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A. The Purpose of Benefit Diversion
B. What Type Of Situations Can Benefit Diversion Help Resolve?
C. Which Families Are Potential Candidates For Benefit Diversion?
D. Presenting The Benefit Diversion Package
E. Completing An Application For Benefit Diversion
F. Determining The Amount Of Benefit Diversion To Give To The Family
G. The Retroactive Medicaid Requirements For Benefit Diversion
H. Authorizing Medicaid During Benefit Diversion
I. Transitional Medicaid After The Benefit Diversion Period Ends
Change #3-2010
April 1, 2010
Benefit Diversion is a cash payment alternative to traditional Work First Family Assistance (WFFA). Work First offers some families Benefit Diversion in lieu of WFFA. It is an optional package of services that may include:
Advise the applicant if Benefit Diversion is offered to the family, the family members will receive Medicaid. The family members may apply for Medicaid prior to being evaluated for Benefit Diversion or instead of Benefit Diversion. The caseworker will advise the applicant that any information provided as a part of the Benefit Diversion assessment will automatically be used as a part of the Medicaid application, including social security numbers, citizenship, immigration status and identity. The caseworker must ask if the applicant wishes to continue with the Benefit Diversion evaluation or if there are individuals in the household who only want to apply for Medicaid. The caseworker must document the applicant’s response in the case file.
Counties determine the families to whom Benefit Diversion is offered, but the family must choose whether it is appropriate for them. If the family decides not to accept Benefit Diversion, continue with the interview. Consider other services or benefits as described in Section 101.
NOTE: Families receiving Benefit Diversion are not precluded from receiving other services such as emergency or energy assistance or one-time work-related expenses.
While families may apply for Work First Family Assistance at any time, they cannot receive cash assistance until the Benefit Diversion period has expired.
Benefit Diversion is defined as nonrecurring short term benefits that must meet the following criteria to be excluded as assistance.
1. Are designed to deal with a specific crisis situation or episode of need;
2. Are not intended to meet recurrent or ongoing needs; and
3. Will not extend beyond 3 months.
If the benefit does not meet all three of the criteria, the benefit meets the definition of assistance, and the applicant will be subject to all of the requirements associated with Work First Family Assistance.
Benefit Diversion provides an opportunity for families to receive immediate help and preserve their independence from public assistance. Benefit Diversion helps to ensure that:
Benefit Diversion is intended to be a one-time service for families. Benefit Diversion can only be provided once within a twelve-month period. Therefore, the caseworker should provide referrals to agency and community resources that will help the family avoid the need for further cash assistance in the future. Benefit Diversion does not have to be repaid.
In most situations, a Benefit Diversion package can be authorized the same day as the initial interview. In any case, the Benefit Diversion application should be approved as quickly as possible.
Benefit Diversion is designed to meet a specific family crisis or episode of need through the use of nonrecurring short term benefits. The Benefit Diversion package may be used for families who are employed, soon-to-be-employed, or between jobs experience different types of work-related circumstances. Many need help with rent and utility payments or with food expenses. While others have a combination of needs.
Benefit Diversion is for families with a bona fide specific family crisis or family episode of need, rather than a chronic or continuing situation. The crisis situation or episode of need, as well as supportive services that can be provided to address such situations may:
Benefit Diversion can not be used to temporarily divert a family for 3 months and then move the family into ongoing Work First Family Assistance.
A family must meet the eligibility criteria for WFFA in order to receive Benefit Diversion. Benefit Diversion is a program option under WFFA. However, not every family is a candidate for Benefit Diversion. Some families may be better served by WFFA. Examples include families who require extensive assistance and services such as caretakers who are incapacitated, or anticipate no new income source within four months, or caretakers who have serious barriers to employment.
During the initial screening process, the caseworker will determine the families to whom the Benefit Diversion package should be offered. If the screening of the applicant indicates the family’s needs may extend beyond the Benefit Diversion period, an application should be taken for Work First Family Assistance. Benefit Diversion should not be offered as an option.
The use of Benefit Diversion to “divert” families from public assistance rolls by providing short term benefits that can resolve family problems is allowable as long as it is based on all three criteria as outlined in 1. B above. Examples of families that are likely candidates for Benefit Diversion include, but are not limited to:
Once a prospective family is identified, decide whether to offer Benefit Diversion. Assess the family's stated needs, existing resources, and income prospects. This assessment must identify a specific family crisis or family episode of need and provide a reasonable assurance that Benefit Diversion will:
If the assessment of an applicant is that the family will likely have ongoing needs beyond the Benefit Diversion period, an application should be taken for Work First Family Assistance and the option of Benefit Diversion should not be offered. The caseworker is not required to offer Benefit Diversion just because an applicant asks for it.
