470 IAC 2.1 — ARTICLE 2.1. PUBLIC ASSISTANCE

TITLE 470 DIVISION OF FAMILY RESOURCES

ARTICLE 2.1. PUBLIC ASSISTANCE

Rule 1

470 IAC 2.1-1-1 470 IAC 2.1-1-1 Definitions

Rule 1. General Provisions

470 IAC 2.1-1-1 Definitions

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-13-1-1; IC 12-14; IC 12-15

Sec. 1. (a) The definitions in this section apply throughout this article.

(b) "Division" or "DFR" means the division of family resources established by IC 12-13-1-1.

(c) "Public assistance programs" means SNAP, TANF, medical assistance, eye treatment, and state supplemental assistance programs.

(d) "Supplemental Nutrition Assistance Program" or "SNAP" means the program established under 7 U.S.C. 2011 et seq.

(e) "Temporary Assistance for Needy Families" or "TANF" means the program established under 42 U.S.C. 601 et seq.

(Division of Family Resources; 470 IAC 2.1-1-1; filed Mar 1, 1984, 2:33 p.m.: 7 IR 1043, eff Apr 1, 1984; filed Feb 12, 1993, 5:00 p.m.: 16 IR 1806; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121- IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR-470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-1-2 470 IAC 2.1-1-2 Applicant and recipient responsibilities applicable to all public assistance programs

470 IAC 2.1-1-2 Applicant and recipient responsibilities applicable to all public assistance programs

Authority: IC 12-13-2-3; IC 12-13-5-3; IC 12-13-7-5

Affected: IC 12-13; IC 12-14; IC 12-15

Sec. 2. (a) Each applicant for and recipient of public assistance shall complete, or assist the DFR office in completing, the appropriate application form and related eligibility forms prescribed by the division.

(b) Each applicant and recipient is required to provide all information necessary to determine eligibility for public assistance and report any change in this information to the DFR office within ten (10) days of the date on which the change occurs.

(c) Each applicant and recipient is required to verify or assist the DFR office in verifying all information required to determine eligibility by signing appropriate release of information forms required to obtain verification of information provided to the DFR office or either of the following:

(1) Obtaining and providing to the DFR office documentation that verifies information required to determine eligibility.

(2) Undergoing required medical examinations necessary to determine eligibility.

(d) A caseworker may conduct an initial interview through a personal interview at the DFR office or by phone.

(e) If an applicant fails or refuses to provide the DFR office information or verification of information required to determine the applicant's eligibility for public assistance, the applicant shall be ineligible for assistance and the application shall be denied. Prior to denying an application under this section, the DFR office must provide the applicant written notice of the specific information or verification needed to determine eligibility and written notice of the date on which the application will be denied if the information or verification is not provided.

(f) Treatment plan requirements shall be as follows:

(1) Except as provided in subdivision (2), a recipient who is receiving public assistance due to disability, incapacity, or visual impairment shall be required to cooperate in a treatment plan that is recommended by the examining physician and approved by the division prior approval section, if the goal of treatment is full or partial alleviation of the recipient's disability, incapacity, or visual impairment.

(2) A recipient shall not be required to cooperate in a treatment plan if good cause for refusing exists. Good cause for refusing treatment includes, but is not limited to, the following:

(A) Treatment is contrary to the recipient's religious beliefs.

(B) Previous surgery of the type recommended was unsuccessful.

(C) The recommended treatment is very risky because of its magnitude, unusual nature, or other reason.

(D) The recommended treatment involves amputation of a limb or a major part of a limb.

(3) A recipient who fails to meet the requirement of this section shall be ineligible and assistance shall be discontinued.

(g) For the purposes of the TANF program, failure of an applicant to comply with the requirements of subsections (d) and (e) shall result in the ineligibility of the entire assistance group.

(Division of Family Resources; 470 IAC 2.1-1-2; filed Mar 1, 1984, 2:31 p.m.: 7 IR 992, eff Apr 1, 1984; filed Dec 16, 1986, 11:00 a.m.: 10 IR 1079; filed Feb 12, 1993, 5:00 p.m.: 16 IR 1807; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR-470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

Rule 2

470 IAC 2.1-2-1 470 IAC 2.1-2-1 Payment for examinations and tests (Repealed)

Rule 2. Medical Examinations; Diagnostic Tests

470 IAC 2.1-2-1 Payment for examinations and tests (Repealed)

Sec. 1.

