DPSS ePolicy

Revision of existing policy and/or form(s)

What changed?

This policy has been revised to include the following changes:

1. Language has been added to clarify and emphasize that when a General Relief (GR) participant decides to resolve a noncompliance that results in the reduction of benefits, they have the right to request and hold a Noncompliance Review and/or a GR Hearing through the last calendar day of the month in which benefit reduction began.
2. Procedures have been updated to emphasize to eligibility staff to review all issued GR overpayment (OP) Notice(s) of Action (NOAs) for accuracy and to issue manually drafted NOAs if the reviewed NOAs are determined to be missing required information.

Note: Changes are shown highlighted in gray throughout the document.

An OP occurs when an applicant/participant is not eligible for GR because eligibility requirements were not met on the first of the month for which the payment was made or when the applicant/participant is eligible, but the amount of the payment is more than what they were eligible for that month.

An OP may occur in the following situations:

1. An applicant/participant did not report a change in time for the correct GR benefit amount to be issued in the affected month(s);
2. The change was reported by the applicant/participant, but the California Statewide Automated Welfare System (CalSAWS) was not updated accurately and/or timely by eligibility staff;
3. The participant’s employability status has changed to employable in the same month that they are scheduled to be time-limited off GR;
4. A participant with approved GR benefits entered into incarceration, or a Board and Care (B&C)/Room and Board (R&B) facility;
5. An applicant/participant was erroneously aided in more than one cash assistance program;
6. An incorrect START-related expense was issued; or
7. A system malfunction or user error resulted in an excess issuance.

There are three types of errors that result in an OP:

Non-fraudulent:

• Participant Error – when an applicant/participant fails to meet their reporting responsibilities or reports information inaccurately and/or untimely.
• Administrative Error – when staff fail to update reported information in CalSAWS accurately and/or timely to prevent an OP.

Fraudulent:

• Intentional Program Violation (IPV) – when an investigation by Welfare Fraud Prevention & Investigations (WFP&I) determines that an applicant/participant committed fraud and the determination is substantiated by a court decision or a Disqualification Consent Agreement (DCA) was signed.
   

Los Angeles County Code of Ordinances, Chapter 2, Section 2.102.250 establishes County policy regarding GR OPs including the definition of an OP, the determination of error, and the method and rate of collection. The County has an obligation to identify, calculate, and adjust all GR OPs.

OP

GR benefits paid to an applicant/participant in an amount that is greater than the amount to which they were eligible.

Fraudulent OP

An OP that is caused by an IPV. An IPV can only be substantiated by a conviction in a court of appropriate jurisdiction or a DCA.

Non-Fraudulent OP

OPs are considered non-fraudulent unless they are caused by a substantiated IPV. OPs that were referred to the WFP&I Section for suspected fraud would also be considered non-fraudulent if:

1. Fraud was not found during an investigation; 
2. Fraud was found during an investigation but has not been substantiated by a court decision or a DCA; or
3. A fraud investigation is ongoing.
   

Participant Error

An error that results in an OP whenever an applicant/participant fails to meet their reporting responsibilities or reports information inaccurately and/or untimely. A Participant Error is known as Customer Caused in CalSAWS.

Administrative Error

An error that results in an OP whenever eligibility staff fail to update information in CalSAWS accurately and/or timely. An Administrative Error is known as Admin Caused in CalSAWS.

IPV

An error that results in an OP as a result of a WFP&I investigationthat determines an applicant/participant committed fraud and the determination is substantiated by a court decision or when a DCA is signed. 

DCA

An agreement between an accused participant and the Department of Public Social Services (DPSS) in which the participant agrees to an IPV designation and its corresponding penalty. A DCA may only be used as an option when an accused participant has met the terms of an agreement with a prosecutor or court in exchange for non-prosecution.

IPV Penalty Period

A period in which an applicant/participant cannot receive GR benefits but may be otherwise eligible.

Benefit Reduction

The process by which the County reduces the eligible monthly GR grant to recover an OP.

Reporting Responsibilities

A GR applicant/participant is required to report, at the time of their initial application or within five calendar days of occurrence, all information that may affect their GR eligibility or monthly grant determination.

Recovery Account

A CalSAWS account that has been set up to recover GR OPs.

Internal Recovery Account

An account that is automatically created by CalSAWS after an OP is identified, a GR grant is recalculated by CalSAWS, and the results are accepted by eligibility staff.

External Recovery Account

An account that is manually created by staff when an OP has been discovered and the benefit issuance was made outside of CalSAWS, or when an Internal Recovery Account cannot be established accurately in CalSAWS due to a system error.

Date of Discovery

The date the County has all information necessary to establish an OP.

POI

A period of time in which an individual is ineligible for GR benefits.

Reporting Responsibilities

An applicant/participant is presumed to know and reasonably understand the provisions for eligibility to GR, as well as their reporting responsibilities, unless evidence to the contrary is presented. Furthermore, an applicant/participant is presumed to know of changes in income, needs, resources, and other circumstances affecting their situation, unless evidence to the contrary is presented.

As such, an applicant/participant is required to report at the initial application and within five calendar days of learning of any change that may impact their GR eligibility or monthly grant determination.

Refer to 40-104 Reporting Responsibilities for General Relief Applicants and Participants Policy for more information on GR reporting responsibilities.

Reporting Responsibilities Met

An applicant/participant meets their reporting responsibilities when making an accurate and complete report of all facts that have an impact on their GR eligibility or monthly grant determination within five calendar days of learning of the change.

Reporting Responsibilities Not Met

An applicant/participant fails to meet their reporting responsibilities if they have been informed of their responsibilities, and knowingly fails to report facts that impact their GR eligibility or monthly grant determination.

