Public Benefits Handbook

The Utah Legal Services Handbook
On Public Benefits



Information on:

  • Financial Assistance and Food Stamps
  • Unemployment Compensation
  • Medicaid and PCN
  • Social Security Disability and SSI Benefits
  • Noncitizen Eligibility
  • Hearing Rights and Overpayments

See the Table of Contents below.

 

Dear Friend:

Like many other Americans, you may at some time need public assistance. Loss of a job, a spouse’s death or absence from the home, or a disabling injury may make you eligible for benefits. It is the purpose of this booklet to give you some basic understanding of the programs that may be available to you. If you are denied benefits under one of the programs discussed in this booklet, you have certain rights. It is hoped that the information contained in the following pages will better help you understand your rights and receive the services you need.

Keep in mind that a booklet of this size cannot answer every question, nor is it a substitute for careful legal advice provided by an attorney. This booklet was designed to give you a basic understanding of your rights and to alert you to some important responsibilities. Should you have questions about your individual case, you may want to ask questions of your caseworker who can often be helpful. Alternatively, you may wish to speak with someone at Utah Legal Services. Call our “intake” number at 800-662-4245 in Utah or 328-8891 in the Salt Lake City area between 9 a.m. and 2 p.m. Monday through Friday.

ULS Offices

 

        Ogden                  801-394-9431 or 800-662-4245
        Provo                  801-374-6766 or 800-662-4245
        Salt Lake City         801-328-8891 or 800-662-4245
        St. George             435-628-1604 or 800-662-4245

ACKNOWLEDGMENTS

This booklet was produced through the hard work of the Utah Legal services Public Benefits Task Force, which includes advocates from each ULS office as well as community organizations. The assistance of Karen Silver from Salt Lake Community Action Program is especially appreciated.

All dollar amounts and laws are accurate as of September 31, 2007.

 

TABLE OF CONTENTS

GLOSSARY OF ACRONYMS

I. DEPARTMENT OF WORKFORCE SERVICES

II. HEALTH BENEFITS

III. SOCIAL SECURITY DISABILITY BENEFITS

IV. ALIEN ELIGIBILITY

V. OVERPAYMENTS

VI. HEARINGS AND APPEAL RIGHTS

A FINAL REMINDER

GLOSSARY OF ACRONYMS

ABAWDS:        Able-Bodied Adults Without Dependents
DDS:           Disability Determination Service
DWS:           The Department of Workforce Services
EA:                    Emergency Assistance
FEP:           The Family Employment Program
FEP-TP:        The Family Employment Program-Two Parent
GA:            General Assistance
INA:           Immigration and Nationality Act
ICE:           Immigration and Customs Enforcement
NAA:OD:        Notice of Agency Action: Overpayment Determination
ODAR:          Office of Disability Adjudication and Review
ORS:           Office of Recovery Services
LAPR:          Lawfully Admitted for Permanent Residence
PASS:          Program to Achieve Self Support
PCN:           Primary Care Network
PEP            Payment Error Prevention Unit
PRUCOL:        Person Residing in the US Under Color of Law
SSA:           Social Security Administration
SSDI:          Social Security Disability Insurance (also referred to as
                    “DIB” or Disability Insurance Benefits)
SSI:           Supplemental Security Income
TANF:          Temporary Assistance to Needy Families
UI:            Unemployment Insurance (also referred to as “UCB” or
                    Unemployment Compensation Benefits)
ULS:            Utah Legal Services, Inc.
WIC:           Women, Infants and Children’s Supplemental Food Program

Table of Contents

I. DEPARTMENT OF WORKFORCE SERVICES

Applying for Assistance

For cash assistance, Medicaid and Food Stamps, you must go to the Department of Workforce Services (DWS) office closest to your home. DWS will ask you to register for employment. You will then complete an application and be interviewed by a DWS worker. There is one application form for cash, medical and Food Stamp assistance. The date you return a completed and signed application is the date of your application. If you cannot come into a DWS Employment Center, call or write for an application. The local DWS Employment Center has up to 30 days after receiving a completed application to determine if you are eligible for Food Stamps and Financial. For medical assistance, the Center has up to 45 days, unless a disability determination is required, in which case if you have provided all of your medical information, you must be given a decision on medical assistance within 90 days.

Documentation

You will usually be required to show each of the following before benefits are issued:

  • Proof of income such as paycheck stubs
  • Bank statements
  • Vehicle registration
  • Proof of identity such as a birth certificate or driver’s license
  • Social Security numbers for all your household members.
  • Proof of job termination, if applicable
  • Child care information
  • Proof of school enrollment for household members

If you have trouble obtaining any of the above items, a worker from DWS or Utah Legal Services may be able to help in obtaining the necessary document.

General Requirements For DWS Financial Programs

Property

You may own some property and still receive financial assistance. The law provides that certain property is excluded. This includes:

  • Your home and its contents
  • The value of an average-size lot for your home
  • Water rights for your home
  • One vehicle with a fair market value less than $8,000
  • Earned income tax credit payments for the month received and the following month
  • A $1,500 burial fund for each family member
Asset Limit

You can have no more than $2,000 in assets in order to qualify for financial assistance. This means you may have personal and non-excluded land, houses, buildings, and trailer homes that have value up to $2,000 and still receive assistance. You have up to nine months to sell real property on which you are not living.

Examples of assets include: savings and checking accounts, stocks, bonds, mutual funds, CD’s (certificates of deposit), promissory notes, mortgages, trust funds, agreements in escrow, boats, campers, homes, buildings, land, IRA’s, 401’s, the cash value of life insurance policies, and other items that can be sold for cash and/or cashed out. However, the house you live in and one car are not included in the asset limit.

The current market value of an asset is counted if the family owns the asset. If the family is buying the asset, then only the equity value is counted. "Fair market value" is how much you could sell the vehicle for. "Equity value" is the fair market value minus any money that you owe on the vehicle.

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Lump Sum Problems

If you receive a large sum of money while you are on financial assistance, DWS will declare you ineligible for the month you receive the payment. If you spend down the lump sum below the asset limit by the next month, you can re-qualify for benefits. If you expect to receive a lump sum, you may want to ask DWS to close your case for the month in which you will receive the payment. This will help you avoid an overpayment.

Assessments

Within twenty days of being determined eligible for financial assistance, you and the caseworker will do an assessment to determine your employment history as well as your family and personal circumstances. You will also complete a self-survey.

Employment Plans

To get benefits under FEP, FEP-TP, and GA (which are described in this booklet), you and the caseworker must develop an employment plan. This plan is based on your assessment. The employment plan includes activities that you promise to complete. If DWS thinks you are not complying with your agreement, they can sanction you. If you are terminated from the program, you may request a hearing.

Your employment plan is like a contract: it should have achievable goals. For instance, if "finding housing" is in your FEP plan, a reasonable requirement would be: "I promise to apply to Salt Lake City and Salt Lake County housing and check in with the director once a week." An unreasonable requirement would be for your worker to ask you to promise to find housing by next week. You must fully understand, and be able to fulfill, all requirements of the employment plan to which you agree. If circumstances change, you can ask that a new plan be drawn up.

You will probably not get everything you want, but your caseworker should work with you to formulate an appropriate plan. This plan should help you get employment and help you to work toward goals that will allow you to become self-sufficient. Remember that you can ask your caseworker for a new plan when your circumstances change. If you feel your caseworker is putting unreasonable activities and goals in your employment plan, you can refuse to sign the plan and request an agency conference with your caseworker and her supervisor.

Meetings With DWS

From time to time, you may need to meet with a DWS caseworker to resolve issues or perhaps as part of the conciliation process. Sometimes it may help to bring a friend with you to such meetings. Your worker may try to discourage you from bringing another person to the meeting. If this happens, remind your worker that the policy manual states that you have the right to have someone with you and the worker must allow them to participate. You may also want to contact ULS. Do not bring a family member if they are very emotional or angry. If you believe DWS has treated you rudely, you have the right to file a complaint. Ask someone at the information desk about contacting the customer service office or how to file a complaint.

Reporting and Record Keeping

For all of the programs discussed in this booklet, it is important that you make timely and accurate reports of all changes in circumstances that might possibly affect your eligibility. An overpayment may occur if you fail to report changes in your circumstances. Additionally, you may be disqualified and face fraud charges which could also subject you to criminal prosecution. You must promptly report any change in marital status, income, number of children in the home, change of address and anything else you think might be important. All of the agencies administering the programs discussed in this booklet have the means through their computer systems to share information about you. Information can also be obtained from the State Tax Commission, IRS, and the Immigration Service. If in doubt, report it.

When you do report important information, be sure to keep records of doing so. Instead of just calling the office to report a change, write a letter, make a copy and take the original to the office. Ask the receptionist to stamp your copy. Keep the stamped copy as a receipt. This will help you a great deal in the future.

Other Available Benefits

If you qualify for one of the state financial assistance programs, you should also get food stamps. You may also qualify for Medicaid or PCN.

Trusts

The effect of a trust on your eligibility for most benefits involves a careful legal analysis. If you have a trust or are the beneficiary of a trust, be sure to contact ULS for advice and assistance.

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Cooperation With The Office Of Recovery Services

Paternity and Child Support

If you receive financial assistance, you will be required to assign your right to child support to the State of Utah. The State may keep any child support collected until it equals the money you have received. If you are currently receiving regular child support payments higher than the monthly financial benefit amount, it may not be in your best interest to apply for financial assistance. Be sure to ask your caseworker about this.

Cooperation

To receive financial assistance, you must cooperate in good faith with the Office of Recovery Services (ORS) in collecting child support and alimony by providing all possible information concerning the father of your children. Under the new rules, you can no longer swear under oath that you do not know the identity of your child’s father and be considered cooperating. ORS will insist on at least the names of the possible fathers and as much information about them as possible. Even though you feel that you have cooperated, ORS may decide you have not and may notify DWS to stop your benefits. If that happens to you, be sure to contact ULS immediately.

