subject to the provisions set forth in rule 5101:1-5-30 of the Administrative Code. Thus, all income which does not meet the definition of earned income as set forth in paragraph (E) of this rule, is considered unearned income.

(2) Eligibility for an unearned payment does not, by itself, affect the amount of unearned income to be counted; actual receipt is the key factor. Potential income must be pursued by the family group, but the income must actually be received by the family group in order to have it included as income.

(3) The amount of unearned income received by the family group to be used in the determination of eligibility for the DFA assistance groups within the family group is dependent upon the amounts and frequency with which the income is actually received. Sometimes there are deductions or withholding taxes deducted from certain types of unearned income. If the deductions are mandatory, only the net monthly amount of the unearned income is to be used. If the deduction is voluntary, the gross amount of the unearned income must be used.

(4) The policy set forth in rule 5101:1-2-20 of the Administrative Code, regarding the methods of verification of unearned income shall be applied in determining eligibility for DFA.

(E) Earned income

(1) The policy set forth in paragraph (C) of this rule regarding the computation of monthly income shall be applied in determining eligibility for the DFA program.

(2) The CDJFS shall determine the monthly gross amount of earnings for each family group member, i.e., the amount of earnings before taxes and other deductions, and apply the appropriate earned income disregards and applicable child care deduction (as set forth in paragraph (G) of this rule) to determine the family group member’s monthly net earned income.

(3) The policy set forth in rule 5101:1-2-20 of the Administrative Code regarding methods of verification of earned income is applicable.

(4) When income is received from room and board or board only, a standard operating expense is deducted from the total income. The standard operating expense is determined by using the zero income level food assistance program allotment for the number of boarders in the household. The remainder is monthly gross earned income subject to the application of the earned income disregards and applicable child care deduction set forth in paragraph (G) of this rule.

(5) Income from real property not utilized as the home must be pursued and, when received, treated as income. Acceptable plans of utilization are to sell the property at fair market value or to rent the property. Annual rental income, after deducting the actual cost of maintaining the property, must be at least six per cent of its fair market value.

(a) The verified costs of upkeep shall be deducted from the gross income. In no event shall the cost of upkeep exceed the gross income. Upkeep is defined as that which is necessary to maintain the property as habitable. Upkeep does not consist of those repairs made to property for cosmetic purposes, such as aluminum siding, or painting. Paragraphs (C)(5) to (C)(6) of this rule sets forth the process for the calculation of expenses.

(b) If the family group lives in the property, the family group’s prorata share of expenses is excluded in computing the actual costs of maintaining the property. The family group’s share shall be in proportion to the total number of separate units. The family group’s share of housing costs is budgeted depending upon the number of rooms/units and number of persons in the assistance group. The expenses of maintaining the property (excluding the family group’s share) are deducted from the gross rental income. The resulting income is considered earned income and the earned income disregards and applicable child care deduction as set forth in paragraph (G) of this rule are applied.

(6) An individual who operates his own business has earnings from self-employment. The gross monthly income from self-employment is the total proceeds or gross receipts of earnings minus operating expenses, or the standard deduction set forth in paragraph (E)(7)(b) of this rule minus the appropriate earned income disregards and applicable child care deduction as set forth in paragraph (G) of this rule.

(a) The provisions set forth in rule 5101:1-23-20 of the Administrative Code define allowable and non-allowable operating expenses and shall be applied in determining eligibility for the DFA program.

(b) The provisions set forth in rules 5101:1-23-20 and 5101:4-6-11 of the Administrative Code regarding the standard deduction for operating expenses for home day care providers are applicable in the treatment of self-employment earnings of family group members who are home day care providers.

(c) The provisions set forth in rule 5101:1-23-20 of the Administrative Code regarding the policy for establishing annual gross earned income from self-employment are applicable in the treatment of the self-employment earnings of family group members in the DFA program.

(d) The provisions set forth in rule 5101:1-23-20 of the Administrative Code regarding the policy for establishing gross earnings from self-employment on a monthly basis are applicable in the treatment of the self-employment earnings of family group members in the DFA program. For the reasons set forth in rule 5101:1-23-20 of the Administrative Code, it may be necessary for the CDJFS to obtain an estimate of gross earnings for the entire taxable year and distribute this figure equally into all months of the taxable year, even if the business is seasonal. If the amount of gross earnings from self-employment is not ascertainable from the business records, use the first of the following methods that is likely to give the most accurate estimate of current and future earnings which may be distributed on a monthly basis.

(i) When the individual has been carrying on the same trade or business for some time, his gross earnings from self-employment have been fairly constant from year to year and he anticipates no change or gives no satisfactory explanation of why the earnings for current and future months would be substantially different from what it has been in the past, the estimate for his current taxable year should be the same as the previous year. His monthly income should be determined as one-twelfth of the gross earnings as shown on his tax return for the preceding taxable year.

(ii) When the individual is engaged in the same business that he had the preceding taxable year and he anticipates no change or gives no satisfactory explanation of why the earnings for current and future months would be substantially different from what has been in the past, his tax return or business records may be used to establish a ratio between his gross earnings and gross receipts for the last year. The actual gross receipts from the current taxable year are projected from the remainder of the year and the ratio is applied. The resulting figure gives an estimated gross earnings for the year which is distributed into monthly income. This method is not suitable for businesses which are seasonal or have income peaks at certain times of the year.

(iii) When the individual can estimate his gross earnings based upon business records, the CDJFS may use the individual’s best estimate.

(F) Countable monthly income

(1) Countable monthly income is defined as the family group’s gross monthly nonexempt earned and/or unearned income less appropriate disregards and child care deduction (earned income disregards and deductions for the DFA program are set forth in paragraph (G) of this rule.) The amount of countable monthly income is compared to the DFA payment standard representing the number of individuals in the family group.

(2) If the family group’s countable monthly income exceeds the DFA payment standard representing the number of individuals in the family group, the DFA assistance group is ineligible.

(3) If the family group’s countable monthly income is less than the DFA payment standard representing the number of individuals in the family group, the DFA assistance group is eligible. DFA eligibility for the DFA assistance group is determined in accordance with the provisions set forth in paragraph (H) of this rule.

(4) The policy set forth in paragraph (C)(3) of this rule regarding the computation of income received other than monthly into converted monthly income shall be applied in determining eligibility in the DFA program.

(5) The policy set forth in paragraph (C)(2) of this rule regarding the rounding down of income shall be applied in the determination of eligibility in the DFA program.

(G) Earned income disregards and deductions

(1) There are certain earned income disregards and deductions that are subtracted from the earned income of each employed individual in the family group in determining eligibility for the DFA assistance groups within the family group. Earned income disregards are deducted from the earned income of each ineligible family group member described in rule 5101:1-5-01 of the Administrative Code. Paragraphs (G)(2)(a) to (G)(2)(d) of this rule set forth the provisions for the application of the program eligibility test. The two hundred fifty dollars and one-half of the remainder earned income disregard, the child care earned income deduction, the summary of the financial determination of eligibility, and the determination of the DFA grant amount are set forth in paragraphs (G)(3) to (H)(3)(g) of this rule, respectively.

(2) In order to determine program eligibility for applicant assistance groups, total all gross monthly earnings of each employed member of the family group.

(a) The first seventy-five dollars of the gross income is deducted from the gross monthly earnings of each employed family group member as a work expense disregard.

(b) If there are any child care costs paid directly by an employed family group member, deduct the actual verified child care expense (as set forth in paragraph (G)(4) of this rule) following the seventy-five dollar work expense deduction.

(c) The remaining income is then added to the family group’s other countable income (i.e., unearned income) and compared to the appropriate DFA payment standard for the family group size. None of the exempt income received by any member of the family group is included in the program eligibility test, or in any subsequent determination of eligibility or grant amount.

(d) If there is a deficit, program eligibility exists and the DFA assistance group’s eligibility and level of benefits shall be determined by applying the earned income disregards and applicable child care deduction as set forth in paragraphs (G)(3) to (G)(4) of this rule to each family group member’s gross monthly earnings.

(3) The two hundred fifty dollars and one-half of the remainder earned income disregard set forth in this paragraph is applied to the earned income of each member of the family group in determining the eligibility and level of benefits for applicant assistance groups who pass the program eligibility test (as set forth in paragraphs (G)(2)(a) to (G)(2)(d) of this rule) and for recipient assistance groups. The family group’s countable monthly earned income is computed by deducting the first two hundred fifty dollars plus one-half of the remainder from the monthly gross earnings of each family group member. If the employed family group member has child care costs, those costs shall be deducted following the application of the two hundred fifty dollar and one-half of the remainder disregards, in accordance with the provisions set forth in paragraphs (G)(4) and (G)(5) of this rule. If there are no child care costs, the CDJFS shall apply the methodology set forth in paragraph (H) of this rule to determine if eligibility for benefits exists for the DFA assistance group.

(4) If there are child care costs paid directly by the employed family group member, the actual verified costs of that care, is deducted, following the two hundred fifty dollars and one-half of the remainder disregard (as set forth in paragraph (G)(3) of this rule.)

