Reasons for Negative Benefit Actions

              Reasons for Negative Benefit Actions
Section I. Financial Assistance tab (Section B), SNAP tab (Section C), Medical General tab (Section D), and computer messages for benefit closures, suspensions, or denials.
Code reasons are in reason type rather than numerical order.
A. Income reasons
Code reason
Computer-generated message
Benefit type and policy cite
03
Excess earnings of caretaker relative OR Excess earnings for your household
The countable earned income received by the members of your household is too high to receive benefits from OKDHS. Rules regarding earned income are found at OAC ___.
Temporary Assistance for Needy Families (TANF)-340:10-3-31, 340:10-3-32, & 340:10-3-33 Supplemental Nutrition Assistance Program (SNAP) -340:50-7-29 SoonerCare (Medicaid), Aid to Families with Dependent Children (AFDC)/Pregnancy related -317:35-10-26 SoonerCare (Medicaid), Aged, blind, and disabled (ABD) related -317:35-5-42
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 1 of 33 Code reason
Computer-generated message
Benefit type and policy cite
03A
New or increased earnings of stepparent
The countable earned income received by your household is too high to receive benefits from OKDHS because of new or increased earnings of a stepparent. Rules regarding stepparent income are found at OAC ___.
TANF -340:10-3-57
03B
New or increased earnings of someone other than caretaker or stepparent
The countable earned income received by the members of your household is too high to receive benefits from OKDHS. Rules regarding earned income are found at OAC ___.
TANF -340:10-3-31, 340:10-3-32, & 340:10-3-33
03C
Earned income exceeds 185% of federal poverty level
Your earned income is too high to receive benefits from OKDHS. Rules regarding this action are found at ___.
TANF -340:10-3-75 Continued medical benefits (CMB) only
03D
No earnings of caretaker relative in at least one of the three reporting months
You did not have earnings in at least one of the three reporting months. Rules regarding this action are found at OAC ___.
TANF -340:10-3-75 CMB only
05
Receipt of Unemployment Compensation
Your household income is too high to receive benefits from OKDHS because of the unemployment compensation income received by one or more members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 2 of 33 Code reason
Computer-generated message
Benefit type and policy cite
06
Receipt of child and/or spousal support or alimony
Your income is too high to receive benefits from OKDHS because of child or spousal support or alimony received by one or more of the members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-10-7 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
07
Contribution
Your household income is too high to receive benefits from OKDHS because of money given to one or more members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 AFDC/Pregnancy-related SoonerCare (Medicaid) -317:35-10-26
08
Lump sum For SoonerCare (Medicaid), use code 14 for lump sum payments.
Your income exceeds OKDHS standards because of a lump sum payment you received. You should already have received a written notice explaining how long you will be ineligible for Temporary Assistance for Needy Families (TANF) benefits and when you can apply again. This action is in accordance with 45 CFR, Sec. 233.20(A)(3)(II)(F) and OAC ___.
TANF -340:10-3-28
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 3 of 33 Code reason
Computer-generated message
Benefit type and policy cite
08A
Lump sum not documented
You did not provide proof of the amount of the lump sum payment you received and when you received it. Rules regarding this action are found at OAC ___.
TANF -340:10-3-28 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
09
Stepparent's unearned income (for stepparent's earned income, see 03A)
The countable income received by your household is too high to receive benefits from OKDHS because of unearned income of a stepparent. Rules regarding stepparent income are found at OAC ___.
TANF -340:10-3-57
09A
Income of a parent(s) of a minor parent
The income received by your household is too high to receive benefits from OKDHS because of the countable income from your parents. Rules regarding this action are found at OAC ___.
TANF -340:10-3-9 & 340:10-3-57
10
Old-Age, Survivors, and Disability Insurance (OASDI)
Your household income is too high to receive benefits from OKDHS because of Social Security income received by one or more members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 4 of 33 Code reason
Computer-generated message
Benefit type and policy cite
11
Supplemental Security Income (SSI)
Your household income is too high to receive benefits from OKDHS because of Supplemental Security Income (SSI) received by one or more members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42
12
Veterans Affairs (VA)
Your household income is too high to receive benefits from OKDHS because of Veterans Affairs (VA) income received by one or more members of your household. Rules regarding income are found at OAC ___.
TANF -340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
13
Receipt of sponsor's income
Your income is too high to receive benefits from OKDHS because of sponsor's countable income received by one or more members of your household. Rules regarding the income of sponsors are found at OAC ___.
TANF -340:10-15-3 SNAP -340:50-5-49
14
Other income or combination of income For SoonerCare (Medicaid), use this code instead of 08 for lump sum payments.
Your total household income is too high to receive benefits from OKDHS. Rules regarding income can be found at OAC ___.
