To determine the amount of child care assistance the family and/or provider were actually eligible to receive, examine the following:

· Eligibility

· Copayment amount in billing

· Authorized hours

· Payment amount.

Policies change over time. Consider the policies in place at the time an action took place when determining whether an overpayment occurred and the amount of an overpayment. In some instances, changes to a family’s case that occurred before a policy changed but were processed after a policy changed may be subject to new policies. This may be appropriate and is not an overpayment.

When calculating an overpayment, use the maximum rates and copays in effect at the time care was provided. See Chapter 9.24.3 (Child Care Rates, Registration Fees, Copayments) for links to current and expired maximum rates and copayment schedules.

Determining the overpayment

Amount of overpayment

The amount of the overpayment is the difference between the child care assistance payments that the family and/or provider received and the child care assistance payments that the family and/or provider were actually eligible to receive. See Chapter 14.1 (Assessing Overpayments).

When to assess an overpayment

Assess an overpayment if a family and/or provider receives more child care assistance than they were actually eligible for if the overpayment occurred:

· Solely as a result of family and/or provider actions or errors.

· Because of a combination or agency error and family or provider actions or errors.

Do not assess an overpayment if a family and/or provider receives more child care assistance than they were actually eligible for solely because of agency error.

Timeframe of overpayment

Do not assess overpayments that occurred more than six years before the overpayment was determined, unless fraud is established. See Chapter 13 (Fraud Disqualifications) and Chapter 14.1 (Assessing Overpayments).

An overpayment is determined on the date the agency computes the overpayment, which is also the “established date.” See definitions of “determined date” and “established date” in Chapter 2 (Glossary). A non-fraud overpayment cannot start more than six years before its established date. For example, an overpayment determined on August 1, 2021 that did not result from fraud cannot go back farther than August 1, 2015.

Fraud overpayments must be assessed and collected regardless of timeframe.

Date of overpayment

Figure out the discovery, established, and determined dates as part of the process of calculating an overpayment. See the definitions of “discovery date,” “established date” and “determined date” in Chapter 2 (Glossary). Examples of documents needed to calculate an overpayment may include paystubs, W-2s or employer statements.

Reporting and processing timelines

Timely reporting

When a family reports changes within 10 calendar days of the change, there is no overpayment.

Failure to report timely

When the family does not report required changes within 10 calendar days, there may be an overpayment. The overpayment is calculated beginning on the date the change occurred. If a family experiences a change but is not required to report the change, there is not an overpayment. See Chapter 8.3 (Reporting Requirements).

Overpayments due to a combination of family error and agency error

When an overpayment resulted from a combination of family and agency error and the agency error portion of the overpayment is able to be calculated separately, only the family portion of the overpayment can be assessed and collected from the family.

Example:

During the 12-month eligibility period, a family had a change in income that put the family over 85% SMI. The family reported and verified the change three months after the change occurred. The family failed to report the change in income within 10 calendar days. The CCAP agency did not act on the reported and verified income change for two months after it was reported and verified.

· An overpayment for failure to report can be assessed to the family from the date of the change in income through the date the family reported and verified the change in income.

· No overpayment is assessed to the family from the date the CCAP agency knew of the change in income but failed to act through the end of the 15-day notice as a result of agency error.

Overpayments due to increased income

If an overpayment is due to increased income, the overpayment is calculated as follows:

· If an overpayment is due to unreported increased income exceeding 85% SMI that occurred during a period of ongoing eligibility, the overpayment is calculated starting with the first biweekly period after the date the increased income was first received.

· If an overpayment is due to unreported increased income that occurred at the same time as an application:

· If the applicant was working and receiving income prior to the application date but they failed to report it on the application, calculate the overpayment back to the application date.

· If the applicant was working prior to the application date but did not receive their first paycheck until after the application date and failed to report the job on the application, calculate the overpayment starting with the first biweekly period after the applicant received their first check.

· If an overpayment is due to unreported increased income that occurred at the same time as a redetermination, the overpayment is calculated starting with the first biweekly period following when the redetermination was processed.

· If a family who continuously received child care assistance exceeded the applicable income limit but later met the applicable income limit, see the “Period of ineligibility” section below.

Overpayments due to attendance record keeping

When assessing an attendance record keeping overpayment, the amount of the overpayment is the maximum daily rate for each day a record is missing, unavailable, incomplete, inaccurate, or does not include required information. See Chapter 11.15 (Provider Record Keeping) for attendance record keeping requirements. The overpayment is assigned to the provider and cannot exceed the total payment for the biweekly period. Attendance records not produced immediately cannot be submitted later to challenge the overpayment. To avoid duplication of effort, follow guidance in Chapter 13.3 (Fraud Referrals) to contact the Department of Human Services Office of Inspector General (OIG) Child Care Provider Fraud Investigations Unit prior to assessing an attendance record overpayment.

Overpayments due to absent day and holiday billing errors

Any day a child does not attend care that a provider fails to accurately mark as an absent day or holiday on the billing form is considered an overpayment. An overpayment can be assessed if the attendance record indicates a child did not attend, but the provider failed to accurately mark the billing form with an “A” for absent or an “H” for holiday. An overpayment can be assessed regardless of whether the child reached or is exempt from the absent day or holiday limits for the year.

Interest

The CCAP agency may not charge interest on overpayments of child care assistance benefits. See Chapter 14.9.12 (Civil Recovery – Families).

Ineligibility

When a family received child care assistance for a period of time when the family was not eligible, the amount of the overpayment is the total amount of child care assistance paid during the time period of ineligibility. If a family reported a change timely or the change was not required to be reported (such as the expedited child care period ending) and the agency did not act on the change, there is no overpayment.

Period of ineligibility

Sometimes it is discovered that a family who continuously received child care assistance was ineligible for a period of that time (for example, when a family did not report a permanent end to an activity and received care for longer than the allowed Extended Eligibility period after the parent’s activity permanently ended). Sometimes the family became eligible again after the period of ineligibility. The time when the family was again eligible begins with the date they met the eligibility requirement(s) that previously made them ineligible.

Assess an overpayment for the period of ineligibility.

Examples

Examples of ineligibility due to exceeding applicable income limits:

· 47% SMI: if a family was later found to be over 47% at application but continuously received child care assistance including a period of time the family went under 47% SMI, eligibility would begin and the overpayment would end when family income went under 47% SMI.

· 67% SMI: if a family was later found to be over 67% at redetermination but continuously received child care assistance including a period of time the family went under 67% SMI, eligibility would “resume” and the overpayment would end when family income went under 67% SMI.

· 85% SMI: if a family was later found to be over 85% SMI during 12-month eligibility period but continuously received child care assistance including a period of time the family went under 85% SMI, eligibility would “resume” and the overpayment would end when family income went under 85% SMI.

Example of ineligibility due to a requirement other than exceeding the applicable income limit:

It is discovered at redetermination that the parent did not report a permanent end in activity that occurred on June 1. The parent did not have another activity until October 1. The family was eligible for Extended Eligibility from June 1st through August 31. The family was not eligible from September 1 to September 30. The family established eligibility on October 1. An overpayment is assessed from September 1 to September 30.

Legal authority

Minnesota Statutes 142E.01
Minnesota Statutes 142E.14, subd. 2
Minnesota Statutes 16D.13
Minnesota Statutes 549.09
Minnesota Rules 3400.0187