(5) The cost of care for a dependent child may be deducted even though the child care provider is a household member or relative. The deduction is not applied if the child care provider is an assistance group member, a member of the family group, a parent of the child receiving child care, or the legal guardian of the child receiving child care.

(H) Computation of DFA benefit eligibility

(1) Paragraphs (H)(1) to (H)(3)(g) of this rule summarize the financial determination of eligibility for DFA assistance groups. These provisions are applied to DFA assistance groups who are applicants that have passed the program eligibility test (as set forth in paragraphs (G)(2)(a) to (G)(2)(d) of this rule), and recipient DFA assistance groups. Paragraphs (H)(2) to (H)(3)(g) of this rule set forth the specific provisions for the determination of the amount of the DFA grant for DFA assistance groups. Financial eligibility for the DFA assistance group is determined by subtracting the family group’s monthly countable income (i.e., gross monthly earned income less earned income disregards and applicable child care deductions, plus all nonexempt monthly unearned income) from the DFA payment standard that corresponds to the size of the family group. If the family group’s monthly countable income is less than the appropriate DFA payment standard, the DFA assistance group is eligible for assistance.

(2) The DFA grant for the DFA assistance group is the lesser of the following figures:

(a) The difference obtained by subtracting the family group’s monthly countable income (i.e., monthly gross earned income less earned income disregards and child care deductions, plus all nonexempt monthly unearned income) from the DFA payment that represents the family group size; or

(b) The DFA payment standard for the DFA assistance group.

(3) The steps set forth in paragraphs (H)(3)(a) to (H)(3)(g) of this rule define the process for determining the amount of the DFA grant:

(a) Calculate gross monthly earned income for each family group member.

(b) If the DFA assistance group is an applicant assistance group, apply the program eligibility test as set forth in paragraphs (G)(2)(a) to (G)(2)(d) of this rule. If the applicant DFA assistance group passes the program eligibility test, or if the DFA assistance group is a recipient assistance group, deduct two hundred fifty dollars and one-half of the remainder from the gross monthly earned income of each member of the family group as set forth in paragraph (G)(3) of this rule.

(c) If any of the employed family group members have child care costs, deduct the allowable child care costs in accordance with paragraphs (G)(4) and (G)(5) of this rule.

(d) Total the family group members’ monthly earned income after application of the earned income disregard and child care deduction, if applicable.

(e) Add the total amount determined in paragraph (H)(3)(d) of this rule to the family group’s nonexempt monthly gross unearned income.

(f) Subtract the total calculated in paragraph (H)(3)(e) of this rule from the DFA payment standard for the family group. The remainder is the maximum DFA grant. If there is no deficit, the DFA assistance group is not eligible for DFA. If there is a deficit, proceed with the step set forth in paragraph (H)(3)(g) of this rule.

(g) The actual DFA grant amount is dependent on the size of the DFA assistance group. The amount of the DFA grant is the lesser of either the amount determined in paragraph (H)(3)(f) of this rule, or the maximum DFA payment standard for the DFA assistance group.

(I) Assessing parental responsibility for the eighteen- to -twenty-two-year-old

(1) Assessing parental responsibility for individuals residing with their parents.

(a) The income of the natural or adoptive parents shall be taken into account in the determination of DFA program eligibility and grant level for covered individuals aged at least eighteen years but under twenty-two years who are living at home.

(b) No portion of the parental gross income shall be considered available to meet the needs of the eighteen-to-twenty-two-year-old when:

(i) The income is equal to or less than the income levels shown in column (1) in paragraph (I)(1)(f) of this rule; or

(ii) The child is married.

(c) The family size shall include the parents, all their children under age twenty-two, and the eighteen-to-twenty-two-year-old DFA applicant(s)/recipient(s) living in the home. Neither the income of the DFA applicant(s)/recipient(s) nor the income of the siblings of the DFA applicant(s)/recipient(s) is considered when comparing the income of the parent(s) to the chart in paragraph (I)(1)(f) of this rule.

(d) If the parental gross income exceeds the income levels shown in column (1) in paragraph (I)(1)(f) of this rule but is equal to or less than the income levels shown in column (2) in paragraph (I)(1)(f) of this rule, the DFA payment standard for the eighteen-to-twenty-two-year-old’s assistance group shall be reduced by fifty per cent. Any countable income of the eighteen-to-twenty-two-year-old shall be deducted from the reduced payment standard to determine DFA eligibility and grant level.

(e) If the parental gross income exceeds the income levels shown in column (2) in paragraph (I)(1)(f) of this rule or if the parent refuses to verify his income, the eighteen-to-twenty-two-year-old’s assistance group is not eligible for DFA.

(f) Income levels:

Family Size Column (1) Column (2)

1 $ 755 $ 1226

2 1038 1604

3 1267 1981

4 1567 2359

5 1830 2735

6 2039 3114

7 2281 3184

8 2531 3255

9 2782 3326

10 3032 3381

For each person above 10, add 313 378

(2) Assessing parental responsibility for individuals who are not residing with their parents.

(a) According to section 3103.03 of the Revised Code, parental duty to support continues as long as a child eighteen -to -twenty-two years of age is continuously attending any recognized and accredited high school on a full-time basis. If the individual is married, or has been married, assessment of parental responsibility shall not be required.

(b) The income of the natural or adoptive parent(s) shall be assessed in determining DFA eligibility and grant amount for an individual who is a full-time high school student and who is not residing with his parents. The same income assessment is required when the individual is not a student but is under the age of eighteen.

(i) The income of the parent(s) shall be assessed to determine if there is income which may be considered available to the individual. If the parent(s) receives income based on need, such as supplemental security income (SSI), OWF or DFA, it is assumed that the parent(s) does not have the ability to support and no action is taken. If the parent(s) has income not based on need, potential parental support exists and a referral shall be made to the county prosecuting attorney in order to obtain support for the individual.

(ii) If the individual is eighteen, not a full-time student, and does not reside with his parent(s), no assessment of parental income shall be required.

(iii) Any parental contribution is treated as unearned income and is deducted when received by the individual.

(3) For purposes of determining whether an individual lives with their parents, consideration shall be given to the following:

(a) When the individual has a separate entrance to his living quarters. If the entrance requires passing through one living quarter to gain access to another, further evaluation will be necessary and the CDJFS should determine whether another condition in paragraphs (I)(3)(b) to (I)(3)(d) of this rule are met.

(b) When the owner of the property considers the property to consist of separate units and if he would rent the structure as separate living quarters.

(d) When the persons involved have separate utility meters and are billed separately for the utilities.

(4) If none of the conditions set forth in paragraphs (I)(3)(a) to (I)(3)(d) of this rule are met, an individual shall be considered to be residing with the individual’s parents.

Effective: 01/01/2009

R.C. 119.032 review dates: 07/01/2011

Promulgated Under: 111.15

Statutory Authority: 5115.03

Rule Amplifies: 5115.03, 3103.03

Prior Effective Dates: 7/1/76, 11/1/76, 5/14/77, 12/31/77, 4/1/79, 4/5/79, 12/1/79, 2/3/80, 5/29/80, 9/7/81, 10/1/81, 12/1/82, 3/1/84, 6/1/84, 7/1/84 (Temp.), 9/1/84, 9/10/84, 7/1/85, 8/1/85 (Emer.), 10/17/85, 1/1/86 (Emer.), 1/2/86, 2/23/86, 8/1/86 (Emer.), 10/3/86, 10/31/86, 10/1/87, 1/1/88 (Emer.), 3/21/88, 7/1/88 (Emer.), 9/25/88, 4/1/89, 6/1/89 (Emer.), 7/1/89 (Emer.), 8/21/89, 9/23/89, 10/1/89 (Emer.), 11/1/89 (Emer.), 12/16/89, 1/1/90 (Emer.), 1/29/90, 4/1/90, 6/1/90, 7/1/90, 10/1/90, 5/1/91 (Emer.), 6/17/91, 7/11/91, 7/12/91(Emer.), 9/22/91, 10/1/91 (Emer.), 12/20/91, 4/1/92, 7/1/92, 9/1/92, 10/1/92 (Emer.), 11/1/92, 12/21/92, 11/1/94, 3/1/95, 8/1/95 (Emer.), 10/30/95, 7/1/98, 7/1/01, 7/1/02, 7/1/03 (Emer.), 9/30/03, 7/1/06

5101:1-5-50 Disability financial assistance (DFA): payments.

(A) General principles

(1) “DFA payments” are those payments made to an individual or family (assistance group) which represent the difference between the countable income and the appropriate DFA payment standard. All DFA payments are calculated based on a thirty-day month.

(2) The county department of job and family services (CDJFS) that serves the county in which a person is receiving DFA and is participating in an alcohol or drug addiction program, shall designate a representative payee for purposes of receiving and distributing financial assistance provided under the DFA program to the person.

(B) Beginning date of DFA

(1) Cash assistance for eligible DFA applicants begins on the date that all eligibility factors are met or the date a signed, completed application is filed, whichever is later. The date all eligibility factors are met is not necessarily the date verifications are provided to the CDJFS. Verification merely establishes that an eligibility factor has been met.

