Coordination of Benefits

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					Public Assistance Coordination of Benefits

Medicaid

The Public Assistance (PA) recipient's automatic entitlement to Medicaid has been eliminated under PRWORA. NYS, however, created two new Medicaid eligibility categories, which generally parallel the Family Assistance and Safety Net Assistance programs, eliminating a separate application process for Medicaid eligible applicants. This allows PA applicants to concurrently apply for Medicaid at the Job Center, so they do not have to file a Medicaid-only application.

Food Stamps

The application for Public Assistance is also an application for Food Stamps. Thus, PA applicants can concurrently apply for Food Stamp benefits. However, the eligibility guidelines for Food Stamps are different from Public Assistance and therefore, eligibility for the two programs are determined separately by the Job Center. Refer to Vol. I. - Food Stamps, Section F6, Eligibility Criteria for more information on the Food Stamp program. Additional Benefits The PA program also provides grants to meet special and emergency needs for those receiving an ongoing PA grant such as relocation expenses, pregnancy allowances, restaurant allowances, etc. These special grants are discussed under Special Grants later in this chapter.

ELIGIBILITY CRITERIA Eligibility Tests 1.  Category 2.  Citizenship 3.  Residency

4.  Resources/Assets 5.  Income

Category

Family Assistance (FA)

The New York State Welfare Reform Act of 1997 (WRA) created the Family Assistance program for families with dependent children that is funded through the federal TANF block grant. FA has a federal time limit of 5 years, see Time Limits below. FA recipients receive cash benefits, however the shelter allowance is restricted as a direct vendor payment or a 2-party check. It is available to:

6.  Families (single or two parent households) with children under the age of 18, or under the age of 19 regularly attending secondary school,

1. The child must reside with a custodial parent or other adult caretaker relative of the child related to the child by blood, marriage or adoption.

1. The absence of a minor child from the home for a consecutive period of 45 days or more will make the child ineligible for the PA grant, unless good cause is established. Good cause is defined as:

1. o placement of the child in foster care with a goal to return home 2. o attendance at school 3. o hospitalization, if it is in the best interest of the child to return home and return home is expected

1. Pregnant women, at the time they are able to medically verify pregnancy, regardless of the date of delivery.

Safety Net Assistance (SNA)

The NYS Welfare Reform Act of 1997 created the Safety Net Assistance Program for individuals and families who are ineligible for Family Assistance or other federal public assistance programs. SNA is comprised of three programs: Safety Net Cash Assistance, Safety Net Non-Cash, and Safety Net Federally Participating.

Safety Net Cash Assistance (SNCA)

While SNA recipients receive cash assistance, the shelter allowance is restricted as a direct vendor payment or a 2-party check. SNCA has a state time limit of 2 years and is available to:

7. 

Adults without dependent children, and

8.  Minors, under age 18, without dependent children, and who have no adult relative with whom to live, and

9.  Immigrants ineligible for FA, refer to Citizenship/Immigrant Status later in this chapter

Safety Net Federally Participating Non-Cash Assistance Program (SNFP)

SNFP provides assistance to households who would otherwise be eligible for Family Assistance. While SNFP recipients receive cash assistance, the shelter allowance is restricted as a direct vendor payment or a 2-party check. SNFP has a federal time limit of 5 years. SNFP is available to:

1.  Family members of those persons who fail to comply with requirements for drug screening, assessment or treatment; the non-complying adult is ineligible for any grant,

1.  Families in which an adult member is unable to work because of substance abuse, and that adult member is complying with substance abuse screening, assessment and rehabilitation treatment; the complying adult remains eligible for a grant.

Safety Net Non-Cash (SNNC)

Recipients who have used their time limited cash benefits are entitled to receive benefits under the Safety Net Non-cash program. Although this program is called “non-cash,” at this time recipients continue to receive a portion of their benefits in cash form. The noncash system restricts shelter payments, as well as fuel and utility costs, that is, payments will be issued typically through a direct vendor payment to the landlord and/or utility company. There are no time limits under the non-cash program. It is available to:

2.  Recipients who have reached their 60-month time limit under FA, and

3.  Recipients who have reached the 24 month time limit under SNCA, and

4.  Individuals who are determined unable to work due to abuse of drugs/alcohol and are compliant with the screening, formal assessment and treatment requirements.

