Department of Health and Human Services
Departmental Appeals Board
QUALITY CONTROL REVIEW PANEL
SUBJECT: Iowa Department of
Human Services
Docket No. A-93-203
Decision No. QC 54
DATE: October 7, 1993
DECISION
The Iowa Department of Human Services (Iowa) appealed the
June 28, 1993
quality control (QC) determination of the
Regional Administrator of the
Administration for Children
and Families (ACF) in State QC Review No.
91267. ACF
found that this case was ineligible for AFDC benefits in
Iowa because the assistance unit (AU) received AFDC
benefits during the
review month of September 1992 from
both the states of Washington and
Iowa.
For the reasons discussed below, we sustain ACF's
determination that Iowa
QC erred in finding the case
properly paid.
Relevant Authority
According to the Quality Control Manual (QCM), the
purpose of the QC
review is "to provide data on the
accuracy with which the local agency is
applying AFDC
eligibility and payment requirements." QCM � 3010.
Section 3020 of the QCM provides:
The QC review independently establishes and verifies
the facts
about each element of eligibility for each
case drawn from [the sample] . .
. for a particular
month called the "review month". The review
establishes whether the sampled case was, in fact,
eligible and whether
the proper amount was
authorized for the review month prior to sample
selection . . . .
Under section 402(a)(7) of the Social Security Act, a
State plan for aid
and services to needy families with
children must--
. . . provide that the State agency--
(A) shall, in
determining need, take into
consideration any other income and resources of
any child or relative claiming aid to families
with dependant children .
. . .
ACF relied on section 3571 of the QCM to support its
position. That
section states:
An eligible AFDC unit is paid by the State in which
the family
resides. It is possible for individuals,
who move from one State to
another, to receive
assistance from both the old and new State in the
same month. However, the new State in which the
assistance unit
resides would have to consider the
assistance paid by the State of prior
residence to
determine need and the amount of assistance payable.
The preamble to 45 C.F.R. 233.40 also provides:
In order for a person to qualify under the new rule
as a resident
in a State, he or she must not be an
AFDC recipient in another state at the
point in time
that he or she gets assistance in the new State. He
or she may have been a recipient earlier that same
month, and assistance
from the prior State may have
been paid for the entire month under that
State's
plan. In that case the new State would need to
consider
that assistance in determining need.
Emphasis supplied. 45 Fed. Reg. 26961 (April 22, 1980).
The QCM further provides that the appropriate primary
evidence of whether
or not an eligible AFDC unit is
receiving benefits from a former State of
residence is
written verification from another State's IV-A
agency
or other evidence appropriate to establishing the receipt
of other assistance payments. QCM � 3571.
Factual Background
T.M. applied for AFDC benefits in Iowa in May 1992. The
Federal QC
reviewers found that the local agency record
stated that the application,
dated May 18, 1992, was
rejected because T.M. was still receiving benefits
in the
State of Washington. The Iowa local agency worker
indicated
in the case file that the Washington case
worker was contacted by telephone
a number of times and
that as of May 26, 1992, the Iowa local worker was
informed that no benefits were returned to the State of
Washington and
that the State of Washington would cancel
T.M.'s case effective July 1,
1992.
The State QC reviewers recorded on the facesheet of the
worksheets that
T.M. reapplied for AFDC benefits on
July 13, 1992 and that the Iowa AFDC
case was opened on
July 8, 1992. The Notice of Decision in the local
agency
record, dated July 14, 1992, indicated, however, only
that AFDC
was approved and the first month's benefits
were prorated from July 8,
1992.
On its review, the Federal Quality Control found that the
local agency
record for the July 1992 eligibility
determination for T.M. did not address
the issue of
whether the benefits from Washington had in fact
terminated. Consequently, Federal Quality Control
contacted
Washington and received written verification
that T.M.'s AFDC benefits from
Washington continued for
the months of July, August, and September
1992. The
Washington benefit amount was $624 for the review month
of September 1992. Therefore, under the applicable
regulation and
QCM provisions, the payment from
Washington should have been considered as
income by the
Iowa local agency workers. Thus, since the Washington
payment was greater than the Iowa payment, Federal
Quality Control
determined that T.M. was not eligible to
receive AFDC benefits of $548 from
Iowa in the review
month.
