218-RICR-20-00-3
218-RICR-20-00-3. General Public Assistance Program (version Amendment, 09/28/2021 to 01/04/2022)
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3.1 Introduction
A. R.I.
Gen. Laws Chapter 40-6, entitled "Public Assistance Act,"
establishes the legal basis for a General Public Assistance Program.
In that the State has resources:
1. The
General Public Assistance (GPA) cash programs are available for
adults age eighteen (18) years of age and older who have an illness
or medical condition that keeps them from working.
2. GPA
shall not be provided to any individual who has been determined
eligible for Supplemental Security Income (SSI) or who is eligible or
who would be eligible for the Rhode Island Works (RIW) program.
3. GPA
eligibility shall not exist for certain persons who are in the care
of, confined by, or in the custody of another State Agency such as
the Department of Corrections (DOC), the Department of Children,
Youth and Families (DCYF) or the Department of Behavioral Healthcare,
Developmental Disabilities & Hospitals (BHDDH).
B. Types
of GPA Assistance
1. Interim
cash assistance, also known as GPA Bridge, may be provided to
individuals who have been approved for Title XIX Medicaid and are
pursuing a claim for Supplemental Security Income (SSI).
2. GPA
Hardship Emergency, may be provided to individuals who have a
disability, expected to last thirty (30) days or more which prevents
them from working, and have applied for Title XIX Medicaid. This
program is subject to funding made available to the Rhode Island
Department of Human Services (DHS) for this purpose.
3. Supplemental
payments for funeral and burial costs may be provided through vendor
payments as determined by Departmental Regulations.
3.2 Interim Cash Assistance –
Bridge Fund
A. Individuals
may be eligible to receive cash assistance in the form of a
semi-monthly payment while they are awaiting the determination of SSI
eligibility. This program of interim cash assistance is referred to
as the “Bridge” Fund or program.
1. This
program is limited to individuals who have applied for and been found
eligible for Title XIX Medicaid and who have applied for and are
actively pursuing a claim for Supplemental Security Income (SSI)
benefits.
2. A
determination for Medicaid affordable care coverage (ACC) must be
completed under the Modified Adjusted Gross Income (MAGI) or Elder
and Adults with Disability rules (EAD) prior to a determination of
eligibility.
3. Eligibility
for the Interim Cash Assistance for Disabled (Bridge Fund) is
restricted to individual applicants only.
a. Couples
may apply as individuals (one (1) or both could be found eligible as
individuals).
(1) If
both are eligible, each may be provided individual Bridge payments.
4. Applicants
must meet the following eligibility requirements:
a. Must
have filed an application for Bridge Fund;
b. Must
have applied for Medicaid affordable care coverage (ACC) for
eligibility under Modified Adjusted Gross Income (MAGI) or Elder and
Adults with Disabilities (EAD) Rules;
c. Must
have been found eligible for Title XIX Medicaid;
d. Must
have filed a claim for Supplemental Security Income (SSI) benefits
and be actively pursuing the claim;
e. Must
have signed an agreement that if the SSI claim is waived in favor of
Title II Social Security Disability Insurance (SSDI), the individual
will repay DHS to the extent DHS would have been reimbursed through
the SSI claim;
f. Must
have completed the Authorization for Reimbursement form before any
benefits can be paid; and
g. Income
and resource must be within the limits established in §§
3.5 and 3.6 of this Part.
B. Bridge
Fund Payments
1. Payments
under the Bridge Fund will be made semi-monthly (approximately the
first (1 st ) and sixteenth (16 th ) of the month).
2. The
payment level is two hundred dollars ($200.00) per month but is
subject to annual appropriations.
3. All
payments to eligible applicants will be made prospectively beginning
with the next effective payroll after all eligibility requirements
have been met and approval granted.
3.2.1 The
Application Process
A. The
application process for General Public Assistance starts when an
individual or his/her representative contacts the DHS to request
assistance by way of a signed DHS-2 application or DHS customer
portal application submission and either are applying for or are
approved for Medicaid affordable care coverage.
1. The
purpose of the application process is to:
a. Ensure
the right of a person to apply without delay for assistance.
b. Provide
an opportunity for the person to state his/her needs and to learn
what the DHS can do to help him/her.
c. Provide
the initial opportunity for the person to know what his/her
responsibilities are in his/her relationship with the DHS.
2. An
applicant may be assisted by an individual(s) of his/her choice and,
when accompanied by such individual(s), may be represented by
him/her.
3. A
request for assistance may be received in the DHS regional office in
person, by phone, electronically or by mail.
a. Applicants
can apply online via www.healthyrhode.ri.gov .
b. Applicants
for GPA hardship and bridge payments must apply for and be determined
eligible for Medicaid affordable healthcare coverage prior to a
determination of GPA eligibility.
c. Applicants
may be required to complete additional forms once an application is
received.
4. If
the application for GPA is necessary by reason of accident, injury or
illness for which a third (3 rd ) party may be liable, such
applicant is advised that the DHS-2, Application for Assistance, or
DHS customer portal GPA application, contains an assignment of rights
to the Department of Human Services (DHS), for and on behalf of the
applicant and any person for whom s/he may legally act, for repayment
limited to the amount of financial assistance furnished by the
Department.
B. The
DHS representative has the responsibility to act promptly upon the
application. A decision on eligibility and payment or ineligibility
is made within thirty (30) days from the date of the receipt of the
signed application.
1. Within
thirty (30) days of submitting an application, the applicant is
responsible to fulfill any eligibility requirements as prescribed in
§ 3.3 of this Part and to provide such verifying documentation
as may be necessary to complete the application.
a. If
the applicant does not comply with the above procedural requirements,
the application is denied and the applicant is notified of his/her
right to reapply.
b. When
the applicant is found ineligible, he/she is notified of his/her
ineligibility and informed of his/her right to appeal the decision,
and the method by which to request a fair hearing.
