CT: 13 Notification of Ineligibility/Terminations (New)

Effective Date: 04/95 Downloads: PDF Version    Revised Date: 12/16
   

Policy

An applicant/participant who will become or is found ineligible for the program will be notified of their ineligibility status or termination from the WIC Program and notified of their right to a fair hearing.

 

Procedure

Notification of Pending Expiration of Certification

All participants shall be notified no less than 15 days and no more than 45 days in advance of their pending certification expiration. Notification can occur in writing, via phone call, or email, and must be documented.

Notification of Ineligibility

Anytime a participant is found not eligible for the program and/or is terminated for the following reasons identified below (#3, 4 and 9), the Local Agency must give no less than 15 days written notification to the participant/parent/guardian indicating the reason for the termination and their right to seek a fair hearing.

For all other reasons (# 1, 2, 5, 6, 7, and 8), the participant can be terminated without notification. If the participant returns before their present certification ends, they can be re-instated, if not receiving benefits from another clinic.

1.  Moving out Of Area or Transfer to Another Clinic 

Frequently, a participant will notify the clinic that they are moving out of the service area, transferring to another clinic or will contact the clinic after the move. A participant in the process of moving should be given the current month food instruments unless they are unable to utilize the food benefit due to the move. The participant should be instructed on transfer procedures and either be given/mailed the transfer information.

2.  Deceased 

To be used in the event of a participants’ death.

3.  Income Ineligibility

Under certain circumstances, you will become aware that a participant’s income is over the income guidelines. Some examples are:

  • Another member of the family is certified and found to be ineligible because of income.
  • The participant volunteers that the family income has increased and, upon questioning, you find that it has surpassed the income guidelines.
  • You reevaluate the income based on a complaint and find that it is over the guidelines.
  • The family size decreases.
  • A participant is determined to no longer have adjunct eligibility. Income eligibility must be redetermined. This may result in mid-certification ineligibility.

Complete and give the participant a copy of the “Notice of Ineligibility, Placement on Waiting List, or Disqualification”.  Retain copy of the completed form in participant’s file.  Additional benefits are not given in this instance. Benefits will just end with the end of the current benefit cycle month.

Example: If you receive information and determine on Dec. 2nd that a family is over income – terminate at the end of December. Do not provide another month’s worth of food instruments (January). Give them the 15-day notice that advises they are terminated effective 12/31/16.

4.  Program Abuse(including Dual Participation)

The participant is discovered applying or had applied for WIC services at more than one clinic site or any other violation of program rules, follow the Sanctions for Participant Abuse procedure.  Complete and give the participant a copy of the “Notice of Ineligibility, Placement on Waiting List, or Disqualification” form no less than 15 days before the suspension or disqualification. Retain copy of the completed form in participant’s file.

5.  Wrong Agency, Family, or Client #

Occasionally an agency, family or client number will be incorrectly imputed into the WIC Computer system. Determine the correct number for the family or participant and terminate the alternate number from the system.

6.  Categorical Ineligibility

If a participant is no longer categorically eligible provide “Graduation from WIC” education and terminate in the WIC computer system, benefits ending at the end of the current benefit month.

  • Exception: if a participant has already gone beyond their categorical eligibility cut-off, but it’s either reported or discovered after the fact, participant(s) are to be terminated effective immediately, including any remaining benefits. Complete and give or mail the participant(s) a copy of the “Notice of Ineligibility, Placement on Waiting List, or Disqualification” form. Retain a copy of the completed form in participant’s file and provide “Graduation from WIC” education. See following examples: 

Example 1: An 8 month postpartum mom comes in and advises that she is no longer Breastfeeding (BF). Terminate mom at that time including any remaining benefits. She is not entitled to additional benefits for herself because she has passed her 6 months PP status and baby will now be fully formula fed. 

Example 2: Child is turning age 5 per WIC system records, and say you discover that the original certification birthdate was entered incorrect. The child is not 5 years old, but instead is actually 5 years, 4mths old. Terminate immediately along with any remaining benefits. Child is not entitled to additional benefits through the end of the month because s/he has already passed their 5th YO birthday month.

7.  Failure to Participate

If a participant fails to have their EBT card revalidated for purchase of supplemental foods for two consecutive months (60 days), s/he becomes disqualified. Participant may be terminated on/after day 61 from date of last active benefit cycle.

8.  Participant Voluntarily Withdraws

Occasionally a participant will contact the clinic to indicate they no longer wish to participate in the WIC program for any reason. Inform the client that they may reinstate or reapply if needed.

9.  Participant is Placed on a Waiting List

Under extreme circumstances, you may be instructed to remove or temporarily withhold benefits to the lowest priority participants. During this period, new applicants at this priority cannot be certified. You will be instructed as to procedure when this occurs.

Mid-certification Ineligibility

Participants are encouraged to provide information to clinic staff on changes in income throughout the certification process. The clinic staff is not responsible for monitoring the continued income eligibility of participant(s) during the current WIC certification period. A local agency must reassess a participant’s income during a current certification period if the local agency receives information indicating that the participant’s income has changed. However, this is required only in cases where more than 90 days remains in the participant’s current certification period. If a participant’s income does exceed income guidelines, and they have more than 90 days left in their current certification period, they shall be terminated from the program. In the case of a household with multiple participants, if household income is found to exceed income guidelines, then all WIC participants in the household should be terminated; even those with fewer than 90 days remaining in their certification. The procedure for “Notification of Ineligibility” will be followed.