TANF -340:10-3-26 & 340:10-3-39 SNAP -340:50-7-29 SoonerCare (Medicaid) ABD related -317:35-5-42 SoonerCare (Medicaid) AFDC/Pregnancy-related -317:35-10-26
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 5 of 33 Code reason
Computer-generated message
Benefit type and policy cite
14A
Due to program violation and other income
A penalty was applied to your TANF benefit because of a program violation. Your income is too high to receive a TANF benefit at the reduced amount. Rules regarding program violations are found at OAC ___.
TANF -340:10-3-57
B. Long term care reasons
Code reason
Computer-generated message
Benefit type and policy cite
21
Not approved for personal care or nursing home level of care
You do not meet the established medical criteria to be approved for nursing care. Rules regarding this action are found at OAC ___.
SoonerCare (Medicaid) ABD related - 317:35-15-4, 317:35-17-5, 317:35-19-7.1
21B
MFP Services no longer needed
You are allowed to receive benefits under the Living Choice program for 365 calendar days, and that time period has ended. Rules regarding this action are found at OAC ___.
SoonerCare (Medicaid) ABD related 317:35-23-2 & 317:35-23-3
21
Not approved for personal care or nursing home level of care
You do not meet the established medical criteria to be approved for nursing care. Rules regarding this action are found at OAC ___.
SoonerCare (Medicaid) ABD related - 317:35-15-4, 317:35-17-5, 317:35-19-7.1
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 6 of 33 C. Medical reasons
Code reason
Computer-generated message
Benefit type and policy cite
18
Incapacity, disability, or blindness not established
You do not meet the established medical standards for disability according to Social Security Administration guidelines nor have you been determined incapacitated by the Oklahoma Health Care Authority. Rules regarding disability or incapacity determinations are found at OAC___
TANF -340:10-10-2 SoonerCare (Medicaid) ABD related - 317:35-5-4 & 317:35-5-5
18A
Incapacity, disability or blindness not determined
According to your statement, you do not meet the established medical standards for disability or incapacity or you have not applied for Supplemental Security Income (SSI). Rules regarding this action are found at OAC ___.
TANF -340:10-10-2 SoonerCare (Medicaid) ABD related - 317:35-5-4 & 317:35-5-5
19
Medical services not provided during coverage period – cannot be approved
The medical service you requested help with was too long ago for OKDHS to approve. Rules regarding time limits for services are found at OAC ___.
SoonerCare (Medicaid) ABD related - 317:35-7-60 SoonerCare (Medicaid) AFDC/Pregnancy related -317:35-6-60
20
Complete application not received
You did not complete or submit all necessary forms for completing your application. Rules regarding this action are found at OAC ___.
SoonerCare (Medicaid) ABD related - 317:35-7-15 SoonerCare (Medicaid) AFDC/Pregnancy related -317:35-6-15 Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 7 of 33 D. Other eligibility requirements
Code reason
Computer-generated message
Benefit type and policy cite
01
Death
No computer-generated notice. Worker-generated letter to the family or guardian is required.
TANF, SNAP, SoonerCare (Medicaid)
24R
Disaster Food Benefits
You do not qualify for disaster food benefits. Rules regarding this action are found at OAC ___.
SNAP –340:50-11-86
31
Failed or refused to provide proof of citizenship
You failed or refused to provide proof of citizenship. Rules regarding citizenship documentation are found at OAC ____.
SoonerCare (Medicaid) -317:35-5-25
32
Failed or refused to provide proof of identity
You failed or refused to provide proof of identity. Rules regarding identity documentation are found at OAC. ____.
SoonerCare (Medicaid) -317:35-5-25
40
Citizenship or alienage requirements not met
You did not meet the eligibility requirement of United States citizenship or qualified alien status to receive benefits or did not provide documents to prove you meet the requirement. Rules regarding citizenship or qualified alien status can be found at OAC ____.
TANF -340:10-15-1 & 317:35-5-25 SNAP -340:50-5-67 SoonerCare (Medicaid) -317:35-5-25
41
Residence requirement not met
You are not a resident of Oklahoma. Rules regarding residency are found at OAC ___.
TANF -340:10-7-1 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-5-26
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 8 of 33 Code reason
Computer-generated message
Benefit type and policy cite
42
Moved to another state
You no longer live in Oklahoma so you do not qualify to receive benefits in Oklahoma. State residency rules are found at OAC ___.
TANF -340:10-7-1 & 340:10-3-75 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-5-26
43
Unable to locate
We have been unable to locate you. Rules regarding this action are found at OAC ___.
TANF, SNAP, & SoonerCare (Medicaid) -340:65-3-7
47
Failed or refused to apply for available benefits
You did not apply for benefits or income that you may be eligible to receive or did not provide proof that you applied. Rules regarding the requirement to apply for other benefits or income are found at OAC ___.
TANF -340:10-3-26 SoonerCare (Medicaid) ABD related -317:35-5-42 SSP -340:15-1-5
48
Living in an institution
You are a resident of an institution where your needs are being met. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-56 SNAP -340:50-5-7 SoonerCare (Medicaid) -317:35-5-26 SSP -340:15-1-5
49
Age requirement not met
You do not meet the age requirement to receive this benefit. Rules regarding age requirements are found at OAC ___.
