Revised June 3, 2011

Purpose:

WAC 388-410-0035  Are alien and alien sponsors jointly responsible for cash and food assistance overpayments?

Worker Responsibilities - WAC 388-410-0035

If the department determines that an assistance unit’s overpayment amount needs to be modified because of an error, the worker should refer to the ACES manual Benefit Error Group, Modify a BEG – Underpayment or Overpayment.

ACES Procedures

See Benefit Error Group (BEG) – Modify a BEG – Underpayment or Overpayment

Revised August 19, 2024

WAC 388-410-0020 What happens if I receive more Basic Food or WASHCAP benefits than I am supposed to receive?

• Clarifying Information

WAC 388-410-0025 Am I responsible for an overpayment in my assistance unit?

• Clarifying Information

WAC 388-410-0030 How does the department calculate and set up my Basic Food or WASHCAP overpayment?

• Clarifying Information

WAC 388-410-0033 How and when does the department collect a Basic Food or WASHCAP overpayment?

• Clarifying Information

Clarifying Information - WAC 388-410-0020

1. Examples of an Administrative Error (AE) overpayment include when we:
   

   1. Didn’t act timely on a reported or known change in circumstances;

   2. Made a mistake in determining the AU’s eligibility or benefits;

   3. Incorrectly issued duplicate benefits;

   4. Issued allotments after the end of the AU's certification period without redetermining the AU's eligibility;

   5. Didn’t disqualify a client for an IPV on time as required under chapter 388-446 WAC;

   6. Made an incorrect change to the case or failed to make a needed change that caused the department to make an incorrect decision on the AU's eligibility or benefit amount.

2. Examples of an Inadvertent Household Error (IHE) include when the AU:
   

   1. Understood what they were required to report; or

   2. Failed to report a change or provided inaccurate and incomplete information, but without the intent to get more food assistance than they were eligible to receive.

3. Examples of an Intentional Program Violation (IPV) include when a client does any of the following on purpose:
   

   1. Makes an oral or written false or misleading statement that affects their benefits;

   2. Misrepresents, conceals, or withholds facts; or

   3. Violates the Food Stamp Act, Basic Food regulations, or any state laws that cover:

      1. How someone can get, have, and use Basic Food benefits or EBT cards; or

      2. The transfer of Basic Food benefits or EBT cards; or

      3. Trafficking.

4. Date of awareness:
   The Date of Awareness is the earlier of the:
   1. Date the overpayment is processed (Benefit Error Group (BEG) status is changed to OP and the letter is sent), or
   2. Date a request for information letter is sent to validate the overpayment.
   3. For cases referred for prosecution or administrative disqualification hearings, the date the case was referred for adjudication.
       
5. Date of discovery:

The Date of Discovery is the date we have adequate information to validate the AU has an overpayment, and determine the amount overpaid. It isn't the date of a system-generated (BEG), because these only give enough information to identify a potential overpayment.

The date we "open" the BEG in ACES is the official date of discovery.  The exception to this rule is Basic Food errors discovered through the federal Quality Control review process.  The official date of discovery for a QC error is the date the QC error report in a client’s electronic case record (ECR).
 

6. Date of establishment: The date staff establishes an overpayment, sends the household notification of the claim, and refers the case to the Office of Financial Recovery (OFR) for collections. The date of the overpayment letter is the official date of establishment.

    

7. Timeframes to set up overpayments:

We must process at least 90% of all overpayments by the end of the calendar quarter after the quarter we discover an overpayment. A claim isn't timely if we sent the AU an overpayment letter later than the last day of the quarter after the quarter in which we "opened" the overpayment BEG.  Even though we can set up a valid overpayment after the timely processing period, federal rules require the department to meet this timeframe. 

NOTE: Potential overpayments discovered by the Basic Food quality assurance (QA) process must be "priority". Every attempt must be made to establish overpayments within federal time limits after the payment errors associated with these overpayments have been finalized by the Division of Program Integrity (DPI).

