07.04.01 - Overpayments

07.04.01 - Overpayments

Effective Date: 01/01/00

Revised: 12/18/06; 09/17/09; 06/10/13; 7/01/2024; 8/01/2024

Reference: 89 Ill. Adm. Code, Chapter IV, §50.130, 45 CFR 98.68(b)(2)

Policy Statement

During the period of time between eligibility determinations or redeterminations, if the family met all of the requirements on the date of the most recent eligibility determination or redetermination, the family shall be considered eligible and will receive services at least at the same level as approved.

Because a child meeting eligibility requirements at the most recent eligibility determination or redetermination is considered eligible between redeterminations, any payment for such a child shall not be considered an error or improper payment due to a change in the family's circumstances.

Applicability

  1. These policies and procedures apply to all families and providers who are or have participated in the Child Care Assistance Program (CCAP).
  2. Child Care Resource and Referral agencies, Site Administered Child Care Providers and IDHS Division of Early Childhood bureaus are to follow all procedures as stated below.

Types of Overpayments

  1. The cause of each overpayment shall be classified as an Administrative Error conducted by a CCR&R, Site Administered Provider or the State, a Client Error, a Provider Error or as a Monitoring Review finding.
    1. An overpayment shall be classified as an Administrative Error if the error was caused solely by actions taken by the department or its agent. An administrative error includes, but is not limited to, an error caused by
      1. Substantiated fraud or intentional program violations that invalidate prior determinations of eligibility.
        1. Fraud committed by an individual who works for the CCAP program.
      2. The provider receives duplicate payments for services provided.
      3. Child Care Resource and Referrals and Site Administered providers will not be charged overpayments for an administrative error other than a duplicate payment.
  2. A Client Error includes, but is not limited to, an error that occurs when:
    1. Substantiated fraud or intentional program violations that invalidate prior determinations of eligibility.
      1. The client falsely reports income or household composition that affects the amount of the parent copayment.
      2. The client would not have been eligible if income, hours of employment or education/training activity, the need for child care, or the household composition had been inaccurately reported.
      3. The client falsely reports provider caring for children.
  3. A Provider Error includes, but is not limited to, an error that occurs when:
    1. Substantiated fraud or intentional program violations that invalidate prior determinations of eligibility.
      1. The provider receives payment in excess of services rendered (i.e., parent changes providers with proper notification and the original provider bills for days beyond the last day of care).
      2. The provider bills for children never or no longer in their care.
      3. The provider bills for licensed care but does not possess a DCFS license
  4. Errors discovered during a Programmatic Monitoring Unit review includes, but is not limited to, an error that occurs when an improper payment is found during a Programatic Monitoring Unit (PMU) review:
    1. The provider bills for children not in care. (Documentation to support non-existence).

Procedures

The Department will attempt to recover overpayments from providers, or parents and other relatives, as appropriate, through demand letters, referrals to the Comptroller's Office for withholding, referrals to collection agencies, or other means determined by the Department

Overpayment Referral Packet

Staff (CCR&R, Site, Programmatic Monitoring Unit) identifying an overpayment shall prepare and submit an Overpayment Referral Packet as soon as completed and all documentation is gathered. 

  1. The Overpayment Referral Packet must contain the following: 
    1. the Child Care Overpayment Referral (IL444-1900) pdf and
    2. the Child Care Overpayment Calculation Worksheet (IL444-3518) pdf.
      1. The Overpayment Referral and the Calculation Worksheet must be typed.
      2. All blanks must be completed. If information does not apply, enter N/A
      3. Check/indicate all program violations that apply
      4. Provide a summary of the program violation(s). Be specific and concise, but do not use abbreviation
    3. Supporting Documentation
      1. Include all written documentation to support or defend that an overpayment occurred. Documentation includes, but is not limited to, IPACS screen prints (AWVS, PASDX, KIDS; do not send ACID Screens), child care application and/or redetermination forms, check stubs, school schedule, grades, SAMS warrant inquiry screen print. Other suggestions are listed on page 2 of the Overpayment Referral form.
      2. The Pre-Payment Detail Inquiry Screen (PF-2/3) and the Payment Inquiry (PF-11) screen prints for each overpayment month are mandatory. If these screen prints are missing, the referral packet will be returned.

Submission

  1. CCR&R, Site and PMU Supervisors should review and approve each overpayment referral before it is submitted to BSM and must sign and date page 2 of the Child Care Overpayment Referral (IL444-1900) pdf).
  2. CCR&Rs, Sites and the PMU must upload the Overpayment Referral packet to the Bureau of Childcare and Development/Overpayment Unit's CCMS Dashboard.
  3. CCR&Rs, Sites and the PMU must maintain or upload a copy to the CCMS a copy of the overpayment packet for the client file or provider file.

