16 Del. Admin. Code § 9000-9011

Current through Register Vol. 28, No. 7, January 1, 2025

Section 9000-9011 - Restoration of Lost Benefits

9011.1 Entitlement

Restore to households benefits which were lost whenever the loss was caused by an error by the Division or by an administrative disqualification for intentional Program violation which was subsequently reversed as specified in DSSM 9011.5, or if there is a statement elsewhere in the regulations specifically stating that the household is entitled to restoration of lost benefits. Benefits will be restored for not more than twelve months prior to whichever of the following occurred first:

1. The date DSS receives a request for restoration from a household; or

2. The date DSS is notified or otherwise discovers that a loss to a household has occurred.

Restore to households benefits which were found by any judicial action to have been wrongfully withheld. If the judicial action is the first action the recipient has taken to obtain restoration of lost benefits, then benefits will be restored for a period of not more than twelve months from the date the court action was initiated.

When the judicial action is a review of an action taken by the Division, the benefits will be restored for a period of not more than twelve months from the first of the following dates:

1. The date DSS receives a request for restoration;

2. If no request for restoration is received, the date the fair hearing action was initiated, but

3. Never more than one year from when DSS is notified of, or discovers, the loss.

9011.2 Errors Discovered by the Division

If the Division determines that a loss of benefits has occurred, and the household is entitled to restoration of those benefits, automatically take action to restore any benefits that were lost. No action by the household is necessary. However, benefits will not be restored if they were lost more than 12 months before the loss was discovered by the Division or were lost more than 12 months before the Division was notified in writing or orally of a possible loss to a specific household. Notify the household of its entitlement, the amount of benefits to be restored, any offsetting that was done, the method of restoration, and the right to appeal through the fair hearing process if the household disagrees with any aspect of the proposed lost benefit restoration.

9011.3 Disputed Benefits

If the Division determines that a household is entitled to restoration of lost benefits, but the household does not agree with the amount to be restored as calculated by the Division or any other action taken by the Division to restore lost benefits, the household may request a fair hearing within 90 days of the date the household is notified of its entitlement. If a fair hearing is requested prior to or during the time lost benefits are being restored, the household will receive the lost benefits as determined by the agency pending the results of the fair hearing. If the fair hearing decision is favorable to the household, restore the lost benefits in accordance with that decision.

If a household believes it is entitled to restoration of lost benefits but the Division after reviewing the case file does not agree, the household has 90 days from the date of the Division determination to request a fair hearing. Restore benefits to the household only if the fair hearing decision is favorable to the household. Benefits lost more than 12 months prior to the date the Division was initially informed of the household's possible entitlement to lost benefits will not be restored.

9011.4 Computing the Amount to be Restored

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, calculate the amount to be restored as follows:

1. If the household was eligible but received an incorrect allotment, the loss of benefits will be calculated only for those months the household participated. If the loss was caused by an incorrect delay, denial, or termination of benefits, calculate the months affected by the loss as follows:

a. If an eligible household's application was erroneously denied, calculate the loss beginning with the month of application. For an eligible household filing a timely re-application, calculate the loss beginning with the month following the expiration of its certification period.

b. If an eligible household's application is delayed, calculate the months for which benefits may have been lost in accordance with the procedures in DSSM 9040.

c. If a household's benefits were erroneously terminated, the month the loss initially occurred will be the first month in which benefits were not received as a result of the erroneous action.

d. After computing the date the loss initially occurred, calculate the loss for each month subsequent to that date until either the first month the error is corrected or the first month the household is found ineligible.

2. For each month affected by the loss, determine if the household was actually eligible. In cases where there is no information in the household's case file to document that the household was actually eligible, advise the household of what information must be provided to determine eligibility for these months. For each month the household cannot provide the necessary information to demonstrate its eligibility, the household will be considered ineligible.

3. For the months the household was eligible, calculate the allotment it should have received. If the household received a smaller allotment than it was eligible to receive, the difference between the actual and correct allotments equals the amount to be restored.

4. If a claim against a household is unpaid or held in suspense as provided in DSSM 7005, the amount to be restored will be offset against the amount due on the claim before the balance, if any, is restored to the household. At the point in time when the household is certified and receives an initial allotment, the initial allotment will not be reduced to offset claims, even if the initial allotment is paid retroactively.

Audit and Recovery Management Services processes all claim determinations. Consequently, benefits will not be restored to any household until ARMS advises the DSS via Form 106, of any off-setting that is required due to outstanding claims. The procedure for effecting benefit restorations is found in DSSM 7002.1.

9011.5 Lost Benefits to Individuals Disqualified for Intentional Program Violation

Individuals disqualified for intentional Program violation are entitled to restoration of any benefits lost during the months that they were disqualified, not to exceed twelve (12) months prior to the date of DSS notification, only if the decision which resulted in disqualification is subsequently reversed. For example, 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.

For each month the individual was disqualified, not to exceed twelve months prior to DSS notification, the amount to be restored, if any, will be determined by comparing the allotment the household received with the allotment the household would have received had the disqualified member been allowed to participate. If the household received a smaller allotment than it should have received, the difference equals the amount to be restored. Participation in an administrative disqualification hearing in which the household contests DSS' assertion of intentional Program violation will be considered notification that the household is requesting restored benefits.

9011.6 Method of Restoration

Regardless of whether a household is currently eligible or ineligible, the agency will restore lost benefits to a household by issuing an allotment equal to the amount of benefits that were lost.

The amount restored will be issued in addition to the allotment currently eligible households are entitled to receive. Reasonable requests by households to restore lost benefits in monthly installments will be honored. As an example of a reasonable request, the household may fear that the excess food stamp benefits will be stolen or that the amount to be restored is more than it can use in a reasonable period of time.

Instructions for the issuance of restored benefits are contained in DSSM 7002.1.

9011.7 Changes in Household Composition

Whenever lost benefits are due a household and the household's membership has changed, restore the lost benefits to the household containing a majority of the individuals who were household members at the time the loss occurred. If DSS cannot locate or determine the household which contains a majority of household members, restore the lost benefits to the household containing the head of the household at the time the loss occurred.

9011.8 Accounting Procedures

If applicable, each case file will contain Form 106 documenting a household's entitlement to restoration of lost benefits. In addition, DMS will maintain a central alphabetic listing of cases where lost benefits have been or will be restored and will cross-reference this listing to cases in which a claim against the household can be used to offset the amount to be restored.

16 Del. Admin. Code § 9000-9011