Good Cause

Sometimes you can be excused from naming the father of your child if you have good cause for not doing so. The reasons for allowing a good cause exception include:

  • The child was conceived as the result of rape or incest
  • Adoption proceedings for the child are underway
  • A public or private agency is helping you decide whether to place the child for adoption, and the discussion has not gone on for longer than three months
  • Disclosing the father’s name would result in physical or emotional harm to the child or would cause emotional or physical harm to you that would reduce your ability to care adequately for the child
Claiming Good Cause

You must provide your good cause evidence within 20 days from the date you make this claim, unless you can get an extension from a DWS supervisor. Evidence such as police reports, medical, or child protective service records are often sufficient to support your good cause claim. If you do not have this kind of information and you think cooperation will result in physical harm to you or your child, you can provide sworn statements from people with knowledge of your situation. The DWS supervisor will then determine whether you have good cause.

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The Family Employment Program (FEP)

Program Purpose

FEP provides short-term assistance for unemployed and underemployed one-parent families with dependent children and pregnant women in their third trimester. Some two-parent families may qualify if one of the parents has been determined disabled. (Click FEP-TP for information about an employment program for two parent families.)

Eligibility

To receive FEP you must:

  • Have one child under 18 (some 18-year-olds may be eligible if they are in school and expect to graduate before age 19); or
  • Be a single, pregnant woman in your third trimester.
Periodic Reviews

Your worker, following DWS guidelines, determines how often your FEP case must be reviewed for eligibility. The frequency of your reviews will depend upon your individual circumstances. When you get eligibility review notices in the mail, be sure to respond to them. Contact your local eligibility center so that your benefits are not cut off. If you are having difficulty obtaining requested information, notify the eligibility service center and your caseworker and ask for assistance in obtaining the information.

Property Limits

You may own certain property and still be eligible for FEP. (Click on General Requirements for DWS Financial Programs.)

Assessments

You will be required to have an assessment with your caseworker to qualify for FEP. (Click on General Requirements for DWS Financial Programs.)

Employment Plans

In order to get FEP benefits, you must develop an employment plan with your caseworker. (Click on General Requirements for DWS Financial Programs.) If DWS thinks you are not complying with your agreement, you can be sanctioned. If you disagree, DWS should initiate a "conciliation process." (If DWS does not initiate the process, you should request the conciliation process.) There are several possible results from the conciliation process, including termination. If you are dissatisfied with the conciliation, you may request a hearing. When requesting a hearing, please remember that it is best to do so in writing. (Click on Hearings and Appeal Rights.)

Time Limits

Applicants for FEP are limited to 36 months of benefits during the lifetime of the parent. In certain circumstances, month-by-month extensions may be granted. If you feel that you should be granted an extension, please consult your case-worker. The 36 months do not need to be consecutive to count toward the time limit. Benefits received in another state count toward the limit. Even months in which you receive partial or reduced assistance count toward the time limit. The time limit does not apply to "child only" cases, including cases where:

  • Assistance is being provided to a child residing with a caretaker relative; or
  • All parents in the household are SSI recipients.

In some circumstances, month-by-month extensions are available. If you think you may qualify or be in need of an extension, please talk to your case worker.

Cooperation

You must cooperate with DWS by providing accurate information concerning the father of your children. (Click on General Requirements for DWS Financial Programs.)

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Family Employment Program - Two Parent (FEP-TP)

Program Purpose

This program provides short-term financial assistance to underemployed and unemployed two-parent families with a child (or an unborn child in the third trimester) who meet the eligibility criteria discussed below.

Eligibility

To receive FEP-TP you must:

  • Have two parents in the household with each able to earn $500/month;
  • Have at least one child; and
  • Meet strict work participation requirements, including:
    • Primary Parent: 8 hours per week searching for a job plus 32 hours per week in work experience and training, including community work, adult education, short- term skill training, and job search training (16 of the 32 hours must be spent at a community work site.)
    • Second Parent: 20 hours per week in a combination of community work, job search, adult education or skills training activities.
Good Cause

The participation requirements must be met unless excused for good cause. Good cause may include a death in the immediate family, unavailable child care or unusual transportation problems. Good cause may excuse temporary or sporadic failure to fulfill the hours requirement.

Property

You may own certain property and still be eligible for FEP-TP. (Click on General Requirements for DWS Financial Programs.)

Assessment

You will be required to participate in an assessment with your caseworker to qualify for FEP-TP. (Click on General Requirements for DWS Financial Programs.)

Employment Plan

In order to get benefits under FEP-TP, you must develop an employment plan with your caseworker. (Click on General Requirements for DWS Financial Programs.)

Time Limits

A household may not be on the FEP-TP program for more than 7 months in any 13-month period. Payment for part of the month counts as a whole month. Months on the FEP-TP program do count toward the 36-month FEP time limit.

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FEP Diversion Assistance-One Time Emergency Assistance

Program Purpose

Diversion is a one-time, temporary cash assistance payment to meet immediate needs until regular income is received from employment, child support and other ongoing sources. If you and your family are eligible for FEP, and you could get on your feet with a one-time payment, DWS may provide diversion assistance. Diversion payments may be up to three times the amount you would have received each month had you gone on FEP financial assistance. If you are eligible, you may still receive other benefits such as Food Stamps or Child Care. Individuals who are employed, or have a reasonable hope of employment, or have other sources of income are eligible. Note that this type of payment can only be made once in any 12-month period.

Effect of Diversion Assistance on Regular FEP

One time assistance under this program can affect your FEP eligibility. After receiving diversion assistance, you may not be eligible for FEP for a period of time. Diversion Assistance does count toward the 36-month FEP time limit.

Qualifying for Diversion

To qualify for this assistance, you must:

  • Meet with an "Employment Counselor" to discuss your circumstances; and
  • Request assistance by signing a Diversion Fund Agreement.

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General Assistance Program (GA)

 

Note: As of September 2010, the GA program was closed to further enrollment.  During July 2010, enrollment was open for three (3) days.  It is not known when enrollment will be opened again.

Program Purpose

The State of Utah offers a program of limited financial assistance for adults who are unemployable and emancipated minors under certain circumstances. This program is often called General Assistance (GA).

Unemployable

To be found unemployable, you must have a physical or mental condition that keeps you from doing your former work and there must not be any reasonable hope you can do other substantial work that might be available. Substantial work usually means work that pays you $500 or more per month. Your condition must be expected to last more than 30 days. If it is determined that your condition is likely to last at least 12 months, you will be required to apply for Social Security benefits.

Self-Sufficiency Plans

In most cases, persons who qualify for GA will be required to develop a plan to achieve self-sufficiency. All GA recipients are required to be involved in activities leading toward employment or, in the alternative, approval for Social Security disability. The state can assist you with transportation or medical care to carry out your plan.

Qualifying for GA

You must provide your caseworker with evidence of your physical or mental impairment, such as records from your care provider. If you are not currently receiving treatment, you need to ask about free medical clinics in your area. The local office may also want to refer you to another doctor chosen by DWS for an examination.

Property

You may own certain property and still be eligible for GA. (Click on General Requirements for DWS Financial Programs.)

Assessment

You will be required to participate in an assessment with your caseworker to qualify for GA. (Click on General Requirements for DWS Financial Programs.)

Work Plans

In order to receive GA benefits, you must develop an employment plan with your caseworker. (Click on General Requirements for DWS Financial Programs.) You must enroll in PCN unless you have some other medical coverage. If you qualify for PCN, you will be required to pay a yearly enrollment fee of $15.

Time Limits

You can only receive GA for 6-12 months out of a 60-month period.

GA and Social Security Disability

If you feel you are unable to work and have applied for Social Security disability, it is important to apply for GA, which will give you financial support while your disability application is pending. If you are approved for SSI, any GA you have received will be taken out of your SSI back payments. When you apply for GA, you will be asked to sign a special form authorizing this recovery. If you receive an unfavorable decision from an Administrative Law Judge on your Social Security Disability application, you will no longer be eligible for GA unless another physical or mental impairment develops or your condition gets significantly worse.

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Emergency Assistance Homelessness Prevention Program (EA Funds)

Program Purpose

The EA program provides immediate short-term help to destitute families to help prevent homelessness.

Eligibility

Emergency Assistance is available to families with at least one dependent child when the family is homeless or in immediate danger of becoming homeless. Services available through Emergency Assistance include rent, mortgage, and utility payments to avoid eviction. Payments will go directly to your landlord, the utility company or mortgage holder.

How to Qualify

To qualify for this assistance, your family must meet the following requirements:

  • Be homeless, facing eviction, foreclosure, utility shutoff, or in need of utilities because of past-due payments caused by forces outside your control;
  • Be able to secure housing, utilities, or be able to prevent the eviction, foreclosure, or utility shutoff, with a one-time rent, mortgage or utility payment;
  • Be able to show that you can pay future months’ rent, mortgage, or utility payments after resolution of the crisis;
  • Have exhausted all other resources first;
  • Have less than $2,000 in assets that are immediately available to the family members.
  • Meet the income eligibility requirements of FEP; and
  • Have a dependent child who is either a lawful citizen or a legal permanent resident of the U.S.
Time Limit

You will be eligible for assistance for only 30 consecutive days during a 12-month period. The 12-month period is defined as beginning after the first day of assistance.

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Child Care Assistance

Purpose and Brief Overview

If you are working, but fall within certain income guidelines, or receive FEP, DWS can help you pay part of your child care. Even if you are not eligible for any other DWS program, you may still qualify for Child Care Assistance.

The purpose of the Child Care program is to support employment. Child care supportive services are available to eligible parents who are employed or are participating in activities that lead to employment. The Child Care program provides direct payment to parents, guardians, or custodians for their child care needs. The payment may not cover the entire cost of care and can never exceed the total cost of care or the local market rate.