C. Potential
Eligibility for Supplemental Security Income (SSI)
1. An
applicant for GPA who will be sixty-five (65) years of age within one
(1) month, or an applicant who is disabled as defined below, is
required to file for and cooperate in the eligibility determination
for SSI.
a. Disability
is defined by the Social Security Administration (SSA) as the
inability to do any substantial gainful activity by reason of any
medically determinable physical or mental impairments which can be
expected to result in death or which has lasted or can be expected to
last for a continuous period of not less than twelve (12) months.
2. The
applicant is expected to file a written application for SSI within
thirty (30) days from the date of the GPA intake appointment.
a. If
verification of filing is not received by the DHS representative
within thirty (30) days, or if the individual applies and
subsequently refuses to cooperate in the determination of SSI
eligibility, a notice of GPA ineligibility is sent, and the case is
closed due to non-compliance.
b. "Interim
assistance" begins with the day on which the individual files an
application for SSI benefits and is found eligible for SSI benefits.
It ends when the individual receives the initial SSI check.
D. SSI
Denial
1. If
upon review by the worker, or if the applicant reports to the worker
that his/her SSI application has been denied, the worker should
instruct the applicant that s/he has sixty (60) days from the SSI
denial date in which to file for reconsideration of the denial.
2. If
the reconsideration is completed and subsequently denied, the
applicant should be aware that, according to SSA policy, the
applicant has sixty (60) days from the reconsideration denial to file
a request for a SSA hearing.
3. Applicants
should always check current SSA policy for appropriate filing dates
and deadlines.
E. Application
for Payment – Collateral Source
1. A
collateral source is a third (3 rd ) party who may be liable
for accident, injury or illness of GPA applicants awaiting a decision
on an application for payment.
a. When
an applicant needs and accepts a GPA payment during the period in
which application for payment from a collateral source is pending,
repayment to the State of Rhode Island may be required if the
applicant is subsequently found eligible for monies from the
collateral source.
2. When
the DHS-2, Application for Assistance, or DHS Customer Portal
application, is signed by the applicant, s/he assigns all rights to
the Department of Human Services (DHS) for and on behalf of
herself/himself and any person for whom s/he may legally act, for
amounts recoverable from a third (3 rd ) party equal to the
amount of financial and/or medical assistance provided as a result of
said accident, injury or illness.
a. Collateral
Sources. (third (3 rd ) parties) include but are not limited
to:
(1) Insurance
companies,
(2) Employers,
(3) Property
owners,
(4) Business
establishments,
(5) Service
providers, and the like who may be liable for personal injury to the
applicant as a result of on-the-job accidents,
(6) Automobile
accidents, slip-and-fall accidents malpractice claims, etc. and
insurance companies liable for Worker's Compensation and other
insurance who may be liable for payment to the insured.
b. Generally,
these payments are retroactive payments covering a period of time GPA
was paid because the income from the collateral source was not
available.
c. RSDI
benefits are not subject to reimbursement.
d. Funds
subject to such assignment and agreement may extend to and are
limited to all GPA payments (monies and vouchers) provided to such
applicant, any family members included in the applicant's GPA
standard of assistance, and all GPA vendor payments made on behalf of
the applicant for medical care related to the accident, injury or
illness for which the third (3 rd ) party may be liable.
(1) The
applicant is informed of his/her right to a hearing regarding the
apportionment of such funds.
3.2.2 Eligibility
Requirements for GPA
A. Residence
Requirements
1. To
be eligible for GPA, a person must be a resident in a city or town in
the state of Rhode Island. No person is eligible for GPA who moves
out of Rhode Island.
2. A
person does not have to reside in a permanent dwelling or have a
fixed mailing address to be considered a resident of a city or town.
a. To
facilitate the application process of homeless persons for GPA, a
sworn statement submitted by the applicant/recipient is acceptable
verification of residence.
B. Age
and Verification of Age
1. The
minimum age requirement for individuals and couples is eighteen (18).
Verification of age is obtained through birth certificates, baptismal
certificates, marriage certificates, or other vital records
documents.
a. Other
acceptable documents on which age is specified are award letters for
Retirement Survivors Disability Insurance (RSDI), insurance policies,
passports, naturalization papers, and employment, school, or military
records.
b. When
verification of age is unobtainable from such documents, a third
(3 rd ) party affidavit is acceptable evidence.
C. Citizenship
and Alienage Requirements
1. To
be eligible for GPA, an otherwise eligible applicant must be either a
United States citizen or a non-citizen lawfully admitted for
permanent residence or otherwise residing in the United States under
color of law.
2. GPA
benefits shall not be provided to undocumented non-citizens.
a. A
non-citizen is any person who is not a citizen or a national of the
United States.
b. There
are legal permanent resident (LPR) non-citizens, non-resident
non-citizens, and undocumented non-citizens.
3. The
following gives the definition of legal permanent resident and
non-resident and undocumented non-citizens and the policies to be
followed for each.
a. Legal
Permanent Resident (LPR) Non-citizen
(1) For
a person who is applying as an individual for GPA, a LPR is defined
as one who was lawfully admitted for permanent residence in
accordance with the immigration laws, such status not having changed
since admission.
(2) A
LPR, sponsored by an individual or an organization and applying for
GPA within three (3) years following entry into the United States, is
requested to obtain the cooperation of the sponsor, if possible, for
the purpose of determining what income and resources, if any, are
available. Income and resources are counted only to the extent that
they are actually available to the lawful permanent resident.
b. Non-resident
Non-citizen
(1) Non-resident
non-citizens are foreign nationals who have applied for admission to
the United States with the intention of merely visiting this country
for a specific purpose (non-immigrants).
(2) Non-resident
non-citizens include the following: diplomats, visitors to the United
States who come for business or for pleasure (tourists), people who
are in transit through the United States, crewmen aboard ships,
qualified students who are here to pursue a full course of study at
an established institution of learning, a fiancé(e) who seeks
to marry a United States citizen within ninety (90) days after entry,
and certain other people who were admitted to this country by the
United States Citizenship and Immigration Services (USCIS) on
temporary status.