1. Eligibility
a. To be eligible for Benefit Diversion, families must meet the following Work First eligibility requirements as described in other sections of this manual:
(1) Who may apply and be included in the family unit (Section 104);
(2) Income guidelines (Section 114);
(3) Resource limits (Section 115);
(4) Minor parent rules (Section 107);
(5) State/county residence (Section 108);
(6) Age rule for children (Section 109);
(7) Rule to have or apply for a Social Security Number (Section 110);
(8) Citizenship (Section 111); and/or Identity;
(9) Qualified Immigration status (Section 111); and
(10) Kinship/living with rule (Section 112).
No other Work First Family Assistance eligibility requirements apply to Benefit Diversion cases.
b. Time limits do not apply to Benefit Diversion. The caseworker may provide Benefit Diversion, if appropriate, to applicants whose time limit(s) have expired.
c. Benefit Diversion may be provided once per twelve-month period. This means twelve months from the first month of the Benefit Diversion period. For example, if the Benefit Diversion period is June through August, another Benefit Diversion period could begin no earlier than June of the next year.
d. To determine income eligibility, key a budget in EIS as is done for a WFFA application. If a budget calculation for any month within 45 days of the date of application results in eligibility for a WFFA payment, the family is monetarily eligible for Benefit Diversion. Establish the Benefit Diversion period starting the first month of eligibility.
NOTE: This budget calculation is for eligibility purposes only. If the family is eligible, determine the Benefit Diversion payment amount according to the discussion in F.
The caseworker can accept the family's statements as verification of their situation. If the family's statements are questionable, the caseworker should request appropriate third-party verification.
e. After the Benefit Diversion package is presented and the family has decided to apply use the DSS-8124 to complete the application. Use the DSS-8125 to approve Benefit Diversion or the DSS-8124 to deny Benefit Diversion. See the instructions in the Work First User’s Manual on how to complete both the DSS-8124 and DSS-8125.
f. If referral to Child Support is part of the benefit package, complete a manual referral. Do not make an automated referral via EIS.
g. Document the family’s eligibility in the same way eligibility is documented for WFFA applicants.
2. The Benefit Diversion Agreement
To ensure the applicant understands the Benefit Diversion package, the caseworker must explain the Benefit Diversion Agreement (DSS-8657). The adult caretaker signs and is given the original copy of this agreement, which contains the following information.
This Benefit Diversion Agreement is the family’s legal notice of benefits.
a. If the caseworker approves the Benefit Diversion while the applicant is still in the agency, complete the Benefit Diversion Agreement, including the Notice of Benefits portion. Enter the 60th calendar day following the date the notice is given to the applicant in the space provided on the back of the Agreement. Have the caretaker sign the Agreement, and give it to the applicant. Maintain a copy of the Agreement and document approval of Benefit Diversion and the amount of the cash payment in the case record.
b. If the caseworker does not complete the Benefit Diversion request while the applicant is still in the agency, complete the agreement through the Caretaker's Signature line. Do not complete the Notice of Benefits portion of the Agreement. The caretaker must sign the Benefit Diversion Agreement. Upon approval of Benefit Diversion, complete the Notice of Benefits, and enter the 60th calendar day following the date the notice is mailed to the family in the space provided on the back of the Agreement. Mail the Benefit Diversion Agreement to the family. Document the approval of Benefit Diversion and the amount of the cash payment in the case record. Also maintain a copy of the Agreement in the case file.
c. If Benefit Diversion is denied, complete the Notice of Denial section of the Benefit Diversion Agreement. Write on the notice that Benefit Diversion is denied and the reason for the denial. Enter the 60th calendar day following the date the notice is mailed to the family in the space provided on the back of the Agreement. Mail the Benefit Diversion Agreement to the family. Document the denial of Benefit Diversion and the reason in the case record. Also maintain a copy of the Agreement in the case file.
If the Benefit Diversion is denied, evaluate each family member for Medicaid eligibility using the original application date.
d. Most requests/applications for Benefit Diversion should be completed the same day as the request. If the request cannot be completed that day, complete the request as soon as possible but no later than 45 days from the request/application. Remember that Benefit Diversion should help relieve an immediate need.
NOTE: Due to the Citizenship / Identity mandates some families may not be able to meet the eligibility requirement within the 45 day timeframe. In such instances Benefit Diversion may not be appropriate in meeting the family’s immediate need. If this situation occurs, the County may explore alternative funding sources, such as Emergency Assistance.
The amount of the Benefit Diversion payment is not determined using the family's income as with a WFFA family. The Benefit Diversion payment will vary according to the needs and circumstances of each family.
When determining the payment amount, consider the family’s current and anticipated income and financial needs. Financial needs can include, for example, past due rent, utilities, car insurance, and other overdue or anticipated debts related to a specific episode of need or family crisis.