Eligibility

To be eligible for Child Care Assistance:

  • The parent(s) must need child care for employment or employment/education and training;
  • The parent(s) must be Utah residents;
  • The parent(s) must be U.S. citizens or have been granted permanent resident status;
  • The parent(s) must be income and asset eligible.
Single-Parent Families

For single-parent families to qualify for child care assistance:

  • The parent must be employed 15 hours or more per week (if self-employed, his/her wages must be equal to or greater than minimum wage); or
  • The parent must be employed 15 hours per week and going to school.
  • You are limited to assistance for 24 months, which may be nonconsecutive, if you are participating under the employment and training/education program.
Two-Parent Families

For a two-parent family to qualify for child care assistance:

  • Both parents must be unable to change their schedules to provide care for the children;
  • Both parents must be employed;
  • One parent must be employed 30 or more hours a week and the other parent employed 15 hours or more per week (A parent may also be receiving training or education in addition to the required work hours. In this case, assistance is limited to 24 months.);
  • The other parent must be employed 15 hours or more a week; and
  • Combined wages must be equal to or greater than minimum wage.
Alternatives to State Assisted Child Care

With both one and two-parent families, if alternative child care is available, the parent is not considered to have a need for child care assistance. Alternatives may include: a close friend or relative willing to provide care at no cost, care provided by a grandparent who resides in the household, care provided by a parent not residing in the household, care provided for in-kind services, and care provided by an employer at no cost.

Income Eligibility

Income is defined as cash or in-kind benefits received by household members and includes both earned and unearned income. To qualify, your income must fall within federal guidelines. Be sure to ask your caseworker about these.

Asset Eligibility

Families may have no more than $8000 in countable assets, including both real and personal property. Click for examples of assets.

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Food Stamps

Purpose of the Program

Food Stamps are issued through the Utah Horizon card, which acts as a "debit card" to buy groceries. Food Stamps can only be used to buy food for human consumption. You do not pay Utah’s sales tax on food when using your Horizon card.

Food Stamps cannot be used to purchase the following items: pet foods, cigarettes, paper products, alcoholic beverages, household products, hot "ready-to-eat" food, unpaid grocery bills.

Applying for Benefits

You may apply for benefits at your closest DWS office, the same place you apply for financial assistance. If you are applying for SSI at your local Social Security office, you may file for Food Stamps at the same office. Be sure to request this assistance. If you have problems, call Utahns Against Hunger at 328-2561 or 1-800- 453-3663. You may also call ULS.

Food Stamp Cashouts

Persons over age 65 and SSI recipients enjoy special privileges under the Food Stamp program. They may have the amount of their Food Stamp allotment deposited directly into a non-Food Stamp account; they may use their Horizon card at an ATM to withdraw as cash all or part of their Food Stamp allotment (a fee of $1.50 to $3.00 will likely be charged); and they may get cash back at a grocery store without incurring a fee. Other Horizon cardholders cannot receive cash back at a grocery store.

Food Stamp Eligibility

You must have limited income and resources in order to qualify for Food Stamps. (See below for information on income and resources.) People apply for Food Stamps as "households." There can be several households living under the same roof. Because the resources and income of each household member is included in determining total household income, it is important that you correctly report the makeup of your household. The number of people in your household also affects the amount you will receive.

Household Definition

For Food Stamp purposes, a household may consist of any of the following:

  • An individual living alone;
  • An individual living with others who buy and prepare food separately;
  • A group of individuals living together who buy and prepare their food together for common consumption (this can include an adult who lives in the residence only part of every month;
  • Spouses and their children age 21 or under living together;
  • In some cases, a person whose disability prevents buying or preparing food separately;
  • Residents of a group home, drug and alcohol treatment program, or a shelter for battered women; or,
  • A person age 60 or older who is disabled and unable to purchase and prepare food separately even when living with other family members.
Exclusions From the Household

Some persons are not considered part of any household. They are not eligible for Food Stamps as individuals, but as of July 2010, their income and resources are included in the household eligibility determination. They include: ineligible aliens, fleeing felons, and persons disqualified from receiving Food Stamps (e.g., someone who has failed to follow work requirements).

Divorced Parents

In families in which the parents are divorced and not living together, only one of the parents may include the children within his or her household. If only one parent has custody, only that parent may include the child in his or her household. If the parents have joint custody (the children alternate living with both parents during the month), the parents must decide which one will include the child in his or her household. The child can only be a member of one household, not both.

Other Eligibility Requirements

Even though you have limited income, you may not be eligible for Food Stamps. If you are 60 years of age or older, are disabled, or have dependent children, you will likely qualify. On the other hand, if you have no dependent children and are considered able-bodied, you may receive Food Stamps only under limited circumstances. (Click on ABAWDS for more information)

Citizenship Requirements

To receive Food Stamps, you must meet one of the following requirements:

  • Be a U.S. citizen; or
  • Have permanent resident status and have 40 quarters of coverage under Social Security or be receiving disability payments; or
  • Be in the U.S. under a special immigration status. For more information, click on Alien Eligibility.
Boarders and Roomers

If you pay for rent and food in a commercial or private boarding house, you cannot receive Food Stamps. However, if you are a roomer (pay rent only), you may be eligible. A household that takes in roomers or boarders may be eligible to receive Food Stamps.

Strikers

If you are on strike, you are eligible for Food Stamps only if you were eligible before the strike. Employees not involved in the strike, but who are prevented from working by the strike, may be eligible.

Students

You are a "student" if you are between the ages of 18 and 49 and enrolled at least half-time at an institution of higher learning. If you are a student, you may receive Food Stamps, provided you meet one of the following requirements:

  • Employed at least 20 hours per week for at least minimum wage; or
  • Participating in a work-study program that is state or federally financed; or
  • Caring for a dependent child; or
  • Receiving TANF benefits; or
  • Receiving disability benefits.

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Calculating Household Income

DWS will count the income, both earned and unearned, of every household member. Your assets will also be reviewed. Be sure to discuss your particular situation with your caseworker. The following sections discuss the most common forms of income and resources.

Earned Income

This may include:

  • Salary or wages from a job
  • Self-reported tips
  • Self-employment income
  • Training allowances from the government, vocational rehabilitation, etc.
  • Rental income from property you own and manage an average of 20 or more hours per week
  • Rent from a boarder or roomer
Unearned Income

This may include:

  • Financial assistance benefits (e.g., FEP or GA);
  • Social Security or SSI benefits;
  • Unemployment or workers compensation benefits;
  • Pensions, child support, or alimony;
  • Payments made to a third party for your benefit (such as someone paying a bill you owe);
  • Some federal educational loans and grants may be considered income (however, BEOG/SEOG or PELL grants, PLUS programs, GSL loans, Perkins loans, Byrd scholarships, and a number of others are NOT considered income. Your caseworker has a list.);
  • Rental income from property you own, but manage less than 20 hours per week (If you are receiving free or reduced rent for managing or providing maintenance on rental units where you reside, you may have countable income.); or,
  • Foster care and guardianship payments.
Excluded Income

Certain forms of income are excluded from consideration. These include:

  • Money withheld to pay an overpayment of a government benefit
  • Child support kept by ORS
  • Some education grants and scholarships
  • Some (but not all) loans
  • A child’s income if living at home under parental control
Resources

A resource is anything of value belonging to a household member, including money to which a household member can gain access. Examples include:

  • Cash on hand;
  • Checking and savings accounts;
  • Stocks, bonds and CDs (certificates of deposit);
  • Inheritances and prizes;
  • Cars and land; or,
  • Trusts.
Resource Limits

The current household resource limits are:

  • $2,000 for most households; or
  • $3,000 for households of two or more persons, provided at least one person is 60 years of age or older.
Excluded Resources

A number of things are not counted as resources. These include:

  • The home you live in and surrounding property
  • A lot on which you are building a home
  • Household and personal goods
  • The cash value of life insurance policy or pension fund
  • Income-producing property or tools
  • Inaccessible resources (Note: money that you could get but that would require you to pay a penalty or would require a petition to a court is still accessible money)
  • Resources of non-household members
  • Burial plots
  • Certain vehicles (see below)

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Vehicles
  • All motorized vehicles, including recreational vehicles, are exempt. Campers, fifth wheels and trailers are not exempt.
Benefit Calculations

After looking at countable resources and income, DWS will deduct certain expenses from income to establish your benefit amount. The income deductions include:

  • A standard deduction for all households
  • A 20 percent earned income deduction
  • A deduction for child care or dependent care costs that you pay a caretaker in order to work (up to $200 per child under 2 years old; up to $175 per child over 2 years old; and up to $175 per adult dependent)
  • A standard rent and utility allowance
  • A deduction for monthly medical expenses over $35 for the disabled or for those over age 60
  • A deduction for some educational expenses
  • A deduction for child support paid as an obligor

A household that pays more medical expenses in a certain month can have its food stamps adjusted and receive more benefits the next month to offset the high medical bills.

Work Requirements

If you are between the ages of 19 (16 if you are emancipated or not enrolled in school) and 60, you must register, look for work, and have an approved employment plan with DWS, unless you meet one of the following exemptions:

  • Physically or mentally unfit to work; or
  • Receiving SSI or SSDI benefits; or
  • Receiving unemployment compensation; or
  • Child care is not available; or
  • In treatment for drug or alcohol addiction in an approved program; or
  • Employed/self-employed at least 30 hours per week or earning more than $100 per week; or
  • A child who is under 18 or older but still in high school, or out of high school but attending vocational technical education classes; or
  • A child under 18 years old who has not finished high school; or
  • A student at an institution of higher education (See section above that talks about students).
Quitting a Job

If you are the head of the household and quit a job without good cause, your household can be denied Food Stamps for up to 90 days.

Able-Bodied Adults Without Dependents (ABAWDs)

Adults between the ages of 18 and 49 who are living in a Food Stamp household without a minor child (under age 18) are subject to special rules. ABAWDs are limited to 3 months of benefits during a 36-month period. In order to continue receiving benefits past the initial 3-month eligibility period, the participant must:

  • Be employed 80 hours a month; or
  • Participate in an employment learning activity consisting of 24 hours a month at a work site or 20 hours a month at work training; or

ABAWD Exemptions

The following persons are exempt from ABAWD requirements:

  • A person who is medically (either physical or mentally) certified as unable to work for the next 30 days
  • A woman who is pregnant (regardless of which trimester she is in)
  • A person responsible for the care of an incapacitated person (either a household member or non-household member)
  • A person receiving unemployment compensation
  • A person participating in a drug or alcohol treatment program
  • A person enrolled at least half-time in a school or training program
  • A student who is eligible for Food Stamps under the criteria given above in the section on "students"
  • A person living in a “distressed county). Consult your local DWS office to determine if you fit into this category.
Expedited Food Stamps

If you have unusually low income, you may be eligible to receive Food Stamps within 7 days after you apply. To qualify, you must have:

  • Less than $150 in monthly gross income and
  • Less than $100 in liquid resources.

