PROGRAM OPERATIONS MANUAL SYSTEMPart GN – GeneralChapter 022 – OverpaymentsSubchapter 50 – Waiver Provisions for Title II and Title XVIII OverpaymentsTransmittal No. 68, 11/22/2024
Audience
Originating Component
OISP
Effective Date
11/25/2024
Background
Based on Commissioner initiative, we are merging the Title XVI POMS with the Title II POMS. We established a new deemed to defeat provision for limited household income where if the resource limits are met and the household income is less than or equal to 150 percent of the Federal Poverty Level (FPL), we would find recovery defeats the purpose. We added to Title II, new criteria for SNAP and Medicare Part D. We added to Title XVI new criteria for SNAP, TANF, VA needs based, and Medicare Part D.
Summary of Changes
GN 02250.110 Deemed to Defeat the Purpose (Ability to Repay) of Title II and Title XVI
We changed the title of this POMS transmittal and added Title II and Title XVI citations.
Subsection A: We retitled this subsection and provided an introduction to this Title II and Title XVI policy.
Subsection B: We retitled this subsection and added new criteria for 1) Title II and Title XVI needs-based assistance programs, 2) criteria for the Federal Poverty Level (FPL), and 3) when deemed to defeat is not met.
Subsection C: We created this new subsection to update the Title II and Title XVI processing instructions for needs-based assistance, the FPL with hyperlinks to the applicable charts providing specific dollar amounts of income that is 150 percent of the FPL, and waiver approval.
Subsection D: We created this new subsection for examples of needs-based assistance and the FPL.
CITATIONS:
Social Security Act §§204(b) 1631(b)(1)(B) ;
20 C.F.R. §§404.506, 404.508, 416.550, and 416.553
We will waive overpayment recovery when:
An individual requests a waiver,
We find the overpaid individual is not at fault, and
Recovery would deprive the overpaid individual of income and resources required for ordinary and necessary living expenses.
We will approve the waiver request under the deemed to defeat the purpose provision, if the overpaid individual meets the criteria outlined in GN 02250.110B.
We must first determine whether the overpaid individual is at fault for the overpayment. To make a fault determination, refer to GN 02250.005 through GN 02250.025. If the individual is not at fault, we will follow these steps to make a deemed to defeat the purpose determination.
We will waive the overpayment under the deemed to defeat the purpose provision, if the overpaid individual or any household family member, currently receives one of the following needs-based assistance programs:
Supplemental Security Income (SSI);
Temporary Assistance for Needy Families (TANF);
Department of Veterans Affairs (VA) service and non-service related disability pension based on need;
Supplemental Nutrition Assistance Program (SNAP); or
Medicare Part D Extra Help Program (Low-Income Subsidy).
We deem recovery to defeat the purpose of the Social Security Act for individuals receiving this needs-based assistance, without an individualized assessment of resources, income, and expenses.
We will also waive the overpayment under the deemed to defeat the purpose provision, if the overpaid individual's and their household family member's income is at or below 150 percent of the FPL; and their resources are within the limit for defeats the purpose, refer to GN 02250.100E. We assume that an individual who meets the resource limit and has a household income of 150 percent of the FPL needs substantially all of their income to meet all of their current ordinary necessary living expenses, so there is no need to review their expenses.
NOTE: Do not review the household's expenses.
If you cannot approve the waiver under the deemed to defeat the purpose provision, and the overpaid individual is not at fault, determine whether you can approve the waiver under one of the following provisions:
Against Equity and Good Conscience, refer to GN 02250.150; or
Defeats the Purpose, refer to GN 02250.100.
Verify any of the needs-based assistance allegations by reviewing our records. Check the Supplemental Security Record (SSR) to confirm eligibility for SSI (i.e., Payment Status Code (PSY) C01 or E01), TANF, SNAP, and VA. For Medicare Part D Extra Help, check the Master Beneficiary Record (MBR) and the Medicare Application Processing System (MAPS).
The waiver requester is responsible for providing proof of TANF, VA service and non-service related disability pension based on need, or SNAP, if they allege receiving these needs-based assistance and this information is not in our records. Accept documentation from an official source that shows the individual or household family member receives TANF, VA service and non-service related disability pension based on need, or SNAP benefits. For example:
A benefit award letter;
Official correspondence from the TANF program, SNAP office, or the VA; or
A SNAP benefit card or statement.
The proof should be no more than one year old from the date we receive it.
If the overpaid individual does not provide supporting documents, send them a notice requesting this information and inform them that they have 30 days to provide the information. For Title XVI, use the SSA-L8009 in the Document Processing System (DPS). For Title II, use the equivalent notice in DPS. If the individual notifies you that they are actively trying to obtain the supporting documents and need additional time, allow them the additional time. If they have not provided the documents within 30 days and have not notified you that they need additional time, determine if you can approve the waiver following the steps in GN 02250.110C.2.
After verifying the allegations of needs-based assistance, approve the waiver by following the procedures in GN 02250.110C.3. If the individual is unable to verify the allegations of needs-based assistance, you may not approve the waiver based on receipt of needs-based assistance, and you should determine whether you can approve the waiver under GN 02250.110C.2, or another provision.
If the individual does not receive needs-based assistance listed in GN 02250.110C.1, we may be able to approve the waiver under the deemed to defeats the purpose provision based on resources meeting the criteria in GN 02250.100E and income is at or below 150 percent of the FPL. Before approving a waiver under the deemed to defeat the purpose provision based on 150 percent of the FPL, first determine if the overpaid individual's resources meet the defeats the purpose resource limit in GN 02250.100E.