(3) An
applicant who is a non-resident non-citizen is not eligible for GPA.
c. Undocumented
Non-citizens
(1) Undocumented
non-citizens are individuals who are not legally in this country.
(2) An
applicant who is illegally in this country is not eligible for GPA.
4. Verification
of Citizenship
a. To
reduce barriers to eligibility for applicants/recipients, the
Department will attempt to verify citizenship and identity via the
State Verification and Exchange System (SVES) interface with the
Social Security Administration.
(1) If
the interface reveals a discrepancy or is unable to provide
verification of citizenship or identity, it is the responsibility of
the applicant/recipient to provide the required verification.
b. Any
document submitted as evidence of United States citizenship must show
either the applicant's United States birthplace or indicate United
States citizenship (e.g., a United States Passport).
c. When
needed, assistance in obtaining the necessary document(s) is provided
to applicants by the DHS staff.
d. Acceptable
documents which may be used as evidence of United States citizenship
by birth or naturalization include the following:
(1) Birth
Certificate (including INS Form I-197);
(2) Naturalization
Papers;
(3) United
States Passport;
(4) Hospital
record of birth;
(5) Baptismal
record (only when the place and date of birth are shown);
(6) Military
service records;
(7) Indian
census record;
(8) Voter
registration record;
(9) Applicant's
name and place of birth on his/her child's birth certificate;
(10) Bureau
of Vital Statistics or local government records of an applicant's
place of birth; or
(11) Family
Bible (the date of publication should be prior to the applicant's
birth date).
(12) When
verification of United States Citizenship is unobtainable from one
(1) of the sources listed above, and the applicant can provide a
reasonable explanation as to why such verification is unobtainable,
an affidavit from a third (3 rd ) party may be accepted as
evidence of United States citizenship, age, and identity.
3.2.3 Determination
of Income
A. Income
is the receipt of money, goods, services or money’s worth which
is available to the assistance unit.
1. The
prospective budgeting method is used to determine the income which
will exist during the period of eligibility for GPA.
a. This
means that weekly income is converted to a monthly amount using the
4.3333 conversion method.
2. The
information the client supplies on the DHS-2 about income is
documented.
3. The
document sources are business records, wage stubs, Income Tax
returns, Award letters, or other similar documents, as well as
reports from Social Security, Veterans’ Administration, and
other agencies.
4. All
available income, both presently available and potentially available,
unless excluded by policy, is considered in determining eligibility.
This includes:
a. All
income, both earned and unearned, of any person for whom assistance
is being sought; and
b. All
income of a spouse in the home, unless the spouse is an SSI
recipient.
5. When
there appears to be potential eligibility for a benefit that an
applicant/recipient does not yet have, such as Retirement, Survivors
and Disability Insurance (RSDI), Unemployment Insurance (UI),
Temporary Disability Insurance (TDI), Veterans Administration (VA)
benefits, etc., the applicant/recipient is required to file for such
benefits.
a. Before
GPA assistance can be provided, an applicant is required to verify
that s/he has filed for the potential source of income.
b. If
verification of filing an application for aforementioned identified
income is not received by the DHS representative within forty-five
(45) days of the GPA-Bridge application, the application is denied.
c. Recipients
who may be eligible for an alternate source of income must apply for
that benefit within ten (10) days of the date the DHS becomes aware
of the potential benefit.
(1) Failure
by the recipient to comply with the referral results in termination
of eligibility.
B. Earned
Income
1. Earned
income is income, in cash or in kind, earned by an individual through
the receipt of wages, salary, commissions, or profit from activities
in which s/he is engaged as a self-employed individual or as an
employee.
a. It
is counted as income only when it is received (or would have been
received except for the decision of the recipient to postpone
receipt) rather than when earned.
2. Earned
income does not include returns from capital investment with respect
to which the individual is not himself/herself actively engaged, such
as dividends and interest, It also does not include benefits such as
individual pensions, RSDI, UI, TDI, or Veterans’ Benefits.
3. Earned
income does include:
a. Earnings
over a period of time for which settlement is made at one given time.
b. Income
which the individual produces as a result of the performance of
service, including managerial responsibilities, is classified as
earned income. (Examples are income from a roomer or boarder and
income from real property.)
c. Earned
Income Credit (EIC), including payments which the applicant/recipient
actually receives.
d. Training
incentives under JTPA (Job Training Partnership Act) as well as wages
from JTPA employment.
C. Unearned
Income
1. Unearned
income may be accessed from many sources, including but not limited
to:
a. Unemployment
Insurance (UI)
An
applicant or recipient of GPA who has worked in the past fifty-two
(52) weeks is required to file a claim for Unemployment Insurance
(UI) and advise the DHS of the results.
b. Temporary
Disability Insurance (TDI)
An
applicant or recipient of GPA who has worked in the past fifty-two
(52) weeks is required to file a claim for Temporary Disability
Insurance (TDI) and advise the DHS of the results.
c. Retirement,
Survivors, and Disability Insurance (RSDI)
In
considering Retirement, Survivors, and Disability Insurance (RSDI),
the total amount of benefit received from RSDI is considered as
income.
d. Workers’
Compensation
e. Veterans’
Benefits
f. Alimony
and/or Child Support
g. Lump
Sum Death Benefits
h. Employment
Pensions
If
an applicant/recipient has had employment of ten (10) or more years
with any one (1) employer, the possibility of eligibility for a
pension exists and should be determined.
i. Insurance
Settlements
(1) Money
received from an insurance settlement is considered income unless it
is used to replace exempt resources.
(2) If
the insurance settlement is received as a result of fire, flood,
lightning or severe wind, and if it is used to replace within a
reasonable time, the loss caused by the fire, flood, lightning or
severe wind, it is not considered as income.
