Department of Health and Human Services
Departmental Appeals Board
QUALITY CONTROL REVIEW PANEL
SUBJECT: Missouri Department of
Social Services
Docket No. A-95-030
Decision No. QC78
DATE: March 8, 1995
DECISION
The Missouri Department of Social Services (Missouri) appealed
the
October 19, 1994 quality control review determination of the
Regional
Administrator (RA) of the Administration for Children
and Families (ACF) in
State QC Review No. 132087. ACF found a
$58 overpayment in this case
because the assistance unit (AU)
included an eighteen-year-old child who ACF
determined could not
reasonably be expected to complete secondary school, or
an
equivalent program, before reaching age nineteen.
On the basis of the record and the arguments of the parties, we
conclude
that Missouri adopted the expected date of graduation as
the standard for
when a child completes a secondary school
program. Since the
eighteen-year-old in this AU was not expected
to graduate until the month
after her nineteenth birthday, we
uphold ACF's finding of an error in this
case.
Background
The AFDC program provides for payments for the care of needy and
dependent children. Section 401 of the Social Security Act
(Act). A "child" is defined by the Act as a person under the age
of eighteen. Section 406(a)(2)(A). However, states are given
the option of paying AFDC to a child who is:
under the age of nineteen and a full-time student in a
secondary
school (or in the equivalent level of
vocational or technical training), if,
before he attains
age nineteen, he may reasonably be expected to complete
the program of such secondary school (or training).
Section 406(a)(2)(B).
Missouri has elected to make payments to eighteen-year-olds who
may
reasonably be expected to complete a program of secondary
school (or
vocational or technical training) prior to reaching
the age of
nineteen. Mo. Ann. Stat. � 208.040.
The AU in this case consisted of a caretaker relative and two
children,
one of whom was the caretaker's daughter and one of
whom was the caretaker's
granddaughter. During the review month
(August 1993), the daughter,
T.J., was eighteen years old. 1/
Therefore, T.J. was
eligible for AFDC only if she was a full-time
student in a secondary school
program or its equivalent who could
reasonably be expected to complete the
program prior to her
nineteenth birthday. T.J.'s nineteenth birthday
was May 30,
1994.
As of the review month, the most current information in the case
file
concerning T.J.'s student status and when T.J. could
reasonably be expected
to complete school was contained on an IM-
10 form dated May 1993. An
IM-10 is a Missouri form which
requests school verification of "regular
attendance" as a full-
time or half-time student. According to the
explanation provided
on the form, its purpose is to obtain information which
can be
used to determine if a child meets the work registration
requirements for AFDC and Food Stamps. The IM-10 contains a
column
titled "Expected Graduation Date." On the May 1993 form
concerning
T.J.'s attendance, "6/94" had been written in the
graduation date column by
a person at her school.
In its QC review, Missouri determined that the case had been
correctly
paid. 2/ Subsequently, the case was selected for
federal
re-review. In its re-review, ACF concluded T.J. was
ineligible because
she would not complete school until her
graduation day which was scheduled
for June 1, 1994, the month
after the month in which she turned
nineteen. Therefore, ACF
determined that T.J. could not reasonably
have been expected to
complete school prior to or in the month of her
nineteenth
birthday. By a letter dated August 1994, ACF notified
Missouri
that it had concluded the AU was overpaid by $58 because T.J. was
not eligible for AFDC.
Missouri requested the RA to review ACF's difference finding. In
its request, it explained that it had contacted the school and
determined that T.J.'s last day of class had been May 26, 1994.
It
also informed the RA that only senior students who completed
their high
school graduation requirements had May 26, 1994 as
their last day of
school. Other students continued to attend
school until June 10,
1994. Based on the last day she attended
classes, Missouri argued that
T.J. completed her high school
program on May 26, 1994, four days before she
turned nineteen.
The RA rejected Missouri's arguments. She concluded that the
Missouri AFDC Income Maintenance Manual established the date of
graduation as the completion date of school. At the time
Missouri
continued T.J.'s eligibility beyond her eighteenth
birthday, the available
information indicated T.J. would graduate
in June 1994, after her nineteenth
birthday. Therefore, the RA
determined that T.J. could not reasonably
have been expected to
complete an approved program before or in the month
she would
attain age nineteen.
Analysis
This case turns on the standard to be used in Missouri to
determine when
a child can reasonably be expected to "complete" a
secondary school
program. 3/ ACF argued that, under Missouri's
manual
provisions, the date of expected completion would be the
date of
graduation. Missouri argued the standard should be the
last day of
class. If the former standard is used, Missouri made
an error in this
case. If the latter standard is used, Missouri
arguably did not make
an error in this case. 4/ For the
reasons explained below,
we conclude that Missouri adopted the
date of gradation as the standard for
completion of a school
program and therefore erroneously included T.J. in
the AU during
the review month.
While the Act authorizes AFDC for eighteen-year-olds who are
reasonably
expected to complete school prior to their nineteenth
birthday, it does not
define "complete." In implementing this
provision, ACF chose to leave
the definitions of "complete,"
"full-time student," and "secondary school or
equivalent level of
vocational or technical training" to the individual
states which
elected to fund this option. Final Rule, 47 Fed. Reg.