Based on the assessment the caseworker and the family makes about the family's situation, determine the amount of cash that is needed and the length (one to three months) of the Benefit Diversion period. Determine a reasonable amount of cash needed to resolve the current need and prevent a future need for WFFA. Ideally, the Benefit Diversion payment will enable the family to meet all their financial obligations that will become due before they begin receiving income from their anticipated employment or other income source. Document in the case record how the caseworker and the family determined the amount of Benefit Diversion.
The amount cannot exceed the maximum payment amount of three months of WFFA benefits for a family of their size. See the chart below for payment standards.
NOTE: Family Cap policy does not apply to Benefit Diversion cases. A child who is subject to the family cap for WFFA should be included in the family size for the purpose of setting the limit for a Benefit Diversion payment.
Number In Family |
1 |
2 |
3 |
4 |
5 |
6 |
Payment Standard |
$181 |
$236 |
$272 |
$297 |
$324 |
$349 |
Maximum Benefit Diversion Payment: |
$543 |
$708 |
$816 |
$891 |
$972 |
$1047 |
Number In Family |
7 |
8 |
9 |
10 |
11 |
12 |
Payment Standard |
$373 |
$386 |
$406 |
$430 |
$448 |
$473 |
Maximum Benefit Diversion Payment: |
$1119 |
$1158 |
$1218 |
$1290 |
$1344 |
$1419 |
NOTE: If an overpayment occurs due to client error or fraud, repayment will be the responsibility of the participant. Refer to Section 263, Financial Responsibility.
Advise the family members that they may request up to three months of retroactive Medicaid with their request/application for Benefit Diversion.
The family members must:
Document in the case record whether the family members express a need for retroactive Medicaid or if there are individuals in the household who only want to apply for Medicaid. The worker will advise the applicant that any information provided as a part of their application for Benefit Diversion will automatically be used as part of their Medicaid application, including citizenship and/or identity, immigration status, and social security numbers.
If the family members meet these conditions, complete the retroactive Medicaid request with the request for Benefit Diversion. (See EIS instructions in the Work First User Manual). If it appears the family may not qualify for traditional WFFA, the family members must make a separate Medicaid application for coverage in another aid/program category.
Complete an inquiry on each individual to determine if the family member is currently receiving Medicaid.
1. If no one in the family is receiving Medicaid, authorize Medicaid for everyone effective the same month(s) as the Benefit Diversion period.
2. When at least one family member receives Medicaid, take the following actions.
a. When the caseworker is ready to approve the Benefit Diversion, any existing Medicaid case must be terminated the day prior to entering the approval in EIS.
b. The effective date on the DSS-8125 screen is the first month all family members are eligible for Medicaid. This will ensure that duplicate Medicaid cards are not issued.
c. Follow the EIS instructions in the Work First User Manual for the DB/PML process to authorize Medicaid for family members for any month before the Medicaid effective date on the DSS-8125 screen.
3. Follow instructions in the Work First User Manual to authorize retroactive Medicaid.
EXAMPLE: John and Sarah Smith are approved for Benefit Diversion for March, April, and May. Their child is receiving MIC, but the parents do not receive Medicaid. Terminate the child’s MIC case effective March 31. Authorize Medicaid on the Benefit Diversion case for April and May (April is the first month all members are eligible.). Use the DB/PML process to authorize Medicaid for Mr. and Mrs. Smith for March.
At the end of the Benefit Diversion period, if new or increased earnings of the parent make the family financially ineligible for Work First, evaluate for Transitional Medicaid.
If the family has verification of anticipated income that is sufficient to cause ineligibility for WFFA by the end of the Benefit Diversion period, the caseworker may authorize Transitional Medicaid following the Benefit Diversion period without any further contact from the family.
If the amount of new income is not known at time of application, ask the family to provide verification of the change in income (i. e., the first pay stub or a statement from the employer). Agree with the family on a date the verification will be returned. Enter that date on the Benefit Diversion Agreement.
When the verification is received, calculate a budget to determine that the verified income causes ineligibility for WFFA. If the family is ineligible for a WFFA payment, then authorize them for Transitional Medicaid. If at the end of the Benefit Diversion Period the family remains financially eligible for a WFFA payment, evaluate the family members for Medicaid eligibility in other aid/program categories.
Refer to the instructions in the Family and Children’s Medicaid Manual on how to authorize Transitional Medicaid.
If the family does not qualify for Transitional Medicaid and the caseworker is not able to determine the family’s ongoing eligibility for Medicaid, transfer the family to one-month Medicaid while their eligibility is being determined.
The instructions for authorizing Medicaid are found in the Work First User Manual. Also, refer to the Family and Children’s Medicaid Manual.
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For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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