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, 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.
Cedar City 435-586-2571 or 800-662-1772 Ogden 801-394-9431 or 800-662-2538 Provo 801-374-6766 or 800-662-1563 Salt Lake City 801-328-8891 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 representatives from Salt Lake Community Action Program is especially appreciated.
All dollar amounts and laws are accurate as of July 1, 2003.
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 GASSP: General Assistance Self-Sufficiency Program (also referred to as “GA” or General Assistance) INA: Immigration and Nationality Act INS: Immigration and Nationality Service NAA:OD: Notice of Agency Action: Overpayment Determination OHA: Office of Hearings and Appeals ORS: Office of Recovery Services LAPR: Lawfully Admitted for Permanent Residence PASS: Program to Achieve Self Support PCN: Primary Care Network 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 WTE: Working Toward Employment
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 you must be given a decision on Medical assistance within 90 days.
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.
You can have no more than $2000 in assets in order to qualify for financial assistance. This means you may have personal and nonexcluded land, houses, buildings, and trailer homes that have value up to $2000 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, CDs(certificates of deposit), promissory notes, mortgages, trust funds, agreements in escrow, boats, campers, homes, buildings, land, and other items that can be sold for cash. 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.
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 requalify 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.
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.
To get benefits under FEP, FEP-TP, WTE, and GASSP (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.
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. Remind your worker that the policy manual gives you this right. Do not bring a family member if they are very emotional or angry. If you believe DWS has treated you rudely, ask someone at the information desk at your local employment center about contacting the customer service office.
For all of the programs discussed in this booklet, it is important that you make timely and accurate reports of any changes in circumstances that might possibly affect your eligibility. An overpayment may occur if you fail to report changes in your circumstances. 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.
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.
The effect of a trust on your eligibility for most benefits involves a careful legal analysis. If you have a trust, be sure to contact ULS for advice and assistance.
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.
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.
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.
FEP provides short-term assistance for unemployed and underemployed one-parent families with dependent children and pregnant women in their third trimester. (Click FEP-TP for information about an employment program for two parent families.)
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.
You may own certain property and still be eligible for FEP. (Click on General Requirements for DWS Financial Programs.)
You will be required to have an assessment with your caseworker to qualify for FEP. (Click on General Requirements for DWS Financial Programs.)
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.
You must cooperate with DWS by providing accurate information concerning the father of your children. (Click on General Requirements for DWS Financial Programs.)
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.
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.
You may own certain property and still be eligible for FEP-TP. (Click on General Requirements for DWS Financial Programs.)
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.)
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.)
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.
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.
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.
If you or your spouse needs medical or mental health treatment, that time may be considered as part of the 32 hours of community work/training. You will be asked to participate in community work, job search, adult education, and short-term skill training.
You may own certain property and still be eligible for WTE. (Click on General Requirements for DWS Financial Programs.)
You will be required to participate in an assessment with your caseworker to qualify for WTE. (Click on General Requirements for DWS Financial Programs.)
In order to get benefits under WTE, you must develop an employment plan with your caseworker. (Click on General Requirements for DWS Financial Programs.)
A household may not be on the program for more than 7 months in any 18-month period. Payment for part of a month counts as a whole month. There are some special exceptions. Be sure to ask your caseworker about this. Participation in WTE does not count toward the 36-month FEP limit.
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).
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 per month or more per month. Your condition must be expected to last more than 30 days.
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.
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.
You may own certain property and still be eligible for GA. (Click on General Requirements for DWS Financial Programs.)
You will be required to participate in an assessment with your caseworker to qualify for GA. (Click on General Requirements for DWS Financial Programs.)
In order to GA benefits, you must develop an employment plan with your caseworker. (Click on General Requirements for DWS Financial Programs.) If your caseworker thinks you may qualify for Social Security Disability, you will be required to apply. You must enroll in PCN unless you have some other medical coverage.
You can only receive GA for 24 months out of a 60-month period.
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.
The EA program provides immediate short term help to destitute families to help prevent homelessness.
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.
You will be eligible for assistance for only 30 consecutive days during a year. The year is defined as beginning after the first day of assistance.
If you are working, but fall within certain income guidelines, or receive FEP, DWS can help subsidize 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 subsidy may not cover the entire cost of care and can never exceed the total cost of care or the local market rate.
With both one and two-parent families, if alternative child care is available, the parent is not considered to have a need for subsidized child care. Alternatives may include: a 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 employee at no cost.
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.
Families may have no more than $8000 in countable assets, including both real and personal property. Click for examples of assets.
Food Stamps are issued through the Utah Horizon card, which acts as a "debit card" to buy groceries. Food Stamp coupons are no longer used. 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.
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.
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.
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.
Some persons are not considered part of any household. They are not eligible for Food Stamps as individuals, nor are their income and resources 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).
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.
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 for a discussion of ABAWDs.
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.
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.
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.
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.
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.
You may also qualify if your combined income and liquid assets are less than your monthly housing (rent or mortgage) and utility costs.
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.
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.
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.
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.
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.
