Eligibility Review

Effective: September 30, 2014

An eligibility review is an administrative process to determine the accuracy of information used to determine current and past eligibility. An eligibility review updates the information on a recipient’s case or contact. It includes examining and analyzing information on a recipient’s case and comparing it to information obtained from third-party checks and documents provided by the recipient, gathering additional information, recording outcomes, and if necessary, adjusting the amount of assistance and/or identifying, calculating, and recording overpayments. Recipients are notified of any changes or debts. 

Eligibility reviews are conducted in accordance with the principles of administrative fairness to ensure the recipient is made aware of eligibility issues and has an opportunity to respond to identified issues.  The ministry may determine whether the client is required to complete the review “in person” in the ministry office, over the telephone, or by the client completing the review form and submitting it to the ministry office.

Recipients are required to provide shelter, financial, identification, and any other required documents to verify their information and ensure that they continue to be financially eligible for assistance.

At each interview with a recipient, including an eligibility review, staff should review all aspects of the recipient’s case, including their employment status, obligations, and progress (if applicable). 

[For the Employment and Assistance/Employment and Assistance for Persons with Disabilities Review (HR0080R), see Forms and Letters.]

A follow-up interview may be required to develop or review an Employment Plan or a voluntary participation plan activity if time scheduled for the eligibility review is insufficient.  [For more information, see Related Links – Employment Plan and Voluntary Participation Plan.]

In addition to an Employment Plan with the ministry, BCEA recipients who are participating in WorkBC Employment Services (ES) will have a signed Action Plan with a WorkBC contractor outlining their agreed-to commitment. Ministry staff can request that WorkBC ES participant provide them with a signed copy of their WorkBC ES Action Plan at any time.  Participation concerns for employment obligated WorkBC ES participants will be communicated to the Ministry by WorkBC, through ICM Service Requests.

Effective: December 1, 2003

The requirement to complete an eligibility review when requested is a condition of continued eligibility and is not appealable.  A family unit ceases to be eligible for assistance if the recipient, and dependent spouse where applicable, fail to attend the review when required or to complete a review form when requested

Effective: September 30, 2014

Eligibility reviews may be conducted annually, or for Persons with Disabilities and adults in special care facilities, every two years.  In addition, eligibility reviews must be conducted when a spouse is added to a case. Eligibility Reviews may also be conducted in other situations where ministry staff  have questions about a recipient’s eligibility, such as when a person requests assistance after a two month absence and their circumstances are not known.

Where a recipient’s prior eligibility for a period of more than three months is in question or fraud is suspected, assess current eligibility and complete a referral to PLMS for review of the other information.

[For information on referrals to PLMS for review or investigation, see Related Links – Referral to PLMS for Review or Investigation.]

Effective: September 24, 2014

At the eligibility review, documents and information provided by the recipient are to be verified for accuracy. This may require further documentation from the recipient or through third party checks.

Third-party checks must not be run unless valid consent is on the case. If consent is on the case, they are run after the recipient submits documents, but prior to the interview. If consent is not on the case, they are run after the HR0080R is signed.

Mandatory third-party checks for all Eligibility Reviews are:
 

• BC Online – BC Assessment (Address Verification and name search)
• BC Online – Personal Property Registry
• Equifax Consumer Credit Report
• Insurance Corporation of BC (ICBC)
• Canada Revenue Agency (CRA) (only for recipients age 19 and over)

Note: Some recipients may not have filed an income tax return for previous years.  Filing an income tax return is not a condition of eligibility.  However, recipients should be encouraged to file an income tax return annually in order to receive exempt tax credits and benefits, such as the Family Bonus, GST Credit, BC Low Income Climate Action Tax Credit, BC Sales Tax Credit, and Working Income Tax Benefit.