If the individual's resources meet the resource requirement, next determine whether the individual's household income is at or below 150 percent of the FPL. The U.S. Department of Health and Human Services (HHS) has published guidelines at HHS.gov, that provides the specific dollar amount of income that is at 150 percent of the FPL, depending on household size.
NOTE: HHS updates the poverty guidelines at least annually. Consult the HHS website (Poverty Guidelines | ASPE (hhs.gov) for current guidelines. FPL guidelines for Alaska and Hawaii are different; a useful reference is published by the American Council on Aging (Federal Poverty Guidelines (medicaidplanningassistance.org)).
To calculate income and to determine whether the household income is at or below 150 percent of the FPL, follow these steps:
Step 1: Determine the individual’s and all household family members' monthly income, per GN 02250.100C;
Step 2: Calculate the individual’s annual household income by multiplying the individual’s monthly household income (step 1) by twelve;
Step 3: Determine the size of the household by adding the overpaid individual plus the total number of household family members, per GN 02250.100B.1; and
Step 4: Refer to the applicable chart located at HHS.gov and for Alaska and Hawaii refer to this link.
NOTE: Alaska and Hawaii have different FPLs. Always refer to the correct chart.
If the household annual income is at or below 150 percent of the FPL and resources meet the defeats the purpose criteria in GN 02250.100B, recovery is deemed to defeat the purpose, and you must follow procedures in GN 02250.110C.3. If you cannot approve waiver under the deemed to defeat the purpose provision, follow the procedures in GN 02250.110C.4. For examples on how to apply this deemed to defeat provision, refer to example 3 in GN 02250.110D.3, example 4 in GN 02250.110D.4, and example 5 in GN 02250.110D.5.
To process a waiver approval:
Input the waiver approval in the Debt Management System (DMS), per MS 01106.004,
Document the not at fault determination and either evidence of needs-based assistance or the 150 percent FPL in the Remarks (RMKS) screen in DMS,
Complete form SSA-635, Waiver Determination, per GN 02250.315, and
Send the decision notice to the individual and their representative payee or legal guardian as applicable, per GN 02250.370.
Reminder: A second review is required for waiver approvals when the overpayment is greater than $2,000 (placeholder for cross reference).
Input the waiver approval on the Waiver (UOWV) screen, per MS 00304.009,
Document the not at fault determination and either evidence of needs-based assistance or the 150 percent of the FPL on a Report of Contact page in CCE or on form SSA-5002 (Report of Contact),
Complete form SSA-635, Waiver Determination, per GN 02250.315; and
If you cannot approve the waiver under deemed to defeat the purpose, continue to process the waiver by determining whether you can approve the waiver under:
Against equity and good conscience, refer to GN 02250.150, or
Defeats the purpose provision, refer to GN 02250.100.
Yrene received an overpayment notice for $2,500 and requested a waiver. We determined Yrene is not at fault in causing the overpayment. Yrene’s overpayment does not meet the administrative waiver tolerance provision because it is over $2,000. They informed us that they currently receive Medicare Part D Extra Help. We verified that Yrene receives Medicare Part D Extra Help through MAPS and approved the waiver under the deemed to defeat the purpose provision.
Lysandra received an overpayment notice for $3,500 and requested a waiver. We determined Lysandra is not at fault in causing the overpayment. We determined Lysandra’s overpayment does not meet the administrative tolerance provision because the overpayment is over $2,000. Lysandra informed us of receiving SNAP and they provided evidence of their receipt of SNAP. We approved the waiver under the deemed to defeat the purpose provision.
Lorcan, whose benefits were terminated, is overpaid $4,500 and requested a waiver in October 2024. Lorcan receives a private pension of $1,100 before taxes and lives alone in New Jersey. We found Lorcan is not at fault in causing the overpayment. Lorcan does not receive needs-based assistance. Their resources are below the defeats the purpose limit. Lorcan’s annual income is $13,200 ($1,100 x 12 months). We used the HHS poverty guidelines and determined that 150 percent of the FPL in 2024 is $22,590 for one individual living in the 48 contiguous states. We approved the waiver under the deemed to defeat the purpose provision because Lorcan’s income is below 150 percent of the FPL and their resources are below the defeats the purpose limit.
Elide is receiving Title II benefits. Elide was overpaid $12,000 and requested a waiver in October 2024. Elide lives alone in Iowa. We found Elide is not at fault in causing the overpayment. Elide does not receive needs-based assistance. Their resources are below the defeats the purpose limit. Elide’s annual income is $14,400 ($1,200 x 12 months). We used the HHS poverty guidelines and determined that 150 percent of the FPL in 2024 is $22,590 for one individual living in the 48 contiguous states. We approved the waiver under the deemed to defeat the purpose provision because Elide’s income is below 150 percent of the FPL and their resources are below the defeats the purpose limit.
Billy and Amber are married and living together in Alaska. Billy, who is age 70, receives Title II benefits of $1,308 and income from a private pension of $545 per month. Billy is overpaid $5,000 and requested a waiver in October 2024. Amber is not receiving SSA benefits and is not working. We found Billy is not at fault in causing the overpayment. Billy does not receive needs-based assistance. Their resources are below the defeats the purpose limit. Billy’s annual income is $22,236 ($1,308 + $545 = $1,853; $1,853 x 12 months = $22,236). We used the HHS poverty guidelines and determined that 150 percent of the FPL in 2024 is $38,310 for a family of two living in Alaska. We approved the waiver under the deemed to defeat the purpose provision because Billy’s income is below 150 percent of the FPL and their resources are below the defeats the purpose limit.