Department of Health and Human Services
Departmental Appeals Board
AFDC QUALITY CONTROL REVIEW PANEL
UBJECT: Connecticut Department
of Income Maintenance
Docket No. A-93-165
Decision No. QC50
DATE: August 27, 1993
DECISION
The Connecticut Department of Income Maintenance (State)
appealed the
quality control (QC) review determination
issued on March 31, 1993 by the
Regional Chief,
Administration for Children and Families (ACF), in State
QC review number 960513. ACF found that an underpayment
of $108
had occurred in the review month of September,
1992 for the assistance unit
of I.W. / ACF found that
the assistance unit, which consisted of I.W.
and her son,
should have also included I.W.'s daughter.
For the reasons discussed below, we uphold the decision
of ACF finding an
underpayment of $108.
Relevant Authority
Title IV, Part A of the Social Security Act (Act)
establishes the Aid to
Families with Dependent Children
program (AFDC). AFDC is designed to
provide assistance
to certain disadvantaged children and their
caretakers.
Assistance under the program is given to those children
who are from low-income families and who are deprived of
financial
support through death, incapacity, or continued
absence of a parent or
through unemployment of the
family's principal wage earner. See
generally Section
402 of the Act.
In order to determine the level of resources otherwise
available to
dependent children who are being considered
for assistance under the program
(and, therefore, which
children are eligible for AFDC payments), the law
provides that these children are considered for
eligibility as part of
"assistance units" (AUs). Section
402(a)(38) of the Act provides that
a state must include
in an AU --
(A) any parent of [the dependent] child, and
(B)
any brother or sister of such child, if
such brother or sister meets the
conditions
described in clauses (1) and (2) of section
406(a) or in
section 407(a), /
if such parent, brother, or sister is living in the
same home as
the dependent child . . . .
Based on this statute, the applicable regulations provide
that --
in order for the family to be eligible, an
application [for AFDC]
with respect to a dependent
child must also include, if living in the same
household and otherwise eligible for assistance:
(A) Any natural or adoptive parent or
stepparent; . . .
and
(B) Any blood-related or adoptive brother or
sister
. . . .
45 C.F.R. � 206.10(a)(1)(vii). These standards are
likewise
reflected in both the federal and State AFDC
quality control policy manuals.
/
Once a dependent child is determined to be eligible for
benefits and a
state determines which members of the
household must be included in the AU,
those
determinations are subject to change should the
household's
circumstances change. Should additional
family members move into the
household who originally
would have been required to be in the AU, the
Federal
Manual states that --
[t]hese family members are "deemed" to be included
in the
application already on file even if s/he
subsequently becomes a member of
the household of
the existing AU (e.g., by birth/adoption, or by
moving
into the household).
Federal Manual, � 3536, at V-24 (emphasis added). The
implementing
provisions for this section specifically
state that when an individual later
joins the AU by
moving into the household of an existing AU, a state must
redetermine eligibility of the AU. Id. States are to
determine continued eligibility for AFDC assistance
prospectively on a
monthly basis and, specifically, are
to determine monthly who should be
included in the AU.
Federal Manual, � 3410, at IV-4 and IV-5. In
order to
assist a state in reviewing the continued eligibility of
an AU,
the regulations provide that state plans must
adopt procedures which assure
that recipients make timely
and accurate reports of any changes in their
circumstances which would affect eligibility or the
amount of assistance
to be awarded. 45 C.F.R. �
206.10(a)(2)(ii) (1992).
Factual Background
At issue in this case is the AU of I.W. ("mother"). At
all times
relevant to this matter, the mother and her son
received AFDC payments as
one AU. Additionally, at all
times relevant to this matter, the
mother's daughter
("daughter") lived with her mother's sister ("aunt") and
her aunt's five children. While living with her aunt,
the daughter
received AFDC assistance as part of her
aunt's AU. See generally ACF
Br. at 1-2.
Prior to July 13, 1992, the mother and the aunt did not
share living
arrangements. However, on July 13, 1992,
the mother and her son moved
in with the aunt, the aunt's
five children, and the daughter. This
change in living
arrangements was reported to the State on July 16 or 17,
1992. See ACF Answers to Board Questions, August 6,
1993; State
submission to the Panel, August 9, 1993.