Other third-party checks that may be required, depending on circumstances, include (but are not limited to):
 

• WEB AOB link
• Warrant Check
• MHR-EI Common Claimant Report (in the Report to Web folder)

Effective: November 1, 2007

When the Eligibility Review is completed and the recipient has signed the Employment and Assistance Review Form (HR0080R), the recipient will be requested to complete the voluntary Aboriginal Self-Identifier form (HR3187), if one has not already been completed. [See Related Links – BCEA Application – Stage 1 – Prospecting for policy]

Effective: January 19, 2015

Recipients of Medical Services Only (MSO) who are requesting income assistance, disability assistance or hardship assistance are required to complete an Eligibility Review and sign the Employment and Assistance Review form (HR0080R).

Recipients of MSO coverage who left disability assistance due to exhausting their annual earnings exemption may reapply for disability assistance at any time during the year if their financial circumstances change due to a loss of employment or a reduction in income.

Recipients of MSO coverage may also reapply for disability assistance at the beginning of a new exemption year as they may be eligible for assistance with a new annual earnings exemption limit.

Effective: September 30, 2014

Eligibility Review (ER) Interviews may be completed in person or by telephone. ER tasks may be done by one worker or the tasks may be shared. For example, one person may send the initial letter, another person may review the documents and conduct the interview.

Cases may be selected for Eligibility Review (ER) based on various factors, including but not limited to:
 

• Eligibility Review Lists
• Adding a Spouse to the case
• MSO recipient returning to assistance
• Missing Consent: An ER must be completed as soon as possible if there is no valid consent on the case
• Reports: Eligibility Review Overdue reports
• Information or an allegation is received that may affect current eligibility.
• Any other situation that leads the worker to determine that an ER is needed.

Prior to proceeding, review for PLMS involvement:
 

• If there is any type of active PLMS Review Service Request on the case, do not proceed with the review.
• If there is an active Incident – Investigation Fraud on a contact, the ER may continue, with the following points:
  • Address current eligibility only. Do not take action on any overpayment identified. Provide information related to a potential overpayment to the Ministry Investigator
  • Do not inform the recipient of PLMS involvement. PLMS will inform the client.

To initiate the Review:
 

• Create a Service Request: Type – Ongoing Eligibility; Subtype – File Review
• Conduct a brief overview of the case to identify any areas of concern.
• Create and send the Eligibility Review Documents: First Request Letter (HR3582) either by My Self Serve (MYSS) messaging or mail
• Allow the client 2-3 weeks (3-4 weeks for remote locations) to provide the documents

A general guideline is to allow 2-3 weeks for documents for persons who reside in urban/suburban areas, 3-4 weeks for persons who reside in rural areas. Adjust as needed to avoid having the document’s due date during cheque issue week.
 

• Exception: if there is a clear eligibility issue (for example, EI Common Claimant Report showing current undeclared income), no further assistance may be issued until eligibility has been re-established.

If the recipient does not respond to the first request for documents, attempt to contact the recipient by phone or MYSS messaging, if they are a registered user, to discuss the request, and send a second request following the same timelines as for the first letter.

Note: Staff may offer assistance if clients have difficulty obtaining documents. For example, if a recipient is unable to get to their bank, the worker should contact the bank and request the bank statements. Staff should assist the client with obtaining documentation where possible, as an alternative to denial for not providing information. If the recipient does not respond to the second request, and the EAW cannot obtain the documents, the recipient is no longer eligible. [See Procedures – Eligibility Review – Non Attendance.]

When the documents are received:
 

• Create and send the Eligibility Review Interview: First Request Letter (HR3584) either by MYSS messaging or mail

Staff may telephone the recipient in advance of sending the letter to arrange the date and time of the appointment, but the phone call must be followed by the letter or MYSS messaging in order to give the recipient a written record of the appointment.

If the recipient does not respond to the first letter, the recipient is offered the opportunity to reschedule:
 

• Create and send the Eligibility Review Interview: Second Request Letter (HR3585)

Staff should attempt to contact the recipient by telephone to arrange the date and time, but the phone call must be followed by the letter or MYSS messaging in order to give the recipient a written record of the appointment.