(3) If
only part of the money is used to replace the loss, any remaining
balance is considered as available income.
j. Interest
When
a recipient retains resources and receives interest or dividends,
they are considered income, when available, and are applied to the
assistance plan.
k. Dividends
l. Income
from Legally Liable Sponsors
Income
actually available from a liable sponsor is treated in the same
manner as any other unearned income in determining the amount of the
GPA assistance payment.
m. Contributions
(1) Regular
and substantial contributions are considered income.
(2) Gifts
and contributions that occur infrequently and unpredictably as
expressions of affection are not related to support and are not
considered income.
2. Since
unearned income is not derived from employment, no earned income
disregards are applicable.
D. Income
Exclusions
1. In
determining the amount of GPA assistance payment, the following kinds
of income are excluded:
a. The
income of an SSI recipient (including the SSI benefit).
b. Income
equal to expenses attributable to the earnings of the income of a
self-employed individual (see § 3.6 of this Part).
c. The
value of home produce of an applicant/recipient utilized by him/her
and his/her household for their own consumption.
d. The
value of United States Department of Agriculture donated foods.
e. Any
benefits received under Title VII, Nutrition Program for the Elderly,
of the Older Americans Act of 1965 (Pub. Law 116-131), as amended.
f. The
value of supplemental food assistance received under the Child
Nutrition Act of 1966, as amended, and the special food service
program for children under the National School Fund Act, as amended,
(Pub. Law 92-433 and Pub. Law 93-150).
g. The
value of SNAP benefit allotments.
h. Foster
care payment paid by the Department of Children, Youth and Families.
i. Any
grant or loan for an undergraduate student for educational purposes
made of insured under any programs administered by the United States
Department of Education.
j. Loans
and grants, such as scholarships, obtained and used under conditions
that preclude their use for current living costs.
k. The
value of government rent and/or housing subsidies.
l. Payments
of allowances received under the Federal Low-Income Home Energy
Assistance Program.
m. Assistance,
in the form of cash or vendor payments from other agencies and
organizations, is disregarded if the assistance is for a different
purpose, goods, or service not provided in the Consolidated Standard
(§ 3.2.5 of this Part).
n. Payments
for reimbursement of out-of-pocket expenses made to individual
volunteers serving as foster grandparents, senior health aides or
senior companions, and to persons serving in the Service Corps of
Retired Executives (SCORE) and Active Corps of Executives (ACE) and
any other program under Title II and Title III of the Domestic
Volunteer Service Act of 1973 (Pub. Law 93-113).
o. Payments
to individual volunteers under Pub. Law 96-143, the Domestic
Volunteer service Act of 1979, which governs the Volunteers in
Service to America (VISTA) Program.
p. Income
from any source when Federal Law prohibits its inclusion. The
applicant/recipient must present evidence of the Federal prohibition.
3.2.4 Determination
of Resources
A. The
DHS representative must explore the possible ownership of resources
by individuals and couples at the initial application for assistance
and at all subsequent determinations of continuing eligibility.
1. Resources
are defined
in terms
of real
and personal
property.
a. Real
property is any interest in real estate and what is attached or
affixed thereto.
b. Personal
property pertains to such items as automobiles, boats, and liquid
assets such as cash, bank accounts, cash value of life insurance
policies and similar properties.
2. Jointly
held resources are considered to be those of the applicant/recipient.
However, the individual is given an opportunity to rebut the
presumption of ownership.
3. The
individual's resources include those of the eligible or ineligible
spouse in the home.
a. In
a joint GPA/SSI household, the resources that are solely the SSI
recipient's are not considered in determining eligibility for GPA.
b. A
sponsored non-citizen’s resources include any resources of the
sponsor and sponsor's spouse (if living together) actually
contributed to the non-citizen.
4. If,
at any time during the receipt of GPA, an individual acquires income
or resources in excess of the amount previously reported, it shall be
his/her responsibility and a condition of eligibility to notify the
Department of this fact within ten (10) days of the receipt of
possession of additional resources or income.
B. Exempted
Resources
1. Exemption
of Home
a. The
home occupied by the individual or family is exempted. It is further
defined as:
(1) The
house, the usual residence of the assistance unit.
(2) The
home exemption applies to any land that appertains to the home and
any other buildings located on such land, for example, a barn or a
shed.
(3) To
appertain to the home, the real property must adjoin the plot on
which the home is located and not be separated from it by intervening
real property owned by others.
(4) The
home exclusion applies, for example, to the home an individual or
family leaves temporarily because of a catastrophic fire to reside in
a shelter, with relatives or elsewhere, pending restoration of the
property to habitable condition and with the intention of resuming
residence there as soon as possible.
(5) The
home is considered owned by a married couple if:
(AA) The
deed indicates the property is held by them as tenants by the
entirety; and
(BB) The
property is not the home of the assistance unit (as defined above);
and
(CC) The
spouse of the applicant/recipient refuses to sell his/her interest in
the property.
2. Exemption
of Automobile
a. Automobile
means a passenger car, truck or other motor vehicle used to provide
transportation of persons or goods. An exemption is provided for one
(1) automobile per household.
b. If
the assistance unit has more than one (1) automobile eligibility does
not exist.
3. Exemption
on Household Items and Effects
Household
furnishings, appliances, clothing, personal effects and keepsakes of
limited value are exempted.
4. Exemption
of Income-Producing Property
a. Tools
of the Trade not to exceed an aggregate value of one thousand dollars
($1,000.00) actually used or reasonably expected to be used to
produce self-employment income may be exempted from consideration as
a resource.
b. In
addition to cases in which the property is currently being used to
produce self-employment income, situations in which the
applicant/recipient is temporarily unable to use the property are
examined.
(1) The
DHS representative evaluates the individual's potential for utilizing
the resource in the future to again become self-supporting.
(2) If
the aggregate value does not exceed one thousand dollars ($1,000.00)
and the property had previously been used by the applicant/recipient
to generate income and a reasonable expectation exists that it will
be used for that purpose in the foreseeable future, the property is
exempted.
