218 R.I. Code R. 218-RICR-20-00-1.18

Current through November 7, 2024

Section 218-RICR-20-00-1.18 - Benefit Underpayments

A. If the agency representative determines that a loss of benefits has occurred, and a household is entitled to restoration of these benefits, action to restore the benefits must automatically be taken.

1. However, benefits are not restored if the benefits were lost more than twelve (12) months prior to the month the loss was discovered by the agency in the normal course of business or were lost more than twelve (12) months prior to the month the agency representative was notified in writing, or orally, of a possible loss to a specific household.

2. Benefits are restored to a household whenever:

a. The loss was caused by an agency error; and/or,

b. There is a statement elsewhere in the Regulations specifically stating that the household is entitled to restoration of lost benefits; and/or,

c. There is an administrative disqualification for intentional program violation which was subsequently reversed.

3. The household is notified of its entitlement, the amount of benefits to be restored, any off-setting that was done, the method of restoration, and the right to appeal through the hearing process if the household disagrees with any aspect of the restoration of lost benefits.

4. If the household was eligible, but received an incorrect allotment, the amount to be restored is the difference between the actual and the correct allotment.

5. The loss of benefits is calculated only for those months the household participated.

6. The agency must restore to a household benefits which were found by any judicial action to have been wrongfully withheld.

a. If the judicial action is the first (1st) action the recipient has taken to obtain restoration of lost benefits, then benefits must be restored for a period of not more than twelve (12) months from the date the court action was initiated.

b. When the judicial action is a review of the agency action, the benefits must be restored for a period of not more than twelve (12) months from the first (1st) of the following dates:

(1) The date the agency receives a request for restoration;

(2) If no request for restoration is received, the date the fair hearing action was initiated; and

(3) Never more than one (1) year from when the agency is notified of, or discovers, the loss.

7. Benefits must be restored even if a household is currently ineligible.

B. If the loss was caused by an incorrect delay, denial, or termination of benefits, the months affected by the loss must be determined as follows:

1. If an eligible household's application was delayed, the months for which benefits were lost are determined in accordance with procedures in § 1.3.8 of this Part for determining whether the delay was caused by the household or the agency representative.

2. If an eligible household's application was erroneously denied, the month the loss initially occurred is the month of application, or for an eligible household filing a timely reapplication, the month following the expiration of its certification period.

3. If a household's benefits were erroneously terminated, the month the loss initially occurred is the first (1st) month benefits were not received as a result of the erroneous action.

4. After determining the date the loss initially occurred, the loss is calculated for each month subsequent to that date until either the first (1st) month the error is corrected or the first (1st) month the household is found ineligible.

C. For each month affected by the loss, the agency representative must determine if the household was actually eligible.

1. In cases which have no information in the household's case file to document that the household was actually eligible, the agency representative advises the household of what information must be provided to determine eligibility for those months.

2. For each month the household cannot provide the necessary information to demonstrate its eligibility, the household is ineligible.

3. For the months the household was eligible, the agency representative calculates the allotment the household should have received.

a. 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.

D. Benefits are not restored if a household is otherwise at fault.

1. Examples of errors for which benefits are not restored:

a. A household does not report a change which increases benefits;

b. A household fails to provide verification without good cause; or,

c. A household provides incorrect information caused by household error, which results in loss of benefits.

E. If it is determined 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 agency representative or any other action taken by the agency representative to restore lost benefits, the household may request a hearing within ninety (90) days of the date the household is notified of its entitlement.

1. If a hearing is requested prior to or during the time benefits are being restored, the household receives the lost benefits as determined by the agency representative pending the results of the hearing.

2. If the hearing decision is favorable to the household, the agency representative restores the lost benefits in accordance with that decision.

F. Offsetting Claims

1. If a claim against a household is unpaid or held in suspense as provided in § 1.18, the amount to be restored must be offset against the amount due on the claim before the balance, if any, is restored to the household.

2. At the point in time when the household is certified and receives an initial allotment, the initial allotment must not be reduced to offset prior claims, even if the initial allotment is paid retroactively.

G. IPV Restoration

1. An individual disqualified for an intentional program violation is 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 agency notification, only if the decision which resulted in disqualification is subsequently reversed.

2. For each month the individual was disqualified, not to exceed twelve (12) months prior to agency notification, the amount restored, if any, is determined by comparing the allotment the household received with the allotment the household would have received had the disqualified member been allowed to participate.

a. If the household received a smaller allotment than it should have received, the difference equals the amount to be restored.

3. Participation in an Administrative Disqualification Hearing in which the household contests the agency assertion of intentional program violation is considered notification that the household is requesting restored benefits.

H. Method of Restoration

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

2. This allotment is added to the current EBT account. This amount is in addition to the benefit a currently eligible household is entitled to receive.

I. Changes in Household Composition

1. Whenever lost benefits are due a household in which the household's membership has changed, the agency representative restores the lost benefits to the household containing a majority of the individuals who were household members at the time the loss occurred.

2. If the agency representative cannot locate or determine the household that contains a majority of household members, the agency representative restores the lost benefits to the household containing the head of the household at the time the loss occurred.

218 R.I. Code R. 218-RICR-20-00-1.18

Amended effective 4/4/2019
Amended effective 12/24/2019
Amended effective 8/1/2021
Amended effective 9/23/2021
Amended Effective 12/4/2021
Amended effective 11/10/2022
Amended effective 1/1/2023
Amended effective 5/14/2023
Amended effective 10/1/2023
Amended effective 12/15/2023
Amended effective 9/22/2024
Amended effective 10/1/2024
Amended effective 10/24/2024