Missouri Revised Statutes, Section 208.210, establishes the responsibility an individual has to report property and income, and the right of the state to recover overpayments of any benefits paid when the participant or his/her spouse is in possession of such undeclared property or income. The overpayment(s) shall be recoverable by the Family Support Division as a debt due to the state.
13 CSR 40-2.190 states restitution and recovery may be required if at any time it is determined that a participant has received benefits to which s/he was not entitled because of a state or federal statutory or regulatory requirement
208.024 RSMo places restrictions on the use of Temporary Assistance (TA) benefits issued on an EBT card in specified establishments and for items primarily marketed for or used by adults 18 or older and/or is not in the best interest of the child or household. TA participants who make a purchase in violation of this section must reimburse the Department of Social Services.
The purpose of the Claims and Recovery System is to recover benefits an individual received in error because of undeclared income or property, or inappropriate use of benefits. Benefits received in error may be due to either non-reporting of income or property, or due to agency error. Benefits used inappropriately may be due to using the EBT card at a restricted establishment or using the benefits for an inappropriate purchase.
Cash assistance payments are paid on behalf of those applicants and participants who meet eligibility requirements and are in need of assistance. Under RSMo 205.967, it is a legal requirement that applicants and participants of benefits (as well as their cohabitating spouse) report to the Family Support Division’s county office changes in, or acquisitions of, income, property or other resources. Upon notification of such changes, the County office may either cancel the benefits or alter the benefit amount, depending upon the circumstances.
Any benefits paid to or on behalf of an ineligible participant are recoverable as a debt due the state through a civil action. There are also provisions in the law for penalties through a criminal action against persons who by means of any willfully false statement or impersonation or other fraudulent act obtain, aid or abet any person to obtain benefits to which he is not entitled.
At the time of application, reapplication (Interview Summary FA-102) or review (Temporary Assistance Eligibility Review Form FA-202) the individual is informed in writing of the need to report changes in circumstances within ten (10) days. The individual signs the appropriate form and the copy is placed in the case record.
The Temporary Assistance Eligibility Unit (EU) must report all changes in address, income or employment, household members, and resources within ten (10) days of the change. If the changes are not reported within ten (10) days of the change, and the amount of the grant or continued eligibility for benefits is affected resulting in an overpayment, a claim is filed by the eligibility specialist.
Eligible Temporary Assistance participants who make an EBT purchase in violation of 208.024 RSMo shall reimburse the Department of Social Services for such purchase through the claim process.
Review the Temporary Assistance (TA) Restricted Purchases and Unauthorized Location Claims User Guide for steps on establishing these types of claims.
208.024 sets forth penalties for individuals, store owners, or proprietors of establishments that knowingly accept TA EBT cards in violation of this statute:
OR
Individuals, store owners, or proprietors of establishments that knowingly accept TA EBT cards in violation of this section shall be punished by a fine of:
The Family Support Division does not have any authority to enforce penalties on retailers or business establishments. If reports are received of retailers accepting TA EBT in violation of 208.024 RSMo, refer the report to the Investigation Unit at DLS.ReportFraud@dss.mo.gov, or telephone 877- 698-0760 Monday through Friday from 8:00 am to 5:00 pm.
Register and track all overpayments and possible overpayments in the Claims Accounting and Restitution System (CARS). CARS is divided into two areas, the discovery tracking system and the claim tracking system. A discovery claim referral is a possible overpayment.
The discovery tracking system processes and tracks:
It also tracks the rejection of a claim referral. This allows another eligibility specialist or reviewer to see that the claim has already been explored. Refer to CARS User Guide REJECTING A DISCOVERY CLAIM REFERRAL for instructions.
After investigating the circumstances and determining that an overpayment does exist, enter information about the claim into the second part of CARS, the claim tracking system.
Notes should be entered on the ADD NOTE (OVNA) screen to electronically store and track claim information, and reduce paper files. The following are examples when notes are entered:
Refer to CARS User Guide RECORDING AND VIEWING NOTES IN THE CLAIMS ACCOUNTING AND RESTITUTION (CARS) SYSTEM for complete instructions.
Claim referral procedures vary according to how the potential claim is discovered.