(3) The
statement of the applicant or recipient recorded on the DHS-2 as to
the value of tools of the trade will be accepted when determining the
aggregate value unless there is reasonable doubt regarding the value
stated.
5. Exemption
of Liquid Assets
a. For
individuals, couples and families, the resource limit for cash and
other liquid assets is three thousand dollars ($3,000.00).
b. Liquid
assets include, but are not limited to, cash, savings accounts,
checking accounts, stocks, savings bonds, mutual fund shares, time
deposit shares, money market certificates, promissory notes,
mortgages and the cash value of life insurance policies.
c. The
combined value of all cash and liquid assets owned by each member of
the assistance unit is counted toward the three thousand dollars
($3,000.00) cash and other liquid assets exceed this limit,
eligibility for GPA does not exist.
(1) Any
cash value of life insurance policies must be included in this
computation.
6. Life
Insurance Policies
a. Common
examples include but are not limited to whole life, universal life,
group and term insurance.
(1) Generally,
group and term life insurance policies have no cash surrender value
and therefore are not counted as resources for GPA.
b. All
life insurance policies should be examined to determine whether or
not a cash surrender provision exists.
(1) Usually
the policy contains a "Table of Value" which can be used to
determine the current cash value.
(2) In
other cases, it may be necessary for the applicant/recipient to
obtain a statement from the issuing company indicating the current
cash surrender value of the policy.
7. Medical
Insurance
Medical
insurance, such as Blue Cross/Blue Shield, Major Medical, Federal
Medicare (Part A, Part B), Delta Dental or other medical insurance is
not considered a resource in the determination of eligibility.
3.2.5 Standards
of Assistance
A. The
GPA Standards of Assistance are used to determine eligibility for
individuals/couples.
B. Income
is applied to the standard after deductions specified in policy are
made and eligibility is then determined.
1. Consolidated
Standard – Individuals/Couples
a. The
consolidated standard of assistance is computed according to the
number of eligible persons in the GPA household.
b. The
table below lists the GPA Monthly Standards for an individual and for
a married couple.
c. The
couple must be married by virtue of a ceremonial or other legal
marriage.
d. When
only one (1) spouse is eligible, eligibility is based on the couple
standard.
(1) Income
available to the couple is compared to the couple standard to
determine eligibility.
PLAN
SIZE
GPA
MONTHLY STANDARD
Individual
$327.00
Couple
$449.00
3.2.6 Lost,
Stolen, or Destroyed GPA Payments
A. If
a GPA recipient reports that s/he has lost his/her GPA payment, the
recipient is directed to file a report of loss or theft with the
local police department. The worker must verify that a report has
been made to the police by obtaining a copy of the report from the
recipient.
1. The
recipient is told that a replacement check cannot be issued until at
least three (3) business days after the date of the report of the
non-delivery, loss, theft, or total destruction.
2. The
recipient is required to sign an affidavit in duplicate attesting to
the non-receipt, loss, or theft of an assistance check.
3. If
two (2) checks are reported lost or stolen in the same six (6) month
period, the case is referred to the DHS designee, who reviews the
case history of reported lost or stolen checks and any measures the
recipient has taken to secure future checks.
a. A
conference may be scheduled to discuss the problem.
b. If
after a thorough review it appears that the recipient’s checks
remain susceptible to loss or theft and no other solution presents
itself, the DHS may decide that the recipient’s checks must be
sent to a DHS regional office and picked up there by the recipient.
This arrangement continues until the recipient can show that checks
can be safely mailed to the home.
3.2.7 Changes
in Circumstances
A. In
the initial contact with the DHS, and in any subsequent contacts, the
recipient is made aware of his/her responsibility to report changes
in circumstances within ten (10) days.
1. Financial
need is subject to change whenever there is a change in the plan
size, the living arrangement, or in income or assets.
2. There
are changes in factors other than need which can affect eligibility
some of which the DHS may be aware of in advance, and others which
are unexpected and the DHS can learn about only when the recipient or
another source makes the information known.
B. Payment
Changes
1. Whenever
a change in circumstances results in a reduction of the payment or
ineligibility for the program, the applicant/recipient must be
notified.
2. When
it is determined that a change in the recipient’s circumstances
will result in a reduction, suspension, or discontinuance of
assistance, the recipient must be notified at least ten (10) day
prior to the effective date.
3. An
advance or ten (10) day notice is not required when:
a. The
DHS has factual information concerning the death of a recipient or
the payee when there is no relative available to serve as a new
payee.
b. The
DHS receives a clear written statement signed by a recipient that
s/he no longer whishes assistance, or that gives information which
requires discontinuance or reduction of assistance, and the recipient
has indicated, in writing, that s/he understands that this must be
the consequence of supplying such information.
c. The
recipient has been admitted or committed to an institution and there
is no other person included in the payment.
d. The
recipient has been placed in skilled nursing care, intermediate care,
or long-term hospitalization.
e. The
claimant’s whereabouts are unknown and DHS mail directed to
him/her is returned by the post office indicating no known forwarding
address.
(1) The
claimant’s check must, however, be made available to him/her if
his/her whereabouts become known during the payment period covered by
a returned check.
f. A
recipient is accepted on GPA, SSI, or assistance in another State and
that fact has been established.
g. However,
adequate notice must be sent not later than the date of action.
3.2.8 Renewal
and Reapplication Requirements
A. Because
no formal redetermination of continuing eligibility process is
required for GPA recipients, if the DHS becomes aware of a change in
the financial circumstances of the recipient that would result in
ineligibility, GPA will be terminated.
1. For
GPA applicants, initial eligibility may be granted for a period of up
to six (6) months, renewable for a period of up to an additional six
(6) months.
2. Prior
to the expiration of the initial period of eligibility, the DHS must
notify the recipient of the procedures to be followed to have another
period of eligibility considered.