Analysis
Iowa argued here that its State Quality Control finding
was correct; that
T.M. received a correct AFDC payment of
$548 from Iowa during the review
month. The State
contended that its State Quality Control verified
with
the client's case worker in the State of Washington that
the
Washington AFDC payment of $624 for the month of
September 1992 was issued
in error and that a warrant for
recoupment of the payment was issued.
Iowa also stated
that the case worker also stated that the client had
signed an affidavit attesting that she had never
received, endorsed or
cashed the payment issued to her
from Washington for September 1992.
Iowa stated that
under its Employees' Manual IV-B-34a, T.M. would be
eligible for assistance in Iowa "if the grant is retained
by or returned
to the other state and is not available to
the recipient or if the other
state determines that the
assistance received from that state is subject to
recoupment." Thus, Iowa contends that T.M. did not
receive a
duplicate AFDC payment in September 1992
because the payment made by
Washington is subject to
recoupment and therefore, the State Quality Control
finding should be sustained.
The primary purpose of the Quality Control review system
is to determine
whether the local agency has made the
proper eligibility
determinations. Iowa's arguments
here, however, are all based on
information received and
determinations made by Iowa after the Federal
Quality
Control review determined the case was ineligible. There
is no indication in the record that the local agency
worker considered
either the Washington payment to be
subject to recoupment or considered
whether the
provisions of Employees' Manual IV-B-34a applied to the
circumstances here. Rather, Iowa presented these after-
the-fact
arguments in an effort to excuse the original
eligibility determination made
by the local agency
worker.
In an effort to determine whether the local agency worker
received
written verification of T.M.'s status from
Washington at the time T.M.
reapplied in July 1992, the
Panel asked Iowa to submit with its reply any
documentation or information contained in the local
agency's record that
states the basis for the local
worker's determination that T.M. was eligible
for AFDC
benefits in Iowa in July 1992. While Iowa stated that
T.M. was approved for benefits effective July 8, 1992
based on
verification from Washington, the only
verification mentioned in the
submission is the prior
June 1992 phone call from the T.M.'s Washington
caseworker in which he stated that T.M. would be
terminated on July 1,
1992. The local agency record
fails to show that the local worker
attempted to update
the information that was received from the Washington
worker by phone in June 1992. Furthermore, there is no
indication
from the record that the Iowa local worker
ever sought written verification
from Washington in
accordance with the requirements of the QCM. Given
that
T.M. had already been found ineligible in May 1992
because she was
still receiving benefits in Washington,
there is no appropriate verification
in the local agency
record at the time of the July 1992 eligibility
determination to show that T.M. was no longer receiving
benefits from
Washington. Therefore, Iowa's recent
contention, for example, that it
now has information from
Washington that T.M.'s endorsement on the September
1992
payment may have been forged is irrelevant because this
was not
information that the local worker received or
considered in making the
eligibility determination here.
We also consider the Iowa
Employee's Manual provision IV-
B-34a inapplicable here. The Social
Security Act,
federal regulations and the QCM provisions clearly
provide
that a State agency must consider all income when
determining need.
The fact that the local worker did not
seek written verification from
Washington means that the
local worker had no basis for assuming that the
Washington benefits had in fact stopped. Moreover, the
local
worker had no basis for assuming that the
Washington benefit for the review
month had been retained
by or returned to Washington or that Washington
intended
to recoup the payment. If Iowa had requested written
verification from Washington, it may have learned that
T.M. continued to
receive benefits from Washington in
July, August, and September 1992 despite
the fact that
T.M. received a termination notice from Washington in
June
1992. Furthermore, if the case worker had received
written
verification that T.M. was not receiving such
benefits, then an eligibility
determination made on that
basis would be supportable, even if it was later
determined that the written verification received was
incorrect.
Based on the record before us, we conclude that the Iowa
local agency
failed to verify that T.M. was in fact no
longer receiving benefits from
Washington before
determining T.M. eligible in Iowa. As a result, Iowa
failed to follow section 3571 of the QCM and 45 C.F.R. �
233.40 when it
did not consider the payment from
Washington in determining the amount of
assistance
payable, if any, to T.M. from Iowa for the September 1992
review month.
Conclusion
For the reasons discussed above, we sustain ACF's
determination that AFDC
recipient was ineligible to
receive benefits in Iowa during the review
month.
_____________________________
Carmen Cafasso
_____________________________
Peggy McFadden-Elmore
_____________________________
Andrea M.
Selzer
(..continued)