H. B. 2729
(By Delegates Householder, Kurcaba, Statler, Butler and Summers )
[Introduced February 13, 2015; referred to the
Committee on the Judiciary then Finance.]
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §9-5-24, relating to the receipt of benefits from the Department of Health and Human Resources; requiring applicants to provide a social security number; requiring the department to establish an income eligibility verification system; requiring the system be used when an applicant first makes a benefit request and quarterly thereafter; describing how the system will be used; requiring notice; requiring investigations; permitting an applicant to respond; requiring a toll-free, state-wide call center to be established; requiring reports; and defining terms.
Be it enacted by the Legislature of West Virginia:
That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §9-5-24, to read as follows:
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-24. Welfare System Integrity.
(a) As used in this section, the following definitions apply:
(1) "Significant discrepancy" means information regarding assets, income, resources, or status of an applicant or recipient of assistance, derived from one or more of the databases in this section, which gives the department grounds to suspect that either:
(A) An applicant or recipient is ineligible to receive assistance, under federal or state law, due to the applicant's or recipient's status; or
(B) The assets, income, or resources of an applicant or recipient are at least, in terms of a dollar amount, twenty-five percent greater than the dollar amount reflected in the information the department possesses about the applicant or recipient with respect to the applicant's or recipient's assets, income, or resources.
(2) "Status" means that the applicant or recipient is in the United States illegally, is no longer living, is an inmate in a prison or jail, or is a fleeing felon.
(b) The Department of Health and Human and Resources shall establish a computerized income eligibility verification system in order to eliminate duplication of assistance and to deter fraud.
(c) The department shall require that as a condition of assistance, an applicant or a recipient supply the social security number of the applicant or recipient. The department shall match the social security number of all applicants and recipients with the following databases, or with databases that are substantially similar to, or successors of, the following databases:
(1) Unearned income information maintained by the United States Internal Revenue Service;
(2) Employers' quarterly reports of income and unemployment insurance benefit payment information maintained by the Division of Tax;
(3) Earned income information maintained by the United States Social Security Administration;
(4) Immigration status information maintained by United States Citizenship and Immigration Services;
(5) Death register information maintained by the United States Social Security Administration;
(6) Prisoner information maintained by the United States Social Security Administration;
(7) Public housing and Section 8 payment information maintained by the United States Department of Housing and Urban Development;
(8) National fleeing felon information maintained by the United States Federal Bureau of Investigation;
(9) Wage reporting and similar information maintained by contiguous states;
(10) The Beneficiary Data Exchange (BENDEX) Title H database maintained by the United States Social Security Administration;
(11) The Beneficiary Earnings Exchange Report (BEER) database maintained by the United States Social Security Administration;
(12) The State Data Exchange (SDX) database maintained by the United States Social Security Administration;
(13) The Veterans Benefits and Veterans Medical (PARIS) database maintained by the United States Department of Veterans Affairs and the United States Department of Health and Human Services;
(14) The Low Income Energy Assistance Program (LEAP) Reporting Utility Expenses database maintained by the state.
(e) Notwithstanding any provision of law to the contrary, the income eligibility verification system shall be utilized for an applicant at the time of application for assistance, and for a recipient on a quarterly basis.
(f) The department shall notify applicants and recipients of the requirement of providing a social security number at the time of application for assistance and as needed thereafter and pursuant to the provisions of this section.
(g) If a significant discrepancy results from a match between the applicant's or a recipient's social security number and one or more of the databases set forth in this section, the department shall review the applicant's or recipient's case, as appropriate, and shall investigate the circumstances of the discrepancy in order to determine eligibility of the applicant or recipient.
(h) The department shall institute the following procedure to investigate the circumstances of a significant discrepancy:
(1) If the information is known to the department, is accurate, and does not result in ineligibility or modification of the amount or type of assistance, the department may take no further action.