FSD county staff discovers potential overpayment:
When the Welfare Investigation Unit (WIU), Temporary Assistance Program and Policy Unit, or another source discovers a potential overpayment:
NOTE: If a check or cash payment is either returned, cancelled or expunged off the Electronic Benefit Transfer (EBT) card, an overpayment has not occurred.
Refer to CARS User Guide REGISTERING A DISCOVERY CLAIM REFERRAL AND ESTABLISHING A CLAIM for complete instructions.
Register a discovery claim referral in CARS using the Discovery Add (OVAD) screen to begin the discovery tracking process. Enter the date the potential claim is identified as the date of discovery. A 20-digit discovery identifier is assigned, which includes the 10-digit DCN, the date of discovery (the four-digit year, the month, the day), and a sequence number starting with 01. The sequence number is the number of claim referrals entered with that date of discovery for that specific DCN. Refer to CARS User Guide REGISTERING A DISCOVERY CLAIM REFERRAL AND ESTABLISHING A CLAIM for instructions.
CARS uses the date of discovery to determine that the claim is established in an appropriate time frame. When a claim referral is registered, CARS calculates the due date of the claim. The discovery claim referral must be acted on and the claim established or rejected by the last day of the quarter following the quarter in which the potential claim was discovered. A Weekly Pending Discovery Claim Referral Report (FCLWK500-01) shows three days prior to the end of the quarter as the due date to act on the claim referral for management purposes.
EXAMPLE: The discovery date is August 6, 2008. The discovery claim referral due date is December 27, 2008. The claim must be established or the claim referral must be rejected by December 31, 2008 to be counted as processed timely. Three work days are allowed from the due date to the end of the month to ensure the claim referral is processed timely.
Several reports are generated out of Discovery to help eligibility specialists and supervisors monitor the progress of the claim.
A Daily Incomplete Pending Claim Registration Report (FCLDY500-01) is generated if incomplete information is entered into CARS and a demand letter cannot be generated. The report is used to identify and track claims that have been initiated, but not completed. It is distributed to the eligibility specialist.
A Weekly Pending Discovery Claim Referral Report (FCLWK500-01) is generated weekly showing the claim referrals assigned to a specific eligibility specialist that have not been completed. The report displays each discovery claim referral due date and indicates delinquent discovery claim referrals. The report is used as a management tool to track pending discovery claim referrals and is distributed to the eligibility specialist and their supervisor.
A Monthly Discovery Claim Status/Activity Report (FCLME502) is generated showing all discovery claim referrals registered, moved, rejected and established during the month. The report includes a summary of the number of claims processed during the month and the number pending at the end of the month. This report is used as a case management tool to monitor timeliness of discovery claim referral processing and is distributed to the supervisor.
A Quarterly Discovery Claim Status/Activity Report (FCLQT502) is generated showing a summary of all claims processed during the quarter. This report shows currency of claims established and is used as a management tool to monitor timeliness of discovery referral processing.
To begin the controlled flow to establish the claim:
When the flow is completed, the discovery claim referral is moved for processing overnight. The status is M (Moved). Overnight the claim is established when the demand letter is generated. The status is changed to A (Active).
Refer to CARS User Guide REGISTERING A DISCOVERY CLAIM REFERRAL AND ESTABLISH A CLAIM for complete instructions.
The claim tracking system tracks claims from when they are established, through payment in full. The debtor information is stored and maintained in the claim tracking system.
Below is a chart that describes the CARS process and where to find that information in the CARS system.
| CARS Process | Inquiry Screen | Update Screen |
|---|---|---|
| Claim Balance | OVCS/OVCI | Automated |
| Debtor Information | OVDI | OVDC |
| Demand Letter | OVLI | OVLU |
| Billing Process | OVLB | Automated |
| Payments | OVPT | OVTA-limited access |
| Repayment Agreements | OVCI | OVCC |
| Fair Hearings | OVCI | OVCC |
| Recoupment | OVPT | Automated |
| WIU Actions | OVCI | OVCC |
| Update debtor Information | OVDI | OVDC |
| Terminated Claims | OVCS/OVCI | OVCC |
| Closed Claims | OVCS/OVCI | OVCC |
| Responsible Members of a claim | OVMI | OVMD (remove) OVMA (add) |
| DCN is a member of claim | OVIM | Automated |
In Temporary Assistance cases, there are no time limits. Recovery will be attempted on any overpayment. However, the Discovery/CARS system only allows entry for the previous 108 months. When a claim is determined for more than 108 months contact Temporary Assistance Program and Policy for further instructions.
