1408645 by cuiliqing

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									                    OHIO DEPARTMENT OF JOB AND FAMILY SERVICES
                             BUREAU OF STATE HEARINGS
In the matter of:

                                         Case Number:          County:
                                         5051522661            FRANKLIN
                                         Appeal:               Program:          Disposition:
                                         1408644               MED               SUSTAINED
                                         1408645               FS                SUSTAINED

                                         Compliance Required

                                         Decision Date:        05/09/2008
                                         Request Date:         04/11/2008
                                         Hearing Officer:      BETSY WEST SUVER


                                   State Hearing Decision

ISSUE SECTION

(1) Appeal #1408645; Food Stamps:

The Franklin County Department of Job and Family Services (Agency) approved the Appellant
for $47 of food stamps based on her income from Arby’s and the Neighborhood Housed. The
Appellant disagrees with the allotment because she had reported to the Agency that she was no
longer employed with Arby’s. She was unable to have Arby’s complete the verification form and
tried to notify her case manager of this but was unable to reach her and sent her last paystub in
with a contact phone number for Arby’s. The issue on appeal is whether the $47 allotment that
was based on a budget that included the Arby’s employment is correct.

After careful consideration of the evidence and regulations that apply, I find the $47 allotment
may be incorrect. Therefore, this appeal should be sustained.

(2) Appeal #1408644; Medicaid:
The Agency terminated the assistance group’s Healthy Families Medicaid due to her income
from Arby’s and the Neighborhood House exceeding the income standard, and placed them on
Transitional Medicaid. The Appellant disagrees with the Healthy Families termination because
she had reported to the Agency that she was no longer employed with Arby’s. She was unable to
have Arby’s complete the verification form and tried to notify her case manager of this but was
unable to reach her and sent her last paystub in with a contact phone number for Arby’s. She
wishes to remain on Healthy Families Medicaid. The issue on appeal is whether the termination
of Healthy Families Medicaid based on income that included Arby’s employment was correct .

After careful consideration of the evidence and regulations that apply, I find the termination may
be incorrect. Therefore, this appeal should be sustained.

PROCEDURAL MATTERS



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JFS 04005 (Rev. 6/2002)
                            STATE HEARING DECISION CONTINUATION

On 4-1-08 the Agency mailed the Appellant notices regarding her food stamps and Medicaid.
She requested a state hearing on 4-11-08. The hearing was scheduled for and duly conducted on
5-6-08 at the Franklin County North Opportunity Center. The Appellant was present and
represented herself. The Agency was represented by Yemani Terfe, a case manager who is not
the Appellant’s assigned case manager. An oath was administered and taken by both parties.

FINDINGS OF FACT
   1. The assistance group size is three. It consists of the Appellant and her two minor
      children. They were on Healthy Families Medicaid.
   2. The Appellant receives $637 in SSI for her child.
   3. She was employed at Arby’s and the Neighborhood House. She ended employment with
      Arby’s in December.
   4. The Appellant re-applied for food stamps and Medicaid on 1-26-08. She reported that she
      was no longer working at Arby’s.
   5. On 2-26-08 the Agency requested a 534 form to be completed and returned by 3-6-08.
   6. Arby’s would not complete the form and return it to the Appellant. The Appellant tried to
      notify her case manager of Arby’s refusing to complete the form.
   7. She provided the Agency with her last paystub and a phone number to contact Arby’s.
      The Agency left the Arby’s income in the food stamp and Medicaid budgets, determined
      she was eligible for $47 in food stamps and Transitional Medicaid and terminated the
      Healthy Families Medicaid. Notices were mailed on 4-1-08.


CONCLUSIONS OF POLICY

(1) Appeal #1408645; Food Stamps:

        The regulations state that the county agency shall use documentary evidence as the
primary source of verification. Documentary evidence consists of a written confirmation of an
AG's circumstances. Ohio Administrative Code § 5101: 4-2-09 (Anderson 2006). Examples of
documentary evidence include wage stubs, rent receipts, and utility bills. Although documentary
evidence shall be the primary source of verification, acceptable verification shall not be limited
to any single type of document and may be obtained through the AG or other source. Ohio
Admin. Code § 5101: 4-2-09 (Anderson 2006).

        Whenever documentary evidence cannot be obtained or is insufficient to make a firm
determination of eligibility or benefit level, the county agency may require collateral contacts
and/or home visits. A "collateral contact" is an oral confirmation of an AG's circumstances by a
person outside of the AG. Ohio Admin. Code § 5101: 4-2-09 (Anderson 2006).The collateral
contact may be made either in person or over the telephone. The acceptability of a collateral
contact shall not be restricted to a particular individual but may be anyone that can be expected
to provide an accurate third-party verification of the AG's statements. Examples of acceptable
collateral contacts are employers, community action groups, migrant service agencies, landlords,
social services agencies, neighbors of the AG, or other persons outside the AG who can be
expected to provide accurate third-party verification. Ohio Admin. Code § 5101: 4-2-09
(Anderson 2006).