TANF -340:10-5-1 & 340:10-3-75 SSP -340:15-1-6
50
Striker
You are participating in a strike. Rules regarding strikes can be found at OAC ___.
TANF -340:10-3-57 SNAP –340:50-5-46
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 9 of 33 Code reason
Computer-generated message
Benefit type and policy cite
51
Social Security number requirement not met
You did not provide proof of a valid Social Security number or proof that you applied for one. Rules regarding Social Security numbers can be found at OAC ___.
TANF, SNAP, SoonerCare (Medicaid) -340:65-3-1
52
Failed or refused to meet work registration requirement
You did not comply with the Supplemental Nutrition Assistance Program (SNAP) food benefit requirement to register for employment. Rules regarding this requirement are found at OAC ___.
SNAP -340:50-5-88
52A
Failed or refused to meet TANF Work requirements
You failed or refused without good cause to participate in the Temporary Assistance for Needy Families (TANF) Work requirements. Rules regarding this action are found at OAC ___.
TANF -340:10-2-2
52B
Failed or refused to meet TANF Work requirements (Automatic closure)
You failed or refused without good cause to participate in the Temporary Assistance for Needy Families (TANF) Work requirements. Rules regarding this action are found at OAC ___.
TANF -340:10-2-2
53
Failed or refused to comply with Employment and Training (E&T) requirements
After agreeing to participate in employment and training related activities for Supplemental Nutrition Assistance Program (SNAP) food benefits, the person you chose as head of household did not participate. Rules regarding this action are found at OAC ___.
SNAP -340:50-5-88
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 10 of 33 Code reason
Computer-generated message
Benefit type and policy cite
53A
Failed or refused to comply with requirements for E&T
After agreeing to participate in employment or training related activities, you failed to participate. Because you failed to participate, you are not eligible for food benefits. The countable household income is too high for the remaining household members to receive food benefits. Rules regarding this action are found at OAC ____.
SNAP -340:50-5-88
54
Absence not established
One or both of the parents of a child(ren) must be absent to receive Temporary Assistance for Needy Families (TANF) and absence was not determined. Rules regarding deprivation of parental support due to the absence of a parent are found at OAC ____.
TANF -340:10-10-4
55
Relationship requirement not met
You do not meet the required degree of relationship to the child(ren) who is deprived of parental support. Rules regarding this action are found at OAC ____.
TANF -340:10-9-1 SoonerCare (Medicaid) AFDC- related - 317:35-5-7
56
No eligible child
There is no eligible child in the home. Rules regarding this action are found at OAC ____.
TANF -340:10-3-56, 10-3-75, 340:10-5-1, 340:10-7-1, 340:10-9-1, 340:10-10-1, 340:10-13-1, & 10-15-1
56M
Ineligible minor parent
You are a minor parent under the age of 18 and are not living in the home of one or both of your parents, a legal guardian, or another relative 18 years of age or older and have not provided a good cause reason why you do not. Rules regarding minor parents are found at OAC ____.
TANF -340:10-3-56
58
Ineligible student household
All household members are ineligible students. Rules regarding student eligibility can be found at OAC ____.
SNAP -340:50-5-45
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 11 of 33 Code reason
Computer-generated message
Benefit type and policy cite
60
Separate household requirement not met
You did not want to include all members who are required to be included in your food benefit household. Rules regarding who must be included in your food benefit household are found at OAC ___.
SNAP -340:50-5-3
61
Household member committed fraud
One or more members of your household are disqualified from receiving food benefits and no further appeal of the disqualification is available through OKDHS. For more information, read your notice of disqualification. Rules regarding reasons for disqualification are found at OAC ___ .
SNAP -340:50-5-10.1 & 340:50-15-25
62
Boarder
Everyone in your household is a boarder and boarders are not eligible for food benefits. Rules regarding boarders are found at OAC ___.
SNAP -340:50-5-5
63
Voluntary quit
(Name) voluntarily quit employment and is your designated head of household. Your household is disqualified from receiving food benefits for three months. You may reapply for food benefits when your disqualification period ends. You may reapply before the disqualification ends if the person who voluntarily quit starts working at least 20 hours per week or has weekly earnings that equal 20 hours per week at the federal minimum wage., leaves your household, or is no longer required to register for work. Rules regarding voluntary quit, head of household, and work registration are found at OAC ___.
SNAP – 340: 50-5-87, 340:50-5-88, 340:50-5-89, & 340:50-5-90
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 12 of 33 Code reason
Computer-generated message
Benefit type and policy cite
64
Household elected to receive commodities
You cannot receive both food benefits and commodities from an Indian tribe in the same month. You chose to receive commodities. Rules regarding this action are found at OAC ____.
SNAP -340:50-5-7
65
Decertification of alcoholic treatment center
No computer-generated notice.
