(A) What is restoration of
food assistance
supplemental nutrition assistance program (SNAP)
benefits?
Restoration of benefits is when an assistance group is issued
benefits because they have been determined eligible, and additional benefits
are due to them because an incorrect amount was issued.
(B) Who is eligible for a restoration of
benefits?
Assistance groups who:
(1) Have lost benefits due to an agency
error.
(2) Were determined to have
committed an intentional program violation that has been reversed.
(a) An individual would not be entitled to
restoration of lost benefits for the period of disqualification based solely on
the fact that a criminal conviction could not be obtained, unless the
individual successfully challenged the disqualification period imposed by an
administrative disqualification in a separate court action. Participation in an
administrative disqualification hearing in which the assistance group contests
the county agency assertion of intentional program violation shall be
considered notification that the assistance group is requesting restored
benefits.
(b) For each month the
individual was disqualified, not to exceed twelve months prior to county agency
notification, the amount to be restored, if any, shall be determined by
comparing the allotment the assistance group received with the allotment the
assistance group would have received had the disqualified member been allowed
to participate. When the assistance group received a smaller allotment than it
should have received, the difference equals the amount to be
restored.
(3) Receive a
judicial action determining benefits were wrongfully withheld. When the
assistance group's situation has been reviewed and determined through the
judicial process that the benefits have been wrongfully withheld, the county
agency shall restore the assistance group's benefits. When the judicial action
is the first action the recipient has taken to obtain restoration of lost
benefits, the benefits shall be restored for a period of no more than twelve
months from the date the court action was initiated. When the judicial action
is a review of a county agency action, the benefits shall be restored for a
period of no more than twelve months from the first of the following dates:
(a) The date the county agency receives a
request for restoration; or
(b)
When no request for restoration is received, the date the fair hearing action
was initiated; but never more than
one year
twelve months from when the county agency is
notified of, or discovers, the loss.
(4) Have gained categorical eligibility.
Assistance groups who gain categorical eligibility are entitled to restored
benefits back to the date of the original
food
assistance
SNAP application, the date it
gained categorical eligibility, or the date categorical eligibility for the
specific type of assistance group was created, whichever is later. To determine
the prior months of eligibility and the date when restored benefits should
begin, consult rule
5101:4-4-27
of the Administrative Code.
(5)
Have been found to be eligible for a restoration of benefits that were
discovered by the agency. The county agency shall automatically take the
necessary action to restore the benefits. No action by the assistance group is
necessary. Benefits shall not be restored when the benefits were lost more than
twelve months prior to the month the loss was discovered by the county agency
in the normal course of business, or were lost more than twelve months prior to
the month the county agency was notified in writing or orally of a possible
loss to a specific assistance group.
The county agency shall notify the assistance group of
its:
(a) Entitlement to restored
benefits;
(b) Amount of benefits to
be restored;
(c) Any offsetting
that was done;
(d) The method of
restoration; and
(e) The right to
appeal through the fair hearing process.
(C) What are the specific timeframes for
making a restoration?
(1) County agencies
shall issue restored benefits within thirty days from the date the lost
benefits were discovered.
(2)
Restored benefits due under rule
5101:4-2-02
of the Administrative Code shall be restored to assistance groups that are
categorically eligible within ten days after the discovery date.
(3) When a restoration is ordered through a
compliance as a result of a fair hearing decision, it shall be completed in
accordance with division 5101:6 of the Administrative Code.
(D) When can a restoration be
made?
Benefits can only be restored up to twelve months prior to
whichever occurs first:
(1) The date
the county agency receives the request for a restoration from the assistance
group; or
(2) The date the county
agency is notified or otherwise discovers that a loss to an assistance group
has occurred.
(E) How
are restorations tracked?
(1) Each county
shall maintain an accounting system for documenting an assistance group's
eligibility for restored benefits and calculating the balance. At a minimum,
the county agency shall use the JFS 07424, "Report of Claim Determination/Lost
Benefits"
(rev. 8/2001)
form and stored in the case record.
(2) The calculation of the restored benefit
shall be documented and stored in the case record.
(3) The county agency shall have a system in
place that readily identifies outstanding claims against assistance groups so
they can be offset against the restored benefit amount prior to issuing the
restoration.
(F) How is
eligibility determined for lost benefits?
The county agency shall determine when the assistance group was
actually eligible for the month the loss occurred. In instances where there is
insufficient information in the case record, the county agency shall advise the
assistance group of what shall be provided to demonstrate eligibility for these
months. For each month the assistance cannot provide the necessary information
to demonstrate its eligibility, the assistance group shall be considered
ineligible.
(G) How is the
amount of the restoration determined?