(2) If subdivision one of this subsection does not apply and a significant discrepancy results from the match between the applicant's or the recipient's social security number and one or more of the databases as listed in this section, the applicant or the recipient, as appropriate, shall be given an opportunity to explain the significant discrepancy. The department shall provide written notice to the applicant or recipient. Notice shall provide sufficient detail regarding the circumstances of the significant discrepancy, the opportunity to resolve the significant discrepancy, including the manner in which the significant discrepancy may be resolved, and the consequences of not responding to the notice or of resolving the significant discrepancy. The explanation of the recipient or applicant may be given over the telephone as set forth in this section, in person, or in writing. After receiving the explanation, the department may request additional documentation in person or in writing if it determines there is a substantial risk of fraud.
(3) If the applicant or recipient, as appropriate, does not respond to the notice, the department may close the applicant's or recipient's case for failure to cooperate. In such a case, the department shall provide notice of intent to discontinue assistance. Eligibility for assistance may not be reestablished until the significant discrepancy is resolved.
(4) If the applicant or recipient disagrees with the findings of the match between the applicant's or recipient's social security number and one or more of the databases set forth in this section, the department shall investigate the circumstances and make a determination regarding whether the position of the applicant or recipient is valid. If, after investigation, the department finds that there has been an error, the department shall take immediate action to correct the error, and no further action may be taken. If, after investigation, the department determines that the position of the applicant or recipient is invalid, the department shall determine the effect of the match on the applicant's or recipient's case and take appropriate action. Written notice of the department's action shall be given to the applicant or the recipient.
(5) If the applicant or recipient, as appropriate, agrees with the findings of the match between the applicant's or recipient's social security number and one or more of the databases set forth in this section, the department shall determine the effect on the applicant's or recipient's case and take appropriate action. Written notice of the department's action shall be given to the applicant or recipient.
(6) If the findings of the match between the applicant's or recipient's social security number and one or more of the databases set forth in this section result in no change in eligibility or overpayment, the department may take no further action.
(i) The department may, in its discretion, review and investigate an applicant's or recipient's case when there is a match between the social security number of the applicant or recipient and one or more of the databases set forth in this section and the match does not result in a significant discrepancy. In such a case, the department shall utilize the procedure for reviewing and investigating a significant discrepancy set forth in this section.
(j) The department shall establish a single statewide toll-free telephone number and call center that shall be used by applicants and recipients in order to resolve discrepancies. The call center shall have sufficient capacity and staff to promptly handle incoming telephone calls. In addition, the department shall assign sufficient numbers of government eligibility workers in order to make determinations regarding eligibility pursuant to this section. The call center shall use available technology to route and track the calls. The department may develop a competitive request for proposal for operating the call center.
(k) No later than one year after the effective date of this section and every year thereafter, the department shall provide a written report to the Legislative Commission on Health and Human Resources Accountability detailing the results of the system, the amount of case closures that result from the system and the savings that result from the system.
(l) Within one year of the effective date of this section, the department shall establish procedures to identify, investigate, and resolve potential cases of fraud, misrepresentation, or inadequate documentation prior to determining an applicant's eligibility for assistance. The plan shall be systematic and ensure that every case is reviewed. Further, the review shall include utilization of the income eligibility verification system established in this section.
(m) Caseworkers shall maintain close contact with an applicant, recipient, or assistance group. Home visits shall be scheduled as frequently as required by the circumstances of the applicant or recipient in order that any treatment or service tending to restore the applicant or recipient or assistance group to a condition of self-support and to the relief distress is rendered and in order that assistance is given only in such amount and as long as is necessary. The department may develop a competitive request for proposal for conducting home visits and may contract with a firm the department certifies as able to design and implement such a system.
(n) Where inconsistencies or gaps in information presented by an applicant or recipient exist or where circumstances in the case indicate to a prudent individual that further information is needed, the caseworker shall seek additional information.
NOTE: This bill requires the establishment of an income eligibility verification system, a computerized system designed to find and root out welfare fraud. The bill addresses the receipt of benefits from the Department of Health and Human Resources. The bill requires applicants to provide a social security number. The bill requires the system be used when an applicant first makes a benefit request and quarterly thereafter. The bill requires notice. The bill requires investigations. The bill permits an applicant to respond. The bill requires a toll-free, state-wide call center to be established. The bill requires reports. The bill defines terms.
This section is new and has been completely underscored.