To ensure that staff review potential overpayments and promptly act on this information, the department monitors BEG lists. 

To measure if we are meeting federal timeliness standards for establishing overpayments, staff compares the dates an overpayment BEG was "opened" to the date we sent the overpayment letter.

 8.   Other program reporting requirements and Basic Food overpayments:

If someone doesn't report a change in circumstances required under WAC 388-418-0005, we determine if there is an overpayment for each program based on that program’s reporting requirements.

• For Basic Food, the household must report changes as required under WAC 388-418-0005(2).

• If a Basic Food assistance unit wouldn't have to report the change based on the AU's circumstances, we don't set up an overpayment even if the household had to report a change for another department program.

Clarifying Information - WAC 388-410-0025

Even though all adult members of an AU with an overpayment are liable for the full overpayment, OFR tracks payments to ensure that we don't collect more than the amount of the overpayment.

Clarifying Information - WAC 388-410-0030
 

1. Calculating the Overpayment
   

   1. The overpayment amount is the difference between what the client received and what they were eligible to receive.

      1. For Administrative Errors where the household has earned income, apply the earned income deduction to all earned income, reported or unreported.

      2. For Inadvertent Household Errors with unreported earnings, don’t apply the earned income disregard to the portion of earnings that wasn’t reported timely.

    iii. For trafficking, the overpayment amount will be provided by the court or in a signed agreement.

b. When determining an overpayment amount, subtract any outstanding underpayment from an overpayment to get the net overpayment amount.
 

2. Overpayment timeframes: For both AE and IHE overpayments, review 12 months from the date of awareness.

3. Overpayments discovered by QC Reviews:  If the department discovered an overpayment or ineligibility for benefits through the federal QC process we must set up an overpayment regardless of the amount. 
    

4. Overpayments discovered outside the QC Review process: If we didn't discover the overpayment through the federal QC process, we set up an overpayment if:

   1.  The responsible household members still receive Basic Food or WASHCAP benefits and the overpayment is over $85; or

   2.  The overpayments total more than $125 and the responsible household members don’t receive Basic Food or WASHCAP.

   3. The thresholds remain the same when the overpayment will be referred as IPV.

5. OFR collects on established debts regardless of the amount.  ​The $85 and $125 thresholds related to QC findings apply to whether or not we establish an overpayment for Basic Food or WASHCAP. OFR collects on established overpayments regardless of the amount. This includes when we:

   1. Set up an overpayment for an AU who no longer receives Basic Food; or

   2. Modify an existing overpayment.

OFR is the point of contact for “compromising” (reducing) overpayment balances or making decisions on waiving overpayment collections. Clients must be referred to OFR for these requests.

6. Trafficking claims are for the entire amount trafficked.

Clarifying Information - WAC 388-410-0033

1. Repaying an overpayment:

   1. The Department collects from the client by reducing Basic Food benefits. Clients can also repay an overpayment by paying the OFR directly.

   2. The adults in the overpayment assistance unit share the responsibility for repaying an overpayment even if they later belong to different assistance units.

   3. We consider a person who receives Basic Food or WASHCAP benefits as having the ability to repay an overpayment.

2. When can an overpayment be reduced:

   1. The CSO can reduce an overpayment debt only if the overpayment was incorrectly calculated for an amount larger than is actually owed.

   2. An Administrative Law Judge (ALJ) can order an overpayment debt waived or reduced to correct an overpayment that was calculated in error.  An ALJ doesn't have the authority to reduce or waive an overpayment based on hardship. 

   3. OFR can reduce an established overpayment:

A person responsible for an overpayment may be able to negotiate a reduction of the debt. OFR is the secretary's designee for the department under RCW 43.20A.110 and uses criteria under RCW 43.20B.030 to determine if an overpayment should be reduced or dismissed  as allowed under Title 7 CFR §273.18(c)(7)  

i. OFR OFR determines if a reduction of the debt would be cost effective for the department instead of continuing collections through other means.

ii. Normally, reducing the debt is cost effective only if the person is willing to pay the remaining debt off in full.

iii. People can contact OFR to negotiate a reduction in the overpayment by calling at 800-562-6114.