SNAP -340:50-5-26
68
Solicitation of alms
You solicit alms and are ineligible for a State Supplemental Payment. Rules regarding this action are found at OAC ____.
SSP -340:15-1-6
69
Other -To be used only when reason codes 01-68 do not apply
No computer-generated notice. The worker sends a hand-written notice stating specific reason. Also used for negative action based on hearing decision not in client's favor. Specific reason must be documented in case notes.
TANF, SNAP, SoonerCare (Medicaid)
70
Caretaker relative has left the home
Your household's eligibility for continued medical benefits was based on the earnings of the caretaker relative who has left the home. Rules regarding continued medical benefits are found at OAC ____.
TANF -340:10-3-75 (CMB only)
80
Able-bodied adult without dependents (ABAWD) without required work history
You have not met the Supplemental Nutrition Assistance Program work requirements for an able-bodied adult without dependents (ABAWD). Rules regarding work requirements are found at OAC ____.
SNAP -340:50-5-64
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 13 of 33 Code reason
Computer-generated message
Benefit type and policy cite
81
Fleeing felon
You may not receive benefits because you are a fleeing felon. Rules regarding work requirements are found at OAC ____.
SNAP -340:50-5-10.1 SSP – 340:15-1-6
82
Probation or parole violator
You may not receive food benefits because you are a probation or parole violator. This action is in accordance with OAC ___. Rules regarding work requirements are found at OAC ____.
SNAP -340:50-5-10.1
88
First positive illegal drug screen result
You are ineligible for TANF benefits for 1 year as the result of a controlled substance screening process for illegal drug(s). Rules regarding this action are found at OAC ____.
TANF – 340:10-4-1
89
Second or subsequent illegal drug screen result
You are ineligible for TANF benefits for 3 years as the result of a controlled substance screening process for illegal drug(s). Rules regarding this action are found at OAC ____.
TANF – 340:10-4-1
E. Procedural reasons
Code reason
Computer-generated message
Benefit type and policy cite
22
Needs included in another case
Your household will not receive benefits from OKDHS under this case number because you are receiving benefits under another case number. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-57 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-6-60
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 14 of 33 Code reason
Computer-generated message
Benefit type and policy cite
22R
Referred or receiving tribal TANF (denial code only)
Either your household was referred to the tribal office to apply for Tribal TANF or your household is receiving tribal TANF.
TANF -340:10-3-57
22T
Needs included in a tribal TANF case (closure code only)
Your needs are included in a Tribal Temporary Assistance for Needy Families (TANF) case. Rules regarding this action are found at OAC___.
TANF -340:10-3-57
23A
Needs transferred to State Supplemental Payment (SSP) - aged category
You will not receive benefits from OKDHS under this case number because you are approved to receive benefits under another case number. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-57 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-7-60 TANF, SNAP, SoonerCare (Medicaid) – 340:65-5-1
23B
Needs transferred to SSP -blind category
You will not receive benefits from OKDHS under this case number because you are approved to receive benefits under another case number. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-57 SNAP –340:50-5-66 SoonerCare (Medicaid) -317:35-7-60 TANF, SNAP, SoonerCare (Medicaid) –340:65-5-1
23C
Needs transferred to TANF category
You will not receive benefits from OKDHS under this case number because you are approved to receive benefits under another case number. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-57 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-7-60 TANF, SNAP, SoonerCare (Medicaid) –340:65-5-1
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 15 of 33 Code reason
Computer-generated message
Benefit type and policy cite
23D
Needs transferred to SSP - disabled category
You will not receive benefits from OKDHS under this case number because you are approved to receive benefits under another case number. Rules regarding this action can be found at OAC ___.
TANF -340:10-3-57 SNAP -340:50-5-66 SoonerCare (Medicaid) -317:35-7-60 TANF, SNAP, SoonerCare (Medicaid) –340:65-5-1
23P
Initial month's benefit prorated to less than $10
You are not eligible to receive benefits for the month of application only because your benefit prorated to less than $10. Rules regarding this action can be found at OAC ___.
SNAP -340:50-9-1
24
State office use only Change in State or Federal law or OKDHS policy
There has been a change in laws or policies affecting eligibility.
TANF, SNAP, SoonerCare (Medicaid)
29
Receipt of 60 months of TANF
You received Temporary Assistance for Needy Families (TANF) benefits for 60 months which is the maximum number of months allowed. Rules regarding this action are found at OAC ___.
TANF -340:10-1-4 & 340:10-3-56
29A
Receipt of 60 months of TANF. Extension not approved.
You received Temporary Assistance for Needy Families (TANF) benefits for 60 months which is the maximum number of months allowed without an extension and your request for an extension has not been approved. Rules regarding this action are found at OAC ___.
TANF -340:10-1-4 & 340:10-3-56
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 16 of 33 Code reason
Computer-generated message
Benefit type and policy cite
29B
Receipt of 60 months of TANF. Failed to participate after extension approved.