You may also qualify if your combined income and liquid assets are less than your monthly housing (rent or mortgage) and utility costs.

Migrant Farm Workers

If you are a migrant farm worker and your source of income has ended, you should qualify for expedited food stamps. If you are a noncitizen farm worker, click on Alien Eligibility.

Verification

Identity is the only item that must be verified for expedited services. Your identity can be documented through available documents (drivers license, work or school ID, voter registration card, birth certificate) or a collateral contact (someone who can be contacted to verify your identity). The DWS worker must promptly contact the person named or help the household get proof. Food Stamps should never be delayed for more than 7 days because the household cannot provide all verification.

If you qualify for expedited services, DWS is required to deliver your Horizon card within 7 calendar days. DWS is currently under a court order requiring that this be done as quickly as possible. The time for delivering your card starts the day the application is received, not when the application is completed.

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Women, Infants and Children’s Supplemental Food Programs (WIC)

Program Purpose

WIC is intended to prevent complications of pregnancy and to promote optimal growth and development of young children. The federal government, through its WIC program, supplements the diets of pregnant women and children up to age 5.

Eligibility

Pregnant women, postpartum women (up to 6 months after delivery), nursing mothers, infants and children up to age 5 who are low income and found to be nutritionally at risk are eligible for WIC. Low income means 185 percent of poverty (same as free or reduced price school lunch programs). Nutritional risk is determined by a free health screening at a WIC clinic.

Benefits Provided

If you qualify, you will be given vouchers, which can be exchanged at your local grocery store for formula, milk, cheese, and other nutritious foods. You will also be eligible to receive nutrition education.

Applying for WIC

To apply, contact your local health department (except in Utah County, where you must contact the HeadStart Program). You may also contact:


        WIC Program
        Utah Department. of Health, Division of Family Services
        288 North 1460 West, P.O. Box 141013, Salt Lake City, Utah 84114-1013
        (801) 538-6960

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Unemployment Insurance (UI)

Program Purpose

Unemployment benefits are intended to ease the transition between jobs for workers who are temporarily unemployed. Benefits are paid to eligible workers who are:

  • Unemployed through no fault of their own;
  • Able to work full-time; and
  • Available for, and actively seeking, full-time work.
Applying for Benefits

You may apply for benefits on-line, or by telephone either from your home or at your nearest DWS office. The address and telephone number for your local DWS office are in the state government section of the phone book. You must complete a standard application form. The worker will need to know about your employer, the amount of wages you earned and your reason for leaving work. Be sure to give a complete and accurate account of what happened.

Benefit Denials

The two common reasons for being denied unemployment benefits are:

  • You voluntarily left work without good cause; or
  • You were discharged from your job, and your employer had just cause for doing so.
Good Cause

You may have good cause for quitting a job, if the conditions were so bad that no reasonable person could have been expected to have continued working there. Some examples include: your employer violates government health and safety codes or you are subjected to unlawful sexual harassment, provided your employer was given the opportunity to correct the problem.

Just Cause

Your employer may have had just cause for terminating you, if you did something that seriously harmed your employer. To establish just cause, the employer must show that you had knowledge of a company rule or policy, that you had control of your actions and that harm was done. Some examples include: You know of your employer’s strict policy against use of drugs or alcohol which you are found to have violated; your employer has given you frequent verbal and written warnings about being tardy or absent and you continue to violate the rules without a good excuse.

Eligibility Determinations

The initial eligibility determination will be made by DWS. If you are found to be ineligible, or if your employer contests a determination that you are eligible, you have a right to go to a hearing. Click on Hearings and Appeal Rights. If you are denied initially, you must act promptly. You have only 10 days to request a hearing. If you lose at the hearing, you will have 30 days to ask the Appeals Board to review the hearing decision.

Benefit Amounts

You will receive a statement showing the amount of benefits you will receive and the number of weeks you are eligible. Be sure to check this statement carefully. If it does not seem correct, talk to the DWS worker handling your case. If you are still not satisfied, you may want to check with ULS. You will not be paid during the first week of eligibility, since this is a waiting week.

Reporting Requirements

Assuming you are found eligible, there are several important requirements you must satisfy, if you are to keep getting benefits. You must:

  • Make yourself available for work by regular contact with prospective employers. A minimum of two contacts per week is generally required. Should you leave the area for a nonemergency, you are likely to become ineligible. Be sure to check with DWS, if you have to leave the area; and
  • For each week that you receive benefits, you are required to report by telephone any earnings you have received as well as job contacts.
Earning Money While on Unemployment

You may have some earnings and still receive unemployment. However, it is very important that you report your earnings, since failure to report can result in an overpayment. You also can be charged with fraud which can mean a penalty and disqualification.

Accepting Other Employment

You are not necessarily required to accept any job that becomes available while you are on unemployment. You have the right to seek a job similar to your past employment if your prospects of locating such a job are reasonable. The law says you have to accept suitable work. Some of the factors that will be looked at to determine whether work is suitable include:

  • Any risks to your health or safety
  • Your physical fitness for the work
  • Your prior experience and training
  • Your prior earnings

If you have questions about the suitability of a job, talk to your DWS caseworker. You may also contact ULS.

Students

Generally, persons attending school cannot receive unemployment. However, there are exceptions. You can attend certain training programs approved by DWS and also draw unemployment. Be sure to ask about this option.

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II. HEALTH BENEFITS

Primary Care Network (PCN)

 

Note:  As of September 2010, PCN was closed to open enrollment.  Further information as to possible future open enrollment may be obtained by calling 1-888-222-2542.

Program Purpose

The PCN program takes the place of the Utah Medical Assistance Program (UMAP). PCN is a Medicaid program for adults aged 19 to 64 who do not qualify for coverage under any other Medicaid program. If you qualify for another Medicaid program but would have to pay a spenddown, and choose not to, you may qualify for PCN. You may not receive PCN if you have access to a private health insurance plan. You may be certified eligible for a 12-month period of time.

Applying for Benefits

You may apply at the same office where you apply for financial assistance or food stamps.

Eligibility

You must meet the general Medicaid eligibility requirements for Medicaid and pay a $50 enrollment fee. If you are receiving GA, the fee is $15. The countable income considered is based on a 12-month certification period and cannot exceed 150 percent of the federal poverty level for your household size. Currently, a single person must have monthly income under $1,354 and a household of two must be under $1,822. The Department of Health may limit the number of people who may enroll in PCN by accepting applications only during certain open enrollment periods.

There is no asset limit.

Should your income increase during the 12-month certification period, you remain eligible until the end of your certification.

PCN Coverage

You may receive basic primary care, emergency care and pharmacy services. The benefits are set out in a benefits chart available from your caseworker. You may be required to make a co-payment for some services.

Denial of Coverage

If denied, you have a right to a hearing. Click on Hearings and Appeal Rights. Call ULS for assistance.

Medicaid as an Alternative

Your caseworker is required to discuss with you the option of applying for Disability Medicaid. You should be given a brochure entitled, Medicaid for Those with Disabilities and the Primary Care Network.

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Medicaid

Program Purpose

Medicaid is a federally funded program that provides health benefits to low income individuals and families. Certain categories of individuals, e.g. those on SSI or participating in FEP, receive Medicaid as a result of qualifying for a particular program. Other persons can qualify under an optional program, if they have few assets and are willing to spend down their income. In recent years, Medicaid eligibility for children has been greatly expanded. You may be required to make a co-payment for some services.

Eligibility

There are many categories of persons eligible for Medicaid and they are often difficult to understand. As we have said before, if you think you might be eligible, file an application, or contact ULS for advice. The following is a listing of people who are usually eligible:

  • Persons receiving financial assistance from the Family Employment Program (FEP), FEP-TP are eligible for Medicaid benefits;
  • Disabled persons receiving SSI will be eligible. Even SSI recipients who are working can sometimes receive Medicaid;
  • Children under age 18, senior citizens 65 and older, or persons of any age who are disabled and who, while not poor, have medical bills in excess of their ability to pay those bills. Such persons must have limited assets, although owning a home does not make anyone ineligible. Even though eligible for Medicaid, such persons will still be responsible for some portion of their medical bills each month;
  • Persons who have just lost their entitlement to financial assistance. Parents and their minor children will still be eligible for Medicaid for some months after their income becomes too high for cash benefits;
  • Pregnant women may qualify at any time during a pregnancy, provided the applicant has a limited income. A child born while the mother was eligible continues to be eligible for one full year, even if the mother loses eligibility;
  • Children born after 9/30/83, if their family income is below federal poverty limits.

The following do not qualify for Medicaid:

  • Individuals receiving GA or EA as a household size of one with no related children living in the household (they usually qualify for PCN benefits)
  • Undocumented aliens who are limited to emergency services only
Applying for Benefits

You may apply for benefits at the same office where you apply for financial assistance. A favorable Social Security disability decision entitles you to Medicaid but you must still apply at the State office.

Disability-Based Medicaid

A person may qualify for Medicaid, when determined by Social Security or the State Medicaid office to be disabled. To be considered "disabled," a person must have one or more medical impairments preventing that person from doing various, but not all, types of work and the medical problem (s) must have lasted, or be expected to last, at least 12 months, or end in death. Very often, disabled people who apply for Medicaid are denied initially. As with any other decision affecting rights to public benefits, denials can be appealed. Click on Hearings and Appeal Rights.