5648, 5670
(1982); Interim Rule, 46 Fed. Reg. 46,750, 46,761 (1981).
The Quality Control Review Manual provides for the same deference
to
state definition of these terms. Section 3532 requires that
reviewers:
. . . verify that the 18 year old student can
reasonably be
expected to complete the program before
reaching age 19, or in the month
he/she turns 19.
Assess the point in time that a student completes a
secondary school program (or equivalent course of study)
in accordance
with the definition (or guidelines)
specified in the State operating
instructions. In the
absence of a definition, consider the date that
the
student takes his/her last exam, or attends his/her last
class,
whichever is earlier, as the point that he/she
completes the program for
eligibility determination
purposes.
In reviewing Missouri's Income Maintenance Manual, we conclude
that
Missouri adopted a "definition" or "guideline" concerning
when a student
completes a secondary school program. Below we
discuss Missouri's
statutory and Income Maintenance Manual
provisions dealing with this
issue. We then explain why we
conclude that Missouri has adopted the date of graduation as the
test for
when a child completes a school program.
Missouri's statutory authorization for AFDC for eighteen-year-
olds
provides that AFDC shall be paid to a dependent child who:
. . . is under the age of eighteen years; or is under
the age of
nineteen years and a full-time student in a
secondary school (or at the
equivalent level of
vocational or technical training), if before he attains
the age of nineteen he may reasonably be expected to
complete the
program of the secondary school (or
vocational or technical training);
Mo. Ann. Stat. � 208.040.
The Missouri statutory provisions
authorizing payment of AFDC to
eighteen-year-olds does not define the terms
"complete" or "full-
time student." However, Missouri's Income
Maintenance Manual
does provide additional guidance to its case workers as
to how to
evaluate when a child will complete a program and whether a child
is a full-time student. Under the heading of "School
Attendance,"
Chapter I, Section II, at page 27g states:
A. Legal Reference
RSMo 208.040 provides that an AFDC cash grant may
also be
received for eligible children under the age
of 19 if the child meets both
of the following
conditions:
1. The child is a full time student in high school
or an
equivalent level of vocational or
technical school in lieu of high
school.
and
2. The child may reasonably be expected to graduate
from
high school or the equivalent level of
vocational or technical school before
or in the
month of his/her 19th birthday.
When both of these requirements are met the child
will
be eligible for cash up to and including the
month he/she reaches age
19.
(Bold emphasis added.)
Subsection D of the Section, titled "Verification," provides:
Full time student status in high school or
vocational/technical
training (in lieu of high school)
and the expected date of graduation must
be verified
before the child can be eligible for a cash grant. The
form IM-10 may be used to verify student status.
(Emphasis added.)
The combination of the plain language of Missouri's Income
Maintenance
Manual, the design of the IM-10, and Missouri's
apparent practices as
evidenced by this case lead us to conclude
that Missouri has adopted the
date of graduation as the standard
for when a child completes
school. 5/
o Chapter I, Section II, at page 27g of the Missouri
manual
provides that a child, who is expected "to
graduate" before or in the month
of his/her
nineteenth birthday, is eligible for AFDC. The act
of
"graduating" is customarily associated with a
scheduled ceremony occurring
on a specific day.
Therefore, this manual provision can reasonably be
read as adopting the date that the student's
successful completion is
recognized (the graduation
date) as the standard for completion of a school
program.
o This interpretation of the term "to graduate" is
supported
by subsection D of that section which
addresses "verification" of the
eligibility of an
eighteen-year-old. That subsection directs the
worker to ascertain the "expected date of graduation"
in order to
determine eligibility. If, as Missouri
argued, the standard was not
the date of graduation,
then the manual would direct the worker to verify
some other event rather than the expected date of
graduation.
o This interpretation of the term "to graduate" is
further
supported by the form Missouri uses to
establish eligibility for
eighteen-year-old students:
the IM-10. The only portion of the
IM-10 dealing
with when a child is expected to complete school is a
column which requests the school to identify the
"expected graduation
date." Therefore, the only
apparent information that case workers
gather about
completion of school concerns, not the last day of
class,
but the date of graduation.
o The fact the Missouri statute and the additional
sections of
the manual use the word "complete" does
not alter the impact of its manual's
use of the term
"graduate." Completion of school could be measured
by any number of milestones including graduation.
The use of the
term graduation is therefore
consistent with and determinative of the
standard
Missouri adopted for eighteen-year-old students.
o Finally, nothing in the contents of the case record
or the
Missouri QC reviewer's record indicates that
Missouri had any other practice
for gathering and
evaluating information concerning when a child would
complete school. Rather, the only information in the
case record
concerning when T.J. would complete
school is contained on two IM-10s, one
dated May 1992
and one dated May 1993. Both identify June 1994 as
the expected graduation date. Neither contains, nor
is there
evidence that the worker sought, any
information concerning when the child
would last
attend school. Additionally, there is no indication
in
the record that the Missouri QC reviewer obtained
any information concerning
when T.J.'s expected last
day of class would be.
