Chapter 1

 

Eligibility Integrity Unit General Provisions

 

Section 1.                Authority.  These Rules of the Department of Family Services (Department) are promulgated pursuant to Wyoming Statute § 42-2-103(b)(xiv). 

 

Section 2.                Purpose.  These Rules are adopted to implement a process for the Department and the Eligibility Integrity Unit (EIU) to investigate public assistance fraud, examine cases for possible erroneous public assistance benefits, sanction fraudulent activity by disqualification or prosecution, and pursue repayment of financial assistance that was incorrectly paid, pursuant to W.S. §42-2-112.

 

Section 3.                Incorporation by Reference.

 

(a)               For any rule or regulation incorporated by reference in these Rules:

 

(i)                 The Department has determined incorporation of the full text in these Rules would be unduly cumbersome or inefficient given the length or nature of the rules;

 

(ii)               The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section;

 

(iii)             The incorporated rule or regulation is maintained at the Department's Office and is available for public inspection and copying at cost at the same location.

 

(b)               The rule or regulation incorporated by reference is the Department's Chapter 1 - Contested Case hearing Procedures adopted by the Office of Administrative Hearings and effective on February 8, 2019, found at https://rules.wyo.gov

 

Section 4.                Severability.  If any provision of these Rules or the application thereof to any person, program, service or circumstance is held invalid, unconstitutional or contrary to federal or state law, the invalidity shall not affect other provisions or applications of these Rules.  To the extent these Rules can be given effect without the invalid provision, the remaining provisions of these Rules are severable.

 

Section 5.                Definitions.

 

(a)               "Benefit Specialist" is a person who determines an applicant's eligibility for the public assistance programs administered by the Department.

 

(b)               "Child Care Assistance Program" is a program for low-income families who need child care services in order to work or attend approved educational or training programs.  The Child Care Assistance Program is funded under the Child Care Development Block Grant (CCDBG).

 

(c)               "Claim" is a record that relates to an overpayment and depicts the month(s) of overpayment and the amount(s) overpaid for each month within that claim.  A total amount of overpaid benefits is also reflected on the claim.

 

(d)               "Claim Establishment Office" is the part of the EIU which is responsible for redetermining eligibility and establishing program claims.

 

(e)               "Date of Discovery" is the date the potential overpayment is identified by the Department.

 

(f)                "Date of Establishment" is the date the claim is authorized and established.

 

(g)               "Delinquent Claim" is a claim that has not been paid by the due date and a satisfactory payment arrangement has not been established; or a payment arrangement has been established but a scheduled payment has not been made by the due date. 

 

(h)               "Disqualification" is an action that is taken against an adult recipient wherein they are not allowed to participate in the Supplemental Nutrition Assistance Program (SNAP), Personal Opportunities With Employment Responsibilities (POWER) or Child Care Assistance program(s) for a specified period of time.

 

(i)                 "Disqualification Hearing" is a formal hearing which is conducted to determine whether an intentional program violation occurred.

 

(j)                 "Electronic Benefits Transfer (EBT)" is the means through which public assistance benefits are transferred to electronic cards.

 

(k)               "Eligibility Integrity Unit", formerly known as the Prosecution Recovery Investigation Collection and Enforcement (PRICE) Unit, is the entity within the Department that is responsible for investigating allegations of public assistance fraud, establishing overpayments and the collection of overpayments. 

 

(l)                 "Eligibility Investigator" is a person who is responsible for reviewing potential overpayment claim cases and making a redetermination of eligibility.

 

(m)            "Hearing Officer" is a person authorized to conduct disqualification hearings and make a decision whether an IPV occurred.

 

(n)               "Intentional Program Violation (IPV)" may occur when an individual intentionally:

 

(i)                 made a false or misleading statement;

 

(ii)               misrepresented, concealed or withheld facts; or

 

(iii)             committed any act that constitutes a violation of SNAP, SNAP regulations, or any Wyoming State Statute for the purpose of using, presenting, transferring, acquiring, receiving, possessing or trafficking of SNAP benefits or EBT cards.

 

(o)              "Investigator" is a person who is responsible for the investigation of allegations of public assistance fraud and who has the responsibility to collect any public assistance overpayments.

 

(p)               "Medicaid" is the medical assistance and services program for family and children, and those who are aged, blind or disabled pursuant to Title XIX of the Social Security Act and the Wyoming Medical Assistance and Services Act.

 

(q)               "Offset" means reducing the amount of the overpayment by the amount of an existing underpayment.

 

(r)                "Overpayment" means the amount of benefits issued to a household that exceeds the amount it was eligible to receive. 

 

(s)                "Performance Requirement" is a specified eligibility child support or work condition an applicant or recipient must meet in order to receive a performance payment from a program.

 

(t)                "Personal Opportunities With Employment Responsibilities (POWER)" is a cash assistance program funded under the Temporary Assistance for Needy Families (TANF) block grant.

 

(u)               "Supplemental Nutrition Assistance Program (SNAP)" is a nutrition benefits program to supplement the food budget of needy families so they can purchase healthy food and move towards self-sufficiency.

 

(v)               "Trafficking" means the buying or selling of EBT cards or other benefit instruments for cash or consideration other than eligible food; or for the exchange of firearms, ammunition, explosives or controlled substances.

 

(w)             "Treasury Offset Program (TOP)" is a program administered through the United States Department of Treasury which allows states to collect outstanding SNAP debts, most commonly through tax intercepts.