Spend down

Some disabled persons may receive too much income to qualify for regular Medicaid. For example, a person found disabled under the Social Security Disability Insurance program (click Social Security for more information) may be required to meet a monthly spenddown in order to qualify. If you are determined eligible for Medicaid but are told you have a "medical excess" or "spend-down," you have two options for meeting your monthly spenddown:

  • If you have outstanding unpaid bills, you may present copies of your bills to the person determining your eligibility and ask that the amount of the unpaid bills be used to meet your spend down, or
  • Pay the spenddown in cash.
Medicaid and SSI Disability

If you have a Medicaid card and receive an unfavorable decision from Social Security on an application for disability, you can still receive Medicaid while appealing the disability denial. You have 60 days to appeal the Social Security decision. When you appeal, be sure to notify the Medicaid office within 10 days and request continued benefits. However, if you are denied disability by Social Security before the State of Utah has found you eligible for Medicaid, you will not be able to get Medicaid unless you appeal the Social Security denial and are later found disabled. If you are not found disabled, you may be assessed an overpayment.

Citizenship Requirements

Medicaid is available to all U.S. citizens. The restrictions on noncitizen immigrants are quite complex. To see whether you might qualify, see Alien Eligibility. Even if you do not meet the citizenship requirements, your child born in the USA may qualify. Ask about it.

Students

If you are admitted as a student, a visitor or some other temporary form of entrance, you are not eligible for Medicaid.

Retroactivity

Medicaid will cover bills incurred 90 days before the date you filed your application. If you were initially denied Medicaid by the State of Utah because of an initial unfavorable Social Security disability decision, which is later reversed on appeal, you may be able to receive retroactive Medicaid benefits for unpaid medical bills back to 90 days prior to the date of your Medicaid application.

Income and Asset Requirements

In general, the income eligibility requirements are the same as those for the financial assistance program to which Medicaid eligibility is linked. However, there are differences in detail. The asset limits are as follows:

  • one person, $2,000
  • two persons, $3,000
  • For each additional person, add 25.00
Transferring Assets

If a person transfers an asset within 60 months of applying for nursing home care, Medicaid may be denied, if fair market value was not received. This does not apply to non-nursing home care. If you are on SSI disability and transfer assets in violation of the SSI rules, you may be found ineligible for both SSI and Medicaid.

“OTHER MEDICAID PROGRAMS”

 

Medicaid Program for Working Individuals

Utah’s Premium Partnership Program (“UPP”) is a Medicaid Program that helps qualified working individuals pay the cost of employer sponsored health insurance. The program reimburses a qualified individual up to $150.00 per adult and $100.00 per child each month toward medical insurance premiums. To be eligible the individual must have access to employer sponsored medical insurance; the cost to the employee for insurance must be 5% or more of their gross monthly income; and the individual cannot be eligible for Medicare, VA Benefits, or any other Medicaid Program. The individual must also meet the following income guidelines:

 

UPP Income Guidelines

 

Gross Income Gross Income

Family Size Adult (qualify) Child (qualify)

1 1,354.00 1,805.00

2 1,822.00 2,429.00

3 2,289.00 3,052.00

4 2,757.00 3,675.00

5 3,224.00 4,299.00

Additional Family add $425 per adult add $567 per child.

Members

 

You must apply for the UPP program before the date your health insurance coverage begins. For more information on the UPP program or to apply for the program call 1-888-222-2542.

 

Medicare Cost Sharing Programs

Medicare Cost Sharing Programs pay the cost of Medicare “Part B” Premiums for elderly and disabled individuals who receive Part A Medicare Benefits, are entitled to Part B Medicare Benefits, are a citizen or qualified alien, and meet specified income and asset limitations. Income limits for a household (“HH”) are between 100% and 200% of poverty depending on the program. Asset limits for the HH are the same for all programs. A HH of one person can have up to $4,000.00 in assets; and a HH of two persons can have up to $6,000 in assets.

 

QMB Program

Covers “Part B” Medicare Premiums, Medicare deductibles and co-pays for Medicare covered services. Also covers “Part A” Premiums (if applicable).

Income Eligibility: (100% of poverty)

HH size of 1 with net monthly income up to $902.00.

HH size of 2 with net monthly income up to $1,214.00.

 

SLMB Program

Covers “Part B” Medicare Premiums only.

Income Eligibility: (120% of poverty)

HH size of 1 with net monthly income up to $1,083.00.

HH size of 2 with net monthly income up to $1,457.00.

 

QI-I Program

Covers “Part B” Medicare Premiums only.

Income Eligibility: (135% of poverty)

HH size of 1 with net monthly income up to $1,218.00.

HH size of 2 with net monthly income up to $1,639.00.

 

QDWI Program

Covers “Part A” Medicare Premiums for Disabled persons whose entitlement to disability benefits has ended but who are still entitled to Medicare Benefits if individual pays “Part A” Medicare Premiums out-of-pocket to Social Security. The individual cannot be eligible for any other Medicaid Program.

Income Eligibility: (200% of poverty)

HH size of 1 with net monthly income up to $1,805.00.

HH size of 2 with net monthly income up to $2,428.00.

 

* net income is the income remaining after federal and state taxes are deducted from ‘gross’ income.

 

Other Medicaid Programs for Children

There are various Medicaid programs for low-income children. For children to be eligible the HH must meet specified asset and income limitations.

Prenatal Plus Medicaid (Age 0-1 year)

Eligibility: Child must be born to a woman on Medicaid, no asset or income limits.

Newborn Medicaid (Age 0-6 years)

Eligibility: HH income must be at 133% of poverty; child cannot be eligible for Family Medicaid, there are no asset limits, and no spend-down is allowed.

Newborn Plus Medicaid (Ages 6-19 years)

Eligibility: HH income must be at 100% of poverty; child cannot be eligible for Family Medicaid, no spend-down is allowed.

Child Medicaid (ages 0-19 years)

Eligibility: HH income must be at 100% of poverty; spend-down allowed; child cannot be eligible for Family Medicaid, Newborn Medicaid, or Newborn Plus Medicaid.

Foster Care Medicaid (ages 0-19 years)

Eligibility: Child must have been removed from the home and be in the custody of the state. The child is currently in placement and foster care maintenance payments are being made.

CHIP - Child Health Insurance Program (ages 1-19 years)

There are three different CHIP programs:

CHIP, Plan “A” – HH income must be between 0 -100% of poverty

CHIP, Plan “B” – HH income must be between 101- 150% of poverty. CHIP, Plan “C”—HH income must be between 151- 200% of poverty.

 

Eligibility: A child cannot be eligible for any other Medicaid Program. A child cannot have access to medical insurance for which the cost of the premiums are less than 5% of the household’s gross monthly income. Each CHIP program has different co-pays and deductibles. Also, your child may be eligible for UPP and a CHIP program. Thus, you may want to compare services provided as well as co-pays and deductibles. For co-pays, services and deductibles specific to each CHIP plan talk to your DWS worker or go on line. to:http://utahcares.utah.gov/infosourcechip/ and see, “Table II – Co-Pay Summary.”

 

 

Medicaid Programs for Pregnant Women

All low-income pregnant women are “presumptively” eligible for Medicaid Benefits and will receive a voucher from DWS for medical care immediately upon applying for Medicaid benefits. Presumptive Medicaid benefits continue until DWS determines Medicaid eligibility. There is a specific Medicaid program for pregnant women, a Medicaid Program that will cover a woman sixty days after she gives birth Pregnant women may also be eligible for Family Medicaid if they meet the income, and asset requirements.

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III. SOCIAL SECURITY DISABILITY BENEFITS

Program Purpose

The Social Security Administration (SSA) offers two related programs for persons who become disabled. Social Security Disability Insurance (SSDI), which is sometimes referred to as Disability Insurance Benefits (DIB), is available to those persons who have worked and paid into Social Security. You must have a certain number of "quarters of coverage" in order to qualify. For 2008, you are credited with one quarter of coverage (QC), if you earn $1050 during a quarter. This amount changes each year. To receive SSDI, you must be "fully insured" which is met if you have worked for 10 years.

To receive SSDI, you must also be insured for disability purposes. This usually means that you must have QCs for 20 out of the past 40 quarters before your disability began. If you are a younger individual (age 31 or younger) when your disability began, different rules apply. If you have questions about your eligibility under these rules ask the Social Security caseworker or check with ULS.

If you have not worked enough to qualify for SSDI, you may qualify for Supplemental Security Income (SSI). This program was created to provide benefits to persons who have reached age 65 or become blind or disabled. To qualify for this program, you need not be insured for disability. However, you cannot qualify if you have too much income or excess resources.

(LINK TO DISABILITY FLYER)

Applying for Benefits

You may apply for these benefits at your closest Social Security office. You may find the address and phone number in the government section of the phone book. You will be asked to complete an application which will include reports on your impairments and your work history. You may be referred to a doctor for additional medical evidence.

Qualifying for Disability

To qualify for SSI disability or SSDI, you must have a severe physical or mental impairment which can be expected to result in death or which has lasted, or can be expected to last, for a continuous period of not less than twelve months. The physical or mental impairment or blindness must be so severe that you cannot return to any work done during the past 15 years. Even if you cannot do any past work, you will not be found disabled, if you can do other work that is within your remaining capacity.

Factors Considered

Social Security must consider a number of important factors in deciding whether you are disabled. Some of these include:

  • Age. Once you reach age 50 and have a severe impairment, you are more likely to be found disabled. At age 55, you are considered to be at advanced age, making disability easier to establish.
  • Education. If you are illiterate or have less than a high school education, your chances for proving disability improve.
  • Job Skills. If you did not acquire any skills in your past work, disability is more likely to be established.
  • Doctor Opinions. A well-written letter from a doctor who has treated you for some time stating why you cannot work can often help establish disability. The letter should discuss thoroughly your condition and state the specific functional limitations you have.
Time Delays

If you are found disabled at the time of your initial application, it may be only a few months before you receive benefits. However, only a small number of applicants receive disability benefits at this stage. An equally small number who ask that an initial denial be reconsidered, receive benefits at this stage. If you are denied reconsideration and have to appear before an administrative law judge, the process could take up to a year. If you lose at the hearing level, the next appeal could take two or more years.