3. In
order to receive GPA for a period greater than twelve (12) months,
individuals must reapply for General Public Assistance.
3.3 Hardship
A. An
applicant who is pending a DHS program benefit determination who has
no income and is unable to work due to a disability may apply for GPA
Hardship.
B. The
recipient may be awarded a one (1) time payment based on availability
of funds.
C. GPA
Hardship will not be approved for individuals who have received a
hardship payment for a program that was subsequently denied if
applying for the same program within a calendar year.
D. No
more than two (2) GPA hardship payments will be issued to the same
individual within a calendar year.
1. The
amount of payment will be based upon the amount of funding available.
3.3.1 Eligibility
Requirements
A. For
an applicant to be considered eligible, the applicant needs to meet
the following criteria:
1. The
applicant must have an application pending for a DHS benefit and have
no income at the time of application.
2. The
applicant shall provide a completed DHS form by his/her physician
stating that the applicant’s illness or medical condition
prevents him/her from working (part-time or full-time) and is
considered ongoing and shall last longer than thirty (30) days.
3. Eligibility
is at the discretion of theDHS’s Economic Security and Supports
Unit (ESSU) Administrator, ESSU Assistant Administrator or ESSU
Supervisor.
4. Due
to limited funding for this program this is not an appealable
benefit.
3.4 Funeral and Burial Expenses
3.4.1 The
Application Process
A. For
the Department to consider granting assistance to those persons who
may be eligible, application for payment of funeral and burial
expenses must be made on behalf of the deceased within thirty (30)
days of the date of death.
1. An
application for payment of funeral and burial expenses shall also be
deemed as received on behalf of a decedent when a person with custody
of an unclaimed body contacts the Department of Human Services (DHS)
to report the unclaimed body.
2. Eligibility
for the expenditure of GPA funds for a funeral or burial does not
exist for anyone who at the time of their demise, was confined by
and/or in the custody of the Department of Corrections, the
Department of Children, Youth and Families or the Department of
Behavioral Healthcare, Developmental Disabilities & Hospitals
(BHDDH).
3.4.2 Eligibility
Requirements
A. Conditions
of Eligibility
1. Payment
is made to meet the cost of funeral and burial expenses up to the
cost standard for any person who dies and owns no, or insufficient,
resources and/or income to meet these expenses.
2. All
resources of the deceased are deducted from the cost standard in
determining the amount of payment. A deceased's resources include,
but are not limited to:
a. Life
insurance policies, and/or fraternal insurance, when the beneficiary
is the deceased's estate or a legally liable relative;
b. Cash,
securities, bonds, patient accounts for those in a nursing home, or
other assets left by the deceased; and
c. Any
real property not being used as a home by dependent survivors.
3. For
the purposes of determining eligibility for GPA burial assistance,
the following are EXCLUDED:
a. Veterans'
benefits
b. Social
Security lump sum death benefits
c. Non-exempt
resources (§ 3.5 of this Part) in excess of four hundred dollars
($400.00) of legally liable relatives (i.e., parents for minor
children and spouses who were living together) are considered
available to meet the cost of funeral and burial expenses.
4. The
income of legally liable relatives, except for a relative on RIW,
GPA, or SSI, must be considered in determining eligibility for and
the amount of payment. The determination is made on a monthly basis.
From the gross monthly income, certain deductions, listed in §
3.4.2(B)(5) of this Part are made.
a. The
amount remaining, after applying the appropriate deductions, is
compared to the approved funeral and burial cost expenses.
5. The
following are deducted from the monthly gross income of the legally
liable relative in determining the amount of the payment for funeral
or burial expenses.
a. Work
Expense Disregard
From
the monthly gross earned income, disregard ninety dollars ($90.00)
from the monthly gross income for each person employed.
b. Dependent
Care Disregard
(1) From
the monthly gross earned income, disregard the actual cost, if any,
of care for each dependent child under thirteen (13) years of age or
incapacitated person who is living in the home and is claimed or
could be claimed as a dependent for the purposes of Federal personal
income tax liability.
(2) For
the legally liable relative employed full-time (one hundred (100)
hours or more per month), this disregard may not exceed one hundred
sixty dollars ($160.00) per month per child or incapacitated person.
(3) For
the legally liable relative employed part-time (less than one hundred
(100) hours per month), this disregard may not exceed eighty dollars
($80.00) per month per child or incapacitated person.
(4) Consideration
of dependent care expenses is only given when the care is provided by
a person not living in the dependent's household.
c. Maintenance
Expense Disregard
(1) An
amount is also disregarded for the support of the legally liable
relative and any other individuals who are living in the home and are
claimed or could be claimed as dependents for purposes of determining
Federal personal income tax liability.
(2) The
amount disregarded equals the appropriate monthly GPA consolidated
standard for individuals and couples or the appropriate RIW standard
based on the size of the legally liable relative's family group.
d. Medical
Expense Disregard
(1) A
deduction is made to meet the cost of specific incurred medical
expenses or medical services verified as needed for the month.
(2) Such
medical expenses include the amount paid for health insurance plus
the amount of verified required monthly medical services that are
within the scope of the GPA program.
C. Private
Supplementation of Funeral Expenses
1. Friends
or family of the decedent (other than legally liable relatives) may
privately contract with the funeral director for additional or
upgraded services and merchandise.
a. Those
individuals may contribute up to one thousand six hundred dollars
($1,600.00), for additional funeral home services and merchandise,
without affecting eligibility for the nine hundred dollar ($900.00)
basic allowance.
b. For
each additional one dollar ($1.00) that those individuals contribute
over the one thousand six hundred dollar ($1,600.00) allowable
supplement, a corresponding one dollar ($1.00) is deducted from the
basic allowance to be paid by the State.
2. The
following are examples of items which might be contracted for
privately by the family:
a. Preparation
of deceased for viewing (embalming, hairdressing, etc.);
b. Use
of funeral home for visitation or funeral services;
c. Transportation
for family members or friends to funeral services;
d. Additional
or upgraded funeral merchandise (casket, vault, cards, etc.).