Some FA or SNCA households may be exempt from the time limits and receive cash assistance beyond the above stated time frames, refer to the section on Time Limits later in this chapter.

Citizenship/Immigration Status

Refer to Vol. I - Immigrant's Eligibility for Public Benefits, Section H 3, for a definition of "qualified alien" or for a clarification on any of the immigrant statuses below, refer to Vol. I – Immigrant’s Status and Naturalization Process, Section H 1.

Family Assistance

1.  U.S. citizens

2.  Qualified aliens who entered the U.S. prior to 8/22/96

3.  Qualified aliens who entered the country on or after 8/22/96 are ineligible for benefits for 5 years, with the following exceptions:

1. Refugees and asylees 2. Immigrants who have had their deportation withheld, and 3. A qualified alien who is on active duty in the U.S. armed forces, or honorably discharged veterans, their spouses, widows and dependent children.

Safety Net Assistance

4.  U.S. citizens 5.  Qualified aliens regardless of their date of entry 6.  Non-qualified aliens who are legally residing in the U.S. with permission from United States Immigration Citizenship Services, which includes those who are PRUCOL

Individuals without a legal status (undocumented) or those with temporary status such as a tourist or here on a student visa do not meet the citizenship criteria.

Residency

Applicants must prove they are residents of NY and apply in the county in which they permanently reside. In NYC they must apply for benefits at the Job Center designated to their zip code.

Moving from One District to Another

When a client moves from one district to another within NYS, the “move from” district must provide cash and food stamp benefits until the last day of the month following the move.

Resources

An applicant's resources are evaluated by the HRA to determine financial eligibility. Resources are cash or other liquid assets or any real or personal property that an individual owns that could be converted to cash or be used to meet needs for food, shelter or clothing. Resources include, but are not limited to, saving accounts, checking accounts, pension funds, IRA's, trust funds, & real estate.

Limits

Public Assistance Resource Limits Households with a member 60 or over $3,000 All other PA households $2,000

Exempt Resources

The following are exempt (not counted) as a resource under PA rules:

4.  A person's home in which they live; however, a lien will be placed on the home. No action is taken on the home as long as the person continues to use the home as their primary residence 5.  Essential personal property such as clothing, furniture, appliances and household goods 6.  An automobile, the fair market value not to exceed $4,650. If the automobile is being used to seek or retain employment or travel to and from work activities, the exemption is $9,300 7.  One burial plot per household member 8.  Burial funds established by the NYS Office of Mental Retardation and Developmental Disabilities (OMRDD) 1. One bona fide funeral agreement up to an equity value of $1,500 per household member 2. Funds from the Earned Income Tax Credit (either as a refund or as an advanced payment), as long as funds remain identifiable 3. Tangible personal property necessary for business or employment purposes 4. For 6 months, real property the household is trying to sell 5. Loans, including student loans 6. College tuition account (maximum amount $1,400) for the purposed of paying tuition at a 2-year accredited post-secondary educational institution (for PA recipients only, not applicants)

Note: Burial funds (except those established by OMRDD) and the cash value of life insurance, often exempt in other programs, count as resources for Public Assistance and will be applied toward the $2,000 (or $3,000) resource limit.

Individual Development Accounts (IDAs)

IDA’s are dedicated savings accounts that operate in a manner similar to an IRA. Individuals are able to save money and community development organizations use funds to match an account holder’s deposits. Each organization that offers matching funds also

sets the eligibility rules for that particular IDA. Thus, rules and eligibility requirements vary based on which organization the IDA is set up with. Organizations also provide additional services such as credit counseling, help with budgeting and economic literacy training.