Note: Reporting requirements for an applicant/participant with a Needs Special Assistance (NSA) designation may be temporarily deferred until co-located Department of Mental Health staff or another designated person has assisted the applicant/participant in reporting information.

Refer to 41-100 Needs Special Assistance Policy for for more information.

OP Responsible Party

In a two-household (HH) GR case, both members of the HH are responsible for an OP arising during the time a case is active and one or both HH member(s) are aided. Once the case is discontinued, adjustment activity may only be initiated against the responsible HH member(s).

Benefit Reduction for a Non-Fraudulent OP

Administrative Error

An Administrative Error occurs when staff fail to process reported information accurately and/or timely. The following steps must be taken when an Administrative Error causes an OP:

1. Action is taken to prevent any further OP from occurring;
2. The OP is recovered by reducing the eligible monthly GR grant by 10% or $10 per month, whichever is greater; and
3. The eligible monthly GR grant is reduced until the OP is recovered in full.

Note: If an applicant/participant chooses to return an OP at the district office in the form of cash, check, or money order, it is not to be refused.

Refer to Administrative Release (AR) 5655, Accepting, Posting, and Reconciling Recovery Account Payments, for instructions on how to accept cash collections at the district office.

Participant Error

A Participant Error occurs when the applicant/participant fails to meet their reporting responsibilities or reports information inaccurately and/or untimely.  The following steps must be taken when a Participant Error causes an OP:

1. Action is taken to prevent any further OP from occurring;
2. The OP is recovered by reducing the eligibility monthly GR grant by 100%; and
3. The eligible monthly GR grant is reduced until the OP is recovered in full.

Note: For a participant with an Needs Special Assistance (NSA) designation, the monthly eligible GR grant is reduced by 10% or $10.00 per month, whichever is greater, irrespective of whether the OP is due to an Administrative Error or a Participant Error.

Benefit Reduction for a Fraudulent OP (IPV)

An IPV designation is only established by the WFP&I Section or its designated staff. Penalties of up to a permanent ban from the GR Program may apply. Additionally, an OP that results from an IPV is recovered by reducing the monthly eligible GR grant by 100% until the OP is recovered in full.

For more information on the IPV process, please refer to the following policies:

GR Program – 44-312 General Relief Intentional Program Violation

CalFresh Program – 63-805 Intentional Program Violation

WFP&I – 20-002 Welfare Fraud Prevention and Investigation Section Processes

Resolving Noncompliances

A participant who decides to resolve a noncompliance that lead to an OP may do so by requesting and participating in a Noncompliance Review and/or requesting and participating in a GR Hearing by the last calendar day of the month in which benefit reduction began. A Noncompliance Review is not required before requesting a GR Hearing. If a noncompliance related to an OP is not resolved by the last calendar day of the month in which benefit reduction began, the participant will be considered to have waived their right to resolve the noncompliance.

Note: DPSS no longer preschedules GR Hearings upon an OP determination. A participant call the Hearing Officer to request a GR Hearing appointment. The contact information for the GR Hearing Officer is located on the NOA informing the participant of the OP.

Refer to 44-401 Initiate Hearings and Notices of Action and 44-403.5 Noncompliance Review and GR/START Hearing Process Policies for more information.

OP Adjustment Caused by GR Time-Limits

CalSAWS tracks the number of days an employable participant is eligible for GR and will discontinue GR when that time-limit is reached. When a participant’s employability status changes from Medical Unemployable/NSA/Administratively Unemployable to Employable after GR is issued for that month, and GR eligibility as an employable participant expires during the same month, the participant is not eligible for the entire month’s GR grant. CalSAWS is programmed to auto-calculate and apply an OP as an Administrative Error.

Refer to the 40-121 Time Limits Policy for more information.

OP Adjustment Identified by the Auditor-Controller (A-C) due to Duplicate Issuances

The A-C identifies OPs involving duplicate issuances in which the participant did not meet their reporting responsibilities. Occasionally, a participant receives a duplicate issuance for the same accrual period through Administrative Error. The A-C establishes an OP adjustment in CalSAWS for these cases. When a participant disputes an OP adjustment initiated by the A-C, the A-C is responsible for validating the OP adjustment.

OP Adjustment During B&C/R&B Facility Stay

An OP cannot be recovered during a participant’s stay in a B&C/R&B facility. If there is an established OP prior to or as a result of a participant entering a B&C/R&B facility, the benefit recovery is automatically placed on hold until the participant leaves the facility and resumes receipt of regular GR.

Refer to the 45-100 Board and Care Policy for more information.

OP Adjustment Caused by the Issuance of Special Need for Occupational Trade Tools Allowance

When the purchase of tools is required to secure full-time employment, a special need allowance of up to $50 may be issued to an employable applicant/participant. If an applicant/participant fails to obtain the subject employment and remains on GR after the issuance of the tool allowance, verification that the funds were spent on tools is required. If the applicant/participant fails to provide the verification for the purchase of the tools, an OP adjustment is initiated as a Participant Error.

Refer to the 44-202 Special Needs Policy for more information.

OP Adjustment due to Incarceration

When a participant is incarcerated, GR is discontinued effective the beginning of the month following the month in which the participant was incarcerated. A benefit recovery must be initiated for the period in which the participant was in jail and receiving GR simultaneously.

Vendor OP Adjustment

An OP that is due to payments made to vendors such as B&C/R&B facilities or Housing Subsidy vendors are handled by the Fiscal Operations Division, Benefit Recovery Accounting Section.

Refer to the 45-100 Board and Care and 46-103 General Relief Housing Subsidy and Case Management Program Policies for details.

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