                                           Page 2 of 6
                             STATE HEARING DECISION CONTINUATION

         The AG has the primary responsibility for providing documentary evidence to support its
statements on the application and resolve any questionable information. The county agency shall
assist the AG in obtaining this verification provided the AG is cooperating with the county
agency, and the AG has not refused to cooperate. Ohio Admin. Code § 5101: 4-2-09 (Anderson
2006).

        In the present case, the Appellant re-applied for food stamps and Medicaid on 1-26-08.
The Appellant reported that she was no longer employed at Arby’s and on 2-26-08 the Agency
requested her to provide a 534 form verifying end of employment at Arby’s by 3-6-08. The
Agency received a paystub that had a handwritten message that it was the last pay, and it listed a
phone number to call. The Agency had not received the 534 form to show employment had
ended, so it used the Arby’s pay in the food stamp budget to calculate a $47 allotment. The
Appellant testified that she was unable to get Arby’s to complete the form and had tried to
contact her case manager several times to tell her this but was unable to. Then, she sent in her
last paystub with the phone number to contact her manager. She also stated that she went into the
Agency to explain her trouble with Arby’s, but was told by someone that her case had already
been approved for $47.

         I understand the case manager was personally unaware that Arby’s would not complete
the form and that the Appellant was having trouble obtaining it, however, the Appellant did not
refuse to cooperate with the verification process. Rather, Arby’s failed to cooperate. The
Appellant attempted to notify the case manager of this problem but could not reach her and
resorted to sending in the paystub with the phone number. Had she been successful in contacting
the case manager, the case manager could have used a collateral contact to verify the end of
employment. Thus, this appeal should be sustained in order for the Agency to contact the
manager at the telephone listed on the paystub to verify the end of employment, then re-
determine the food stamp allotment with the Arby’s pay removed from the budget.

(2) Appeal #1408644; Medicaid:
        The failure to verify in the application process and/or with the verification requirements
results in a denial or termination of Medicaid. A failure occurs when the information requested is
not provided after the county agency has properly advised the assistance group what
information/verification is needed to determined eligibility and no request for assistance was
made. Ohio Admin. Code § 5101: 1-38-01 (Anderson 2003). The county agency is responsible
for sending a follow-up letter, after the requested information/verifications are not received,
notifying the individual that it has not been received and if it is not received within ten days, it
must deny and/or terminate Medicaid. Ohio Admin. Code § 5101: 1-38-01 (Anderson 2003).

        When it appears to the county agency that an assistance group or individual within the
assistance group may no longer be eligible for Medicaid under their current category of
assistance, the county agency is required to complete a pre-termination review (PTR) of
continuing Medicaid eligibility for the assistance group, and for each individual, under every
other category of Medicaid before proposing an adverse action for that assistance group or
individual. Ohio Admin. Code §5101:1-38-01.1 (Anderson 2003). A PTR must be completed
prior to proposing to terminate benefits.

       In the present case, the Agency terminated the Appellant’s Healthy Families Medicaid
and placed the assistance group on Transitional Medicaid. Based on the her Arby’s employment


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                             STATE HEARING DECISION CONTINUATION

and the Neighborhood House employment, the Agency determined she was over income for
Healthy Families. The Agency testified it used the Arby’s employment because she did not
return the 534 form to verify her employment had ended with Arby’s. As explained in the food
stamp appeal above, the Appellant re-applied for food stamps and Medicaid on 1-26-08. The
Appellant reported that she was no longer employed at Arby’s and on 2-26-08 the Agency
requested her to provide a 534 form verifying end of employment at Arby’s by 3-6-08. The
Agency received a paystub that had a handwritten message that it was the last pay, and it listed a
phone number to call. The Agency had not received the 534 form to show employment had
ended, so it used the Arby’s pay in the food stamp budget to calculate a $47 allotment. The
Appellant testified that she was unable to get Arby’s to complete the form and had tried to
contact her case manager several times to tell her this but was unable to. Then, she sent in her
last paystub with the phone number to contact her manager.

        Based on the evidence and regulations that apply, I find the termination of Healthy
Families to be incorrect. First, there is no evidence that a follow up letter was mailed to the
Appellant requesting the verifications that had not been received. Second, the Appellant did not
refuse to cooperate with the verification process. rather, Arby’s failed to cooperate. The
Appellant attempted to notify the case manager of Arby’s failure to complete the form but could
not reach her and resorted to sending in the paystub with the phone number. Thus, I find the
termination of Healthy Families to be incorrect and this appeal should be sustained.