WIC Program Utah Deptartment. of Health, Division of Family Services 44 Medical Drive, Salt Lake City, Utah 84113 (801) 584-8232
You may apply for benefits at your nearest DWS office. The address and telephone number 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.
If you have questions about the suitability of a job, talk to your DWS caseworker. You may also contact ULS.
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.
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.
You may apply at the same office where you apply for financial assistance or food stamps.
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 $1,123 and a household of two must be under $1,515. The Department of Health may limit the number of people hwo may enroll in PCN by accepting aplications only during certain open enrollment eriods.
There is no asset limit.
Should your income increase during the 12-month certification period, you remain eligible until the end of your certification.
You may receive basic primary care, emergency care and pharmcy services. The benefits are set out in a benefits chart available from your caseworker. You may be required to make a copayment for some services.
If denied, you have a right to a hearing. Click on Hearings and Appeal Rights. Call ULS for assistance.
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.
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 copayment for some services.
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.
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.
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.
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.
If you are admitted as a student, a visitor or some other temporary form of entrance, you are not eligible for Medicaid.
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 can receive retroactive Medicaid benefits back to the date of your Medicaid application. This can sometimes mean Medicaid coverage going back many months or even years.
If a person transfers an asset within 36 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.
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 2001, you are credited with one quarter of coverage (QC), if you earn $830 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.
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.
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.
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.
You usually do not need an attorney 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 (801-531-9075; 1-800-698-9077).
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 Hearings and Appeals where an administrative law judge will conduct a hearing.
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 when 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 the Office of Hearings and Appeals. 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.
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 2003 monthly benefit amount for a single SSI recipient is $552 and $829 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.
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.
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.
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. 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.
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 all other programs, you must be both a "qualified alien" and an "eligible alien" as discussed below. The following definitions apply:
A household may apply for financial assistance even though one or more members are ineligible aliens. The ineligible alien is not included as a member of the household.
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.
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.
To be eligible for GASSP and WTE, discussed earlier in this booklet, you must be classified as both a qualified alien and an "eligible alien.".
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.
If your immigration status satisfies the requirements for FEP and FEP-TP, you will also be eligible for Medicaid.
For Medicaid based on disability and UMAP, 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:
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.
To be eligible for food stamps, you must meet one of the criteria for a "qualified alien" listed above. You will also be considered a "qualified alien" if you are a battered spouse, battered child or parent or child of a battered person with a petition pending under sections 204 or 244 of the INA.
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:If you are a noncitizen and meet the other requirements to qualify for Social Security Disability Insurance, you may receive benefits, provided you are residing in the US.
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.
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.
Generally, aliens who seek admission to the US must establish that they will not become public charges by having sponsors pledge to support them by signing affidavits of support. 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 the benefits received.
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.
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 as soon as you discover the overpayment or receive notice of the overpayment. If you disagree with the amount of the overpayment, or dispute that an overpayment actually occurred, you can request a hearing.
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.First, call an attorney. If you are low-income, ULS may be able to help you.
Second, be careful what you sign. The Office of Recovery Services 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.
Social Security overpayments are handled somewhat differently. You have more rights than under the other programs discussed in this booklet. These rights include:
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.
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: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.
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.
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.
Both the State ORS 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.
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.
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 record of having requested a hearing.
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:
| Unemployment | 10 Days |
| SSI, Social Security | 60 Days |
| FEP, FEP-TP, WTE, 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 post mark on the envelope that you receive. To be safe, 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 address on your denial notice. If you do not hear anything within a reasonable time, call the office. Hearing requests involving Social Security benefits are made through your local Social Security office.
In most cases, you will be given the opportunity to have your benefits continue while your hearing is pending. However, should you lose 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, Food Stamps, or Medicaid benefits, you must request a hearing within 10 days of the notice mail date 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.
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.
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 cases 10-day advance notice is required in Food Stamp cases. In other state-administered programs, you will be given notice as soon as possible before your case is closed.
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. At the first level of conciliation, your DWS Employment Counselor will meet with you and try to determine why you are not participating in your plan. Your counselor will try to determine why you have not been able to participate and may discuss alternative ways of meeting the requirements. There may be a home visit and, in some cases, other DWS personnel, including a special counselor, may become involved.
If the first level of conciliation does not solve the problem, you may have a second level conciliation. At this level, your caseworker will contact her supervisor and ask for help. Then you, your caseworker, and her supervisor will meet. A specialized DWS employment counselor may also be involved. It is always a good idea in conciliation meetings 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.
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.
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.
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.
ORS 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 ORS 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.
ORS 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 ORS, 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 ORS 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 to not agree to anything until you have consulted with legal counsel. The presiding officer is an ORS 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.
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.
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.
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.
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.
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.
If you want a hearing, you should complete and submit these forms as soon as possible. The deadline is 60 days. ULS does not have sufficient personnel to help you complete the forms. You may want to ask a friend 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.
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 call the Utah State Bar Referral Service at 531-9075 or 1-800-698-9077. If you have a good case, they will usually represent you without requiring payment up front. They will, instead, recover their fee 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.
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 at 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.
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.
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.
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:Utah Legal Services, Inc. Community Legal Center 205 North 400 West Salt Lake City, Utah 84103-1125