Work First 264 - Notice and Hearings Process

A. Definition

B. Automated Notice of Benefits, DSS-8108A (Figure 264-1)

C. Manual Notice of Benefits, DSS-8108

D. Completing and mailing a manual DSS-8108, Notice of Benefits

II. NOTICE OF BENEFITS

A. Definition

The Notice of Benefits form (DSS-8108A and DSS-8108) serves as a written notice to:

• Inform an applicant that his application for assistance was approved. This includes approval of add-on applications and open/shut cases.
• Inform a recipient that his case has been reviewed, and there is no change.

B. Automated Notice of Benefits, DSS-8108A (Figure 264-1)

EIS automatically produces the notice for approvals and for reviews when there is no change in assistance except as indicated in C. below. The notice produced by EIS is mailed directly to the A/R from Raleigh.

For approvals, the notice is produced based on the approval reason code entered into EIS. Refer to the Work First User’s Manual.

For reviews with no changes in benefits, the notice is produced based on the code entered in the CHANGE REASON field in EIS.

C. Manual Notice of Benefits, DSS-8108

When a manual notice is required, override the automated notice in EIS. Always complete and send a manual notice when:

• You approve an application and issue more than two months’ county-issued checks. This procedure also applies when you issue one county check that covers more than two months.
• You approve an application and authorize state-issued prior month checks on a DMA-5022. If prior month checks are issued via the DSS-8125, EIS can produce an automated notice.
• You approve an application but the assistance unit is not eligible for one or more month’s benefits.
• You approve an application but deny one or more month’s benefits for an individual.

D. Completing and mailing a manual DSS-8108, Notice of Benefits

1. For application approvals and open/shut cases, complete the following:

a. Application Approvals

(1) Enter the date of application and the appropriate aid program/category.

(2) Check the line beside the phrase “Your application for _________ is approved for:” Enter the payment amount(s) and the payment month(s).

(3) Check the line beside the phrase “Medicaid is approved starting _________.” Enter the beginning months of Medicaid eligibility for open/shut cases. For approved applications with retroactive Medicaid eligibility, enter the beginning month of Medicaid eligibility for the approved application. Mark through the words “and ending.” Check the block “Retroactive Medicaid coverage is approved for the month(s) of ________________.” Enter the months of retroactive Medicaid eligibility.

For open/shut cases with retroactive Medicaid eligibility, enter the beginning and ending months of Medicaid eligibility for the open/shut case. Check the block “Retroactive Medicaid coverage is approved for the month(s) of ________________.” Enter the months of retroactive Medicaid eligibility.

(4) Check the line beside the phrase “Your Medicaid covers all necessary medical services. If you get Medicare from the Social Security Administration, Medicaid will pay your Medicare A and B premiums, deductible, and coinsurance beginning ____________.” Enter the first month of eligibility for Medicaid paid Medicare benefits, if appropriate.

Do not check the phrase “You Medicaid pays only your Medicare A and B premiums, deductibles and coinsurance for Medicare approved services.” This phrase is not applicable to Work First.

Do not check the phrase “You Medicaid only pays for services related to pregnancy and for conditions that may complicate the pregnancy.” This phrase is not applicable to Work First.

(5) Enter the “Work First Manual” as the State rules to approve this application.

(6) If appropriate, enter the month(s) for which assistance was denied and the specific reason for denial.

Enter the “Work First Manual” as the State rules used to make this decision. Enter the specific eligibility requirement used to deny eligibility.

EXAMPLE: “Benefits from January 1 through January 31, 1999, were denied because you did not meet the following rule(s): Your net income of $700.00 exceeds the Work First Need Standard of $544.00 for a family of 3. The State rule(s) used to make this decision is found in the Work First Manual.

b. Continuing Eligibility – DO NOT complete this section for application approvals and open/shut cases.

c. Signature – Enter the worker’s signature and county phone number.

d. When to Ask for a Hearing – Enter the 60^th calendar day in the space provided for “Your Right To a Hearing.” To determine this date, count sixty (60) calendar days beginning the day following the date the notice is mailed or given to the recipient. If the 60^th calendar day falls on a non-workday, the recipient has until the end of the next workday to request a hearing.

e. Give or mail the original to the recipient on the same day it is completed. File a copy in the case record.

2. For reviews and changes in situation when the recipient remains eligible, complete the following.

a. Application Approvals

DO NOT complete this section for Work First reviews and changes in situation.

b. Continuing Eligibility

(1) Enter the appropriate aid program/category and payment amount for which the recipient continues to be eligible.

(2) Enter "Work First Manual" as the State rules used to make this decision.

c. Signature

Enter the caseworker's signature and county phone number.

d. When To Ask For a Hearing

Enter the 60^th calendar day in the space provided for "When To Ask For A Hearing." Day one is the day following the day the notice is mailed or given to the recipient. If the 60^th calendar day falls on a non-workday, the recipient has until the end of the next workday to request a hearing.

e. Give or mail the original to the recipient on the same day it is completed. File a copy in the case record.