Determination of Overpayment

  1. Division of Early Childhood (DEC) Bureau of Subsidy Management (BSM) Policy and Customer Service Unit will review the Overpayment Referral and will either approve or deny the claim.
  2. If the case does not meet the overpayment criteria, DEC Overpayment Unit will deny the referral and notify the referring agency.
  3. If the case meets the criteria for overpayment, DEC Overpayment Unit will issue the Overpayment letter to the responsible party (client, provider...).
    1. Copies of the overpayment letter will be uploaded to CCMS to the referring entity (CCR&R, Site, PMU...) Documents section of the provider or clients case.  in CCMS case documents of the Overpayment Referral leaving it available for CCR&R and Site providers to access if needed
    2. BSM will retain copies of all referrals, overpayment letters and supporting documents.
    3. BSM will forward the overpayment referral packet to the IDHS Bureau of Collections (BOC) to establish an account receivable.
    4. BOC will establishe the debt in the IDHS fiscal system and issues an invoice via mail in order to collect the payments.
    5. BOC then holds for 90 days before forwarding to the Illinois Debt Recovery Offset Portal (IDROP), Illinois Office of the Comptroller (IOC) for possible withholding of payments being issued by the State, and/or refer to a private collection company.

Inquiries and Disputes

  1. All overpayment inquiries and disputes shall be directed to the BSM Policy and Customer Service Unit at DHS.CCAP.Policy@illinois.gov.
  2. If the responsible party contacts BSM to dispute the debt, the client will be informed to submit a written statement along with supporting documentation to dispute the calculated overpayment.
  3. The client will have 30 days from the date of the Overpayment letter to submit the request and supporting documents.
  4. BSM will send a copy of the dispute to the referring agency (CCR&R/Site/PMU...) and BOC . B. The DEC Overpayment Manager will have 30 days from the date of the dispute to reply.
  5. If BSM determines that the documentation submitted by the client is dis-proves the overpayment, BSM will issue a letter to rescind the overpayment to the responsible party and notify BOC. The letter will be uploaded into CCMS system for access if needed for CCR&R/Site providers. Bureau of Collection will receive a copy of the letter.
  6. If BSM determines that the documentation does not disprove the original overpayment finding, a letter regarding the determination of the dispute will be mailed to the client, and a confirmation notice regarding the overpayment will immediately follow. A copy of the overpayment letter will also be sent to BOC and uploaded into CCMS for access if needed for CCRR/Site and providers.

Repayments

  1. Payments sent to CCR&Rs and Sites should be forwarded to BSM at: IDHS Div. of Early Childhood, Bureau of Subsidy Management Policy Unit, 100 South Grand Ave East, Springfield, Il 62762.
  2. BSM will forward all payments to BOC for tracking and processing the returned funds. 
  3. BOC will make re-payment plans with responsible parties based on the amount owed.

Sanctions

  1. The Department has the discretion to impose sanctions upon parents or other relatives or child care providers that commit an intentional program violation or an act of fraud in an effort to obtain eligibility, benefits, or financial gain or profit from the Child Care Assistance Program to which they would otherwise not be entitled.
  2. The Department shall take into consideration the nature of the offense, whether or not an improper payment was made, the amount of the improper payment, and the length of time over which the offense occurred when determining the level of sanction to be imposed.
  3. The Department's Division of Early Childhood is responsible for the detection, prevention, reduction, and identification of intentional program violations or fraud by parents or other relative recipients of child care benefits and child care providers.
  4. All cases of suspected intentional program violations or fraud will be referred to the Division for investigation which may lead to the recovery of improper payments, sanctions, and/or criminal prosecution.
  5. Depending on the nature of the violation, the Division may refer cases to the Department of Healthcare and Family Services' Bureau of Investigations or the State of Illinois Office of the Executive Inspector General for additional review and potential prosecution as determined by the Office of the Attorney General.
  6. The Division may impose any of the following sanctions on parents or other relatives or child care providers for a first-time offense:
    1. If there is no improper payment involved, issue a warning and require a counseling/educational session on program rules and requirements.
    2. Require repayment of improper child care assistance payments.
    3. Require repayment of the child care assistance payment; and
      1. Suspend the parent or other relatives from the program for one year; or
      2. Suspend the child care provider from new case approvals for one year.
    4. Require repayment of the improper payment and terminate the parent or other relative and/or the child care provider from the Child Care Assistance Program permanently.
    5. If the parent or other relative commits a second intentional program violation, the Division will require repayment of all child care assistance payments related to the violation and the parent or other relative will be permanently terminated from the Child Care Assistance Program.
    6. If a child care provider commits a second intentional program violation, the Division will require repayment of all child care assistance payments related to the violation and the provider will be permanently terminated from the Child Care Assistance Program.
    7. Families who are receiving TANF (and their child care providers) and have child care listed as a required activity on their Responsibility and Service Plan are exempted from suspension or termination.