(2) DFA may not be issued to supplement prorated Ohio works first (OWF) payments.

(1) The CDJFS shall prorate the payment when an assistance group has eligibility for less than a full month’s grant. The CDJFS issues a prorated payment for initial assistance or for DFA covering prior months.

(2) Retroactive DFA may be authorized as the result of a hearing decision, court order or when the CDJFS determines that DFA was erroneously denied, terminated, or delayed and corrective action is being taken.

(3) The method of calculating prorated payments, as set forth in rule 5101:1-23-40 of the Administrative Code, shall be applied in the DFA program.

(D) Concurrent receipt

(1) “Concurrent receipt of assistance” is defined as the receipt of assistance by an assistance group under more than one public assistance money grant in the same month. The receipt of public assistance, from two or more different states, for a duplicate time period, also constitutes concurrent receipt of assistance.

(2) An assistance group member shall not be eligible to receive or have his needs covered by DFA in more than one assistance group or more than one county in any given month.

(3) An individual whose needs are met by the supplemental security income (SSI) program shall not be eligible to have his needs included in a DFA assistance group concurrently.

(4) If the assistance group is receiving or is believed to be receiving cash assistance from another state, the CDJFS must determine at what point the assistance group became ineligible for cash assistance in the former state prior to approving DFA in Ohio. Prior to the approval of DFA, the CDJFS must contact the other state to verify when the assistance group became ineligible and the time period for which assistance was last authorized.

(5) The method of calculating concurrent OWF and DFA payments is set forth in rule 5101:1-23-40 of the Administrative Code.

(E) Reporting responsibilities of the family group

(1) The family group shall make an accurate and complete disclosure of all information necessary for a determination of eligibility and for computation of the correct amount of DFA. Such disclosure shall be made at the time of initial application, at reapplication, and within ten days of the date that any change specifically identified as a reporting requirement in rule 5101:1-2-20 of the Administrative Code occurs.

(2) In situations where the family group has a change that is not specifically listed as a reporting requirement in rule 5101:1-2-20 of the Administrative Code, the family group must report the change in circumstances at the next reapplication.

(F) Effective date of budget adjustment

(1) For any change in circumstances that may affect the assistance group’s eligibility or the amount of DFA to which it is eligible, the CDJFS is responsible for taking appropriate action so that the DFA payment is properly adjusted by the first day of the second month following the month of change, subject to the requirements of prior notice and the hearing process.

(2) If a family group has a change which is not specifically listed as a reporting requirement in rule 5101:1-2-20 of the Administrative Code, and the change is not reported by the family group until the next reapplication (or between reapplication periods), the effective date of the budget change must be effective by the first day of the second month following the month in which the change was reported, or the CDJFS became aware of the change.

(G) Underpayments

(1) An “underpayment” is either:

(a) DFA received by or for an assistance group which is less than the amount that the assistance group was eligible to receive; or

(b) The failure to issue DFA to an eligible assistance group. This includes a denial or discontinuance of DFA.

(H) Determination of underpayments

(1) An underpayment occurs when the assistance group/family group has met the reporting responsibility as set forth in rule 5101:1-2-20 of the Administrative Code, and the appropriate and timely action was not taken by the CDJFS.

(2) An underpayment shall be issued for the period, not to exceed twelve months, prior to whichever of the following occurred first:

(a) The date that the CDJFS receives a request for an underpayment from an assistance group; or

(b) The date that the CDJFS is notified or otherwise discovers that a loss to an assistance group has occurred.

(I) Calculation and issuance of underpayments

(1) The amount of the underpayment is the difference between the amount of DFA which an assistance group was eligible to receive for a particular period of time and the lesser amount which the assistance group actually received for that same period of time.

(2) In calculating the underpayment amount for situations involving the untimely processing of income, the CDJFS shall use the actual income received by the assistance group. If all of the documentation is not available, the CDJFS shall follow the provisions set forth in rule 5101:1-2-20 of the Administrative Code.

(3) In situations where the error does not involve the untimely processing of income, the CDJFS shall use the converted income already established for the month(s).

(4) When there is earned income, the appropriate deductions (i.e., earned income disregard, child care costs) are allowed in order to compute the amount of an underpayment.

(5) Underpayments which are not offset against overpayments are adjusted by authorization of an auxiliary payment, regardless of whether the assistance group is in receipt of DFA.

(J) Erroneous payments

(1) A primary objective in the administration of DFA is the prevention of erroneous payments. In order to achieve this objective, it is necessary that:

(a) The family group receive frequent and complete explanations regarding the method of computing a public assistance grant, the factors that cause ineligibility, the factors that cause erroneous payments (changes in income, resources, or need as set forth in rule 5101:1-2-20 of the Administrative Code), and the family group’s responsibility to report such changes within ten days.

(b) The CDJFS shall take prompt appropriate action following any reported changes which may affect an assistance group’s eligibility or the amount of the grant.

(2) For purposes of this rule “erroneous payments” are defined as:

(a) DFA received by or for an assistance group for the payment month which exceeds the amount that the assistance group was eligible to receive; or

(b) DFA received by or for an assistance group for the payment month when the assistance group was not eligible to receive any financial assistance; or

(c) DFA payments made to persons who are not entitled to receive them, including payments made as a result of misrepresentation or fraud, and payments made due to an error by the recipient or by the CDJFS that made the payment.

(3) An erroneous payment may occur because of any change in the family group’s situation which decreases the level of assistance for which the assistance group is eligible.

(4) Erroneous payments are classified according to whether reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code were met and the cause of the failure to make the appropriate budget change.

(K) Erroneous payments due to pendency of a state hearing or administrative error

(1) Erroneous payments may occur even when the family group meets the reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code. The erroneous payment may be due to the pendency of a state hearing or to an administrative error.

(a) The CDJFS may recover erroneous payments made during the pendency of a state hearing. When specific amounts of erroneous payments are stipulated in the decision, those amounts are binding.

(b) Unless paragraph (I)(3) of this rule applies, all recovery provisions apply to overpayments erroneous payments which are the result of administrative error. The state or county may recover funds/ warrants that were erroneously misprinted. Such gross transcription errors are correctable by reissuing the warrant or any of the procedures set forth in paragraph (N) of this rule.

(2) An erroneous payment resulting from an administrative error shall not be recovered when all of the following criteria are met:

(a) The family group met all of its reporting responsibilities as set forth in rule 5101:1-2-20 of the Administrative Code, and did nothing to cause the erroneous payment.

(b) The family group was not aware of the error or erroneous payment and did not have any information which should have made the family group aware of the error or put the family group on notice of the error.

(c) Without notice of the error, the family group relied upon the honest belief that the assistance group was entitled to the payment. The family group must provide the CDJFS with clear evidence that one of the following three actions has been taken:

(i) The family group has spent the money; or

(ii) The family group has given up possession of the money; or

(iii) The family group’s situation has changed (e.g., quit a job, entered into a purchase contract) to the extent that the repayment of the money would put the family group into a worse situation than it would have been in if the assistance group had never received the erroneous payment.

(3) Reporting responsibilities are not met when a family group does not make an accurate, full and complete disclosure of the facts bearing upon the family group’s eligibility within ten days of the date that any change specifically identified in rule 5101:1-2-20 of the Administrative Code occurs.

(4) Failure to disclose the facts necessary for a correct determination of eligibility is considered to be beyond the family group’s control when there is evidence that, but not limited to:

(a) The individual person was too ill or too disturbed to understand his responsibility to report a change in his circumstances;

(b) The person was senile or otherwise limited mentally, or had difficulty understanding the instructions, which prevented him from assuming responsibility to report.

(L) Willful withholding of information

(1) Failure to disclose is considered to be willful withholding of information in any of the following circumstances:

(a) A willful misstatement (either oral or written) made by a family group in response to oral or written questions from the CDJFS concerning the family group’s income, resources, or other circumstances which may affect the amount of payment. Such misstatement may include understatements of amounts of income or resources and omission of an entire category of income or resources;

(b) A willful failure by the family group to report changes in income, resources or other circumstances which may affect the amount of payment, if the CDJFS has clearly notified the family group of an obligation to report such changes;

(c) A willful failure by the family group to report receipt of a payment which the family group knew represented an erroneous overpayment payment, or to notify the CDJFS of receipt of a check which exceeded the assistance group’s prior check and exceeded the amount to which the assistance group was entitled.

(M) Erroneous payment determination

(1) Upon notification of a change in the family group’s need, income, or resources, the CDJFS makes the following determinations:

(a) The date the change in income, resources, or need occurred;

(b) The date the change in income, resources, or need was reported to the CDJFS and whether the change was a reporting requirement change set forth in rule 5101:1-2-20 of the Administrative Code;

(c) The amount of DFA erroneous payment by month. When there is earned income, the erroneous payment is calculated by using the actual earnings, minus any appropriate disregards, such as the earned income disregards and child care costs;

(d) Whether the family group met or failed to meet the reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code;

(e) Whether the failure to report was willful;

(f) The amount of liquid assets available, including exempt and disregarded incom;

(g) The amount of erroneous payment that can be adjusted through proposing to reduce the grant for two months; and

(h) The amount of the erroneous payment that can be adjusted through grant reduction.