3. Payment
of fees by the family or friends to clergy, church musicians,
florists, newspapers, state officials, or city officials for
certified copies of death certificates in no way diminishes the
amount that the family is permitted to supplement toward services or
merchandise provided by the funeral director.
D. Funeral
and Burial Arrangements
1. Relatives
and/or friends have a choice among those undertakers willing to
provide a quality of service in accordance with the cost standard.
a. Church
and municipally-owned cemeteries often provide, free of charge,
burial lots and/or the cost of opening and closing graves for persons
unable to pay.
b. The
Rhode Island Veterans Cemetery also provides the above to eligible
veterans and their eligible dependents.
c. These
resources must be explored and utilized, where available.
d. Additionally,
if a city or town provides burial space free of charge, this resource
must be used.
e. If
the above resources are not available, burial costs can be met in
accordance with the cost standards.
2. Payment
of funeral and burial expenses by the Department is not considered
unless an application is filed on behalf of the deceased within
thirty (30) days of the date of death.
3. When
no relatives or friends are available, the designated DHS
representative makes the arrangements appropriate to the faith of the
deceased, when known.
E. Application
for Payment of Burial Costs
1. The
application is made in the city/town of the residence of the
deceased.
a. When
a client dies in a nursing/group home, the community in which the
home is located is responsible for burial if need exists.
2. If
the deceased was a recipient of RIW, GPA, Medicaid, SNAP, or Long
Term Services and Supports (LTSS) at the time of death, the
information in the eligibility system is used to determine
eligibility for GPA burial assistance.
3. If
the deceased was a recipient of SSI at the time of death, contact is
made with the Social Security Administration to determine available
resources to document the application.
a. If
this information is unobtainable, and there are no relatives or
friends, the application is filed by the DHS representative to the
best of his/her ability in behalf of the decedent.
4. If
the deceased was not an active recipient of RIW, GPA, Medicaid, SNAP,
or LTSS but had filed an application within ninety (90) days prior to
death, and the current information is available to the DHS, a
determination of eligibility may be made from the information on
file.
5. If
the deceased was not previously known to the DHS, an application must
be made on behalf of the deceased by a family member, an individual
legally identified as next of kin, nursing home, hospital or an
individual legally appointed by a court to obtain information to
determine eligibility.
F. Cost
Standard for Burial
1. The
DHS can provide payment up to its cost standard minus the resources
and/or income of the deceased, including any amount deemed from
legally liable relatives. The cost standard covers at least the
following services and merchandise:
a. Professional
Services
Basic
management and supervisory services of the Funeral Director and staff
in handling all arrangements relative to final disposition;
b. Use
of Facilities and Equipment;
c. Transportation
(includes local within ten (10) mile radius) transfer of deceased to
funeral home, local transfer of deceased to church and/or cemetery or
crematory;
d. Merchandise
(includes minimum burial casket or appropriate cremation container;
and casket name plate when required by the cemetery).
2. A
bill must be submitted by the Funeral Director, itemizing the cost of
services, by category, as indicated above.
a. The
bill must also include the amount non-legally liable relatives and/or
friends have paid or agree to pay toward the expense.
b. If
eligibility exists, the department meets the balance, up to the cost
standard, less any resources that must be considered.
c. Refer
to § 3.4 of this Part for specific items for which family and/or
friends may pay, without diminishing the amount the Department may
pay as defined by this Part
3. Cemetery
and/or crematory expense is separate and distinct from the Funeral
Director/funeral home expense and should be treated as such. Although
the Funeral Director will often coordinate the arrangements with the
cemetery, the cemetery should be recognized as a separate vendor,
which will bill the Department of Human Services.
G. Standards
for Funeral and Burial Expenses
1. Basic
standards for funeral and burial expenses follow:
a. Stillborns:
An amount up to twenty-five dollars ($25.00) may be authorized for
the funeral and an additional amount up to forty dollars ($40.00) may
be authorized for the burial of a stillborn. These amounts are
authorized regardless of the duration of the pregnancy.
b. Adults
and Children: An amount up to nine hundred dollars ($900.00) may be
authorized to meet funeral expenses of an adult or child. Further,
with regard to burial or cremation of an adult or child, when the
cost of the lot, opening and closing of the grave and/or cement grave
liner is required, or when a crematory fee is required, in lieu of
opening and closing the grave, consideration is given to these costs
according to the following maximum amounts:
(1) Cost
of a lot – one hundred fifty dollars ($150.00);
(2) Opening
and closing of the grave – one hundred seventy-five dollars
($175.00);
(3) Cement
liner, if required by the cemetery – one hundred twenty-five
dollars ($125.00); and
(4) Crematory
fee – one hundred fifty dollars ($150.00).
c. Note
that payment to meet burial or crematory costs in excess of these
amounts may be authorized only when the designated DHS representative
ascertains and documents the existence of special circumstances.
2. Additional
Costs in Special Circumstances
a. With
the approval of the designated DHS representative, the following
costs can also be met:
(1) Transportation:
If a Funeral Director must transport a body from one community to
another, beyond a radius of ten (10) miles, the mileage above and
beyond the ten (10) miles is reimbursable at the following rate:
Travel by road: two dollars ($2.00) per mile – one way; Travel
by train or air: the verified train or air fare.
(2) Special
Expenses: Funeral and burial expenses in excess of the basic standard
because of individual needs such as, but not limited to, a special
sized casket and special sized outer container to accommodate the
casket are taken into consideration when such need is documented by
the undertaker and approved by the designated DHS representative.
H. Payment
of Funeral and Burial Expenses
1. The
Department makes payment only to service providers and does not
reimburse any other person for payment of funeral and burial
expenses.
2. A
bill presented for payment must be itemized.
3. GPA
payment of the expenses may not exceed the appropriate cost standards
and, after application of the total resources available to the
deceased, is limited to either the actual balance or the cost
standard, whichever amount is less.