You failed or refused without good cause to participate in the Temporary Assistance for Needy Families (TANF) Work requirements after your request for a TANF extension was approved. Rules regarding this action are found at OAC ___.
TANF -340:10-3-56
29C
Receipt of 60 months of TANF. Extension time frame completed.
You received Temporary Assistance for Needy Families (TANF) benefits for 60 months and the time frame for the hardship extension approval has been completed. Rules regarding this action are found at OAC ___.
TANF -340:10-1-4 & 340:10-3-56
30
Automatic expiration
You were approved for an adjustment period following your marriage or reunion with your spouse. The adjustment period has ended. Rules regarding this action are found at OAC ___.
TANF -340:10-3-81
36A
Automatic expiration of certification period
No computer-generated notice.
SNAP
36C
Automatic expiration of certification period
The period of time you were certified for a category of SoonerCare (Medicaid) has ended. You may be eligible under another category. You must make a new application before this can be determined. Rules regarding this action are found at OAC. ____.
AFDC related SoonerCare (Medicaid)
36D
Automatic SNAP closure when TANF closes using 52A
A new application is needed to determine your eligibility for food benefits. Rules regarding this action are found at OAC ____.
SNAP 340:50-11-27
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 17 of 33 Code reason
Computer-generated message
Benefit type and policy cite
36S
Failed to return Form 08MP004E (FSS-BR-1)
You did not finish your benefit renewal. Call the phone number on this notice right away to find out what you must do to complete the renewal or reapply for benefits. Rules regarding this action can be found at ___.
SNAP -340:50-9-5 SoonerCare (Medicaid) -340:65-3-8
44
Failed or refused to cooperate in determining eligibility Code 45 or 59 is more appropriate for SNAP
You failed or refused to help OKDHS determine your eligibility to receive benefits. This could include failing to complete an interview, answer questions, or not signing the application or review as requested. Rules regarding this action can be found at OAC ___.
TANF & SoonerCare (Medicaid) -340:65-3-7, 340:65-5-1, & 340:65-5-5 SNAP -340:50-3-2
44G
Failed or refused to cooperate with Office of Inspector General (OIG) investigation
You failed or refused to cooperate with an Office of Inspector General (OIG) investigation. Rules regarding this requirement are found at OAC ___.
SNAP -340:50-3-2 & 340:50-13-3
44Q
Failed or refused to cooperate with SNAP quality control (QC) review
You failed or refused to cooperate with a federal food benefit quality control review. Rules regarding this requirement are found at OAC ___.
SNAP -340:50-3-2 & 340:50-13-3
45
Failed or refused to provide necessary verification within the time allowance
OKDHS asked you to provide documents to prove you are eligible to receive benefits and you did not provide one or more of the required documents. Rules regarding this action can be found at OAC ___.
TANF, SNAP, SoonerCare (Medicaid) -340:65-3-7, 340:65-5-1, & 340:65-5-5
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 18 of 33 Code reason
Computer-generated message
Benefit type and policy cite
46A
Client's request because of employment
You requested closure of your benefits or denial of your application because of employment. Rules regarding this action can be found at OAC ___.
TANF, SNAP, SoonerCare (Medicaid) -340:65-3-7 & 340:65-5-5
46B
Client's request because of marriage
You requested closure of your benefits or denial of your application because of marriage or reunification with a spouse. Rules regarding this action can be found at OAC ___.
TANF, SNAP, SoonerCare (Medicaid) -340:65-3-7 & 340:65-5-5
46C
Client's request for other reasons
You requested closure of your benefits or denial of your application. Rules regarding this action can be found at OAC ___.
TANF, SNAP, SoonerCare (Medicaid) -340:65-3-7 & 340:65-5-5
59
Failure to meet scheduled interview
You failed to complete your scheduled interview within 30 calendar days of the date of application. Rules regarding this action are found at OAC ___.
SNAP -340:50-3-2
66
Expiration of time limit for Refugee Medical Assistance
Your eligibility for Refugee Medical Assistance ends after 8 months from entry into the U.S. Rules regarding this action are found at OAC ____.
Refugee Medical –340:60-1-6
99
State office use only Closure for procedural or audit purposes
No computer-generated notice
TANF, SNAP, SoonerCare (Medicaid)
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 19 of 33 F. Resources reasons
Code reason
Computer-generated message
Benefit type and policy cite
15
Exceeds resource standard
The resources available to your household are too high to receive benefits from OKDHS. Rules regarding resources are found at OAC ___.
TANF -340:10-3-2 SoonerCare (Medicaid) ABD related -317:35-5-41
16
Transfer of resources without commensurate return
You did not receive equal value for resources you transferred to someone else. Rules regarding resources transfers are found at OAC ___.
SoonerCare (Medicaid) ABD related -317:35-9-67, 317:35-17-10 & 317:35-19-20
G. Special SoonerCare (Medicaid) codes
Code reason
Computer-generated message
Benefit type and policy cite
73
TPA backed up eligibility
No computer-generated notice
Insure Oklahoma only
36V
Third party administrator (TPA) voided eligibility
No computer-generated notice.