Effective: September 30, 2014

Review all information provided by the recipient and obtained from third-party checks (Note: if consent is not on the case, the third-party checks cannot be run until after the interview has been completed and the HR0080R signed).

Review case information and identify any issues to discuss with the recipient, including but not limited to:
 

• Questions or anomalies resulting from documentation, third-party checks, or case information
• Employment planning

Review alerts and identify any specific requirements, such as an interpreter.

Effective: September 30, 2014

To conduct an eligibility review, complete the following steps:

Update case/contact information:
 

• Review and update all tabs/fields to ensure all case and contact information is accurate (e.g. marital status, family unit composition, citizenship/immigration status, income, assets, address and shelter expenses, personal information such as spelling of names, AKAs, date of birth, SIN).
• Review all ongoing supplements to confirm eligibility
• Ensure appropriate documents to verify all case and contact information, and eligibility for supplements, is on the case. (Obtain from recipient if needed)

Complete the Employment and Assistance Review form (HR0080R):
 

• Ask all relevant questions, including question on warrants, assets, bank accounts, etc.
• Enter a response to each question (do not leave fields blank). Update all assets, including bank names and all account numbers. If no bank account is declared, enter “no bank acct” in the bank name field. (This confirms the question was asked and answered).
• Explain the rights and responsibilities, including reporting responsibilities, to the recipient and record on the case that this was done. Explain the consents, notifications, and privacy information.

Obtain recipient signature on the HR0080R – In-Person Appointment:
 

• If the appointment is in person, print two copies of the HR0080R. Obtain the recipient’s (and spouse’s, if applicable) initials on each page (and for any manual changes), their signatures on each place in the general consent and CRA consent sections. Ensure the location (city) and the dates are entered. Witness in all applicable places.

Obtain recipient signature on the HR0080R – Telephone Appointment:
 

•  If the appointment is on the phone, arrange for the recipient to sign the HR0080R, either later in the EAC, or at a Trusted Third Party (TTP). In exceptional circumstances, where a recipient is unable to attend at an EAC or a TTP, the ministry may accept witness signatures from:
  • Other government staff, or
  • Prescribed professionals (as described in EAPWD Regulation section 2 (2).
• Set a Notification or the SR Due Date as a reminder to ensure the HR0080R is signed and returned within 20 business days.
• Note: the role of the TTP or other non-EAW witness is solely to verify the person’s identity and witness their signature. In cases where the HR0080R is completed by phone, the EAW, not the TTP or other witness, is responsible to advise the recipient of the information contained in the form, and explain their rights and responsibilities.

Attach the completed HR0080R to the Service Request
 

• For in-person appointments, provide one copy of the completed HR0080R to the recipient; scan the other copy to the Service Request. Ensure the document is profiled and labelled “Signed HR0080R”. Batch-file the original.
• For phone appointments, when the form is received, review to ensure all required fields are initialled or signed, as applicable, and that locations and dates are entered, and that witness and recipient dates/locations match. If not complete, follow up is required. If complete, scan it to the Service Request. Ensure the document is profiled and labelled “Signed HR0080R”. Batch-file the original. 

Review and confirm eligibility
 

• Scan and profile all documents and third-party check printouts to the Service Request (except do NOT scan the CRA/TXI printout – it must be batch-filed)
• Complete any outstanding third-party checks that have not yet been completed
• Review all information, documents, and third party checks, and assess financial ability
• Follow up if needed with the recipient on any outstanding documents or questions

Advise recipient of changes
 

• Notify the recipient in writing if assistance is reduced or discontinued, or if an overpayment is calculated
• Include a Reconsideration and Appeals brochure

Effective: September 30, 2014

Recipients who do not complete an eligibility review when required cease to be eligible for assistance. If a recipient or their spouse does not provide required documents, does not attend the interview, or does not sign the HR0080R:
 

• Notify the recipient in writing that they are no longer eligible, using the Eligibility Review Non-compliance letter (HR3586)
• Provide the Reconsideration and Appeals brochure
• Cancel all outstanding cheques and turn cheque production off
• Set a reminder to review after the reconsideration period (urban recipients 4 business days mailing plus 20 business days for reconsideration; rural recipients 7 business days mailing plus 20 business days for reconsideration)
• If no contact from the recipient, close the case using the close reason “Non-Comply EA Review” and/or “Non-comply Info Request”, as applicable.

