S.C. Code Regs. § § 114-1020

Current through Register Vol. 48, No. 9, September 27, 2024

Section 114-1020 - Application and Redetermination Procedures

A. Applications for public assistance shall be filed at the County Department of Social Services Office located in the county in which the applicant actually resides at the time of application. For children in Regular foster care, the application shall be filed in the county where the court order was issued, if different from the county of current residence.

(1) An application shall be taken without delay and the individual may apply for whatever category of assistance he chooses.

(2) The county department shall make every reasonable effort to help the applicant establish his eligibility.

B. If an application is made for an individual without his knowledge, the county department may take no action without first obtaining his knowledge and consent, unless such individual is incompetent or incapacitated. In this latter case, assistance payments may be made only to the individual's duly appointed legal guardian or authorized representative.

C. Application shall be by agency form and shall be signed, except for SSI recipients. The application form shall:

(1) Clearly signify the intent of the individual to apply and the effective date of such application;

(2) Advise the applicant of his rights and responsibilities;

(3) Put the applicant on notice that he is liable for the truthfulness of the information he includes on the application;

(4) Provide the agency with sufficient information to begin an accurate determination of eligibility or ineligibility.

D. The applicant or recipient shall:

(1) Provide complete and accurate information about his circumstances, and shall be told that State Law provides a penalty for making false statements, for willful misrepresentation of facts, or for impersonation;

(2) Report any changes in circumstances which may affect his eligibility or entitlement for assistance within ten days of such change;

(3) Repay funds received during a period of ineligibility resulting from failure to report changes of circumstances or from giving incorrect information.

E. An applicant may be assisted by any individual of his choice in the various aspects of the application process and may be accompanied by such individual in contacts with the agency and, when so accompanied, may also be represented by such individual.

F. Application interviews shall include:

(1) An explanation of eligibility requirements, the agency's standard of promptness in acting on applications, the applicant's right to a fair hearing, the procedure for requesting a hearing, and the applicant's rights under Title VI of the Civil Rights Act of 1964.

(2) An explanation of the applicant's responsibilities to give complete and accurate information, to report any changes in his circumstances, and to repay funds received ineligibly.

(3) An explanation of the need for a home visit.

(4) An explanation of the methods of establishing eligibility, including the need for making collateral contacts and the use of documentary and other records for verifying pertinent information.

(5) In AFDC cases, an explanation of the availability of family planning and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services and the means for obtaining these services.

(6) The information that the public assistance payroll is open to public inspection in each county office.

(7) The signing of the proper application form by the applicant, his legal guardian, or an authorized representative.

G. An individual's basic rights shall be respected and protected during the eligibility determination process.

(1) The determination of a person's initial or continued eligibility for public assistance shall be conducted in a manner consistent with his rights under the United States Constitution, the Social Security Act, and Title VI of the Civil Rights Act of 1964.

(2) Any person wishing to apply for any form of public assistance shall have the right to do so.

(3) The applicant or recipient's use of public assistance payments shall not be limited or restricted by agency policies.

(4) All information obtained during interviews with and by the verification of information about applicants or recipients of financial or medical assistance shall be confidential. The use of or disclosure of information shall be limited to the following situations:

(a) Pertinent information regarding an applicant or recipient may be disclosed to any official government or agency representative, on the basis of need, and for purposes directly relating to the administration of the agency's programs, such as establishing eligibility, determining amount of assistance and providing services for applicants and recipients.

(b) Any investigation, prosecution, or criminal or civil proceeding conducted in connection with the administration of federal programs administered by the agency.

(c) Information other than confidential medical reports may be disclosed to any individual or agency with the written consent of the applicant or recipient or his authorized representative.

(d) The names of recipients receiving public assistance payments and the amount of such payments are public records and open to public inspection. However, the publication of lists of such names for commercial or political purposes is unlawful.

(e) Information regarding applications or recipients of financial assistance, including names and addresses, may be disclosed to a legislative body or designated audit committee when such body or committee certifies that the information is needed for purposes, including audits, specified in subparagraphs a and b above.