Insure Oklahoma only
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 20 of 33 Code reason
Computer-generated message
Benefit type and policy cite
83
Creditable insurance coverage
You have creditable health insurance for breast or cervical cancer. Rules regarding creditable insurance coverage are found at OAC ____.
SoonerCare (Medicaid)-(Breast and Cervical Cancer (BCC) only) 317:35-21-4
84
No longer in need of BCC services
You are no longer in need of treatment for breast or cervical cancer. Rules regarding this action are found at OAC ____.
SoonerCare (Medicaid) –(BCC only) 317:35-21-12
86A
No longer eligible for Tax Equity and Fiscal Responsibility Act (TEFRA)
You do not meet the eligibility requirements for the TEFRA Program. Rules regarding the TEFRA Program are found at OAC ____.
SoonerCare (Medicaid) ABD related - 317:35-5-4
86B
No longer meet cost effectiveness for TEFRA
You do not meet the cost-effectiveness for the TEFRA program. Rules regarding this action are found at OAC ____.
SoonerCare (Medicaid) ABD related -317:35-5-4.1
87
TPA ended eligibility
No computer-generated notice.
Insure Oklahoma only
H. TANF Emergency Assistance codes
98A
No emergency need was determined
You did not meet OKDHS standards for emergency assistance or no emergency funds were approved. Rules regarding emergency assistance are found at OAC ____.
TANF EA -340:10-19-2 & 340:10-19-3
98B
Income and/or resources exceeded the emergency needs
You do not meet income and/or resource standards for emergency assistance. Rules regarding this action are found at OAC ____.
TANF EA -340:10-19-3
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 21 of 33 I. Unemployed parent reasons
Code reason
Computer-generated message
Benefit type and policy cite
71A
Principal wage earner employed with new or increased earnings
The countable earned income received by the members of your household is too high to receive Temporary Assistance for Needy Families (TANF) from OKDHS. Rules regarding earned income are found at OAC ___.
TANF-340:10-3-31, 340:10-3-32, & 340:10-3-33
71B
Principal wage earner not unemployed 30 days prior to application
The principal wage earner in your family was not unemployed for 30 calendar days prior to the date of application for Temporary Assistance for Needy Families (TANF) so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF-340:10-10-3
71C
Principal wage earner unavailable for work or training
The principal wage earner in your family is not available to participate in Temporary Assistance for Needy Families (TANF) Work activities so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
71D
Principal wage earner terminated without good cause or refused without good cause a bona fide offer of employment
The principal wage earner in your family quit a job or refused a valid offer of employment without good cause so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
71E
Work history requirement not met by the principal wage earner
The principal wage earner in your family does not meet the work history requirement so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 22 of 33 Code reason
Computer-generated message
Benefit type and policy cite
71F
The principal wage earner failed or refused to apply for Unemployment Insurance Benefits (UIB)
The principal wage earner in your family failed or refused to apply for or accept unemployment benefits so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
71G
The principal wage earner is unemployed due to involvement in a strike
The principal wage earner in your family is unemployed due to participation in a strike so deprivation due to unemployment does not exist. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
71H
Failed or refused to cooperate in determining eligibility
You have not cooperated in determining your eligibility based on unemployment. Rules regarding deprivation due to unemployment are found at OAC ____.
TANF -340:10-10-3
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 23 of 33 Section II. Child Care Subsidy Section E and K authorization computer messages for closures and denials.
On denials and closures, enter in the Auth. Daycare tab the Action type (K12), Reason (K16), and the Ending date (K47) fields. Remember to close K section authorizations before closing or making changes to Section E. Choose the appropriate reason from the table below.
Code reason
Computer-generated message
Benefit type and policy cite
1
Death of client
No notice generates to the client; provider notice will generate.
4
Change in provider (Section K only)
No notice generates to the client, provider notice will generate.
Child Care Subsidy 340:40-9-2
5A
Income exceeds agency standards (Use 03 for Section E)
Your income exceeds agency standards.
Child Care Subsidy 340:40-7-13
5B
Alternative caretaker available
An alternative caregiver is available.
Child Care Subsidy 340:40-5-1
5C
Caretaker/relative failed to cooperate in determining eligibility (Use 44 for Section E)
You failed to cooperate in determining eligibility.
Child Care Subsidy 340:40-3-1 Applications 340:40-9-2 Closures
5D
Parent/caretaker not employed
You are not employed and there is no authorized need for care.
Child Care Subsidy 340:40-7-7
5E
Parent/caretaker not in school
You are no longer in school and there is no authorized need for care.
Child Care Subsidy 340:40-7-7
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 24 of 33 Code reason
Computer-generated message
Benefit type and policy cite
5F
Parent/caretaker not in training
You are no longer in training and there is no authorized need for care.
Child Care Subsidy 340:40-7-7
5G
Need not met for a two parent/caretaker family
You no longer meet the need factor for a two parent/caretaker family.