However, the State continued
to pay AFDC payments for the
daughter as part of her aunt's AU and not as
part of her
mother's AU.
On March 31, 1993, ACF issued a memorandum to the State
finding an
underpayment in the benefits issued to the
mother for the month of
September, 1992. See ACF Br.,
Ex. 1. The decision was based on a
finding that the
underpayment occurred because of the exclusion of an
eligible household member:
The assistance unit was the recipient and her son.
In the
household was the recipient's sister and the
recipient's daughter. The
sister and the daughter
were on a separate grant. Standard Filing Unit
policy states that the assistance unit must include,
if otherwise
eligible for assistance, all members of
the household who are siblings of a
dependent child.
Id. The State requested reconsideration by letter dated
April 19,
1993. See ACF Br., Ex. 2. The State excepted
to ACF's
determination, arguing that the daughter was not
"otherwise eligible" for
AFDC payments since her basic
financial needs were met by the assistance she
received
as part of her aunt's AU. On reconsideration, ACF upheld
its decision, and this appeal followed. See ACF Br.,
Exs. 3-4.
Analysis
The statute, regulations, and federal and State AFDC
policy manuals are
clear that all natural or adoptive
parents and siblings of a dependent child
must be
included in the AU of the dependent child if they are
living in
the same household. / These program
requirements are equally clear
that a state is to review
the composition and eligibility of an AU on a
monthly
basis and adjust the benefits accordingly. Clearly, the
daughter was required to be included in the AU of her
mother and brother
once they were living in the same
household beginning July 13, 1992.
Since the State was
notified of the change in living arrangements on July 16
or 17, 1992, the State was required to reflect the change
in the
assistance level beginning with the next monthly
review period.
However, as of the review month of
September, 1992, two months later, the
daughter was still
being incorrectly included in her aunt's AU instead of in
her mother's AU.
The State argued that the daughter was not a mandatory
member of her
mother's AU because the daughter was not a
needy individual within the
meaning of the statute. The
State argued that since the daughter
received assistance
as part of her aunt's AU, her basic needs were met and
she was not eligible for AFDC payments as part of her
mother's AU.
See State Appeal File. /
However, the State clearly missed the point. The
daughter was a
needy individual within the meaning of the
statute and was otherwise
eligible for AFDC or she would
not have been receiving assistance under her
aunt's AU. /
The statute and regulations clearly define to which AU a
dependent child must belong. / The State simply cannot
provide
benefits to a dependent child as part of an AU to
which she was not required
to belong, while declining to
provide benefits to her under an AU to which
she was
required to belong, and attempt to minimize the clear
violation
by stating that her basic financial needs have
already been met.
Since the daughter was clearly required to be a member of
her mother's AU
by September, 1992, an underpayment to
that AU occurred. Neither party
has disputed the
calculation of $108 as the proper amount of the
underpayment. The Federal Manual provides that --
[i]f the AU would have been entitled to a larger
payment, an
underpayment discrepancy is cited only
if the change in circumstances
regarding the
individual was known by or reported to the State and
s/he
met all eligibility requirements as of the
review date . . . .
Federal Manual, � 3536, at V-28. It is clear from the
record, and
the parties have not disputed, that the State
was informed of the change in
living arrangements of the
mother and her son a few days after the change
occurred
and two months prior to the month which was being
reviewed when
the discrepancy was found. Furthermore, we
have rejected the State's
argument that the daughter was
not a needy child within the definition of
the statute,
regulations, and policy guidelines, and the State has
neither argued nor proven that the daughter was not
otherwise eligible
for assistance. For these reason, an
underpayment has clearly
occurred, and we uphold ACF's
findings on this matter.
CONCLUSION
For the above reasons, we affirm ACF's decision finding
an underpayment
of $108 to the AU of I.W. for the review
month of September, 1992.
_______________________________
Thomas
Horvath
_______________________________
Leslie
A. Sussan
_______________________________
Gilde
Breidenbach Morrisson
* * * Footnotes * * *
1. / The March 31, 1992
notice to the State
identified an underpayment amount of exactly $100.
