1414 Disposition of Application

1414 Disposition of Application

The purpose of this section is to provide instructions regarding the procedures which follow the determination of eligibility or ineligibility for assistance. Eligibility/ineligibility is documented using KEES procedures. A copy of the Notice of Action is to be sent to medical providers to certify eligibility/ineligibility when required.

One of the following case actions must occur within the established time period outlined in 1413.

1414.1 Approval

A notice of approval(s) shall be sent for all programs determined eligible. Notices must contain the amount of benefits and the beginning and ending dates of the review period.

1. Approved - The application will be approved if automatically eligible or if determined eligible with respect to all factors including financial. All households are to be notified of the appropriate reporting requirements upon approval for assistance benefits. See 9120.
2. Approved - Suspended - If the applicant is eligible with respect to all factors other than financial but there is a spenddown (see 7530), the application will be approved in a spenddown status if there appears to be a likelihood that the spenddown will be met within the 6-month eligibility base period using evidence provided by the client and known to the agency. Eligibility staff shall refer to the guidance provided in Policy Memo 2017-03-01, re: Living Arrangement Changes including HCBS Termination - Special Project , to determine whether a spenddown should be approved. This is an administrative procedure to meet the application disposition time requirements and to preserve the original application date. However, there is no eligibility until the spenddown is met. See 1422 concerning suspension.

1414.2 Denial

A denial shall be processed to assure that the applicant is provided with his/her denial notice in a timely manner. A notice of denial shall be sent at the time of denial, explaining clearly the reason for the denial.

1. Found Ineligible
   1. An application shall be denied if the applicant is found to be ineligible (i.e., excess income, excess resources, etc.) as soon as possible, but not later than 45-days following the date the application was filed.
   2. A denied application may be reinstated without a new application any time within the original 45 day processing time line. See also 1414.2 (3).

   In no case does the denial of the application abridge that individual's right to reapply at any time.

2. Reserved
3. Failure to Provide Required Information/Cooperation - An application shall be denied after a period of 12-days from the date of a written request for information when the applicant has failed to provide required information or cooperate with eligibility requirements. The applicant must be informed in writing of the 12 day standard and the date by which the verification/cooperation must be received.

   If the information is subsequently received or the household cooperates within the 45 day application processing time period, the application shall be reactivated and, if eligible, benefits prorated from the date of application. If the information/cooperation is not received within the above time frames, then the client must re-apply.

   If the requested information/cooperation is not received within the 45-day application processing time period, but is provided within 12-days of the date of denial, the application shall be reconsidered and processed based on the original application date. This gives the applicant the later of 45-days from the date of application or 12-days from the date of denial to provide the information.

   NOTE: For reviews discontinued for failure to provide or failure to return the review, see the reconsideration period policy in 9350.

4. Spenddown - If there is a spenddown which appears unlikely to be met within the 6-month eligibility base period, the application shall be denied. See also 1414.1 (2).
5. Another Agency Assumes Responsibility - The agency may dispose of the application if another agency assumes complete responsibility for meeting the applicant's need.
6. Cannot be Located - The agency may dispose of the application if the applicant has moved and cannot be located. The agency shall not send a notice of decision.