Child Care Subsidy 340:40-7-7
5J
Need not met for single parent/caretaker family (Section K only)
You no longer meet the need factor for a single parent/caretaker family.
Child Care Subsidy 340:40-7-7
5K
Failure to cooperate with child support requirement (Use 44 for Section E)
You have failed to cooperate with child support requirements.
Child Care Subsidy 340:40-7-9
6
Services received in another case (Use 22 for Section E)
Services are to be received in another case.
Child Care Subsidy 340:40-9-2
7
Ineligible provider
The provider is ineligible for OKDHS child care payment.
Child Care Subsidy 340:40-3-1 & 340:40-13-5
7A
Provider contract terminated (State Office use only)
The provider is ineligible for OKDHS child care payment.
Child Care Subsidy 340:40-13-5
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 25 of 33 Code reason
Computer-generated message
Benefit type and policy cite
8
Client request (Use 46 for Section E)
You requested closure.
Child Care Subsidy 340:40-9-2
9
Provider request
The provider requested closure.
Child Care Subsidy 340:40-9-2
26
Job search child care (30 days eligibility)
The period of time you were eligible for job search has ended.
Child Care Subsidy 340:40-7-8 & 340:40-9-2
36
FSS-BR-1 not completed
The FSS BR-1, Benefit Report Form was not completed.
Child Care Subsidy 340:40-9-1
42
Moved to another state (Section E only)
You no longer live in Oklahoma so do not qualify to receive benefits in Oklahoma. State residency rules are found at OAC ___.
Child Care Subsidy 340:40-7-5
43
Unable to locate (Section E only)
We have been unable to locate you. Rules regarding this action are found at OAC ___.
Child Care Subsidy 340:40-9-2
69
Other
No notice generated to client. Provider notice will generate.
81
Plan of service complete
Plan of service completed.
Child Care Subsidy -340:40-9-2
88
EBT inactivity State Office only
There is no documented attendance for your child for the past 60 days.
Child Care Subsidy 340:40-10-2
99
State Office use only
No notice generates.
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 26 of 33 Section III. Supplemental Security Income-Disabled Children's Program (SSI-DCP) authorization message for closures and denials.
On denials and closures, the worker enters the Action type (K12), Reason (K16), and the Ending date (K47) fields in the Auth. SSI-DCP tab.
Code reason
Computer-generated message
Benefit type and policy cite
81
Plan of service completed
Plan of service completed.
SSI-DCP 340:70-8-1
Section IV. SoonerCare (Medicaid) Section K long term care (LTC) authorization computer messages for closures and denials.
On denials and closures, the worker enters the Action type (K12), Reason (K16), and the Ending date (K47) fields in the Auth. LT Care tab. Choose the appropriate reason from the table below. Codes 11 through 16 are only used for Advantage Waiver.
Code reason
Computer-generated message
Benefit type and policy cite
1
Death of client
No computer-generated message.
SoonerCare (Medicaid) LT and SW
2
Client's request
You have withdrawn your request for Personal Care, Advantage Waiver, Nursing Home, or Assisted Living.
SoonerCare (Medicaid) LT and SW 317:35-15-10 & 317:35-17-19
3
Change in level of care
A change in level of care.
SoonerCare (Medicaid) LT and SW 340:65-5-1
4
Change in providers
A change in providers.
SoonerCare (Medicaid) LT and SW
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 27 of 33 Code reason
Computer-generated message
Benefit type and policy cite
6
Change in case number
A change in the DHS case number for authorization.
SoonerCare (Medicaid) LT and SW 340:65-5-1
7
Ineligible provider
The provider is no longer eligible.
SoonerCare (Medicaid) LT and SW 317:35-17-21.1
9
Non-cooperation
You have not cooperated in the delivery of services.
SoonerCare (Medicaid) LT and SW 317:35-15-10 & 317:35-17-19
10
Financial eligibility not met
You do not meet the financial eligibility for Personal Care, Advantage Waiver, Nursing Home, or Assisted Living.
SoonerCare (Medicaid) LT and SW 317:35-5-41.8; 317:35-5-42; 317:35-15-5; 317:35-17-10; 317:35-17-11; 317:35-19-20; & 317:35-19-21
11
Not in targeted group for the Advantage Waiver (AW)
You are not in a targeted group for the Advantage Waive.
SoonerCare (Medicaid) SW authorizations only 317:35-17-3
14
Cost of services exceed allowable capitalization
The cost of services exceeds the allowable capitalization.
SoonerCare (Medicaid) SW only 317:35-17-3
15
No open Advantage Waiver slot
There is no open Advantage Waiver slot.
SoonerCare (Medicaid) SW only 317:35-17-4
16
Needs cannot be met through AW
Your needs cannot be met through Advantage Waiver services.
SoonerCare (Medicaid) SW only 317:35-17-3
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 28 of 33 Code reason
Computer-generated message
Benefit type and policy cite
17
Harm to self or others
Harm to self or others.