(Repealed by Division of Family Resources; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR- 470230215FRA)

Rule 3

470 IAC 2.1-3-1 470 IAC 2.1-3-1 Release of information from DFR case records

Rule 3. Case Records

470 IAC 2.1-3-1 Release of information from DFR case records

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-14-22; IC 12-15-27

Sec. 1. (a) The DFR shall give an applicant or recipient, or their authorized representative, upon request, the opportunity to examine the entire case record.

(b) Before releasing information from public assistance case records in circumstances not required by state or federal laws or regulations, the DFR shall obtain a written release of information, signed by the applicant or recipient, authorizing the DFR to release the information to the requesting agency or individual. The written authorization must specify the scope of information the county department is authorized to release and the specific agency or individual to whom the information is to be released.

(c) As permitted by Section 2636 of Public Law 98-369, the DFR shall release the name and current address of TANF recipients who are fugitive felons to law enforcement officers when requested. The law enforcement officer must provide the DFR with a TANF recipient's Social Security number and sufficient information to demonstrate that the TANF recipient is a fugitive felon.

(Division of Family Resources; 470 IAC 2.1-3-1; filed Mar 1, 1984, 2:31 p.m.: 7 IR 993, eff Apr 1, 1984; filed Mar 7, 1985, 2:54 p.m.: 8 IR 797; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR- 470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

Rule 4

470 IAC 2.1-4-1 470 IAC 2.1-4-1 Claiming good cause for refusing to cooperate

Rule 4. Medical Support Enforcement

470 IAC 2.1-4-1 Claiming good cause for refusing to cooperate

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 1. (a) An applicant for or recipient of Medicaid will have the opportunity to claim good cause for refusing to cooperate as required by 42 CFR 433.147.

(b) Prior to requiring cooperation under 42 CFR 433.147, the DFR will notify the applicant or recipient of the right to claim good cause as an exception to the cooperation requirement and of all the requirements applicable to a good cause determination as follows:

(1) The notice will be in writing, with a copy furnished to the applicant or recipient.

(2) An acknowledgment that the applicant or recipient received the notice will be signed and dated by the caseworker and the applicant or recipient, and the acknowledgment will be placed in the case file.

(c) An applicant for or recipient of Medicaid who refuses to cooperate and who claims to have good cause for refusing to cooperate has the burden of establishing the existence of a good cause circumstance. The applicant or recipient will be required to:

(1) specify the circumstances as described in section 3 of this rule that the applicant or recipient believes provide sufficient good cause for not cooperating;

(2) corroborate the good cause circumstances in accordance with section 4 of this rule; and

(3) if requested, provide sufficient information to permit an investigation pursuant to section 4 of this rule.

(d) If the requirements of subsection (c) are not met, the DFR shall, on that basis, determine that good cause does not exist.

(Division of Family Resources; 470 IAC 2.1-4-1; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1298, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR- 470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR-470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-4-2 470 IAC 2.1-4-2 Determination of good cause

470 IAC 2.1-4-2 Determination of good cause

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 2. (a) For each applicant for or recipient of Medicaid who claims to have good cause, the DFR will determine, in accordance with sections 1, 3, and 4 of this rule, whether good cause exists.

(b) The DFR's final determination that good cause does or does not exist will:

(1) be in writing;

(2) contain the agency's findings and basis for determination; and

(3) be entered into the Medicaid case record.

(c) The DFR's determination of whether or not good cause exists will be made within forty-five (45) days from the day the good cause claim is made unless the department needs additional time because the information required to verify the claim cannot be obtained within the time standard, or that the claimant did not provide corroborative evidence within the period required by section 4(b) of this rule.

(d) If the DFR determines that good cause does not exist:

(1) the applicant or recipient will be notified and afforded an opportunity to cooperate, withdraw the application for assistance, or have the case closed; and

(2) continued refusal to cooperate will result in imposition of the sanction provided by 42 CFR 433.148.

(Division of Family Resources; 470 IAC 2.1-4-2; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1299, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR- 470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-4-3 470 IAC 2.1-4-3 Good cause circumstances

470 IAC 2.1-4-3 Good cause circumstances

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 3. (a) The DFR will determine that cooperation in securing support is against the best interests of an individual only if the applicant's or recipient's cooperation in securing support is reasonably anticipated to result in physical or emotional harm to the individual for whom support is to be sought.

(b) Physical harm and emotional harm must be of a serious nature in order to justify a finding of good cause under subsection (a). A finding of good cause for emotional harm may only be based upon a demonstration of an emotional impairment that substantially affects the individual's functioning.