Legal Assistance

An attorney can be helpful at the initial or reconsideration stages of your application. However, when you need a hearing, it is best to have an attorney help you. Utah Legal Services can help in some cases, if you are seeking only SSI or are entitled to limited SSDI benefits. If you do not qualify for ULS assistance, there are a number of private attorneys who can help you for a fee. You may want to check the Yellow Pages or the Utah Bar Referral Service at utabhar.legalmatch.com.

Disability Terminations

Social Security periodically reviews disability cases to see whether a disability recipient’s condition has improved. If you get a notice saying your case is being reviewed, you should cooperate fully by completing all forms, attending doctor appointments, and submitting any new medical evidence you may have. If you receive notice that your benefits are going to be terminated, you may request reconsideration. You will then be able to attend an informal hearing on your disability at the state disability determination service (DDS). If this informal hearing is unfavorable and you still want to contest the termination, you may then request a formal hearing before the Office of Disability Adjudication and Review where an administrative law judge will conduct a hearing.

Continued Benefits

You may request continued benefits while you are contesting the proposed termination of your disability benefits. If you want to receive continued benefits, you must request them within 10 days after you are first notified of termination and again when you request a hearing before an administrative law judge. Your benefits will then continue until you receive a hearing decision from ODAR. Note that even if you missed the deadline at the reconsideration stage, you may still request continued benefits at the hearing stage. If you ask for continued benefits and are eventually determined to be not disabled, you will be asked to pay back the benefits you received while your case was pending. You may ask that the claimed overpayment be waived and SSA must consider your request. See the discussion of waivers in Section V, Overpayments. Contact ULS for assistance, if you receive notice that your benefits are to be stopped.

Benefit Amount

If you qualify for SSDI, the amount you will be paid depends on how much you have paid into Social Security while you were working. SSA periodically sends out a statement to all workers advising them of the monthly amount they can expect to receive, should they become disabled. If you do not have this statement, you may inquire at your local SSA office. The formula for calculating your benefit amount is quite complicated. If you have questions, feel free to contact ULS.

The year 2010 monthly benefit amount for a single SSI recipient is $674 and $1,011 for a couple. The amount increases every year, depending on inflation. If you are married, your spouse’s income will affect the amount of SSI you will be paid.

Asset Limitations

There is no limit on the amount of assets you may own and still qualify for SSDI. However, your eligibility for SSI is affected by your assets. Currently, a single person may have up to $2000 in liquid assets, while married persons are allowed $3000. Such assets as your car, the home you live in, and a burial plot are exempt from asset consideration. Do not transfer assets without first consulting with a qualified attorney, since transfers for less than fair market value can disqualify you from SSI. If you have questions about whether your assets might make you ineligible, talk to your SSA claims representative, or call ULS.

Disability for Children

A disabled child under the age of 18 may qualify for SSI disability, provided the child’s parents meet the income and asset limitations. A child who becomes disabled before age 22 may also qualify for SSDI benefits, if a parent is disabled or retired. There are also programs which provide benefits to surviving children, when a parent dies.

Working While on Disability

You may have some earnings from work and still receive disability benefits. However, you must discuss this possibility with SSA before doing so. There are opportunities to test your ability to return to work while receiving disability. The SSDI program permits you to try a 9-month trial work period, during which time you may receive your SSDI payment and work. The Social Security Administration has a program called “Ticket to Work”, talk to your local Social Security representative about this. Under SSI, you may want to ask about the Program to Achieve Self Support (PASS) which allows you to save your earnings in order to achieve a certain goal (e.g. starting your own business) without affecting your SSI eligibility. In all cases, it is very important that you report any earnings you may have to SSA so as to avoid an overpayment. It is also a good practice to keep records of all information you report to any government agency.

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IV. ALIEN ELIGIBILITY

General Limitations

Changes in the law in recent years have made it more difficult for noncitizens to receive public benefits. The limitations vary from program to program. For FEP and FEP-TP, you must be a "qualified alien" as described below. For most other programs, you must be both a "qualified alien" and an "eligible alien" as discussed below. The following definitions apply:

Qualified Alien

To be classified as a "qualified alien," you must be lawfully admitted to the United States under one of the following categories:

  • Permanent Resident This category refers to aliens admitted for lawful permanent residence and includes Amerasians who may have INS Form I-94; other permanent residents may have INS Form I-551
  • Refugee Admitted under section 207 of the Immigration and Nationality Act (INA) with INS Form I-94 and when filing for permanent residence will have INS Form I-551
  • Asylee Admitted under section 208 of the INA and may have INS Form I-94 or INS Form I-551
  • Conditional entry Admitted under section 203(a)(7) of the INA as in effect prior to April 1, 1980 and will have INS Form I-94--"Refugee-Conditional Entry"
  • Parolee Admitted under section 212(d)(5) of the INA for at least one year with INS Form I-94 with parole status indicated
  • Deportation withheld Deportation withheld under section 243 (h) of the INA pursuant to an order signed by a judge
  • Cuban or Haitian Entrant Admitted under section 501(e) of the Refugee Education Assistance Act of 1980
  • Certain abused immigrants, their children, and/or their parents I-130 (showing status as a spouse) I-360, I-797, I-485, any verification from the INS or other authoritative documents
Eligible Alien

To be classified as an "eligible alien," you must be admitted to the US under one of the following categories:

  • Refugee Eligible for assistance for the first 7 years from the date refugee status was granted
  • Asylee Eligible for the first 7 years from the date asylum was granted
  • Deportation Withheld Eligible for the first 7 years from the date the order is signed by the judge
  • Cuban/Haitian Entrant Eligible for the first 7 years from the date status was granted
  • US Veteran/US Active Military An alien who is a US veteran or active military is eligible without time limit
  • Spouse The spouse of a US veteran or active military is eligible without time limit
  • Lawful Permanent Resident Aliens may be in this category based on either of two criteria: (a) The lawful permanent resident entered the US before August 22, 1996 and has earned 40 QCs of SSA coverage; or (b) the alien entered the US on or after August 22, 1996, has been in the US for 5 years and has earned 40 QCs of SSA coverage
  • Certain abused immigrants, their children, and/or their parents: The need for the public benefits must be “substantial connection” to the domestic violence and the victim must no longer reside with the abuser.
Ineligible Aliens

A household may apply for financial assistance even though one or more members are ineligible aliens. The ineligible alien will not receive the public benefit but will be considered in determining household size and deeming income.

Undocumented Aliens

This category of persons is not eligible for benefits described in this book, except emergency Medicaid. DWS is required to report undocumented aliens to the Immigration Service.

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State Financial Assistance

FEP and FEP-TP

To be eligible for financial assistance under FEP and FEP-TP, discussed earlier in this booklet, you must be a "qualified alien." In addition to the foregoing categories of "qualified aliens," certain aliens who have been battered or subjected to extreme cruelty by a spouse, parent or family member, admitted under section 1641(c) of the US Code, can be eligible for FEP and FEP-TP.

GASSP

To be eligible for GASSP,  you must be classified as both a qualified alien and an "eligible alien.".

Noncitizens And Medicaid

There are several different categories of Medicaid available in Utah. If you are a noncitizen, your eligibility will depend on which category of Medicaid you are seeking. These eligibility requirements are discussed below and are quite complicated. You are encouraged to contact ULS for assistance in determining whether you are eligible.

Family Medicaid

If your immigration status satisfies the requirements for FEP and FEP-TP, you will also be eligible for Medicaid.

Disability-Based Medicaid and PCN

For Medicaid based on disability and PCN, your eligibility will depend on when you entered the US and your immigration status:

        Entry after 8/22/96

If you are a qualified alien (defined above) and enter the US after 8/22/96 you are not eligible for full Medicaid for 5 years after date of entry unless you meet one of 9 exceptions. These include:

  • Amerasian immigrants
  • American Indian Born in Canada (Must be at least half American Indian)
  • Some Eligible aliens (Refugee, Asylee, Deportation Withheld, Cuban/Haitian entrant, US Veteran, US Active Military, Spouse)
  • Hmong and Other Highland Lao Tribal People (Must be admitted for permanent residence)

During the 5 years you are ineligible, you may receive emergency Medicaid services.

        Entry before 8/22/96

The five-year bar on receiving full Medicaid does not apply to qualified aliens who entered the US before 8/22/96. Such persons may become qualified aliens and receive Medicaid. Date of entry is the actual date of coming into the US and not the date that may appear on the INS alien registration card.

SSI-Based Medicaid

A person receiving Medicaid based on SSI eligibility is subject to the following rules:

  • If you were receiving SSI and living in the US before 8/22/96, you cannot be terminated from or denied Medicaid on the basis of your immigration status
  • If you applied for and received SSI before 1979 and there is no convincing evidence you are not a qualified alien, you cannot be terminated from or denied Medicaid
  • Aliens who were lawfully residing in the US on 8/22/96 who become disabled and receive SSI cannot be denied Medicaid on the basis of their immigration status
  • Aliens who were classified as Permanently Residing in the US Under Color of Law (PRUCOL) on 8/22/96 and continue to receive SSI can also receive Medicaid

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Food Stamps

To be eligible for food stamps, you must meet one of the criteria for a "qualified alien" listed above.

You must also be an “eligible alien.” Which includes refugees, Amerasians, asylees, deportation withheld. Cuban/Haitian Entrant, US Veteran/US Active Military or spouse/dependent children described previously. You may also meet the “eligible alien” test as a permanent resident if you were admitted as a lawful permanent resident and you are:

  • A qualified alien under age 18; or
  • 65 or older and legally residing in the US on 8/22/96; or
  • A disabled person receiving disability payments or Medicaid regardless of when you entered the US; or
  • You have 40 qualifying QCs from SSA.

Social Security And SSI

Social Security Disability

If you are a noncitizen and meet the other requirements to qualify for Social Security Disability Insurance, you may receive benefits, provided you are lawfully residing in the US.

Supplemental Security Income (SSI)

The rules pertaining to noncitizen eligibility for SSI are significantly more complicated and are discussed below. Starting on 8/22/96, major changes were made in the law which restricted the eligibility of noncitizens for SSI benefits. Under these changes, a noncitizen must be both a "qualified alien" and must fit within one of several eligible alien categories. Some of these categories limit eligibility to seven years. A qualified alien who was receiving SSI on 8/22/96, and who is lawfully residing in the US, will continue to receive SSI, provided all other eligibility requirements are met. The chart that follows summarizes noncitizen eligibility for SSI.