SoonerCare (Medicaid) SW only 317:35-15-10 & 317:35-17-3
18
Another person threatens harm to others
A household member or frequent guest threatens harm to others.
SoonerCare (Medicaid) 317:35-15-10 & 317:35-17-3
20
Medical eligibility not met
You do not meet the medical eligibility for Personal Care, Advantage Waiver, Nursing Home, or Assisted Living.
SoonerCare (Medicaid) LT and SW 317:35-15-10 & 317:35-17-2
21
Transfer of resources
Due to transfer of resources you are ineligible for nursing home level of care.
SoonerCare (Medicaid) LT and SW 317:35-17-10
22
Moved out of state
You moved out of state.
SoonerCare (Medicaid) 340:65-5-1
23
Unable to locate
We have been unable to locate you.
SoonerCare (Medicaid) 340:65-5-1
49
Entered nursing facility (for closure only)
You entered a nursing care facility.
SoonerCare (Medicaid) LT and SW 317:35-15-2 & 317:35-17-19
69
Other
No notice generated
SoonerCare (Medicaid) LT and SW
99
State Office use only
No notice generated
SoonerCare (Medicaid) LT and SW
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 29 of 33 Section V. TANF Work Section K authorization computer messages for closures and denials.
On denials and closures, the worker enters the Action type (K12), Reason (K16), and the Ending date (K47) fields in the Authorization tab. Choose the appropriate reason from the table below. Closure of TANF Work authorizations does not affect the TANF benefit. A computer-generated message does not generate to the client.
Code reason
Benefit type and policy cite
1
Death of client
70
Good cause no longer applicable
TANF 340:10-2-2
80
Completed activity as defined by provider of activity
TANF 340:10-2-3
81
Completed activity as defined by provider of activity and entered another TANF Work component
TANF 340:10-2-3
82
Illness, injury, or physical incapacity
TANF 340:10-2-2
83
Substance abuse or dependence
84
Illness of dependent child or other dependent person requiring the participant's care
TANF 340:10-2-2
85
Lost or had other problems with child care
TANF 340:10-2-2
86
Lost or had other problems with transportation
TANF 340:10-2-2
87
Moved out-of-state
88
Dropped out of activity without explanation or other reasons not listed above
TANF 340:10-2-2
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 30 of 33 Section VI. Low Income Home Energy Assistance Program (LIHEAP) computer messages for closures and denials using the 105H or 105E transactions.
Denial and closure reason codes are separated as workers can only enter denials. Closure codes are reserved for State Office use only. The reason for denial or closure is shown at the bottom of the notice.
A. Denials
Code reason
Computer-generated message
Benefit type and policy cite
01
Excess income and/or resources
Excess income and/or resources.
LIHEAP 340:20-1-11
02
Not vulnerable (not responsible for own heating or cooling cost)
Are not responsible for your own heating or cooling cost.
LIHEAP 340:20-1-10
03
Failure to complete application
Failure to complete application.
LIHEAP 340:20-1-12
04
Received maximum payment
Received maximum payment.
LIHEAP 340:20-1-10
05
Application not received timely
Application not received timely.
LIHEAP 340:20-1-10
06
Other reasons
Hand generated notice is required
07
Primary source of home energy cannot be established
Primary source of home energy cannot be established.
LIHEAP 340:20-1-10
08
No feasible plan for establishing or restoring service
No feasible plan for establishing or restoring service.
LIHEAP 340:20-1-17 (ECAP use only)
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 31 of 33 Code reason
Computer-generated message
Benefit type and policy cite
09
State Office use only
10
Received tribal assistance
Received tribal assistance.
LIHEAP 340:20-1-4
11
Crisis could not be established
Crisis could not be established.
LIHEAP 340:20-1-17 (ECAP use only)
B. Closures (State Office use only)
Code reason
Computer-generated message
Benefit type and policy cite
01
Death
Hand generated notice is required
LIHEAP 340:20-1-14
02
Unable to determine continued vulnerability
Unable to determine continued vulnerability.
LIHEAP 340:20-1-14
03
Income and/or resources exceed the maximum
Income and/or resources exceed the maximum.
LIHEAP 340:20-1-11
04
Moved
Moved.
LIHEAP 340:20-1-14
05
For State Office when maximum is received
06
Other reasons
Hand generated notice is required
07
Change of supplier
Change of supplier.
LIHEAP 340:20-1-14
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 32 of 33 Code reason
Computer-generated message
Benefit type and policy cite
08
Administrative error
Administrative error.
LIHEAP 340:20-1-17 (ECAP use only)
09
State Office use only
10
Supplier cannot identify
Supplier cannot identify.
LIHEAP 340:20-1-10
11
Received tribal assistance
Received tribal assistance.
LIHEAP 340:20-1-4
12
Will receive in another case
Will receive in another case.
LIHEAP 340:20-1-14
Appendix U (08AX015E) revised 11-1-2012 may continue on next page, page 33 of 33