HEARING OFFICER'S RECOMMENDATION
Based on the record and Agency policy before me, I recommend that appeal #1408645 be
sustained with compliance. To comply, the Agency should contact the manager at the telephone
number listed on the paystub to verify the end of employment, then re-determine the food stamp
allotment with the Arby’s pay removed from the budget. It should issue proper notice of the re-
determination and issue a supplement if necessary.

Based on the record and Agency policy before me, I recommend that appeal #1408644 be
sustained with compliance. To comply, the Agency should contact the manager at the telephone
number listed on the paystub to verify the end of employment, then re-determine the Appellant’s
eligibility for Healthy Families Medicaid. It should send the Appellant proper notice of the re-
determination.

FINAL ADMINISTRATIVE DECISION AND ORDER
Since I find the Hearing Officer's recommendations to be supported by policy and the evidence, I
hereby adopt the recommendations and the appeals are sustained with compliance required.
Ohio Admin. Code § 5101:6-7-03 requires compliance for decisions involving public assistance,
social services or child support services within fifteen calendar days from the date the decision is
issued, but in no event later than ninety calendar days from the date of the hearing request.
Ohio Admin. Code § 5101:6-7-03 requires any increase in benefits to be reflected in the coupon
allotment within ten calendar days of receipt of the decision, even if the local agency must
provide a supplement, outside the normal issuance cycle for compliance to be achieved in the
food stamp program.
Compliance shall be promptly reported to the bureau of state hearings, ODJFS, via "State
Hearing Compliance," JFS 04068, accompanied by appropriate documentation to show that
compliance has been achieved.



                                            Page 4 of 6
                                      STATE HEARING DECISION CONTINUATION




Hearing Authority

May 9, 2008



                                                       Notice to Appellant

This is the official report of your hearing and is to inform you of the decision and order in your case. All papers and materials
introduced at the hearing or otherwise filed in the proceeding make up the hearing record. The hearing record will be maintained
by the Ohio Department of Job and Family Services. If you would like a copy of the official record, please telephone the hearing
supervisor at the COLUMBUS District hearing section at 1-866-635-3748.

If you believe this state hearing decision is wrong, you may request an administrative appeal by writing to: Ohio Department of
Job and Family Services, Bureau of State Hearings, P.O.BOX 182825, Columbus, OH 43218-2825 or fax: (614) 728-9574.
Your request should include a copy of this hearing decision and an explanation of why you think it is wrong. Your written
request must be received by the Bureau of State Hearings within 15 calendar days from the date this decision is issued. (If the
15th day falls on a weekend or holiday, this deadline is extended to the next work day.) During the 15-day administrative appeal
period you may request a free copy of the tape recording of the hearing by contacting the district hearings section.

If you want information on free legal services but don't know the number of your local legal aid office, you can call the Ohio
State Legal Services Association, toll free, at 1-800-589-5888, for the local number.


                                        Aviso a la Apelante

Esta es la decisión estatal administrativa de su caso. Todos los documentos y materiales presentados como prueba en la vista o de
otra manera radicados componen el récord administrativo. El récord administrativo será mantenido por el Ohio Department of
Job and Family Services.

Si usted cree que esta decisión estatal administrativa es erronea, usted puede solicitar una apelación administrativa escribiendo al:
Ohio Department of Job and Family Services, Bureau of State Hearings, P.O. Box 182825, Columbus, Ohio 43218-2825 o
facsímil (614) 728-9574. Su solicitud debe indicar por qué usted piensa que la decisión administrativa es erronea. Usted puede
completar la solicitud de apelación incluida con esta decisión. Su solicitud escrita o formulario de apelación tiene que ser
recibido por el Bureau of State Hearings dentro de los 15 días calendario desde la fecha en que esta decisión es expedida. (Si el
15to. día recae sobre un fin de semana o un día feriado, esta fecha límite es extendida al próximo día laborable). Durante el
período de 15 días de apelación administrativa, usted o su representante pueden solicitar una copia gratuita del récord
administrativo y de la grabación de la vista llamando al Bureau of State Hearings al 1-866-635-3748 (seleccione la opción 1 del
menú principal).

Si usted quiere información sobre servicios legales gratuitos pero no sabe el número de su oficina local de servicios legales, usted
puede llamar al Ohio State Legal Services Association, gratuitamente, al 1-800-589-5888, para el número local.




                                                          Page 5 of 6
                             STATE HEARING DECISION CONTINUATION


                                          Appendix

EXHIBITS

Agency:
 A. Appeal Summary
 B. Running Record Comments
 C. Verification Request Checklist
 D. 534 Form -incomplete
 E. Last Paystub
 F. Notice Detail
 G. Individual Eligibility History
 H. Food Stamp Budget

Appellant:
  1. State Hearing Request




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