IF YOU ARE:

THEN YOU ARE:

A US citizen or national

Always potentially eligible

An American Indian born in Canada or a member of a federally recognized Indian tribe

Always potentially eligible

Receiving SSI for months after July 1996, on the basis of an application filed before 1/1/79

Always potentially eligible if other SSA criteria are met

LAPR (Lawfully Admitted for Permanent Residence to the US under the Immigration and Nationality Act)

Potentially eligible only if:

  • a. you are lawfully residing in the US and were receiving SSI on 8/22/96: or
  • b. you are blind or disabled and were lawfully residing in the US on 8/22/96; or
  • c. you meet the SSA 40 QC requirement; or
  • d. you entered the US as a Cuban/Haitian entrant within the last seven years; or
  • e. you entered the US as an Amerasian immigrant within the last 7 years; or
  • f. you entered the US as a refugee within the last 7 years; or
  • g. you were granted status as an asylee within the last seven years; or
  • h. you were given an order withholding your deportation or removal within the last seven years; or
  • i. you are a veteran or active duty military; or
  • j. you are the spouse or dependent child of a living or deceased veteran/military member.

A refugee

Potentially eligible only if:

  • you entered the US as a refugee within the last 7 years; or
  • you meet the criteria for categories a, b, i, or j described above.

An asylee

Potentially eligible only if:

  • you were granted asylum within the last 7 years; or
  • you meet the criteria for categories a, b, i, or j described above

A person whose deportation was suspended (or removal was withheld)

Potentially eligible only if:

  • your deportation or removal was withheld within the last 7 years; or
  • you meet the criteria for categories a, b, i, or j described above

A conditional entrant

Potentially eligible only if you meet the criteria for categories a, b, i or j described above.

A Cuban or Haitian entrant

Potentially eligible only if:

  • you were granted Cuban/Haitian entrant status within the last 7 years; or
  • you meet the criteria for categories a, b, i, or j described above.

A battered spouse or child

Potentially eligible only if you meet the criteria for categories a, b, i, or j described above.

A nonqualified alien who was receiving SSI as of 8/22/96

Potentially eligible if PRUCOL status is met.

Other status

Ineligible

Family Members of Nonqualifying Aliens

Even if you do not qualify because you are an ineligible alien, your family may still be eligible for assistance. Be sure to ask about this.

Sponsor-to-Alien Deeming

Generally, aliens who seek admission to the U.S. must establish that they will not become public charges by having sponsors pledge to support them by signing affidavits of support. Because the sponsors income is deemed to the sponsored alien the alien will not be income eligible for public benefits.

Under the new law, these affidavits are legally enforceable contracts. Thus, if you sponsor an alien who receives SSI, you may be required to reimburse the federal government for benefits received. However, sponsored aliens will generally not be eligible for SSI and other public benefits therefore this problem generally does not arise.

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V. OVERPAYMENTS

How Overpayments Occur

An overpayment occurs when you have received public benefits that you are not entitled to receive, whether or not the overpayment was your fault or the fault of the agency providing the benefits. The most common cause of an overpayment is failure to report an increase in household income. If your household income or assets have changed so that you are no longer eligible for the public benefit, the agency will seek to recover from you the entire benefit received during any month that you were ineligible for assistance.

 

When You Are Not At Fault in Causing the Overpayment

Even if DWS made the mistake that caused an overpayment of financial assistance, Food Stamps, Child Care or Medicaid, you are required to return the overpaid benefits. Food Stamp overpayments must be repaid regardless of fault. If you disagree with the amount of the overpayment, or dispute that an overpayment actually occurred, you can request a hearing.

When You Are At Fault in Causing the Overpayment

If the state proves that the overpayment is your fault because you intentionally or knowingly provided false information to the agency that provided the benefit, in addition to paying back the overpayment, the following additional penalties may be imposed:

  • A penalty of 10 percent of the overpayment;
  • Interest on the unreturned balance which accrues at the rate of 10 percent per year;
  • Disqualification from receiving benefits for 12 months for the first offense, 24 months for the second offense, and permanently for the third offense;
  • Attorney fees and court costs if the state files a court action against you to collect the overpayment.
Criminal Penalties

In addition to civil liability for an overpayment obtained by false or fraudulent means, you may be prosecuted criminally for "public assistance fraud." The penalty depends on the amount of public benefits you received through fraud. For example, if you received $5,000, the penalty is a second degree felony which may carry with it a prison sentence. If you are accused of public assistance fraud, you have the right to an attorney. If you cannot afford one, ask the judge to appoint an attorney to represent you. ULS cannot help you with criminal matters.

What To Do If Notified of an Overpayment

First, call an attorney. If you are low-income, ULS may be able to help you.

Second, be careful what you sign. DWS may ask you to sign a stipulation admitting that the overpayment was your fault. Do not sign anything until you have talked with a lawyer. Finally, you have the right to request a hearing. Click on Hearings and Appeal Rights. At a hearing, your rights will be better protected, and there is a much better chance that you will have to repay only what is required by law.

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Social Security Overpayments

Social Security overpayments are handled somewhat differently. You have more rights than under the other programs discussed in this booklet. These rights include:

Reconsideration

If you receive notice of a Social Security overpayment, you may always request that the determination be reconsidered. You may want to request reconsideration, if you think there is no overpayment or you disagree with the amount. Once you request reconsideration, you will have the opportunity to meet with a claims representative at your local Social Security office. You usually have 60 days to act. Don’t miss the deadline.

Waiver

At any time, you may ask that the Social Security overpayment be waived. When SSA waives an overpayment, it means the debt is forgiven and you do not have to pay it back.

You must convince SSA of several things before the overpayment can be waived:

  • Fault. You must first prove that you were not at fault in causing the overpayment. For example, if you were in the hospital and were unable to report information to SSA.

If you were not at fault, you must also show:

  • Inability to repay. If your income is barely enough to meet your monthly expenses, or if you are receiving SSI, the overpayment should be waived; or
  • Changed circumstances. If you relied on the Social Security payment as being correct and, as a result, changed your position, the overpayment should be waived. For example, you signed a lease based upon the belief that you were entitled to the SSI benefits you received.
Hearing

If your case is reconsidered and you are still not satisfied, or if your request for waiver of an overpayment has been rejected, you may ask for a hearing before an administrative law judge. Again, 60 days is the deadline.

SEE OVERPAYMENT FLYERS

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Repayment Of Overpayments

State Overpayments

If it is finally determined that you do owe an overpayment, it will have to be repaid. Often, you can work out small monthly payments or a reduction in benefits, based on your ability to pay.

Social Security Overpayments

If the amount is not waived, it will usually be recovered by withholding a monthly amount from your check. You may negotiate with Social Security to set the monthly amount at the lowest figure possible based on your current income and circumstances. If you are receiving SSI, the monthly recovery amount is limited to 10 percent of your income, unless the overpayment was caused by fraud. Social Security may recover an SSI overpayment from any SSDI to which you or your dependents are entitled. If you have an outstanding overpayment and later are underpaid benefits, Social Security will first offset the overpayment against the underpayment before paying you any balance owing.

Tax Refunds

Both DWS and Social Security have the authority to recover an overpayment from any state or federal tax refund you may have coming. If you file a joint return, the person filing jointly with you may be entitled to a refund of that portion of the tax refund belonging to that person.

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VI. HEARINGS AND APPEAL RIGHTS

Your Right to a Hearing

If you are denied or terminated from any of the benefits discussed in this booklet, or if you are notified of an overpayment, you have the right to request a hearing. The procedures that will be followed at the hearing vary with each program. In general, a hearing is conducted by a hearing officer or an administrative law judge who will take evidence in the form of written documents and testimony. Public benefits hearings are more informal than what you might experience in a court of law. The rules of evidence do not strictly apply and hearsay statements are allowed. However, the same fundamental principles apply: the testimony of witnesses is under oath, a tape-recorded record is kept, and a written decision is issued after the hearing. Because the hearing is usually your only opportunity to present evidence, it is important that you prepare well. It always helps to have legal advice and assistance, so do not hesitate to call ULS.

Notice

Before you can be denied or terminated from a public benefit, the agency that administers the benefit program is required to give you written notice of the action to be taken. You need to read the notice carefully. It should tell you what and when some action will be taken (e.g., your benefits will stop at the end of the month). It should also give you an explanation of the reasons for the action and how you may request a hearing. Remember that your time for requesting a hearing is limited. You must act promptly to protect your hearing rights. Follow the instructions on the notice, and if you have questions, call ULS. Be sure to keep a written record of having requested a hearing.

Time Deadlines

To protect your valuable rights, it is important that you request a hearing within a limited period of time. The time deadlines for the programs covered in this booklet can be summarized as follows:

Program Time Limit For Requesting a Hearing:

 

Unemployment

10 Days

SSI, Social Security

60 Days

FEP, FEP-TP, GASSP

90 Days

Food Stamps

90 Days

Medicaid, PCN

90 Days

WIC

90 Days

The time limit you have to request a hearing begins when the agency gives you notice of the action with which you disagree. In Social Security cases, the time limit begins with the date you receive the notice. You are presumed to have gotten the notice within 5 days of the date shown on the notice unless you can prove a later date. If you are notified by DWS of an action in writing, then the time begins as of the date of the notice that you receive. To be safe, you should record when you got the notice, save the envelope, and request a hearing as soon as possible.

If Medicaid or DWS denies your application and you request a hearing, the hearing officer must make a decision on your application within 21 days.

If you are disputing a decision made by Medicaid or PCN, you must request a hearing through your local DWS office. If you hand-deliver the request for hearing, ask for a copy and have it date-stamped. You may also mail your request to the hearing office, certified mail, return receipt requested, address on your denial notice. If you do not hear anything within a reasonable time (approximately 7 to 10 days), call the office. Hearing requests involving Social Security benefits are made through your local Social Security office.

