Department of Health and Human Services Departmental Appeals Board AFDC QUALITY CONTROL REVIEW PANEL
SUBJECT: Connecticut Department of Income Maintenance Docket No. A-92-220
DATE: October 26, 1992
DECISION
The Connecticut Department of Income Maintenance (State) appealed the August 10, 1992 quality control (QC) review determination of the Regional Administrator of the Administration for Children and Families (ACF) that an Aid to Families with Dependent Children (AFDC) assistance unit (AU) was ineligible for its assistance payment for the review month of December, 1991, due to excess resources belonging to an optional member of the AU. The State disputed the finding of ineligibility, and asserted that the QC error was only an overpayment of the difference between the award and the amount to which the AU would have been entitled without the optional member. For the reasons discussed below, we sustain ACF's determination.
Background
The AU was comprised of two minor children and their grandmother, the recipient. The recipient applied for AFDC for herself and her two grandchildren in September, 1991, and reported that her only bank accounts had been closed. The State approved her application in November, 1991, and issued a $631 AFDC award for the review month of December, 1991. 1/ However, inquiries by the State revealed that the recipient had an account at a credit union with a balance of over $1,900 during the review month, which was above the AFDC resource limit of $1,000. The State QC review determined that a $523 payment should have been made to an AU comprised of the two grandchildren alone, and concluded that there had thus been an overpayment of $108. The federal QC review found the AU of three persons totally ineligible for the review month due to the recipient grandmother's resources.
Arguments
The State argued that ACF's ineligibility determination was improper, since both children by themselves were eligible for assistance and the recipient grandmother was not required to be included in the AU. As the two children would have been entitled to a $523 payment on their own, the State contended that it was proper to find only an overpayment of $108. The State asserted that section 3578 of the AFDC QC Manual (QCM), "Proper persons in budget," implies that if a non-mandatory ineligible individual is included in the AU, it is only that person who is improperly included in the budget. The State reported that its permissible State practice (PSP) limits corrective action in this case to removal of the ineligible recipient from the AU and recoupment of only that portion of the AFDC award representing her needs. The State asserted that ACF's instructions that the State close the case and recover money issued while the over- resource grandmother was included in the grant was inconsistent with ACF's recommendation that an application be made for only the two grandchildren.
Analysis
Title IV-A of the Social Security Act (Act) provides for payments to needy families with dependent children. Section 406(b) of the Act defines "aid to families with dependent children" as money payments with respect to a dependent child, and includes money payments to meet the needs of the relative with whom any dependent child is living. Section 402(a)(7) of the Act requires states, in determining need, to take into consideration the income and resources of any relative claiming AFDC, and to determine ineligible for assistance any family whose combined resources exceed $1,000.
Here, the State did not dispute that it made an AFDC payment to an AU that was composed of the recipient and her two minor grandchildren. That AU was ineligible for assistance due to the recipient's excess resources during the review month. The regulations governing the QC system define "payment to ineligibles" as a payment received by an AU for the review month, when "that assistance unit was not eligible for any part of the payment" under permissible State practice. 45 C.F.R. § 205.40(b)(11). 2/ Thus, a determination of ineligibility focuses on the particular AU that received the payment, and not on whether another possible AU could have been eligible. The AU in question here included the recipient grandmother, and was not eligible due to her excess resources. Our inquiry is what the State did that led to the finding of a QC error, not what other actions the State might have been permitted to take. Additionally, the State did not introduce evidence to support its claim that its PSP called for removal of the ineligible grandmother from the AU and recoupment of that portion of the AFDC award representing only her needs.
Section 3578 of the QCM does not support the State's position that the amount of the error is only that portion of the AFDC payment attributable to the recipient grandmother. By its terms, that section of the QCM applies when certain persons are improperly included in (or excluded from) the AU. That was not the case here, as both parties conceded that the recipient was an optional member permitted to be included in the AU as a custodial relative. Once included, however, her resources could not be excluded from consideration.
The error in this case was not the grandmother's inclusion in the AU, but rather the State's failure to discover and consider her resources which rendered that AU ineligible for the review month. ACF agreed with the State that an AU consisting of the two minor grandchildren alone would be eligible, and suggested that this is how the case should be handled. However, this was not the AU to which the State awarded the payment here, and ACF's prospective suggestion as to how the case should be handled was not inconsistent with the determination that the AU was ineligible for the payment it received during the review month.
Conclusion
For the reasons discussed above, we conclude that the AU was not eligible for the review month payment because of
excess resources, and we sustain ACF's finding of ineligibility.
Thomas D. Horvath
Maxine M. Winerman
Jeffrey A. Sacks
* * * Footnotes * * *
1. The award consisted of a flat $581 grant for the AU, plus a $50 special needs payment for excess rent.
2. Final rule published October 13, 1992, 57 Fed. Reg. 46782, effective October 1, 1990, (with specified exceptions). The cited definition formerly appeared at 45 C.F.R. § 205.40(a) and was not substantively changed in the new rule.