Effective: September 1, 2016

When a Medical Services Only (MSO) recipient requests assistance, the process for scheduling an appointment may vary, however, in all other aspects the eligibility review is conducted in the same manner as for any eligibility review [see Procedures - Eligibility Review: Conducting the Interview.] The recipient must provide all relevant documents to verify their eligibility, third party checks are completed, and the HR0080R is completed and signed.

Note: Recipients who leave disability assistance because of employment income and become eligible for MSO can continue to submit their Monthly Report (HR0081) monthly to automatically re-establish eligibility for disability assistance when they become financially eligible.  MSO recipients who do not continue to submit their HR0081 monthly will be required to complete a reapplication.

Each calendar year, annual earnings exemption (AEE) is reset and covers qualifying income received from January 1 to December 31, for March to February assistance months. January is the earliest month a PWD MSO client who has exhausted their AEE limit for the year can begin the reapplication process for disability assistance under the next year’s annual exemption limit, if the recipient did not submit an HR0081 each month.

If the MSO recipient (due to employment income) submitted the HR0081 monthly, disability assistance will be reinstated if or when the recipient becomes financially eligible.  If the MSO recipient is found eligible for disability assistance, the recipient should be reminded of the choice between the Transportation Supplement (TS) as a bus pass or as a monthly payment of $52.  The TS will default to the current form of Transitional Transportation Support (TTS) the MSO client is receiving [see Related Links - Transportation Supplement].

Staff will need to assess eligibility for disability assistance based on what the PWD designated client is reporting each month on the stub while in receipt of MSO coverage as a result of employment income. Staff will need to manually reinstate PWD designated clients onto disability assistance if their income drops below the disability assistance rate before January income/March benefit month. 

When the eligibility review is completed, advise the recipient of the outcome:

If the recipient is eligible for income assistance, hardship assistance, or disability assistance, update the case and initiate payment.

If the recipient is not eligible for income assistance, hardship assistance, or disability assistance:
 

• Offer to provide written substantive reasons for the decision. Inform the recipient of their right to request a reconsideration of the decision. Provide a copy of the Reconsideration and Appeals Brochure
• Re-assess eligibility for Medical Services Only [see Related Links – Medical Services Only.] If the recipient is not eligible for Medical Services Only, offer to provide written substantive reasons and provide the right to request a reconsideration of the decision. Provide a copy of the Reconsideration and Appeals Brochure

Effective: September 30, 2014

The following is the process to complete the Aboriginal Self Identifier (ASI), when one has not previously been completed:
 

1. If the system indicates blank data in the self-identified field, ask the recipient if they would like to complete the ASI form as it is difficult to determine by observation alone who is an Aboriginal person.
    
2. Review the form verbally with the recipient and advise of the rationale for collecting this data.  
   
   Recipients may wish to take the form and decide later if they wish to complete the ASI.  Encourage recipients to contact Aboriginal groups and organizations for further information.
    
3. Ask the recipient if he or she has questions regarding the ASI form.
    
4. After the recipient completes the form, ensure the recipient has signed the release on the bottom of the form.  If there is more than one adult in the family unit ensure each person signs their consent separately.  Enter the answers on the system. Scan the signed ASI on the recipient’s case.
    
5. If the recipient answers “No” to “I do not agree to complete this form” then update the corresponding field on the system. The recipient does not need to complete the form or sign it.  The recipient will be prompted to answer the question again at a future Eligibility Review or the next time the recipient makes an application for assistance. 
    
6. If the recipient states he/she is not of Aboriginal descent then update the system.

Follow the same process above if completing the Eligibility Review on the phone.  Advise the recipient to complete and sign the form with a trusted third party (for example, a government agent).