Generally, the account holder may choose to save money toward one of three goals:

7. Purchasing a home, 8. Continuing education or job training, or 9. Starting or expanding a small business.

Corporation for Enterprise Development, CFED, is a nonprofit organization working to improve economic security for all people. CFED has wealth of information on IDA’s including a statewide IDA directory, an IDA list serve, and a 4 page fact sheet on IDA’s, see: http://www.cfed.org/focus.m?parentid=31&siteid=374&id=374. To obtain more information on CFED call (202) 408-9788 or visit their website at: http://www.cfed.org

Lump Sum Rule

A lump sum is defined as a substantial, non-recurring (one-time) amount of money. Examples include gifts, inheritances, lottery winnings, litigation settlements, etc. Lump sums that are not of substantial amounts (below the standard of need) will be budgeted as income in the month received. If a PA recipient receives a lump sum of money, the recipient is allowed to set aside that portion of the lump sum which, when combined with the household’s current countable resources, would fall below the resource limits. Only when the amount of the lump sum, when combined with countable resources exceeds the resource limit will the lump sum rules apply. Recipients may choose to assign the lump sum over the resource limit to HRA, thus PA grant would continue unchanged or the recipient can retain the lump sum, in which case the PA case will be closed for a period of time calculated in the following manner.

1.  Add the lump sum amount and any other countable household income and divide it by the standard of need for the size of the household, the result is the number of months of ineligibility. See Income, Standard Of Need below,

2.  If the lump sum is from earned income, the earned income disregards are applied - see Income, Net Income Test below.

The computation of the period of ineligibility begins with the month of receipt of the lump sum, not when it is discovered or reported. If the Job Center discovers the lump sum payment after the fact, they will recoup any amount of overpayment for the appropriate number of months. The period of ineligibility may be shortened if the recipient has expenses beyond their control, such as uncovered medical expenses, or loss of some or all of the funds due to emergencies or theft.

The following are excluded from the lump sum rule. When the recipient applies any or all of the lump sum to any of the following within 90 days of receipt:

1.  An automobile (maximum amount $9,300) exempt from the resource limit because it is need to seek or retain employment or for travel to and from work activities 2.  A resource exempt bank account, such as a first or replacement automobile account for the purpose of purchasing an automobile to seek or retain employment (maximum amount $4,650) or a college tuition account for the purpose of paying tuition at a 2-year accredited post-secondary educational institution (maximum amount $1,400) 3.  A resource exempt burial plot, or 4.  A resource exempt bona-fide funeral agreement (maximum amount $1,500)

The recipient must document that he/she used the amount of the lump sum in excess of the resource limit to purchase one or more of these exempt resources within 90 days of receipt.

Tax Refunds

Income tax refunds, including rapid refunds, other than the Earned Income Tax Credit, which is exempt, are treated as a resource rather than a lump sum payment. An applicant/ recipient must first determine whether his/her refund plus the equity value of all other non-exempt resources exceeds the resource limit. If the amount does not exceed the limit,

the household may retain the refund and still be eligible for PA. If the amount is more than the resource limit, the applicant/recipient will be ineligible for PA because of excess resources.

Transfer of Assets

For FA applicants: the voluntary transfer of assets does not affect eligibility. For SNA applicants: a person shall be ineligible for SNA if they transferred resources for the purposes of qualifying for Public Assistance. A transfer made within one year prior to the date of application may be presumed to have been made for the purpose of qualifying for PA. However, this is rebuttable if there was no intent to defraud, and the action was not taken for the purpose of qualifying for assistance.

Income

HRA considers income to be any recurring payment received from any source that can be used, directly or indirectly, to meet the need for food, clothing or shelter. Included is income from all sources, both earned and unearned. Examples of some sources of income are employment, Social Security, Unemployment Insurance, NYS Disability, Worker’s Compensation, pensions, bank interest, rental income, and cash contributions from non-legally responsible individuals.

All the income and resources of all members in the filing unit, see below Public Assistance Budgeting, Determining Household Composition for an explanation of filing unit, is considered when determining eligibility.