3. OFR takes the necessary steps to collect the overpayment. This includes allotment reduction, installment payments, and lump sums, as well as other means of collection.

We don’t recover an existing overpayment from the first month's benefits of a newly-approved application for WASHCAP or Basic Food. We do recover an overpayment from the first month of an AU's certification period if we recertified the AU with no break in eligibility. How overpayments are collected:

Top of Page

Revised July 27, 2012

WAC 388-410-0040 Cash and food assistance underpayments.

• Clarifying Information and Worker Responsibilities

Clarifying Information - WAC 388-410-0040

Effect of Underpayments on Resources: The unspent amount of a cash assistance underpayment is not included in computing the value of a household's nonexempt resources in the month the underpayment is reimbursed or in the following month.

Date of Discovery for Department Errors: When the underpayment is discovered by the department, the date of discovery is the date we have adequate information to validate the household has an underpayment and determine the amount the household was underpaid.  It is not the date the department received information or verification.

Worker Responsibilities - WAC 388-410-0040

1. Repay all underpayments that are not applied toward reducing an overpayment.
2. Document in the ACES narrative, any request received, oral or written, from an assistance unit indicating a belief they were entitled to more benefits than were received.
3. To restore unpaid food assistance benefits, determine the amount the household was eligible to receive during each month in which there was an error. Disregard any months in which the household was not certified except those months where benefits were lost due to an incorrect denial or termination.
4. Restore food assistance benefits back to the date of application when a delay past the first 30 days is the fault of the department.
5. Upon discovering an underpayment, check the history file to determine if an outstanding balance on an overpayment remains. If so, complete a notice to Office of Financial Recovery indicating the adjustment to the overpayment balance from a restoration of unpaid benefits.
6. If a cash or food assistance underpayment is in excess of any overpayment or remaining overpayment balance, create a beg for the excess amount to the appropriate assistance unit.

Revised October 10, 2023

Purpose:

WAC 388-410-0001 What is a cash assistance overpayment?

• Clarifying Information and Worker Responsibilities

WAC 388-410-0005 Cash assistance overpayment amount and liability

• Clarifying Information and Worker Responsibilities

Clarifying Information - WAC 388-410-0001

1.      Intentional Overpayment: 

1. The result of the client's willful knowing concealment of information or failure to reveal information resulting in an overpayment.

2.     Unintentional Overpayment: 

a.   An unintentional client error overpayment is based on the condition that although caused by the client, there was no intent to obtain or retain assistance for which the client knew they were not eligible.

b.   An unintentional department error overpayment is the direct result of omission, neglect, or error by the department in taking action on information affecting the amount of benefits for which a client is eligible.

c.   An unintentional technical error is an overpayment not directly caused by department error or client error. These types of overpayments are due to effective dates and procedural requirements. Following are examples of technical errors:

1. Administrative Hearings:  Continued assistance pending a fair hearing results in an overpayment when the decision of the Department is upheld.  Continued assistance overpayments can't be established for more than 60 days' worth of benefits from the date the administrative hearing was requested.
2. Ten-Day  Advance Notice:  When advance notice requirements for termination or a reduction in benefits results in a payment of benefits for which the client isn't eligible, the resulting one-time payment is an overpayment.

3.   Strikers:

Prior to July 1, 1999, an overpayment exists for any month in which a member of a TANF/SFA household is on strike on the last day of that month.  Starting with July 1999 benefits, there are no overpayments based solely on a member of the TANF/SFA assistance unit being on strike.

4.    Prospective Budgeting:

An overpayment exists when a client intentionally understates their estimated income for the first 2 months of eligibility.  See WAC 388-450-0215.