After correcting the loss for future months and excluding those
months for which benefits may have been lost prior to the twelve-month time
limit, the county agency shall calculate the amount to be restored as
follows:
(1) Incorrect allotment -
when the assistance group was eligible but received an incorrect allotment, the
loss of benefits shall be calculated only for those months the assistance group
participated.
(a) Under issuance - when the
assistance group received a smaller allotment than it was eligible to receive,
the difference between the actual and correct allotments equals the amount to
be restored.
(b) Offsetting claims
- when a claim against an assistance group is unpaid or terminated as provided
in rule
5101:4-8-19
of the Administrative Code, the amount to be restored shall be offset against
the amount due on the claim before the balance, if any, is restored to the
assistance group. At the point in time the assistance group is certified and
receives an initial allotment, the initial allotment shall not be reduced to
offset claims, even when the initial allotment is paid retroactively.
(2) Delay, denial, or termination
- when the loss was caused by an incorrect delay, denial, or termination of
benefits, the months affected by the loss shall be calculated as follows:
(a) Incorrect denial: when an eligible
assistance group's application was incorrectly denied, the month the loss
initially occurred shall be the month of application, or for an eligible
assistance group filing a timely
reapplication
recertification, the month following the expiration of
the certification period.
(b)
Incorrect delay: when an eligible assistance group's application was delayed,
the months for which benefits may be lost shall be calculated in accordance
with procedures in
rule
rules 5101:4-2-01
and
5101:4-5-07 of the Administrative Code.
(c) Incorrect termination: when an assistance
group's benefits were incorrectly terminated, the month the loss initially
occurred shall be the first month benefits were not received as a result of the
erroneous action.
(H) What are the payment methods of
restoration?
There are two ways to issue a restoration of benefits:
(1) Lump sum - the county agency shall
restore lost benefits to an assistance group by issuing an allotment equal to
the amount of benefits that were lost. The amount restored shall be issued in
addition to the allotment the assistance group is currently eligible to
receive.
(2) Monthly installment -
the county agency shall honor reasonable requests by assistance groups to
restore lost benefits in monthly installments when, for example, the assistance
groups fears the excess benefits may be stolen or that the amount to be
restored is more than it can use in a reasonable period of time.
(I) What if the assistance group
composition has changed since the benefit loss occurred?
When lost benefits are owed to an assistance group and the
assistance group's membership has changed, the county agency shall restore the
lost benefits to the assistance group containing a majority of the individuals
who were assistance group members at the time the loss occurred. When the
county agency cannot locate or determine the assistance group that contains a
majority of assistance group members, the county agency shall restore the lost
benefits to the assistance group containing the individual who was head of the
assistance group at the time the error occurred.
(J) What happens when the assistance group
disagrees with the determination of the restoration request or benefit amount?
When the assistance group does not agree with the county
agency's decision regarding the lost benefits or with the amount of lost
benefits computed by the county agency the following procedures apply:
(1) When the assistance group does not agree
with the amount to be restored as calculated by the county agency or any other
action taken by the county agency to restore lost benefits, the assistance
group may request a fair hearing within ninety days from the date the
assistance group is notified of the entitlement to restoration of lost
benefits. When a fair hearing is requested prior to or during the time lost
benefits are being restored, the assistance group shall receive the lost
benefits as determined by the county agency pending the results of the fair
hearing. When the fair hearing decision is favorable to the assistance group,
the county agency shall restore the lost benefits in accordance with that
decision.
(2) When an assistance
group believes it is entitled to restoration of lost benefits, but the county
agency does not agree, the assistance group has ninety days from the date of
the county agency determination to request a fair hearing. The county agency
shall restore lost benefits to the assistance group only when the fair hearing
decision is favorable to the assistance group. Benefits lost more than twelve
months prior to the date the county agency was initially informed of the
assistance group's possible entitlement to lost benefits shall not be
restored.
Notes
Ohio Admin. Code
5101:4-8-03
Effective:
11/1/2022
Five Year Review (FYR) Dates:
5/3/2022 and
11/01/2027
Promulgated
Under:
111.15
Statutory Authority:
5101.54
Rule Amplifies:
329.04,
329.042,
5101.54
Prior Effective Dates: 06/02/1980, 01/22/1982, 03/20/1983,
07/01/1983 (Temp.), 08/19/1983, 09/24/1983 (Temp.), 11/11/1983, 04/10/1984
(Emer.), 08/01/1984 (Emer.), 10/20/1984, 01/16/1987 (Emer.), 04/06/1987,
06/22/1987, 04/01/1989, 01/05/1990 (Emer.), 03/22/1990, 10/01/1990, 08/01/1992
(Emer.), 10/30/1992, 08/01/1995, 10/01/1996, 05/01/1999, 10/01/2001 (Emer.),
10/11/2001, 12/01/2005, 02/10/2011,
08/01/2016