Grant Amount

The amount of the Public Assistance grant depends on whether the household has children under 18 or not. The shelter allowance for households with children increased November 2003, thus increasing the amount of grant these households are eligible for. However, shelter allowances did not increase for households without children under 18,

or under 19 if in secondary school or a pregnant woman. The two charts below represent the income guidelines and grant amount (or standard of need) for the respective households.

Eligibility Chart

Monthly Public Assistance Income Guidelines for Households with Children in NYC 100% FPL Basic PA Home Maximum Test Energy Shelter Allowance Allowance Allowance

# in Household

185% Standard of Need Test $766.09 926.85 1,278.35 1,527.55 1,784.70 1,959.52 2,134.35 2,268.47

Maximum PA Grant or Standard of Need (SON) 414.10 501.00 691.00 825.70 964.70 1,059.20 1,153.70 1,226.20

1 2 3 4 5 6 7 8

$851 $1,141 $1,431 $1,721 $2,011 $2,301 $2,591 $2,881

$112.00 179.00 238.00 307.00 379.00 438.00 498.00 558.00

$25.10 39.00 53.00 68.70 84.70 97.20 109.70 122.20

$277.00 283.00 400.00 450.00 501.00 524.00 546.00 546.00

Add $60.00 for each additional person for Basic PA Allowance. Add $12.50 for each additional person for Home Energy Allowance.

Monthly Public Assistance Income Guidelines for Households without Children in NYC 100% FPL Basic PA Home Maximum Test Energy Shelter Allowance Allowance Allowance

# in Household

185% Standard of Need Test $651.38

Maximum PA Grant or SON

1

$851

$112.00

$25.10

$215.00

352.10

2 3 4 5 6 7 8

866.72 1,067.45 1,272.24 1,481.29 1,635.77 1,869.79 2,037.22

$1,141 $1,431 $1,721 $2,011 $2,301 $2,591 $2,881

179.00 238.00 307.00 379.00 438.00 498.00 558.00

39.50 53.00 68.70 84.70 97.20 109.70 122.20

250.00 286.00 312.00 337.00 349.00 403.00 421.00

468.50 577.00 687.70 800.70 884.20 1,010.70 1,101.20

Add $60.00 for each additional person for Basic PA Allowance. Add $12.50 for each additional person for Home Energy Allowance.

Benefit Structure

The amount of Public Assistance benefits is based on the sum of three parts, referred to as the "standard of need" (SON). The SON is computed according to household size: a basic allowance, a home energy allowance and a shelter allowance.

1. The basic allowance and the home energy allowance are for food, clothing, transportation, utility bills, and other expenses. Public Assistance workers usually call this the "pre-add," "food and other," or "f & o."

2. The shelter allowance is for rent or mortgage and taxes, if the applicant owns a home. The shelter allowance is the amount the applicant actually pays, up to a maximum according to family size. If the applicant's actual rent is less than the maximum shelter allowance, PA will provide only the amount of the actual rent. If the applicant's rent exceeds the shelter allowance, PA will usually not make up the difference. In addition, the shelter allowance differs if there are children in the household, thus the two charts: one for households with children and the second for households without children. The shelter portion of the SON varies by county in NYS. The information presented above represents NYC's shelter allowance.

Special grants, such as a pregnancy allowance, would increase the SON. For more information on these kinds of grants, see below, Special Grants.

Income Tests

Three tests of income are applied to determine an applicant's eligibility for PA; the 185% Standard of Need Test, 100% of the Federal Poverty Test, and the Needs Test.

185% Standard of Need Test (SON)

A household’s total gross monthly income (earned and unearned income) must fall below 185% of the household’s SON. There are certain income deductions allowed, see below under Gross Income Disregards, to determine a household’s gross income. The SON of the applying household must first be established before executing the 185% SON test. If shelter costs have been considered and the maximum shelter allowance is used, the 185% gross income test is listed in the Eligibility Chart above. If the shelter costs are below the maximum shelter allowance, calculate the SON using the actual shelter expenses and the basic PA allowance and home energy allowance for the applying household and multiply by 1.85. If the applicant’s gross income is greater than 185% of his/her SON, he/she will not be eligible for PA.