(2) The JFS 07095, “Erroneous Benefit Determination Form” (rev. 6/2007), shall be completed on all cases in which an erroneous payment has been found. One copy of the JFS 07095 must be retained in the case record. Another copy must be retained in a central file so it may be used to compile information for reports required on cases involving willful withholding of information.

(N) Recovery of erroneous payments

(1) Erroneous payments may be recovered by lump sum repayment, monthly repayment, reducing the grant for a two-month period and/or referral to the county prosecutor for civil collection. All cases in which there is probable cause to believe that the crime of fraud has been committed shall be referred to the county prosecutor by the CDJFS director. The CDJFS does not have the authority to collect DFA erroneous payments through judicial proceedings unless the CDJFS is represented by the county prosecuting attorney. Therefore, the CDJFS is prohibited from attempting collection of anerroneous payment in small claims court, except in situations where the CDJFS is represented by the county prosecutor.

(2) An erroneous payment may be collected by grant reduction only when the assistance group has liquid assets to meet its needs according to the DFA payment standard. “Liquid assets” refers to any income and/or any personal property reserve which is immediately transferable to cash. The erroneous payment is collected by adjusting the grant in two subsequent months by the amount of the erroneous payment or by the amount of available liquid assets, whichever is less.

(3) The amount of an erroneous payment remaining after a grant reduction may be recovered by referring the case to the county prosecutor for civil collection. Referral to the county prosecutor for civil collection is not mandatory. The amount remaining after a grant reduction may affect a repayment agreement. The CDJFS and county prosecutor shall decide when a referral is cost-effective.

(4) It is mandatory that the CDJFS director refer to the county prosecutor all cases in which there is probable cause to believe that the crime of fraud has been committed. The determination of probable cause is the joint responsibility of the CDJFS director or his designee and the county prosecuting attorney.

(5) In all phases of erroneous payment collection, the CDJFS shall provide prior notice to the assistance group of all proposed adverse actions such as the two-month grant reduction. Erroneous payment collection activity that does not affect the amount or receipt of the DFA grant does not require prior notice. The assistance group’s rights to due process shall not be modified in any manner during the erroneous payment recovery process.

(6) Recoupment of erroneous payments in an amount of thirty-five dollars or less owed by former DFA assistance groups shall be waived. Recoupment of these erroneous payments is not cost-effective since the cost of collection exceeds the amount of the erroneous payment.

(O) Treatment of erroneous payment activity against former general assistance (GA) recipients

Erroneous payment activity against former GA recipients ceased on August 1, 1997. No claims shall be established nor collection activity continued on or after that date. The exception to this requirement shall be claims established or collection initiated as a result of a court order requiring restitution. The CDJFS shall follow the court order in these instances.

Effective: 11/01/2007

R.C. 119.032 review dates: 08/08/2007 and 11/01/2012

Promulgated Under: 111.15

Statutory Authority: 5115.03

Rule Amplifies: 5115.03, 5115.23

Prior Effective Dates: 1/1/74, 10/1/75, 11/1/76, 12/31/77, 10/1/78, 10/26/78, 12/1/78, 5/1/79, 9/21/79, 12/1/81, 5/1/82, 7/1/83, 11/1/83 (Temp.), 11/11/83, 1/1/84, 6/1/84, 7/15/84 (Temp.), 10/1/84, 2/1/85 (Emer.), 5/2/85, 8/1/85 (Emer.), 10/17/85, 8/1/86 (Emer.), 10/3/86, 5/1/87 (Emer.), 7/30/87, 4/1/88 (Emer.), 6/10/88, 7/1/88 (Emer.), 9/25/88, 4/1/89(Emer.), 4/24/89, 7/1/90, 10/1/90, 10/1/91 (Emer.), 12/20/91, 4/1/92 (Emer.), 6/30/92, 10/1/92 (Emer.), 12/1/92 (Emer.), 1/1/93, 2/11/93, 9/1/93, 9/1/94, 5/1/95, 8/1/95 (Emer.), 10/30/95, 1/1/96, 5/1/97, 7/24/97 (Emer.), 10/1/97, 10/1/97 (Emer.), 12/11/97, 12/30/97, 7/1/98, 7/1/03 (Emer.), 9/30/03, 7/1/05(Emer.), 9/29/05

5101:1-5-60 Supplemental security income (SSI) case management program.

(A) Purpose of the SSI case management program

(1) The SSI case management program is an effort to identify individuals applying for or in receipt of disability financial assistance (DFA) who may be potentially eligible for SSI and to help the individual in obtaining financial assistance from the social security administration (SSA). The Ohio department of job and family services (ODJFS) and county departments of job and family services (CDJFS) shall cooperate in efforts to assist applicants and recipients who might be eligible for SSI.

(2) The objective of the SSI case management program is to ensure that individuals applying for or in receipt of DFA who are eligible for SSI receive the benefits to which they are entitled and to ensure that medicaid is provided to all eligible individuals. Benefits to the assistance group include increased cash assistance through SSI and more comprehensive medical coverage through medicaid.

(3) Each CDJFS shall establish an SSI case management program or join with other CDJFS to provide a joint SSI case management program in accordance with section 5115.20 of the Revised Code. For applicants and recipients of DFA who might be eligible for SSI, the CDJFS may enter into a written contract for services with attorneys and non-attorneys that in the judgement of the CDJFS have demonstrated expertise in representing individuals seeking SSI. The agreement should take into consideration whether or not a direct-fee payment has been entered into between the attorney/non-attorney with the SSA before a fee will be paid by the CDJFS in accordance with paragraph (H) of this rule.

(4) SSI case management eligibility determination functions shall be set up in such a manner to ensure that the individual does not experience unnecessary delays or hardships throughout the referral process and the determination of the final SSI decision.

(B) Overview of SSI application and appeal process

(1) The process of qualifying for SSI begins with the filing of an application at the local SSA office. The local SSA office establishes non-medical eligibility, determines when presumptive disability exists and authorizes payment of SSI for six months while an application is pending a decision from the Ohio rehabilitation services commission’s (ORSC) bureau of disability determination (BDD). BDD is the agency responsible for establishing medical eligibility.

(2) If the application is denied, the claimant may file an appeal. All requests for an appeal at any level of the appeals process must be received by SSA within sixty days of each decision unless good cause for a late filing can be established.

(a) The first appeal is termed a “reconsideration” and is to be requested in writing by the applicant or the applicant’s representative. At reconsideration, effort(s) should be made to present additional information such as progress notes concerning the individual’s ongoing treatment.

(b) A denial of the reconsideration may be appealed to a hearing before an administrative law judge. This is the only time that the applicant is seen in person by someone making the disability determination. For this reason it is important that when SSI benefits are denied, those denials be appealed to the hearing level.

(c) The final appeal stage, before seeking adjudication through the federal courts, is the appeals council. The appeals council reviews the hearing decision and bases its decision on the information already presented. The appeals council can grant or deny a request for review. If a review is granted, the appeals council can affirm, modify, reverse, or vacate and remand the request back to the administrative law judge for disposition.

(1) Participants applying for or in receipt of DFA with potential eligibility for SSI shall be identified and referred to a CDJFS SSI case manager. Individuals shall be identified at intake and at reapplication.

(2) Referrals shall be made to the SSI case manager by the eligibility, social services or other agency worker when any of the factors listed below are known to the agency:

(a) The individual has an SSI application pending.

(b) The individual meets any of the conditions listed in 42 United States Code (U.S.C.) 1382c (1/2005).

(c) The individual has a condition which is identified as potentially meeting the blindness or disability criteria as stated in 42 U.S.C. 1382c.

(d) The individual has been denied SSI in the past twelve months for lack of disability and has not appealed the denial.

(e) The individual has received a notice of termination of SSI benefits for lack of disability.

(f) The individual has been identified as potentially disabled through the use of a profile listing and/or survey form.

(g) Any other time the CDJFS believes a referral is appropriate.

(3) The referral to the SSI case manager shall contain, at a minimum, the following information:

(a) Identifying information including name, case number, address, contact telephone number, social security number, date of birth, last grade completed, and date and type of last employment.

(b) A brief description of the disabling condition(s), including how the condition prevents the participant from working and whether the condition has lasted or is expected to last twelve months or more.

(d) Copies of information pertinent to the individual’s SSI application including any existing medical information, as well as a copy of the JFS 07319, “Repayment Authorization for Interim Assistance Paid During Initial Eligibility Payment Period,” (rev. 05/2001) or the JFS 07233, “Repayment Authorization for Interim Assistance Paid During Initial Post Eligibility Payment Period,” (rev.05/2001) if applicable.

(D) SSI case management program responsibilities

(1) Individuals potentially eligible to receive SSI are to be provided a mechanism for assistance and representation in the SSI application and appeal process. Each SSI case management program shall:

(a) Assist individuals applying for or in receipt of DFA who might be eligible for SSI and assist them as necessary in applying for such benefits.