(c) For each good cause determination which is based in whole or in part upon the anticipation of emotional harm to the individual, the state department will consider the following:

(1) The present emotional state of the individual subject to emotional harm.

(2) The emotional health history of the individual subject to emotional harm.

(3) Intensity and probable duration of the emotional impairment.

(4) The degree of cooperation to be required.

(5) The extent of involvement of the individual in the support enforcement activity to be undertaken.

(Division of Family Resources; 470 IAC 2.1-4-3; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1299, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR- 470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-4-4 470 IAC 2.1-4-4 Proof of good cause claim

470 IAC 2.1-4-4 Proof of good cause claim

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 4. (a) The DFR will make a good cause determination based on the corroborative evidence supplied by the applicant or recipient only after it has examined the evidence and found that it actually verifies the good cause claim.

(b) The applicant or recipient who claims good cause must provide corroborative evidence within twenty (20) days from the day the claim was made. In exceptional cases where the DFR determines the applicant or recipient requires additional time because of the difficulty of obtaining the corroborative evidence, the DFR shall allow a reasonable additional period of time.

(c) A good cause claim may be corroborated with the following types of evidence:

(1) Court, medical, criminal, child protective services, social services, psychological, or law enforcement records which indicate that the person from whom support would be sought might inflict physical or emotional harm on the individual.

(2) Medical records which indicate emotional health history and present emotional health status of the individual for whom support would be sought, or written statements from a mental health professional indicating a diagnosis or prognosis concerning the emotional health of the individual for whom support would be sought.

(3) Sworn statements from individuals other than the applicant or recipient with knowledge of the circumstances which provide the basis for the good cause claim.

(d) If, after examining the corroborative evidence submitted by the applicant or recipient the DFR wishes to request additional corroborative evidence which is needed to permit a good cause determination, the DFR will:

(1) promptly notify the applicant or recipient that additional corroborative evidence is needed; and

(2) specify the type of document which is needed.

(e) Upon request, the DFR will:

(1) advise the applicant or recipient how to obtain the necessary documents; and

(2) make a reasonable effort to obtain specific documents that the applicant or recipient is not reasonably able to obtain without assistance.

(f) Where a claim is based on the applicant's or recipient's anticipation of physical harm as specified in section 3 of this rule, and corroborative evidence is not submitted in support of the claim:

(1) the DFR will investigate the good cause claim when the agency believes that:

(A) the claim is credible without corroborative evidence; and

(B) corroborative evidence is not available; and

(2) good cause will be found if the claimant's statement and the investigation which is conducted satisfies the DFR that the applicant or recipient has good cause for refusing to cooperate.

(Division of Family Resources; 470 IAC 2.1-4-4; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1300, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR- 470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-4-5 470 IAC 2.1-4-5 Granting or continuation of assistance

470 IAC 2.1-4-5 Granting or continuation of assistance

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 5. The DFR will not deny, delay, or discontinue assistance pending a determination of good cause for refusal to cooperate if the applicant or recipient has complied with the requirements of sections 1 and 4 of this rule to furnish corroborative evidence and information.

(Division of Family Resources; 470 IAC 2.1-4-5; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1300, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR- 470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR-470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)

470 IAC 2.1-4-6 470 IAC 2.1-4-6 Periodic review of good cause determination

470 IAC 2.1-4-6 Periodic review of good cause determination

Authority: IC 12-13-2-3; IC 12-13-5-3

Affected: IC 12-15

Sec. 6. The DFR will:

(1) review, at each redetermination of eligibility, those cases in which it has determined that good cause exists based on a circumstance that is subject to change; and

(2) if it determines that circumstances have changed so that good cause may no longer exist, it will rescind its findings and proceed to enforce the requirements of 42 CFR 433.147.

(Division of Family Resources; 470 IAC 2.1-4-6; filed Jun 4, 1985, 2:37 p.m.: 8 IR 1300, eff Jul 1, 1985 [IC 4-22-2-5 suspends the effectiveness of a rule document for thirty (30) days after filing with the secretary of state. LSA Document #85-29 was filed Jun 4, 1985.]; readopted filed Jul 12, 2001, 1:40 p.m.: 24 IR 4235; readopted filed Oct 24, 2007, 11:25 a.m.: 20071121-IR-470070448RFA; readopted filed Aug 23, 2013, 3:36 p.m.: 20130918-IR-470130306RFA; readopted filed Nov 13, 2019, 11:56 a.m.: 20191211-IR- 470190490RFA; filed Aug 28, 2023, 9:55 a.m.: 20230927-IR-470230215FRA)