100% Federal Poverty Level (FPL) Test

Under NYS's 1997 Welfare Reform Act, a poverty test has also been imposed. Any household with a gross monthly income (earned and unearned income) in excess of the monthly federal poverty level (FPL) will be ineligible for PA. Just as with the 185% SON test, there are certain income deductions allowed, see below under Gross Income Disregards to determine a household’s gross income. The FPL changes every July and are listed in the Income Eligibility Chart, above. This test applies to all households except those residing temporarily in hotels/ motels, homeless shelters, domestic violence shelters, AIDS housing, congregate care facilities, etc. If the applicant’s gross income is greater than 100% FPL, he/she will not be eligible for PA

Gross Income Disregards

The following are common incomes disregards for both the 185% SON test and 100% FPL test:

3.  The first $50 of child support 4.  Educational grants and loans 5.  $5 per day when providing day care for each child, excluding caretaker’s own child 6.  Adoption subsidies can be excluded if it is to the financial benefit of the household 7.  Foster care payments received for a child boarded out in the home of a PA recipient 8.  Exempt payments received under the Workforce Investment Act 9.  For federally assisted households only (FA and SNFP households) – bona fide loans from non-legally responsible person 10.  Any income tax returns or advanced payments made under the Earned Income Tax Credit 11.  All of the earned income of a dependent child (under 21, if living with legally responsible relative or who resides in an institution that exerts parental control over the child), who is a employed full or part-time and is a full or part-time student and is attending elementary, high school, college, a vocational or technical training program or a Job Corps training program

Needs Test

After application of the 185% SON and 100% FPL test, HRA will determine if the applying household’s net income falls below the standard of need. Certain additional income deductions are subtracted from the household’s income (less the gross income disregards listed above) to determine the applicant's net countable income.

12. The first $15 per month of lodger income, the first $60 per month of boarder income; if the out-of-pocket expenses are over these amounts the actual expenses are deductible; any amounts over these limits or proven actual expenses are considered as earned income 13. The first $90 of earned income

14. 48% disregard (as of June 1, 2007) of any remaining earned income for households, but only for households with dependent children and only if the family received PA for at least one of the immediately preceding four months.

If the applicant's net countable income, after these deductions, is less than the SON for their household size, they are eligible to receive a benefit. To determine the amount of the benefit, see below Public Assistance Budgeting. If the applicant's net countable income is more than the SON, the applicant is ineligible for PA.

Assistance from Non-Legally Responsible Individuals

When a non-legally responsible individual provides assistance to a PA household for a restricted purpose, it will be considered exempt as income. However, if the contribution is restricted for the purpose of supplementing a State approved standard, that is, for shelter or food and other, the contribution will not automatically be exempt; HRA must determine that such a contribution would be to benefit of the health and welfare of the household in order to be exempt. For example, there is a State approved maximum standard allowance for shelter expenses, see charts above. If a non-legally responsible individual contributes to the shelter expense in the amount that is in excess of the shelter maximum HRA must approve it. Typically HRA will approve such a contribution through a third party guarantor agreement, W-146E, found at http://www.nyc.gov/html/hra/html/general_information_center/claim_forms.shtml, click on Request for Payment of Rent Arrears in Excess of Agency. In these cases, such contributions are exempt income for the gross income tests and the needs test. Note: The contributions must not be in the form of cash, but in the form of in-kind assistance or direct vendor payment to be exempt.

PUBLIC ASSISTANCE BUDGETING

Households with earned income may remain eligible for a grant as long as their total gross income (earned and unearned) does not exceed the 185% SON or 100% of the FPL for the household size.

Calculating the Grant Amount – Unearned Income

For new applicants and ongoing recipients, whether there are children or not in the household, if there is no earned income in the household, the household’s net countable income (after all allowable deductions are applied) is budgeted dollar for dollar and is subtracted from the household’s SON to determine the grant amount.


				
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