Wisconsin pays a state supplement to SSI recipients who are Wisconsin residents. In this case, the state SSI office claimed an overpayment because the Social Security Administration coded the petitioner as a California resident from December 2021 to August 2022. However, the petitioner showed that she had in fact moved to Wisconsin and lived in Sun Prairie during that time by submitting bank statements with regular transactions at local businesses and no transactions at California businesses. ALJ Brian Schneider concluded she was a Wisconsin resident entitled to the state SSI supplement and there was no overpayment.
Preliminary Recitals
Pursuant to a petition filed April 7, 2023, under Wis. Admin. Code, §HA 3.03, to review a decision by the Division of Medicaid Services (DMS) to recover State SSI, a hearing was held on June 21, 2023, by telephone.
The issue for determination is whether petitioner was overpaid state SSI benefits.
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Written submission of Melissa Sherry
Division of Medicaid Services
PO Box 309
Madison, WI 53701-0309
ADMINISTRATIVE LAW JUDGE:
Brian C. Schneider
Division of Hearings and Appeals
Findings of Fact
- Petitioner is a resident of Dane County who is eligible for federal and state SSI.
- Petitioner formerly lived in California. She moved to Dane County in August, 2021, and she began to receive Wisconsin state SSI.
- For unclear reasons, the Social Security Administration (SSA) coded petitioner as being a California resident between December 1, 2021 and August 31, 2022. Because of that coding, the State SSI Office notified petitioner that she was overpaid $754.02 in Wisconsin State SSI during this period, by a letter dated March 23, 2023.
- Petitioner was a resident of Sun Prairie, Wisconsin during those months. Her federal SSI payments were deposited directly into the —, and petitioner regularly made transactions at local businesses.
Discussion
Effective January 1, 1996, the State of Wisconsin began sending out its state supplemental SSI payments separately from federal SSI payments (they had previously been sent out as one check by the SSA), as mandated by Wis. Stat., §49.77. As part of the change, the state began to perform administrative functions involving the state payments that were done by the SSA for the federal SSI. One such function is the recovery of state SSI overpayments. When the state seeks to recover an overpayment, it must inform the recipient or former recipient of the action, and give that person the right to appeal the decision.
Wis. Admin. Code, §DHS 2.04(3) allows for the department to recoup, at the rate of 10% of the benefit paid, overpayments of incorrectly paid benefits including state SSI, regardless of fault. “Incorrectly paid benefits” means payments in an amount in excess of what the person was eligible to receive during the period in which the payments were made. Admin. Code, §DHS 2.03(5).
Petitioner was and is eligible for state SSI because she is a federal SSI recipient. See Wis. Stat., §49.77(2)(a)2. As a result, if she resides in Wisconsin, she is eligible for the Wisconsin state SSI supplement of $83.78 monthly. When the DMS noticed that petitioner’s residence within SSA records was listed as being California during several months in which Wisconsin SSI were issued, it followed that petitioner was not eligible for the Wisconsin benefits.
This is the one type of case in which the Division of Hearings and Appeals can review the merits of the overpayment. Most state SSI overpayments result from the SSA determining that the person was ineligible for federal SSI during a retroactive period. In those instances, the only response the Division of Hearings and Appeals can give is that the person must try to get the SSA to reverse the ineligibility determination. However, in this instance petitioner was eligible for federal SSI the entire period. To tell her to go to the SSA to change the residency would be a gesture of futility. The SSA does not care what state she lived in from December, 2021 through August, 2022, so it is unlikely that the SSA would even bother to change the residency code.
The evidence is convincing that petitioner resided in Sun Prairie during the months in question. Petitioner provided a copy of her bank transaction logs for the entire period, and as noted in the findings, the SSA was depositing petitioner’s federal SSI into the — account. Also evident are numerous and regular transactions at Sun Prairie businesses, and notably, no transactions at California businesses.
I conclude, therefore, that despite the SSA coding of California as petitioner’s residence during the months at issue, petitioner actually resided in Wisconsin and was entitled to the State SSI supplement. I thus will order that the overpayment be rescinded, and that any money already recovered should be reimbursed to petitioner.
Conclusions of Law
Despite the SSA coding of California as petitioner’s residence during the months at issue, petitioner actually resided in Wisconsin and was entitled to the State SSI supplement from December, 2021 through August, 2022.
THEREFORE, it is
Ordered
That the matter be remanded to the agency with instructions to rescind the $754.02 state SSI overpayment claim against petitioner, and to reimburse any amount already recovered, within 10 days of this decision.
[Request for a rehearing and appeal to court instructions omitted.]