(5) Any person who is dissatisfied as the result of an action taken or not taken by the County or State Department of Social Services with respect to his application or his grant may appeal for an impartial review of his circumstances through the fair hearing procedure in Article 3 of these regulations.

(6) The State and County Departments of Social Services shall maintain agency program procedures and policies and shall make them available for examination by the public upon request.

H. An application may be approved when all eligibility criteria are met. Once eligibility is established, for programs other than GDA and GA-IS, assistance shall continue regularly until such time as eligibility no longer exists. For GDA and GA-IS grants, eligibility shall terminate at the end of the grant period, and shall continue only if a new application has been completed and approved.

(1) An application shall be denied when the applicant or family group fails to meet one or more eligibility criteria or when the applicant fails to furnish necessary data within the standard of promptness, unless the delay is due to circumstances beyond the applicant's control.

(2) An application may be denied because of the death of an applicant inability to locate an applicant, or at the applicant's request.

I. A County Board of Social Services may review, approve, disapprove, or amend an award of assistance made by the County Department of Social Services. The State Department of Social Services may review applications for public aid, disapprovals, or modifications of awards made by the county departments and may make decisions as to the granting and the amount of payment.

J. Determination of Eligibility and Continued Eligibility.

(1) No more than forty-five days (sixty days for Medical Assistance Only -Disability) shall elapse between the date of application and the date that either the first assistance grant, or the notice of denial of assistance, is mailed to the individual or family, unless:

(a) The applicant or the agency, after repeated attempts, has failed to secure the necessary facts regarding eligibility and further processing time is necessary;

(b) An applicant or physician has failed to provide needed information or an administrative or other emergency which could not be prevented causes a delay;

(c) The applicant requests that an imminent negative action be delayed until additional information concerning eligibility can be secured.

(2) Continued eligibility for financial or medical assistance shall be redetermined or reviewed in each of the following instances, whichever occurs earliest.

(a) Immediately after the agency receives a report that a change has occurred in the recipient's circumstances which may affect eligibility or the amount of the assistance grant;

(b) When required on the basis of information the agency has obtained previously about anticipated changes in the recipient's situation;

(c) Every six months in Aid to Families with Dependent Children -Foster Care, Regular Foster Care, and Mandatory State Supplementation, and every twelve months for Aid to Families with Dependent Children, Medical Assistance Only and Optional Supplementation.

(3) A home visit prior to certification shall be made on each AFDC application and review. A home visit shall be made before certification for General Disability Assistance, General Assistance-Ineligible Spouse and Optional Supplementation, but a home visit is not required for subsequent redeterminations in these assistance categories. Home visits are not required on Medical Assistance Only applications and reviews. Applicants and recipients shall be given oral or written notice of the intended date and purpose of any home visit.

(4) The applicant or recipient shall provide necessary information and documentation of his eligibility for assistance, unless he is unable to do so because of age, physical or mental disability, language barriers, or other pertinent reason.

(a) If the individual is physically or mentally incapable of providing complete or accurate information, the agency may take the initiative to secure such information.

(b) An individual other than the applicant or recipient may be used as a collateral source of information as long as he:

(i) Has definite knowledge of facts which relate to the applicant's or recipient's eligibility; and

(ii) Is willing to have his identity revealed to the applicant or recipient, upon request, should the information provided result in an adverse action.

(c) If an applicant refuses to provide information necessary to establish eligibility, which is within his capacity to provide, assistance shall be denied or terminated because eligibility cannot be established.

(5) The agency shall give prompt written notification to an applicant or recipient of any decision concerning an application for financial or medical assistance.

(a) If assistance is authorized the notice shall include the amount of the financial assistance grant, if applicable.

(b) If assistance is denied the notice shall contain:

(i) A written explanation of the reason for denial,

(ii) The citation of the specific manual section or circular letter supporting the reason for denial; and

(iii) A written explanation of the individual's right to request a fair hearing pursuant to Article 3 of these regulations.

S.C. Code Regs. § 114-1020