However, ACF stated in its brief that the federal quality
control
reviewer used the incorrect standard and that the
actual underpayment should
have been $108. See ACF Brief
(Br.) at 2,
n.1.
2. / Sections 406(a)
and 407(a) define the term
"dependent child" to include children who are
needy,
under a certain age (generally eighteen), and deprived of
parental support because of certain factors, including
continued
absence, incapacity, death or
unemployment.
3. / The
federal manual provides:
The AU must include, if otherwise eligible for
assistance, all
members of the household who are:
(1) the natural or adoptive parents of a
dependent
child; or
(2) siblings of a dependent child . . .
Federal AFDC Quality Control Manual ("Federal Manual"),
� 3536, at V-23
(October, 1992). The State manual
provides:
The primary member of the AFDC assistance unit is
the dependent
child for whom assistance is requested
or received. The brothers,
sisters and parents of
that child who live with the child and who meet the
AFDC eligibility requirements must be included in
the child's assistance
unit.
Connecticut Department of Income Maintenance Uniform
Policy Manual, �
2005.05(A) (January 1, 1991) (emphasis
in
original).
4. / ACF cited
two cases for the proposition
that courts have held that a child who falls
within the
definition of a mandatory family member of an AU does not
have to be needy before that child must be included in
the AU. See
ACF Br. at 3, citing Skidgel v. Maine Dept.
of Human Services, 994 F.2d 930
(1st Cir. 1993); Bowen v.
Gilliard, 483 U.S. 587 (1987). However,
while both of
these cases do contain general statements to that effect,
these cases dealt with the question of whether a child
who was not
financially needy, due to having independent
resources, must be included in
an AU when the fact of
including the child and his or her resources could
disqualify the family from eligibility for AFDC or reduce
its benefit
level under the program. We think these
cases are distinguishable from
the case here where the
child is clearly needy and the question essentially
is
which AU the child must be included in. Because the
facts of
this case are dissimilar to those cited above,
we do not find the cited
cases to be helpful,
particularly where the applicable statute, regulations,
and policy guidelines on who must be included in an AU
are
clear.
5. / The State also
offered an additional
argument which was difficult to comprehend:
A secondary argument presented by the State is
predicated upon the
qualified acceptance that the
Standard Filing rules required the mandatory
inclusion of this child in the A.U., but
simultaneously reflecting the
AFDC income in the
amount of her portion of the financial grant
available via her aunt's AFDC case. The result of
this process
also supports the State's original
contention that no underpayment
exists.
State Appeal File at 1. The State may have been arguing
here that
while the AFDC program requires the mandatory
inclusion of the daughter in
the mother's AU, the AFDC
income for the daughter was reflected in the
aunt's AFDC
payment for the review month in question. Therefore, to
include the daughter in her mother's AU for the review
month would
result in "double counting." However, our
review of ACF's
determination is limited to ACF's
findings of error, which in turn was
limited to a review
of the mother's AU.
In the alternative, the State may have been arguing that
there was no
material error in the amount of AFDC
payments made here since an increase in
benefits to the
mother's AU would have resulted in a corresponding
decrease in benefits to the aunt's AU. However, we
cannot make
this assumption without further evidence
concerning other resources
available to these two AUs and
the exact level of benefits which were being
paid prior
to the change in living arrangements. Furthermore, it is
immaterial for our purposes whether the benefits levels
would have
changed since the program requirements are
clear that the daughter should
have been included in her
mother's
AU.
6. / The
State did not argue, nor do we find
any evidence in the record, that the
daughter was not
properly eligible for AFDC payments as part of her aunt's
AU prior to the change in living
arrangements.
7. / In fact,
the regulations provide that when
a dependent child is required to be a
member of two AUs
which are in the same household, the AUs must be
consolidated. Federal Manual, � 3536, at V-23. However,
this
requirement does not apply here because the daughter
was not a mandatory
member of her aunt's AU; rather, the
daughter was originally included in her
aunt's AU because
she was living with her aunt and the aunt was her
caretaker. The State did not attempt to consolidate the
two AUs in
this case.
(..continued)