(b) Assist individuals applying for or in receipt of DFA in securing documentation of disabling conditions when there is a need or refer them for such assistance to an attorney or non-attorney with which the CDJFS has entered into an agreement.

(c) Inform individuals applying for or in receipt of DFA of available sources of representation which may include the SSI case manager, an attorney or non-attorney and/or the right to represent themselves in reconsiderations and appeals of SSA decisions that deny them benefits.

(2) The SSI case manager shall review each referral received to determine if potential eligibility for SSI exists and/or the best avenue by which to pursue a reconsideration or appeal. If the SSI case manager cannot determine potential eligibility for disability, he may contact the bureau of clinical management, disability determination unit (DDU) for technical assistance.

(3) The SSI case manager shall notify the individual in writing of services available through the SSI case management program, interview the individual to assess the individual’s needs, and in consultation with the individual shall develop a plan for service. The plan should identify services to be provided to address the individual’s needs.

(4) In accordance with the provisions set forth in rule 5101:1-5-20 of the Administrative Code and as a condition of eligibility for DFA, the SSI case manager shall require individuals, who in the case manager’s judgment may be eligible for SSI, to apply for such benefits and to pursue reconsiderations and appeals of SSA decisions that deny them SSI benefits.

(5) Individuals applying for or in receipt of DFA shall receive SSI case management assistance at all stages of the SSI application and appeal process.

(6) SSI case management program services shall be provided to an individual until:

(a) SSI is approved;

(b) All avenues for seeking SSI have been exhausted;

(d) The individual has been referred to and is being represented by an attorney or non-attorney.

(7) When a DFA recipient relocates from county “A” in which a claim is initially filed, to county “B”, then county “B” shall assume responsibility for the SSI case management activities.

(8) Individuals referred to the SSI case management program shall be required to apply for medicaid. The determination of disability for individuals pending an SSI determination is made by ODJFS in accordance with rule 5101:1-39-03 of the Administrative Code. If, as a result of the ODJFS decision, the CDJFS determines that SSI case management services shall be denied, the JFS 07334, “Notice of Denial of Your Application for Assistance,” (rev. 10/2007) shall also indicate the denial of SSI case management services.

(E) SSI case management advocacy duties The SSI case manager has the following advocacy duties:

(1) Arranging interviews with the SSI applicant to discuss the case manager’s roles;

(2) Assessing the individual’s needs including the ability to complete the application and when necessary, assisting the individual in the completion of an application for SSI and accompanying the participant to the SSA office for the application interview.

(3) Developing with the individual a social, medical, and employment history (SSA-3368-BK, “Disability Report-Adult” {rev. 2/2004}).

(4) Assisting the individual and if necessary acting for the individual in obtaining available hospital, physician, pharmacy and other medical documentation of disability, including where appropriate, help with making, keeping, and rescheduling appointments with medical examiners and assisting with transportation.

(5) Assisting the individual in obtaining social and vocational documentation.

(6) Developing and maintaining contact with the local SSA office and the ORSC, BDD.

(7) Submitting all completed medical documentation as required under rules 5101:1-5-20 and 5101:1-39-03 of the Administrative Code to ODJFS when the CDJFS assigns this duty to the SSI case manager.

(8) Establishing and maintaining communication with ODJFS and taking the necessary action as stated on the JFS 03600, “Ohio Department of Job and Family Services County Medical Services Section Disability Determination,” (rev. 5/2003).

(9) Reviewing SSI denial notices and medical reports and consulting with the bureau of clinical management, DDU for technical assistance to determine the feasibility of appealing the decision.

(10) Assisting the individual in appealing any SSI denial and gathering additional medical information, if necessary.

(11) Assisting the individual in submitting forms timely as required for each level of the SSI appeal and advocating for the individual at the appeal or at the hearing.

(12) Assisting the individual in securing an attorney or non-attorney to provide appropriate representation if the individual desires or when the SSI case manager deems it to be in the individual’s best interest.

(13) Representing the individual in appealing an SSI denial if the CDJFS offers this service to individuals.

(14) Signing the SSA-1696-U4, “Appointment of Representative,” (rev. 1/2005) during the SSI application process if the SSI case manager is representing the individual. This will result in a copy of all notices with information pertaining to appointments for consultative examination, noncompliance on the part of the individual, etc. sent to the individual also being sent to the SSI case manager.

(F) SSI case management administrative duties

The SSI case manager has the following administrative duties:

(1) Ensuring that the interim assistance agreement is signed in accordance with rule 5101:1-5-70 of the Administrative Code.

(2) Informing the appropriate eligibility worker, if applicable, of the individual’s failure to keep scheduled appointments.

(3) Notifying the eligibility worker, if applicable, of the status of each SSI applicant’s case, including the outcome of the initial application decision and subsequent appeals. The status can be tracked through use of the ODJFS state verification and exchange system (SVES).

(4) Notifying the eligibility worker, if applicable, of the individual’s failure to pursue reconsiderations or appeals of SSA decisions that deny SSI benefits.

(5) Notifying the eligibility worker, if applicable, to approve and initiate medicaid coverage when SSA approves the application for six-month presumptive disability or when ODJFS approves physical and/or mental disability.

(6) Performing the eligibility worker duties associated with the individual’s DFA and/or medicaid case, when the CDJFS assigns these duties to the SSI case manager and sending a JFS 07365, “Application for Release of Interim Assistance Reimbursement (IAR) to Attorney or Representative of an SSI Applicant,” (rev. 10/2007) to whom an individual has chosen for representation.

(7) Assuring that individuals who are denied through the reconsideration stage are aware of the right to be represented through the administrative and judicial levels of appeal.

(8) Maintaining a tracking system of all individuals and their progress. This applies even when an individual has been referred to alternative representation.

(G) Representation on SSI appeals

(1) The SSI case manager shall inform participants applying for or in receipt of DFA, of all available sources of representation in reconsiderations and appeals of SSA decisions that deny them SSI. Each CDJFS should contact its county bar association for a list of attorneys willing to handle SSI cases.

(2) The sources of representation include:

(a) Attorney;

(b) SSA approved non-attorney;

(d) Non-attorney not approved by SSA; or

(e) Self-representation.

(H) Representation by attorneys and SSA-approved non-attorneys

(1) Section 302 of the Social Security Protection Act (SSPA) of 2004 extends the current attorney fee withholding and payment process under title II of the Social Security Act (the Act) to claims for benefits under title XVI of the act. Section 303 of the SSPA has implemented the same fee withholding and payment process for non-attorneys approved by the SSA through an examination process. Title II of the act refers to the retirement, survivor’s and disability insurance (RSDI) and Title XVI of the act refers to the supplemental security income (SSI) program. The SSA will make a direct payment of fees to an attorney or SSA approved non-attorney who successfully represents an SSI claimant from the beneficiary’s past-due benefits.

(a) For cases in which a fee agreement and representation authorization by the attorney/approved non-attorney is on record with the SSA (of which, the attorney/approved non-attorney has not waived a fee or waived direct payment) and the case is effectuated after February 28, 2005, SSA is required to pay the attorney fee from the RSDI or SSI past-due benefits that result from a claim even if the claim was filed before the February 28, 2005 effective date.

(b) For RSDI claims, the attorney/approved non-attorney shall be issued a written notice from the SSA of the dollar amount of the past-due benefits. The claimant shall also be issued a written notice from the SSA of the dollar amount of the past-due benefits payable to the claimant. For SSI claims, the attorney/approved non-attorney shall be issued a notice from the SSA regarding the amount of the fee and the claimant shall be issued a notice from the SSA of the amount of the retroactive payment.

(c) Each case involving interim assistance reimbursement (IAR) to the CDJFS which also involves an attorney/approved non-attorney, SSA will submit an SSA-L8125-F6, “IAR Payment Pending Case: State Due Payment******Priority Handling” (rev. 10/1997) at the time that the individual has been awarded an SSI claim for benefits.

(i) The CDJFS shall complete the section titled “States Account of Reimbursement Claimed” and must return the form to the SSA within ten working days;

(ii) The SSA will then reimburse the CDJFS for the IAR paid upon the approval of SSI benefits; and

(iii) The attorney/approved non-attorney shall be paid directly by the SSA.

(d) Notification of either approval or denial is sent by the SSA to an attorney/approved non-attorney in all cases where a representative agreement has been filed with the SSA. In cases where a fee is not charged, the claimant receives a notice from the SSA that the attorney/approved non-attorney agreed not to charge a fee.

(e) If a CDJFS receives a JFS 07365 from an attorney/approved non-attorney for payment of a successful SSI claim, the CDJFS shall request a copy of the SSA notification. If the attorney/approved non-attorney reports that he or she has not received a notice from the SSA and has filed with the SSA to represent the claimant, the CDJFS shall refer the attorney/approved non-attorney to the local SSA office to resolve the issue and provide verification. SSA notice verification will ensure that fees are not paid to the attorney/approved non-attorney by both the SSA and the CDJFS when claims have been approved.