The amount of the claim is computed by determining the number of months of overpayment and the amount of overpayment for each month.
The first month of overpayment is determined by applying the change reporting rules that would have applied to the case situation if all facts and figures required to be reported had been reported to the agency within the proper time frames.
EXAMPLE: Mr. B applies for Temporary Assistance benefits on 8/5/2008 and is approved for 08/2008 issuance. He does not report Social Security income he has been receiving since 2007. SDX is received by the county office on 10/3/2008. The claim for over issuance when the Social Security income is budgeted begins with 08/2008 because the income was not reported at application.
EXAMPLE: Ms. B. is currently receiving Temporary Assistance. On 09-11-08 she became employed, and did not report this change until she reapplied for food stamps on 01-21-09. Taking into account the 10-10-10 rule, Ms. B. should have reported employment by 09-21-08. The eligibility specialist completes a budget by 10-01-08 and sends an adverse action to reduce Temporary Assistance benefits. The adverse action expires on 10-11-08 and action could have been taken to affect November, 2008 Temporary Assistance benefits. The overpayment begins with November, 2008 Temporary Assistance benefits.
EXAMPLE: Ms. P. signs an IM-80A at the local FSD office on 9-22-08. The eligibility specialist fails to enter a Worker Initiated Closing (WICL) in the month of September, 2008 to close the TA case effective for October, 2008. The overpayment begins with the October, 2008 Temporary Assistance benefits.
EXAMPLE: Ms. J applies and was approved for Temporary Assistance benefits on 8/5/08 and reports no income. On 8-26-08, Ms. J reports she began a new job on 8-25-08 and her income exceeds 185% of the poverty level. The eligibility specialist does not act on the reported change. A reinvestigation was completed on Ms. J 1-18-09, and the eligibility specialist discovers she is ineligible for Temporary Assistance benefits. The overpayment begins with October 2008 Temporary Assistance benefits.
The eligibility factors and budget process in effect during the period of the claim are used in determining the amount of overpayment.
The eligibility specialist responsible for establishing the claim obtains the needed information and computes a budget for each month of the overpayment period using the Worker Initiated Budget Calculation Area (WIBCA) in FAMIS. Refer to the FAMIS User Guide WIBCA for instructions. The correct benefit amount for each month as determined from the WIBCA budget(s) and the amount actually received by the EU is entered in CARS. CARS uses this information to determine the overpayment amount. To determine a claim amount for an EU use the following guidelines.
NOTE: In situations where all efforts to obtain actual income have failed and the claim period covers the entire quarter and the income information is consistent on IMES, this source of income verification may be used to calculate the overpayment.
To determine the Temporary Assistance grant amount the claimant was eligible for, the following policies apply:
If a participant receives two assistance grants for the same month, whether the grants are either from Missouri, or from Missouri and another state, the participant received an overpayment for that month. If another state is involved, coordinate with the other state to determine in which state the overpayment occurred.
In those cases where an EU receives an overpayment because of income received by an optional EU member, the overpayment will be the lesser amount of the correct grant, after determining the amount of the grant, if the person:
These steps are to be followed even in those cases where additional income was not reported.
Examples of optional inclusions in an EU include: NPCR, legal guardian, and nieces and nephews.
The participant and/or the participant’s spouse or second parent, if not married, are responsible for repayment of Temporary Assistance that occurred due to undeclared property or income.
If an individual is established as a responsible member in error, the individual is removed from the claim. For instructions refer to CARS User Guide REMOVING RESPONSIBLE INDIVIDUALS FROM AN ESTABLISHED CLAIM.
A Demand Letter For Over issuance (CARS3-IM80) is generated and sent to the head of the EU when a Temporary Assistance claim is entered. The day the letter is generated is the day the claim is established. The demand letter contains:
Check to see if there is a current address available when a demand letter is returned as undeliverable. If there is an updated address available, place the entire demand letter in another envelope and mail to the correct address. If there is no other address available, record the returned date on the Demand Letter Inquiry (OVLU) screen and enter Y in the returned field.