Missouri argued that the state statute authorizing payments to
eighteen-year-olds used the phrase "reasonably be expected to
complete a
program" and that this was the standard which defines
completion of a high
school program. Missouri Br. at 3.
Missouri concluded the
statute does not indicate that a
"'specified date in a specified year'
(graduation date) be used
as the reasonable standard to determine when the
individual
completes their educational program." Id.
We agree that the Missouri statute does not define what is meant
by
"complete." However, the Missouri Department of Social
Services, as
the state agency administering the AFDC program, has
promulgated manual
provisions which set a standard for workers to
use in formulating a
reasonable expectation as to whether a child
will "complete" school by the
month of their nineteenth birthday.
The manual defines completion in
terms of graduation and directs
the worker to verify the "date of
graduation" as the standard for
eligibility. Congress and ACF
intentionally allowed states to
define "complete" and Missouri cannot escape
the definition its
state agency adopted and instructed its workers to
use.
Missouri also argued that, since T.J. no longer met the
definition of
"full-time student" when she stopped attending
classes on May 26, the
Missouri "completion" standard must be
construed to be the last day of class
rather than the day of
graduation. We disagree. Eligibility for
eighteen-year-olds has
two distinct and independent elements: status
as a full-time
student and reasonable expectation of completion as of the
month
of the nineteenth birthday. It is easy to envision situations in
which a child could meet one element while not meeting the other
according to how a state chooses to define these elements.
6/
Missouri failed to explain why the fact that a child could cease
being a full-time student in one month but not graduate until the
following month leads to the conclusion that the child's last day
of
school should be considered to be the "expected date of
graduation."
Conclusion
For the reasons discussed above, we conclude that ACF correctly
determined that T.J. was not eligible for AFDC during the review
month
and there was an overpayment error in this case of $58.
__________________________
Sara
Anderson
___________________________
Fern
J. Feil
___________________________
Leslie
A. Sussan
* * * Footnotes * * *
1. In order to protect
her privacy, this AFDC recipient
is identified by her
initials.
2. The
Missouri QC reviewer wrote that she had verified
that T.J. was expected to
complete the school program before
reaching the age of nineteen by an IM-10
dated September 10,
1993. Missouri Ex. 2, unnumbered page 8.
However, even though
Missouri Exhibit 2 appeared to be the entire QC review
file, no
IM-10 with this date was included in Exhibit 2. Pursuant to
the
Panel's request for this document, Missouri indicated that it was
"apparent that the State QC reviewer meant to indicate that she
used the
Board of Education's letter dated 9-10-93" to verify the
expected completion
date. However, the Panel was also unable to
locate a Board of
Education letter date "9-10-93" or any other
correspondence in Exhibit 2
concerning when T.J. could reasonably
be expected to complete
school.
3. This case
was complicated by the fact that T.J.'s
completion of school occurred prior
to the completion of the QC
process. This allowed Missouri to argue
that, on the basis of
events occurring nine months after the review month,
the case had
been correctly paid. In this regard, we note that the Act
requires payment decisions for eighteen-year-olds to be based on
a
reasonable expectation of future events. As ACF explained in
its
brief, the fact that the expectation might subsequently prove
incorrect
(e.g., a child drops out of school the month before
completion), does not
mean that the expectation the worker
originally formulated was unreasonable
or the payment decision
erroneous. ACF Response Br. at 3.
However, in this case we do
not reach the question of whether subsequent
events can be used
to rehabilitate a payment decision which was not based on
information which would support a reasonable
expectation.
4. We say
arguably because, if the standard for
completion was the last day of class,
the case would then present
questions about how to apply the reasonable
expectation standard
in light of the fact that the only information in the
case file
concerned the date of graduation. Missouri argued that the
fact
that the file contained no evidence on which the worker could
have
formulated a reasonable expectation that T.J.'s last day of
class would be
May 26 was a procedural issue which was irrelevant
to the QC process.
We do not reach the question of procedural
versus factual correctness
because we conclude that the standard
for completion in Missouri was the day
of graduation. Under that
standard, T.J. was
ineligible.
5. The
decision in this case was delayed by Missouri's
failure to provide the Panel
with the entire text of its manual
provisions dealing with this element of
eligibility. Based on
Missouri's quotations of its manual, the Panel
preliminarily
concluded that Missouri had not adopted graduation as the
standard for completion and was prepared to apply the standard
set forth
in the QC Manual. The Panel therefore asked the
parties to brief
issues concerning procedure versus factual
correctness and how to evaluate
the correctness of this payment
in relation to the reasonable expectation
standard. The Panel
also reiterated its request to Missouri for the
entire text of
its manual provision. Upon receiving the manual
provision which
included the Verification standard, the Panel revised its
initial
conclusion.
6. For example, Missouri referred to the fact that it
is
possible for a student to complete a secondary school program
in mid-school
year and still participate in the graduation
exercises at the end of the
school year. We do not reach the
question of what "graduate" means in
reference to children who
finish their school requirements in mid-school
year and do not
attend school for the remainder of the school
year.