(2) An individual may be eligible for reimbursement from the CDJFS when a contract has been entered into with the CDJFS in accordance with section 5115.20 of the Revised Code provided the individual has not received or applied to receive payment from the SSA.

(3) In IAR cases where the attorney/non-attorney has not waived the right to collect a fee, the CDJFS shall request that the representative provide verification from the SSA that he has not received payment or has not applied for payment on the SSA claim. Once verification is provided, the CDJFS shall follow the claim procedure outlined in rule 5101:1-5-70 of the Administrative Code.

(I) Representation by non-attorneys not approved by the SSA

(1) In accordance with the provisions set forth in this rule, a non-attorney representative who does not meet SSA qualifications may still represent DFA individuals who apply for or have been denied SSI benefits. The non-attorney representative who successfully appeals an SSI claim may receive payment from the CDJFS for services rendered when the requirements set forth in paragraph (J) of this rule for fee payment by the CDJFS have been met.

(2) Non-attorney representatives who do not meet the qualifications set forth by the SSA may not receive a direct fee payment for representation of approved SSI claim awards from the SSA.

(J) Payment of fees

(1) Fees shall be payable by the CDJFS only when the following has occurred:

(a) The attorney/non-attorney who has not received notice of SSA direct payment has represented the DFA individual in a successful reconsideration or appeal of the SSI denial; and

(b) The attorney/non-attorney has filed a JFS 07365 with the CDJFS within sixty calendar days of the issuance of the SSI award letter; and

(i) A copy of the reconsideration or appeal order which grants SSI eligibility to the individual; and

(ii) Either a signed waiver of the right to collect a fee from the individual or a copy of the SSA or court order which authorizes the attorney/non-attorney to collect a fee; and

(iii) A bill for services rendered.

(2) Upon receipt of a completed application (including, if applicable, a copy of the SSA or court order which authorizes the right to collect a fee) the CDJFS shall within fifteen calendar days either deny the application, stating the reason for the denial on the JFS 07365, or approve the application and indicate on the JFS 07365 the amount of the IAR received by the CDJFS and the amount of the reimbursement to be paid as a fee. The CDJFS shall provide a copy of the JFS 07365 to the attorney/non-attorney representative and to the SSI claimant. The fee shall be paid within thirty calendar days of the CDJFS approval and shall be the lesser of the following:

(a) Twenty-five per cent of the individual’s SSI award; or

(b) The amount of the IAR received by the CDJFS; or

(d) The amount billed by the attorney/non-attorney.

(3) There shall be no interim assistance reimbursement fee payable by the CDJFS to an individual who elected to represent himself in the SSI claim process or to a CDJFS or CDJFS employee who may be representing an individual in the SSI claim process.

(4) An attorney/non-attorney who has made an application for a fee with the CDJFS and believes that the CDJFS has made an incorrect decision on the application may, within fifteen calendar days of the decision, file a written request for a review with the “Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825.” The review request shall include a copy of the CDJFS decision on the JFS 07365, an explanation of why the decision is incorrect and any supporting documentation. The availability of this review, whether or not utilized, is not intended to restrict the availability of any judicial remedy the attorney/non-attorney may have against a CDJFS.

(K) Coordination with local alcohol, drug addiction, and mental health services

(1) If the SSI case manager finds that the SSI applicant may have significant mental health problems and is in need of mental health services, the individual may benefit from a referral for mental health services provided under a local alcohol, drug addiction, and mental health services board. Several county alcohol, drug addiction, and mental health services boards have initiated a program to expedite SSDI/SSI mental impairment claims. The CDJFS is encouraged to work with its local alcohol, drug addiction, and mental health services boards to arrange a referral agreement for those persons having significant mental health problems. Mental health professionals who treat, counsel and/or coordinate care of persons having mental health problems are key sources of information and assistance in the SSI application process.

(2) The CDJFS is encouraged to coordinate the SSI case management responsibilities through the local alcohol, drug addiction, and mental health services boards where appropriate.

Replaces: 5101:1-5-60

Effective: 07/01/2008

R.C. 119.032 review dates: 07/01/2013

Promulgated Under: 111.15

Statutory Authority: 5115.20

Rule Amplifies: 5115.20

Prior Effective Dates: 2/1/88 (Emer.), 5/1/88, 5/2/88, 10/1/90 (Emer.), 12/2/91, 11/1/92, 7/1/98, 7/1/03 (Emer.), 9/30/03

5101:1-5-70 Disability financial assistance (DFA): interim assistance.

(A) General principles

(1) Section 1631 of the Social Security Act, as amended by Section 5 of Public Law 93-368 (08/07/74), Section 1 of Public Law 94-365 (07/14/76), and Section 204 of Public Law 104-193 (08/22/96), provides for the reimbursement to states that have furnished assistance (cash or vendor payments) to an individual for meeting basic needs during:

(a) The interim period for initial supplemental security income (SSI) claims, as set forth in paragraph (B) of this rule; or

(b) The interim period for initial posteligibility SSI claims as set forth in paragraph (E) of this rule.

(2) “Interim assistance” (IA), as defined by the social security administration (SSA) means assistance furnished to an individual or on behalf of the individual, financed totally from state and/or local funds, for meeting basic needs and furnished:

(a) During the period beginning with the first day of the month following the later of:

(i) The month in which the individual filed an application for SSI benefits; or

(ii) The month for which the individual was found eligible to receive SSI benefits; and

Ending with (and including) the month the individual’s SSI benefits began; or

(b) During the period beginning with the day the individual’s SSI benefits were reinstated after a period of suspense or termination, and ending with (and including) the month the individual’s SSI benefits were resumed.

(3) IA for initial claims, or initial posteligibility claims, does not include:

(a) Payment for medical assistance; or

(b) Assistance that is financed in whole or in part from federal funds; or

(c) Assistance financed totally from state and/or local funds which is authorized for individuals for whom an SSI application is not pending, or for whom SSI benefits have not been terminated or suspended.

(4) The terms “initial claims” and “initial posteligibility claims” mean the first payment with respect to the IA, as defined in paragraph (A)(2) of this rule, but do not include:

(a) Any emergency advance payments authorized under section 1631(a)(4)(A) of the Social Security Act (01/06/2006); or

(b) Any presumptive disability or presumptive blindness payment authorized under section 1631(a)(4)(B) of the Social Security Act (01/06/2006). Payments to individuals based on presumptive disability or blindness are made by the SSA and are issued directly to the individual without regard for IA involvement. Any retroactive payment due the individual after a final determination has been made will automatically be made to the Ohio department of job and family services (ODJFS) through the county department of job and family services (CDJFS); or,

(B) Interim period for initial claims

(1) The interim period for initial claims begins with the first day of the month following the later of:

(a) The month in which an individual filed an application for SSI benefits; or

(b) The month that the individual is found eligible for SSI benefits; and

ends with (and includes) the month that SSI benefit payments are made.

(2) The interim period includes the last IA payment which is authorized and for which delivery cannot be stopped, following the CDJFS receipt of the individual’s retroactive SSI benefit payment from the SSA.

(3) The interim period may be extended when the initial claim is denied and a timely appeal is filed. In this situation, the interim period shall be extended pending SSA’s decision on the appeal, which is the final determination. The interim period may be prolonged by reconsideration and other appeals of the initial SSI eligibility determination.

(4) If a new initial claim is filed, rather than an appeal, the interim period shall begin with the date of the new initial claim, and a new JFS 07319 “Repayment Authorization for Interim Assistance Paid During Initial Eligibility Payment Period” (rev. 05/2001) shall be required.

(5) The CDJFS shall not retain reimbursement for IA paid by ODJFS for the month in which the application for SSI is filed if the individual is not eligible for SSI in that month.

(6) The CDJFS shall not recoup IA issued by ODJFS to an individual during the interim period for any month in which the individual was not eligible for an SSI payment.

(1) For each individual who applies for DFA for whom an SSI application is pending, a JFS 07319 must be completed.

(2) If the individual refuses to sign the repayment authorization, the application for DFA shall be denied.

(3) A JFS 07319 must be completed for each individual in receipt of ongoing DFA who applies for SSI. Following completion of the JFS 07319, the individual shall be considered to be receiving IA.

(4) The interim period as set forth in paragraph (B) of this rule, applies to individuals in receipt of ongoing DFA benefits who apply for SSI. Refusal of the individual to sign the JFS 07319 renders the individual ineligible for DFA while the SSI application is pending.

(5) The repayment authorization remains in effect until a final determination has been made by the SSA. If the claim is denied and a timely appeal is filed, the decision from the appeal is the final determination. If a new claim is filed rather than an appeal, a new JFS 07319 is required.

(6) Once the authorization is executed, the individual cannot withdraw or cancel it, unless both the individual and the CDJFS agree in writing to the withdrawal. In this situation, the individual is not eligible for DFA once the authorization is withdrawn.

(7) If at a later date the JFS 07319 is withdrawn at the agreement of both the individual and the CDJFS, the revocation of the authorization form is effective the date of the joint agreement between the individual and the CDJFS. It is not retroactive to the date the authorization was signed.