5.    When Someone Fails to Report a Change of Circumstances Required for Cash Only:

When someone doesn't report a change of circumstances required under WAC 388-418-0005, we determine if a client has an overpayment for each program based on that program’s reporting requirements.

If the person was not required to report a change for Basic Food or medical benefits, we do not set up an overpayment for these programs based on the unreported change. This is true even if we would have reduced benefits if the household reported the change.

6.    Diaper Related Payments (DRP):

DRP is not pro-rated and all overpayments will be for the full amount issued in the ineligible month(s). DRP will only have an overpayment if the assistance unit was completely ineligible for DRP (i.e., no child under 3 in the household and/or the assistance unit wasn’t eligible for TANF)

Worker Responsibilities - WAC 388-410-0001

1. Don't establish an intentional overpayment when the overpayment is directly due to any omission, neglect, or error by the department unless:
   
   1. The client kept the assistance; and
   2. Knew or had reason to believe they weren't eligible for the assistance.
2. Establish an intentional overpayment for funds that were authorized to replace lost, unendorsed warrants when it is later determined the claimed loss was false. See WAC 388-412-0035.

 Clarifying Information - WAC 388-410-0005

1. All adult members of a cash assistance unit are responsible for overpayments incurred after January 1, 1982 provided they were members of the assistance unit at the time of the overpayment.

2. The amount of an overpayment can be reduced by the amount of any unpaid underpayments in any period prior to the month in which the overpayment is computed.

3. As of May 1, 2019 children will no longer be included when establishing an overpayment for cash.

4. On child-only TANF cases, the overpayment is established for the adult receiving the grant.

5. When a non-needy caretaker relative or guardian is assessed an overpayment for a child who isn't currently part of the assistance unit:

   1. We'll no longer recoup the overpayment by means of mandatory grant reduction.

   2. Alert the Office of Financial Recovery (OFR) when a caregiver is in this situation by sending an email to DSHS RE OFR Client Overpayment.  This email must include the:

      1. Caregivers name and client ID,

      2. Date of the original overpayment letter and

      3. Text explaining we must no longer recoup the overpayment from the cash grant.

   3. Once OFR learns about this change, they will stop the automatic deductions from the TANF grant and pursue other means of collection.

      EXAMPLE: Zack was receiving non-needy TANF for his grandson Thomas and an overpayment was established. Once Thomas left the household the grant was closed and the recoupment ended. The following year Zack applied for his other grandchild, Katy. Because the prior overpayment wasn’t related to an error in benefits for Katy, no reductions will be assessed to the non-needy TANF grant for Katy. Staff will alert OFR that Thomas is no longer part of the assistance unit. Two months later, Thomas returns to Zack’s home and is added to the non-needy TANF grant. Staff will alert OFR that the child is back in the home.  The prior overpayment would now be reduced from the grant.

Worker Responsibilities - WAC 388-410-0005

Verification of Overpayment

1. The department will attempt to verify all pertinent information when an overpayment has occurred.
2. If the verification obtained is incomplete, the department will contact the recipient to obtain an explanation of the circumstances to clarify the overpayment.
3. If the recipient fails to cooperate, the department will make an independent determination based on all available information and initiate recovery of the overpayment.
   
   1. If an employer does not respond to a request for a statement of earnings in a timely manner the department may file a Subpoena Request without a FRED or DFI referral.

Invalid Overpayment

1. When the department determines that it has mistakenly charged an assistance unit with an overpayment, the department will cancel the overpayment account and credit any amount paid to any other outstanding debt obligation.
2. The client will be notified of the error and of the amount credited to any existing debt obligation. If any balance remains from the amount paid by the client the department will refund the balance to the assistance unit.
3. If the department determines that an assistance unit’s overpayment amount needs to be modified because of an error, the worker should refer to the ACES manual, Benefit Error Group (BEG) - Modify a BEG - Overpayment or Underpayment.