Continued Benefits

In most cases, you will be given the opportunity to have your benefits continue while your hearing is pending. However, should you lose at the hearing, you will be required to repay the benefits given you during this time. In Social Security cases, you may ask that the overpaid amount be waived. In state assistance and Medicaid cases, there is no opportunity to request a waiver. You may want to discuss these considerations with an experienced advocate before making your decision.

In order to continue receiving financial assistance under the FEP, TP-FEP, Food Stamps, or Medicaid benefits, you must request a hearing within 10 days of the notice date on the letter or any time before the effective date of the action, if you want to continue receiving these benefits while your hearing is pending. For Social Security purposes, you must request continued benefits within 10 days of the date of the notice.

Representation

It may be to your advantage to have someone represent you. This person need not be an attorney. Your representative will be allowed to ask questions of the other side, ask you questions, review the documents, and argue on your behalf.

Utah Legal Services has a number of well-trained lawyers and paralegals who have a good working knowledge of the programs discussed in this booklet. Call them if you need help. You may be eligible for assistance.

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Hearing Procedures For State Assistance Programs

Written Notice

DWS must give you the written notice discussed above. However, when you are sanctioned for not participating in your employment plan, 10-day advance notice of adverse action is not required. Your caseworker should let you know if there is a problem in your case, so you can correct it or seek conciliation.

In most Food Stamp cases 10-day advance notice is required. In other state-administered programs, you will be given notice as soon as possible before your case is closed.

Conciliation

In FEP and FEP-TP cases involving your employment plan, you have the right to conciliation before any action is taken against you. For example, if DWS says you are not participating as required by the FEP rules, you may ask for conciliation. There are two phases of conciliation. You can have someone with you to help during both levels of conciliation.

Participation review. Your employment counselor will meet with you and try to determine why you are having problems following your employment plan. If your counselor thinks you have a good reason, the two of you will work out changes to the Plan as needed. If you don’t have a good reason, your cash grant will be reduced by $100 for one month and you will go to the next phase.

Problem Solving. You are invited to a case one staffing with the Counselor, other staff from DWS (one of whom may be a Licensed Clinical Social Worker) and allied agencies. It may be helpful to bring along a friend or an advocate from one of the poverty rights groups. If you are unable to resolve the participation issues at the level two conciliation stage, your benefits will likely be reduced by $100. The reduction may last up to two months.

If the level two conciliation does not solve the problem, level three conciliation will start. You will meet with your caseworker, her supervisor, and perhaps other workers from DWS. Sometimes DWS will bring every worker who has ever worked with you to this conciliation meeting. A room filled with such workers can be overwhelming. Ask your worker who will attend this meeting and ask her to put it in writing. You may want to ask for the DWS specialized employment counselor to attend. Sometimes, although not always, the specialist has had training in mediation and may understand poverty issues better than a regular caseworker. If this third level of conciliation does not resolve the participation issues to DWS’ satisfaction, your FEP benefits will be terminated within two months.

Requesting a Hearing

In some cases, you may be able to resolve a problem without requesting a formal hearing. For example, if you are unhappy with how things are going with your employment plan, you may go through the conciliation process. If you have other complaints, you may want to request an agency conference. At an agency conference, you will meet with your caseworker and her supervisor in an effort to resolve whatever problem you are having. If you cannot resolve the problem and you receive a written Notice of Decision, you should then consider requesting a hearing.

Preparation for the Hearing

First, be clear on what disagreement you have with DWS. Many people find it helpful to list clear points that they want to make at the hearing. If you are being represented at your hearing, be sure to inform your advocate of any important points or information regarding your case prior to the hearing. You have the right to see your welfare file. Ask to see it. Try to find any information that relates to your hearing issue. If the person behind the counter at DWS questions your right to see your file, remind her that you have the right to see your file. The only information you cannot look at is "confidential information" which is a very narrow class of information such as information provided by third parties to DWS without your knowledge. For example, information regarding a pending criminal prosecution may be confidential. At the hearing, DWS is not allowed to use any confidential information it would not let you see. DWS may not use this information to close, deny or reduce financial assistance.

DWS will photocopy up to 10 pages for free. Ask them to copy the information that you either disagree with, or that helps your argument. In addition to information in your case file, DWS keeps a computer case log of actions taken by your caseworker, your interactions with DWS caseworkers, and any notices sent to you. Ask DWS to print out a copy for you. Be polite but firm with DWS. You have the right to see your case file and that includes the case log. You may also request a copy of the policies used to decide your case.

Finally, you may want to talk to your caseworker or her supervisor to find out what the agency position is and what policy rules the agency is relying on. You may request an agency conference. It is possible that your disagreement may be cleared up at this time and you will no longer need a hearing. DWS workers should never try to discourage you from requesting a hearing. Having a hearing on an area of disagreement is your right.

Appeals

If you receive an unfavorable hearing decision, you can usually request reconsideration or further review by the director of the program or the hearing office. If the hearing decision is upheld, your next avenue of appeal is to the courts. You will likely need an attorney to help you at this level.

Payment Error Prevention Unit Hearing Procedures

PEPU has responsibility for assessing and collecting overpayments in all state financial and medical programs as well as Food Stamps. Since the eligibility requirements for many of the programs are quite complex, it is often the case that you do not owe the overpayment as alleged, or only owe a part of it. The state statutes set out specific procedures PEPU must follow in attempting to recover an overpayment. Again, it is important that you read any notices carefully and consult with a legal representative promptly, since failure to act may mean that a judgment will be entered against you.

Notice

PEPU begins the recovery process by sending you, usually by certified mail, a Notice of Agency Action: Overpayment Determination (NAA:OD) signed by a presiding officer who is an employee of PEPU, not a judge. This notice will advise you of an alleged overpayment, will list the programs and the amounts claimed, and should give you a brief explanation of why PEPU thinks you were overpaid. The notice will also inform you that you may contact the presiding officer. If you contact the presiding officer, it is advisable that you not agree to anything until you have consulted with legal counsel. The presiding officer is a PEPU employee and is under no obligation to protect your rights. Usually, if you request a hearing, the amount of the alleged overpayment is reduced. You are encouraged to contact ULS before agreeing to an overpayment.

Requesting a Hearing

The notice should tell you the amount of time you have to request a hearing. It should provide a form for requesting a hearing and tell you where to send it. Be sure to keep a copy of your hearing request.

Hearings

Your hearing will be conducted by a hearing office within the Department of Workforce Services. An impartial judge will review all the facts. Like other hearings, it is helpful to have legal representation. If you decide to go ahead on your own, be sure to bring any witnesses who can help you as well as any written records pertaining to your case.

Appeals

If you lose the hearing, you may request review by the director of the hearing office. If you are unsuccessful and want to appeal further, you will most likely need an attorney since the appeal will have to go to a court of law. ULS can review your hearing decision, but it is less likely that we will be able to help if we did not represent you at your hearing.

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Social Security Hearing Procedures

The procedures followed by the Social Security Administration (SSA) are well-established, since thousands of hearings are handled every year. You must follow each step of the process carefully or you could lose valuable rights. Currently, SSA requires that you request reconsideration of any unfavorable decision affecting your benefits. In disability cases, this means that the state agency (in Utah this is DDS) which made the initial unfavorable decision will have a different team of examiners and doctors review your case. In nondisability cases (e.g., requests for waiver of an overpayment), a claims representative in the district office will review the denial. If reconsideration is denied, you must then request a hearing before an administrative law judge.

Notice

Social Security will send you written notice which should contain an explanation of the unfavorable action and instructions on how to appeal. It will inform you of the forms which must be used to request a hearing and the time limits.

Requesting a Hearing

If you want a hearing, you should complete and submit the SSA forms as soon as possible. The deadline is 60 days. ULS may be able to help you complete the forms. You may also want to ask your DWS case worker or a case manager to help you. Try to answer all the questions as best you can before turning them in. Social Security should help you with questions you do not understand.

Hearings

It is always advisable to have legal representation at your hearing. If ULS is unable to help you, contact one of the many private attorneys who handle disability cases. You may want to check the Yellow Pages for disability lawyers or use the Utah Bar Referral Services @ utahbar.legalmatch.com. If you have a good case, they will usually represent you without requiring payment up front. They will, instead, recover their fee and costs from any retroactive benefits you are paid. Since disability cases often take many months to complete, there is usually a significant amount owing to you which can be used to pay your attorney. By law, fees are limited to 25 percent or your back benefits or $5,300.00 whichever is less.

At your hearing, you will have the opportunity to testify and present any new medical evidence you may have. The judge will want to know about your past work, your medical condition, your education and any skills you may have gained. The judge may have a medical expert present to help decide whether you are disabled. Often there is a vocational expert participating in the hearing who will testify about jobs that may be available that are within your remaining capacity to work. A hearing assistant will also be present to record your testimony.

Appeals

If you receive an unfavorable decision from the judge, you have the right to ask the Appeals Council to review the decision. This usually takes more than two years to complete. If the Appeals Council agrees with the judge, your only remaining avenue of appeal is through the federal courts. This process is also time-consuming. Although this process is lengthy, your chances for success are best at this level.

Since the hearing and appeal process takes so long, you are permitted to file a new application while your case is pending on appeal. Be sure to ask about this possibility.

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A FINAL REMINDER

Remember You Have Rights

We hope the information contained in this booklet will be of help to you.

In working with any of the agencies providing the benefits discussed in this booklet, remember that you have both rights and responsibilities. You have the right to:

  • Apply or reapply for any program;
  • Be treated with courtesy, dignity and respect;
  • Prevent an investigator from entering your home without your permission;
  • Receive written notice of any change affecting your benefits, including notice that your application has been approved or denied;
  • Be given an agency conference and a fair hearing if you disagree;
  • Review your case file and state policy manuals.
Remember You Have Responsibilities

You also have the responsibility to:

  • Give complete and accurate information, especially when completing the application;
  • Report all changes in your situation within 10 days, including: family size, income changes, marriages, lump sums, deaths, asset changes and work changes. This is true in all programs.

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Utah Legal Services, Inc.
Community Legal Center
205 North 400 West
Salt Lake City, Utah 84103-1125