(D) CDJFS responsibility when eligibility for IA for initial claims period is determined.

When an individual’s eligibility for IA for an initial claim, as defined in paragraphs (A)(4) and (B) of this rule, is being determined, the CDJFS shall:

(1) Secure a signature on the JFS 07319 for each individual for whom an SSI application is pending.

(2) Register a medicaid application for the individual.

(3) Complete a disability determination referral to the ODJFS disability determination unit (DDU).

(4) Send the repayment authorization to the local social security office within ten working days of obtaining the individual’s signature on the JFS 07319. The CDJFS shall keep a copy in the assistance group record. If the individual is determined not eligible for DFA, the JFS 07319 shall be rescinded within one working day of the determination of ineligibility. It is necessary to keep the ten working days requirement as no retroactive SSI payment will be received if the local social security office has processed the SSI application before the repayment authorization is received.

(5) Issue IA if all DFA eligibility requirements are met.

(6) Upon receipt of the retroactive SSI benefits, the CDJFS shall compute the amount of IA issued. When a married couple is receiving IA, and only one spouse is found eligible for SSI benefits, the IA amount to be reimbursed shall be the difference between the DFA payment for one person and the DFA payment for two. When both of the individuals are found eligible for SSI benefits, and both were receiving DFA, the IA amount to be reimbursed for each individual shall be one-half of the total monthly payment.

(7) Any amount that represents the difference between the amount of the retroactive SSI payment and the amount of IA issued shall be paid to the individual by county warrant. The warrant shall be issued within ten working days of the receipt of the individual’s retroactive SSI check by the CDJFS.

(8) If the SSA has selected a representative payee for the individual, the CDJFS shall pay the balance of the retroactive SSI benefits due the individual to the payee. The name and address of the payee are shown on the SSA-8125 “Notice of Interim Assistance Reimbursement Eligibility and Accountability Report” (undated).

(9) If the law requires the commissioner of SSA to restrict the manner in which the residual amount of a retroactive SSI payment may be paid to an individual, such as installment and/or dedicated account cases, SSA will ask the CDJFS to determine the amount of IA it is entitled to be reimbursed and SSA will then release that amount to the CDJFS.

(10) Within ten working days of the CDJFS receipt of the individual’s retroactive SSI check, a JFS 07107 “Notice of Interim Assistance Reimbursement” (rev. 04/01) shall be sent to the individual explaining the apportionment of the retroactive SSI check. If no payment is being made to the individual, the CDJFS shall enter “no warrant” in the blocks designated for “date of warrant” and “amount of warrant” on the JFS 07107.

(11) If an individual dies or disappears before the individual has received all the SSI benefits to which the individual is entitled, ODJFS retains the right to receive benefits due for the retroactive period. In this situation, the SSA will forward a one-time payment to the CDJFS for ODJFS. Any excess benefits received must be returned to the SSA on an individual case basis showing the individual’s name and social security number. The CDJFS shall send the excess funds to the SSA district office which services the CDJFS or to the district office which services the individual’s last address.

(12) If required, the CDJFS shall complete part IV of the SSA-8125 as set forth in the instructions for completion of the SSA-8125 in paragraph (I) of this rule, and return it to the SSA. The CDJFS shall report the receipt and distribution of retroactive SSI benefits retained by the CDJFS as reimbursement for IA on the JFS 02827 “Monthly Financial Statement.”(rev. 11/00) The CDJFS shall determine the amount of retroactive SSI benefits to be retained as reimbursement by including all DFA benefits paid by ODJFS that meet the definition of IA as set forth in paragraph (A) of this rule, irrespective of the number of Ohio counties in which the individual resided during the interim period.

(13) The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DFA funds paid by ODJFS on the SSA-8125. If the individual’s claim for SSI is denied or no retroactive payments are due, the CDJFS is not required to complete part IV of the SSA-8125 but shall retain the original in the assistance group record.

(E) Interim period for initial posteligibility claims

(1) The interim period for initial posteligibility claims begins with the first day that the individual’s SSI benefits were suspended or terminated, if the individual is subsequently found eligible for SSI benefits, and ends with, and includes, the month that the SSI benefit payment is made.

(2) The interim period for initial posteligibility claims includes the last IA payment which is authorized and for which delivery cannot be stopped, following the CDJFS receipt of the individual’s retroactive reinstated SSI benefit payment from the SSA.

(3) The CDJFS shall not recoup IA issued by the ODJFS during the initial posteligibility claim period for any month in which the individual was not eligible for a retroactive reinstatement of SSI benefits.

(4) The interim period for initial posteligibility claims continues until:

(a) The period of time has elapsed that the individual has to file an appeal if the suspension or termination requires an appeal for reinstatement; or

(b) SSA releases a retroactive SSI payment after a period of suspension or termination; or

(c) SSA makes a final determination on the claim and the individual does not file a timely request for review. If a timely request for review is filed, the decision from the review is the final determination; or

(d) One year has elapsed from the date that the SSI benefits were suspended or terminated, if the SSA has not reopened the individual’s claim to explore the individual’s eligibility for reinstated SSI benefits.

(5) Under no circumstances shall the interim period for initial posteligibility claims exceed one year unless the SSA has reopened the individual’s claim and is in the process of exploring the individual’s eligibility for reinstated SSI benefits.

(6) The initial posteligibility claim period shall expire twelve months following the suspension or termination of the individual’s SSI benefits if the SSI payments are not reinstated by the twelfth month, and if the SSA has not reopened the individual’s claim and is not in the process of exploring the individual’s eligibility for reinstated SSI benefits.

(7) If the individual’s SSI benefits are not reinstated within the twelve-month initial posteligibility claim period, and no SSA decision is pending, the individual must reapply for SSI benefits.

(8) In addition, the CDJFS must secure the individual’s signature on a JFS 07319, as the JFS 07233 “Authorization for Reimbursement of Interim Assistance – Initial Posteligibility Payment” (rev. 05/01) will cease to be effective following the expiration of the twelve-month initial posteligibility interim period.

(F) Written authorization for IA during initial posteligibility claim period

(1) For each individual who applies for DFA and whose SSI benefits have been terminated or suspended, a JFS 07233 must be completed.

(2) If the individual refuses to sign the repayment authorization, the application for DFA during the initial posteligibility period shall be denied.

(3) An individual who applies for DFA whose SSI benefits have been terminated or suspended shall be referred to the local SSA office for verification of the status of the individual’s termination or suspension of SSI benefits, prior to authorizing DFA.

(4) The repayment authorization remains in effect until one of the following events occurs:

(a) SSI releases a retroactive payment after the period of suspension or termination; or

(b) SSA makes a final determination on the issue and no timely request for review is filed; or

(c) The period of time has elapsed that the individual has to file an appeal if the reason for the suspension or termination requires an appeal for reinstatement; or

(d) The CDJFS and the individual agree in writing to terminate the authorization, which shall result in the individual’s ineligibility for DFA; or

(e) One year has elapsed from the date that the individual’s SSI benefits were terminated or suspended, unless the SSA has reopened the individual’s claim and is in the process of exploring the individual’s eligibility for reinstated SSI benefits. The repayment authorization for the interim period of the initial posteligibility claim shall not exceed one year, unless the SSA has reopened the individual’s claim and is in the process of exploring the individual’s eligibility for reinstated SSI benefits; or

(f) SSI benefits are not reinstated within one year from termination or suspension, and the SSA has not reopened the individual’s claim. In such cases, the JFS 07233 is no longer in effect as the individual must reapply for SSI benefits which requires that a JFS 07319 must be completed, because reinstatement of SSI benefits will not occur. Therefore, the initial posteligibility claim period ends, and an initial claim period begins with the individual’s reapplication for SSI benefits.

(G) CDJFS responsibility when eligibility for IA for initial posteligibility payment period is determined.

When an individual whose SSI benefits have been suspended or terminated applies for DFA, the CDJFS shall:

(1) Secure a signature on the JFS 07233 for each individual who applies for DFA and whose SSI benefits have been terminated or suspended.

(2) Send the repayment authorization to the local SSA office within one working day of obtaining the individual’s signature on the JFS 07233. The CDJFS shall keep a copy in the assistance group record. If the individual is subsequently determined to be ineligible for DFA, the JFS 07233 shall be rescinded within one working day of the determination of ineligibility. It is necessary to keep the one working day requirement as the CDJFS will not receive the individual’s retroactive reinstated SSI check if the SSA office processes the individual’s reinstatement of SSI benefits prior to receipt of the JFS 07233 from the CDJFS.

(3) Prior to approving DFA for an individual whose SSI benefits have been suspended or terminated, the CDJFS shall refer the individual to the local SSA office to secure verification of the status of the individual’s termination or suspension of SSI benefits.

(4) Issue IA if all DFA requirements are met including verification from the SSA office that the individual’s SSI benefits will not be immediately reinstated.

(5) Once the individual’s SSI benefits are reinstated, the retroactive reinstatement SSI award will be sent to the CDJFS that forwarded the JFS 07233 to the SSA. If the SSA denies the individual’s request for reinstatement, and the individual does not timely request a review of the determination, the SSA-8125 will be sent to notify the CDJFS of the denial of reinstatement.