Establishing Overpayments

1. Once an overpayment is verified, determine the assistance program involved in the cash, medical or food assistance overpayment. Determine the amount of the overpayment using the following criteria:
   
   1. Reconstruct eligibility in cases where the client failed to report information or where reported information was not acted upon.
   2. Consider the change as it would have been considered if reported and acted upon timely.
2. If all criteria specified in WAC 388-410-0005 (3) (a)&(b) are met do not refer cases to Office of Financial Recovery.

Eligibility for Other Programs

1. Financial Assistance:  Reduce the amount of an overpayment by the amount of cash assistance a client would have received if eligible for another cash program during the period of the overpayment.
2. Medical Assistance:
   
   1. Redetermine eligibility for medical assistance beginning the first of the month in which ineligibility occurs.
   2. If the assistance unit was ineligible for any medical assistance, all medical expenses paid by the Health Care Authority (HCA) for the period of ineligibility are an overpayment.
   3. If the assistance unit was eligible for the Medically Needy Program the overpayment is:
      
      1. The amount the assistance unit would have been required to spend-down before medical expenses would have been paid for the overpayment period.
      2. The difference between those medical payments covered by the CN program and those covered by the MN program.
      3. Scope of care determinations are referred to HCA.
   4. If the assistance unit was eligible for the Psychiatric Indigent Inpatient Program (PII), the overpayment is:
      
      1. The amount paid by HCA up to the deductible; plus
      2. Any additional amount the assistance unit would have been required to spend down; plus
      3. The difference between medical payments covered by the CN program and those covered under the PII program.

Establishing Overpayments for vendors

1. If it is determined that a vendor has been overpaid, an overpayment must be established.Overpayments for vendors are processed by the Office of Financial Recovery (OFR). 

   1. Staff will complete form DSHS 18-398A and email the form to OFR at vendorop@dshs.wa.gov.

   2. OFR will establish the overpayment in their system and mail a copy of the DSHS 18-398A to the vendor.

ACES Procedures

• Benefit Error Group (BEG) - Confirm a BEG Overpayment
• Benefit Error Group (BEG) - Modify a BEG –  Overpayment or Underpayment

Revised March 25, 2011

WAC 388-410-0015 Recovery of cash assistance overpayments by mandatory grant deduction

• Clarifying Information and Worker Responsibilities

Clarifying Information - WAC 388-410-0015

Grant Deductions

1. A grant deduction is a specified dollar amount used to recover grant overpayments. If the amount is more than the mandatory deduction standard (10 per cent) for intentional grant overpayments, it must be agreed to by the client.
2. Five percent mandatory deductions are used for unintentional grant overpayments
3. A grant deduction to temporarily reduce the standard 5 or 10 per cent deduction can be used if an exception to policy due to hardship is approved.
4. A grant deduction can be taken in addition to, or instead of, a 5 or 10 per cent deduction.

Worker Responsibilities - WAC 388-410-0015

1. If the recipient requests a fair hearing regarding the assessment of the overpayment or the monthly deduction of overpayment during the advance notice period, notify OFR to discontinue collection.
2. Reimburse the client as soon as possible for any underpayment resulting from erroneous monthly deductions.

Revised March 25, 2011

Purpose:

WAC 388-410-0010 Repayment of grant overpayment occurring prior to April 3, 1982, and resulting from department error

• Worker Responsibilities

 Worker Responsibilities - WAC 388-410-0010

1. If recovery of the overpayment is determined to be inequitable;
   1. Determine the months that the overpayment occurred, but do not compute the amount of the overpayment.
   2. Complete a DSHS 06-094(X), Overpayment Letter (Liability Waived), and notify the client.
   3. Document the reason for the decision in the narrative in ACES.
2. If recovery of the overpayment is not determined to be inequitable:
   1. Follow normal overpayment recovery procedures; and
   2. Notify the client the reason the overpayment was not waived.
3. Revoke the waiver and establish an overpayment if it is later determined the requirements specified in WAC 388-410-0010 (1) (a-e) were not met.