Record a comment regarding whether contact was made with the EU and the address to which the demand letter was re-mailed on the Note Add (OVNA) screen.
For instructions refer to CARS User Guide RECORDING A DEMAND LETTER HAS BEEN RETURNED AS UNDELIVERABLE.
When a claim is entered into CARS, the process to collect the overpaid amount begins. The head of the EU receives a demand letter telling him/her the Temporary Assistance claim balance, repayment procedures, and hearing rights. After the demand letter is generated, the head of the EU does not receive another notice regarding the Temporary Assistance claim balance or hearing rights on this specific claim.
Collections are made against an EU with at least one responsible debtor for a single claim when responsible claim members reside in multiple Temporary Assistance EUs.
When a claim is established a demand letter is sent to the EU notifying them of their right to a fair hearing. Any responsible member may request a fair hearing regarding the claim.
A request for a fair hearing does not absolve a participant from overpayment during the hearing process.
Temporary Assistance benefits received during the ten (10) day advance notice of a proposed reduction or closing, or during the hearing process, are included in the total amount to be recovered.
To track the hearing go to the CARS Change Claim Information (OVCC) screen. Enter Y and the date the hearing was requested in the FAIR HEARING REQ field. There is no recoupment of Temporary Assistance benefits pending the hearing decision. The hearing request must be entered to prevent recoupment.
A hearing may be requested on the establishment of the claim or recoupment within 90 days of the date of the Demand Letter for Overissuance (CARS3-IM-80). The same day a hearing is requested by a responsible member of the claim, obtain a copy of the Demand Letter from Mobius, Report #FCLD400201, to submit as evidence at the hearing. Demand letters are not re-produced for claims established prior to November 9, 2009. If the claimant is requesting a hearing because collection has begun on a claim that was established prior to November 9, 2009 you must obtain a copy of the Adverse Action Notice (IM-80) from the case record. The hearing decision is entered into CARS on the CHANGE CLAIM INFORMATION (OVCC) screen. Make the following entries in the DECISION field:
The hearing decision is sent to the claimant and the agency. If the agency is upheld and an overpayment exists, an after-hearings notice of the claim is included in the hearing decision. The EU is given an opportunity to complete the repayment agreement. Thirty days after the hearing decision, recoupment of Temporary Assistance benefits may begin if another repayment method is not chosen and the individual receives Temporary Assistance benefits.
For instructions refer to CARS User Guide ENTERING AND TRACKING FAIR HEARING REQUESTS IN CARS.
A Temporary Assistance claim can be compromised only by WIU or by a judicial determination. Compromise means reduce a claim amount.
A CARS Repayment Agreement is sent to the EU with the Demand Letter for Overissuance (CARS3-IM80). The debtor is given the following options:
The debtor(s) signs the agreement according to the best repayment method for the EU. If the EU chooses to not agree to make repayment and the EU has an active Temporary Assistance case, benefit reduction is applied. If the repayment agreement is returned with benefit reduction section completed, take no action as the system automatically initiates the benefit reduction. Benefit reduction is also known as recoupment. Temporary Assistance benefits will be reduced based upon 10% of the maximum benefit amount for the household size with zero income.
EXAMPLE: EU consists of Ms. X and her daughter. Maximum grant for a household size of two with zero income is $234. The benefit reduction, or recoupment, is $23.
If the CARS3-IM80 Repayment Agreement is returned with a method of repayment other than recoupment to:
For instructions see CARS User Guide ENTERING REPAYMENT AGREEMENTS AND PROCESSING PAYMENTS IN THE CLAIMS ACCOUNTING AND RESTITUTION SYSTEM (CARS).
The CARS Repayment Agreement is filed in the CLAIMS SECTION of the case record.
If the EU fails to make a repayment in accordance with the CARS Repayment Agreement, CARS generates a billing statement. If any responsible member of the EU is receiving Temporary Assistance benefits, the system may begin automated recoupment of Temporary Assistance benefits.
An individual may request renegotiation of a repayment agreement. If the agency agrees with the request, a new payment is negotiated. The individual signs a new CARS Repayment Agreement and OVCC is updated. If the agency finds the EU’s economic circumstances have not changed enough for the repayment agreement to be changed, the original repayment amount remains. The request for renegotiation and the reason for the decision are recorded on the Note Add (OVNA) screen.