(6) Upon receipt of the individual’s retroactive reinstated SSI benefits, the CDJFS shall compute the amount of IA issued as follows:

(a) When a married couple is receiving IA, (DFA) during the initial posteligibility payment period, and only one of the individuals receives reinstated SSI benefits, the amount of the IA to be reimbursed shall be the difference between the DFA payment for one and the DFA payment for two. When both of the individuals are found eligible for SSI during initial posteligibility payment period, the IA amount to be reimbursed for each individual shall be one-half of the total monthly payment.

(b) Additionally, if the SSA prorates the individual’s SSI payment for any month, the initial posteligibility IA amount for that month (remainder of difference between payment for one and two) must be prorated as set forth in paragraph (H) of this rule.

(7) Any amount that represents the difference between the amount of the retroactive reinstated SSI payment and the amount of IA issued shall be paid to the individual by county warrant. The warrant shall be issued within ten working days of the CDJFS receipt of the individual’s retroactive reinstated SSI check.

(8) If the SSA has selected a representative payee for the individual, the CDJFS shall pay the balance of the retroactive reinstated SSI benefits due the individual to the payee. The name and address of the payee are shown on the SSA-8125.

(9) If the law requires the commissioner of the SSA to restrict the manner in which the residual amount of a retroactive SSI payment may be paid to an individual such as installment and/or dedicated account cases, SSA will ask the CDJFS to determine the amount of IA it is entitled to be reimbursed and SSA will then release that amount to the CDJFS.

(10) Within ten working days of the CDJFS receipt of the individual’s retroactive reinstated SSI payment, a JFS 07107 shall be sent to the individual explaining the apportionment of the retroactive reinstated SSI check. If no payment is being made to the individual, the CDJFS shall enter “no warrant” in the blocks designated for “date of warrant” and “amount of warrant” on the JFS 07107.

(11) If an individual dies or disappears before the individual has received all the SSI benefits to which the individual is entitled, ODJFS retains the right to receive benefits due for the retroactive period. In this situation, the SSA will forward a one-time payment to the CDJFS for ODJFS. Any excess benefits received must be returned to SSA on an individual case basis showing the individual’s name and social security number. The CDJFS shall send the excess funds to the SSA district office which services the CDJFS or to the district office which services the individual’s last address.

(12) If required, the CDJFS shall complete part IV of the SSA-8125 as set forth in the instructions for completion of the SSA-8125, and return it to the SSA. The CDJFS shall report the receipt and distribution of retroactive SSI benefits retained by the CDJFS as reimbursement for IA on the JFS 02827. The CDJFS shall determine the amount of retroactive SSI benefits to be retained as reimbursement by including all DFA benefits paid by ODJFS, that meet the definition of IA, irrespective of the number of Ohio counties in which the individual resided during the interim posteligibility period.

(13) The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DFA funds paid by ODJFS on the SSA-8125. If the individual’s initial posteligibility claim for retroactive reinstated SSI benefits is denied or no retroactive reinstated benefits are due, the CDJFS is not required to complete part IV of the SSA-8125 but shall retain the original in the assistance group record.

(H) Computation of IA reimbursement to be retained by the CDJFS

(1) In determining the amount of IA to be retained as reimbursement for initial posteligibility claims, the CDJFS must prorate the amount it recoups for any month that SSA prorates the retroactive SSI payment.

(2) The CDJFS must prorate the amount of DFA issued beginning with the day from which the SSI payments are prorated and retain only that prorated amount of DFA issued as reimbursement.

(3) The CDJFS shall determine that a month’s SSI payment was prorated by reviewing the “payment summary” of the SSA-8125. If the day shown under the “payment summary” of the SSA-8125 is other than the first day of the month, the CDJFS shall determine that the SSI payment was prorated and shall prorate the amount of DFA to be applied as reimbursement.

(4) The CDJFS shall not recover the difference paid for a prorated month from any other month in the interim period for initial posteligibility claims.

(5) The CDJFS shall not recoup DFA issued to the individual during the interim period, either the initial eligibility or the initial posteligibility interim period, for any month in which the individual was not eligible for an SSI payment.

(I) Accounting for IA reimbursement

(1) In every situation in which an individual has received IA, either during initial eligibility or initial posteligibility payment period, the SSA-8125 shall be forwarded by the SSA to the CDJFS.

(2) The SSA-8125 will contain the following information:

(a) Amount of retroactive payment being made;

(b) The period of time covered by the retroactive payment;

(d) The amount of the check.

(3) In all cases, when the commissioner of SSA is not required by law to restrict the manner in which the retroactive SSI payment may be paid to an individual, the SSA will send the retroactive SSI payment to the CDJFS. When the CDJFS receives the first SSI payment due an individual, part IV of the SSA-8125 must be completed as set forth in paragraphs (I)(5)(a) to (I)(5)(h) of this rule. Within thirty working days of receipt of the IA reimbursement, the original copy of the SSA-8125 must be forwarded to the SSA.

(4) When the commissioner of the SSA is required by law to restrict the manner in which the retroactive SSI payment may be paid to an individual, the CDJFS must forward the completed SSA-8125 to the designated SSA office within ten working days of the date SSA forwarded the form to the CDJFS. If the CDJFS does not complete and forward the SSA-8125 to the SSA office within ten working days of the date that it was forwarded to the CDJFS, SSA will forward a follow-up request to the CDJFS for the completion and return of that form. If the CDJFS fails to return the form to the designated SSA office within fifteen working days of the follow-up request, SSA will release the retroactive amount to the individual through its applicable processing procedures to protect the individual from hardship that may arise from the failure of the CDJFS to comply with SSA’s interim assistance processing requirements. In these situations, the CDJFS may pursue recovery from the individual for any IA that the CDJFS may be due. However, the commissioner of the SSA will not be a party to or responsible for participating in the recovery effort under these circumstances.

(5) The CDJFS shall retain a photocopy of the completed SSA-8125 for audit purposes. The CDJFS shall list the total amount of DFA funds paid by ODJFS on the SSA-8125. If the individual’s claim for SSI is denied or no retroactive payments are due, the CDJFS is not required to complete part IV of the SSA-8125, but shall retain the original in the assistance group record.

(6) In all cases, the CDJFS shall complete part IV of form SSA-8125 within thirty working days after an IA reimbursement payment for either an initial SSI benefit claim or an initial posteligibility benefit claim is received from the SSA by the CDJFS.

(a) “Item 1” – amount of the reimbursement check the CDJFS received from the SSA. Enter the total dollar amount of the payment received from SSA for the individual.

(b) “Item 2” – amount of IA paid to the individual by ODJFS (using definition of IA printed on form SSA-8125). Enter the total dollar amount representing IA payment made by the CDJFS to the individual.

(c) “Item 3” – amount of the reimbursement check retained by the CDJFS for ODJFS. Enter the total dollar amount of reimbursement retained by the CDJFS as reimbursement.

(d) “Item 4” – amount of the reimbursement check forwarded to the individual. Enter the dollar amount of the reimbursement which exceeds the IA benefits paid by ODJFS and which excess was actually paid to the individual or his representative payee. “date sent” : enter the date the excess was actually sent to the individual or representative payee.

(e) “Item 5” – amount of the reimbursement check returned to the SSA. Enter the total dollar amount of reimbursement returned to the SSA for any reason.

(f) Generally, the “remarks” section of the form is to be used by the CDJFS to indicate any other pertinent information relating to the applicable IA reimbursement payment involved which should be explained.

(g) Some specific items which should be explained in the “remarks” section are as follows:

(i) Enter the reason for the return of any portion of the reimbursement check to the SSA.

(ii) If for any reason the total of the amounts shown in items 3, 4, and 5 of the report does not equal the amount shown in item 1, enter the reason for the discrepancy and outline what has been done to resolve the situation.

(iii) If the CDJFS is unable to submit the SSA-8125 to the SSA within thirty working days from the receipt of the reimbursement check, explain the reason for the delay in reporting.

(iv) Nonreceipt of the IA reimbursement check.

(h) “Signature, title, agency, and date” – the date the IA report is forwarded to the SSA should be entered in the appropriate space. In the signature space, the name of the authorized individual who will sign the report should be typed or printed as well as signed. The title of the individual signing the report and his agency should also be typed or printed.

Effective: 09/01/2008

R.C. 119.032 review dates: 06/10/2008 and 09/01/2013

Promulgated Under: 111.15

Statutory Authority: 5115.03

Rule Amplifies: 5115.03

Prior Effective Dates: 7/1/84, 8/1/85 (Emer.), 10/17/85, 4/9/87, 7/1/88 (Emer.), 9/15/88, 5/1/89 (Emer.), 7/1/89 (Emer.), 9/23/89, 8/1/90 (Emer.), 10/25/90, 10/1/91 (Emer.), 12/20/91, 2/1/95, 5/1/95, 8/1/95 (Emer.), 10/30/95, 7/1/98, 7/1/2001, 7/1/2003 (emer.), 9/30/03