4. If
payments for funeral and burial expenses are made by non-legally
liable relatives or friends, the GPA payment in such cases may not,
in combination with payments made by friends and/or non-legally
liable relatives, exceed the two thousand five hundred dollar
($2,500.00) maximum for funeral expenses, and may not exceed the
separate maximum for burial and/or crematory fees as described in §
3.4 of this Part.
5. In
determining the maximum payment for financial expenses, refer to §
3.4 of this Part for items that are independent of and not counted
toward the maximum payment.
6. Determination
of eligibility and authorization of payment for approved burial
expenses are the responsibility of the DHS.
a. If
the deceased was a recipient of assistance other than GPA, the DHS
representative bases the determination of eligibility on the
information contained in the eligibility system (see § 3.4 of
this Part).
I. Recoupment
of Funeral and Burial Expenses
1. If,
subsequent to payment of funeral and burial expenses on behalf of a
decedent by DHS through the GPA Program, resources are discovered,
the Director or his/her designee shall determine if efforts will be
made by the Department to recoup the cost of funeral and burial
expenses from the resources of the decedent or legally liable
relative, or, if applicable, recovery in accordance with R.I. Gen.
Laws § 40-8-15 is to be made, DHS shall file necessary Petitions
with probate Court.
2. Recoupment
of expenses by DHS may be made by acceptance of cash, or any of its
generally accepted equivalents, including checks money orders and
credit/debit cards.
J. GPA
Burial of Unclaimed Bodies
1. Payment
of funeral and burial expenses by the department is not considered
unless an application is filed on behalf of the deceased within
thirty (30) days of the date of death, or if the Department is
contacted by a person, entity, agency, or Funeral Director to request
a public expense burial.
a. In
such instances, the person having custody of the unclaimed body shall
attempt, within the first twenty-four (24) hours after death, to
locate relatives or friends of the decedent who will assume
responsibility.
(1) If
no such person is found within twenty-four (24) hours after death,
the person having custody of the dead body shall notify the director
of the Department of Human Services or his/her designee who shall
arrange for the removal of the unclaimed body.
(2) If
a body is unclaimed at or before the expiration of thirty (30) hours,
DHS shall make a reasonable effort to find relatives or friends of
the decedent.
(3) If
no one is located, the Director or his/her designee shall have the
authority to authorize a public expense burial in accordance with
R.I. Gen. Laws Chapter 23-18.1.
(4) For
the purpose of these Rules, a public expense burial may be treated as
a General Public Assistance (GPA) burial.
(5) After
a reasonable period of time, the Director or his/her designee shall
have decision-making authority for the funeral and burial
arrangements, appropriate to the faith of the deceased, when known.
b. If
a non-legally liable relative or friend of a decedent comes forward,
that contact shall be deemed a request for a general public
assistance burial on behalf of the decedent.
(1) This
person is encouraged to make application for general public
assistance burial on behalf of the decedent. The application shall be
processed in accordance with § 3.8(E) of this Part.
c. An
application made by a legally liable relative shall be processed in
accordance with § 3.8(B) of this Part. DHS shall make every
attempt to ascertain income and resources of the decedent in either
case.
d. If
there are relatives unwilling to authorize burial, or unwilling to
pay for the decedent's burial, the GPA burial application shall be
processed and the Director or his/her designee shall determine if
recovery of the decedent's assets shall be made by DHS.
e. To
the extent that the Department of Human Services makes payment of the
burial expenses, it shall have the right to recover the burial
expenses from the estate of the deceased person if there are
resources.
(1) If
the Director or his/her designee determines recovery should be made
to reimburse DHS for payment of burial expenses or for estate
recovery in accordance with R.I. Gen. Laws § 40-8-15, then an
affidavit shall be obtained from the relative(s) not willing to
authorize burial, stating the names and addresses of all known
relatives, and a statement attesting to the fact that they that
particular relative(s) waives their rights to the decedent's estate,
if any.
3.5 Appeal Rights
A. An
applicant/recipient has a right to request a hearing within ten (10)
days of the DHS's notice of action regarding an impending reduction,
suspension, or discontinuance of assistance except for Hardship under
§ 3.3 above.
1. If
a request for a hearing is made within the ten (10) day advance
notice period of the date of the notice and a written request for
continuation of assistance is included in the request for hearing, no
action for reduction, suspension, or discontinuance is taken until
the hearing decision is reached except in the following instances:
a. When
the reduction, suspension or discontinuance is caused by a change in
State law that requires automatic grant adjustment for classes of
recipients, a timely notice of such grant reduction can be issued by
mass mailing, and the payment is not continued and no hearing need be
granted.
(1) However,
a hearing is granted and the payment is continued when the reason for
the appeal is incorrect grant computation. The DHS supervisor will
review the issue to determine this and will inform the recipient, in
writing, of the action that will be taken.
b. When
a second (2 nd ) change occurs while the hearing decision is
pending, and the recipient does not request a hearing within the
advance notice period on the second (2 nd ) issue,
assistance is reduced, suspended or discontinued and the recipient
must be promptly informed of this in writing.
c. At
the end of the ten (10) day period, the action remains in force if
the client has not responded and requested a hearing and submitted a
written request for continuation of benefits. No hearing will be
granted unless requested within ten (10) days of the date of the
notice.
B. Conditions
under Which Assistance Continued
1. If
the request for a fair hearing is made within the ten (10) day
advance notice period and a written request for continuation of
assistance is included in the request for hearing, no action for
reduction, suspension, or discontinuance is taken until the fair
hearing decision is rendered.
2. If
the reduction, suspension, or discontinuance is caused by the
application of a change in DHS policy which affects all recipients, a
timely notice can be issued by mass mailing.
a. If
the client requests a hearing regarding the change in policy itself,
assistance is not continued.
b. However,
when the request is based on improper determination of benefits in
the individual situation, assistance is continued.