If the EU is receiving Temporary Assistance benefits, the repayment agreement cannot be less than the amount that can be recovered with recoupment. The repayment agreement is not renegotiated when the Temporary Assistance benefit amount changes. Recoupment is 10% of the Temporary Assistance benefit based upon the maximum benefit amount for the household size with zero income.
A claim can be repaid by:
For instructions refer to CARS User Guide ENTERING REPAYMENT AGREEMENTS AND PROCESSING PAYMENTS IN THE CLAIMS ACCOUNTING AND RESTITUTION SYSTEM (CARS).
NOTE: Temporary Assistance claims are not offset by Missouri state income tax refund interceptions or recovery from an estate.
If a claim is to be repaid in cash, the EU is instructed to make the payment in the form of bank draft, cashier’s check, or money order whenever possible. Cash payment is accepted. A receipt is given to the EU and a copy filed in the claims section of the record. If a cash payment is made to the local office, a money order or cashier’s check may be purchased at the local office’s expense. Checks received are endorsed "FOR DEPOSIT ONLY TO THE CREDIT OF THE TREASURER OF THE STATE OF MISSOURI - DEPT OF SOCIAL SERVICES" and all payments are submitted daily.
Payments received in the local office are forwarded to Division of Finance and Administrative Services (DFAS) with a completed CARS-2, using transaction code 01.
For instructions see CARS User Guide ENTERING REPAYMENT AGREEMENTS AND PROCESSING PAYMENTS IN THE CLAIMS ACCOUNTING AND RESTITUTION SYSTEM (CARS).
A debtor may voluntarily use Temporary Assistance benefits in their EBT account to repay a Temporary Assistance overpayment. A Voluntary Repayment Authorization form (IM-114), is completed and signed by the debtor. Verify a claim has been established for the overpayment on the Display Claim Information screen (OVCI). To view the claim, type OVCI, space, I, DCN and press enter. To view additional claims for this individual, press enter. When all claims have been displayed, the message "END OF INQUIRY" displays. The voluntary repayment action is entered into the EBT Administrative Terminal. For instructions refer to CARS User Guide Entering a Voluntary Repayment in EBT. The repayment is automatically posted to the claim. A CARS-2 is not submitted for posting. If the claim is entered the same day the authorization is entered, a report is generated to the Claims and Restitution Unit to manually post the payment.
For instructions refer to CARS User Guide ENTERING REPAYMENT AGREEMENTS AND PROCESSING PAYMENTS IN THE CLAIMS ACCOUNTING AND RESTITUTION SYSTEM (CARS).
CARS automatically initiates recoupment for any claim that is eligible to be paid for an active Temporary Assistance EU through reduction of Temporary Assistance benefits. CARS knows when to begin recoupment on Temporary Assistance claims. Information entered in the repayment agreement fields does not affect the amount recouped. Claims are eligible for recoupment if:
There is no recoupment of Temporary Assistance benefits when:
If a responsible member of a claim is receiving Temporary Assistance in any EU, that allotment may be reduced to pay for the overpayment.
A Temporary Assistance claim can be terminated when:
When a claim is established in error or a hearing decision reverses the claim and orders it terminated, the eligibility specialist must complete each field applicable on a Claim Payment Transmittal (CARS-2) form. Use Transaction Type Code 22-Write-Off.
If the claim is paid in full, the claim is closed.
For instructions see CARS User Guide TERMINATING OR CLOSING A CLAIM.
If it is discovered a claim was originally established for more than it should have been, submit a CARS-2 requesting the balance be reduced using transaction code 22, credit. Write on the top of the CARS-2 the reason for the reduction. Record the reason for the reduction and describe the documentation used to make the decision on the ADD NOTE (OVNA) screen.
The County Manager or designee must approve all CARS-2s. The person who approves the CARS-2 cannot be the same person who completes the CARS-2. Submit the completed and approved CARS-2 to Division of Finance and Administrative Services (DFAS).
When an over collection occurs on a Temporary Assistance claim, a report is generated to the Temporary Assistance Program and Policy Unit in Central Office. The Program and Policy Unit then contacts DFAS, who then informs the claimant and issues a repayment.