Requiring use of the “Here’s Why” section of CalFresh overissuance notices

CDSS has issued instructions to counties about the content of CalFresh overissuance notices.  Counties must complete the free-form “Here’s Why” section of the overissuance notice.  The drop-down menu explanations in the “Here’s Why” section of the overissuance notice do not provide sufficient detail about the reason for the overissuance and must be accompanied by additional information that is specific to the case.  The free-form “Here’s Why” section must be completed even if the county consortia computer system allows the notice to be issued without completing the free-form section in order to meet state and federal due process requirements.

At a minimum, the free-form “Here’s Why” section must include: 1) the amount of benefits the household received, 2) the amount of benefits the household should have received, 3) the time period of the overissuance, 4) the specific reason that caused the overissuance, 5) the amount of benefits to be repaid, and 6) how the household can pay the claim.  ACL 16-71 (September 12, 2016).

CalWORKs Time Limit Exemption for Indian Country Residents

CalWORKs has a time limit exemption for Indian Country residents where at least 50 percent of adults are not employed.  The California Department of Social Services did a survey to determine which Indian Country areas qualify for this time limit exemption.  Based on the survey, CDSS identified and listed 25 Indian Country areas where at least 50 percent of adults are not employed.

If a CalWORKs recipient lives in an Indian Country area not identified by CDSS as having at least 50 percent of adults not employed, the recipient, county or Tribal-TANF program can get a written certification from a federally-recognized tribe that the recipient lived in where at least 50 percent of adults are unemployed to qualify for the time limit exemption. ACL 16-68 (August 26, 2016).

Preserving Medi-Cal eligibility for Foster Youth who run away from placements

DHCS has issued a letter to clarify eligibility guidelines for foster care youth who leave court-ordered placements.  While loss of contact with the youth may discontinue foster care payments, that youth may be in other Medi-Cal aid codes and must not be discontinued simply due to loss of contact.

During ex parte review of Medi-Cal cases, workers should determine if the foster care youth is still under jurisdiction of the court; if so, the youth should be placed in the appropriate Medi-Cal only aid code not associated with a foster care payment.  If the foster care youth is still under the court’s jurisdiction, that youth should stay in the appropriate aid code regardless of whether the youth is located.  Foster care youth are not required to enroll into managed care unless in a COHS county.

The letter runs down scenarios about whether a foster care youth is located, where that youth is located, and whether the youth is under jurisdiction of the court.

DHCS ACWDL 16-20 (September 1, 2016).

Adult Immunizations as a Medi-Cal Pharmacy Benefit

DHCS has issued a letter to Medi-Cal managed care plans to instruct plans to include adult immunizations on plan formularies.  A pharmacist may administer immunizations according to plan protocols as long as the pharmacist completes an immunization training, is certified in basic life support, and comply with all state and federal recordkeeping and reporting requirements.

DHCS APL 16-009 (August 31, 2016).

MFG Repeal

The California Department of Social Services has informed counties that the legislature has repealed the CalWORKs Maximum Family Grant (MFG) rule.  Effective January 1, 2017, no child will denied aid because the child was born into a family receiving CalWORKs.  Any child previously excluded by the MFG rule must be added to the assistance unit effective January 1, 2017.

Counties are required to review their caseloads to determine existing cases with children excluded by the MFG rule and inform those families that their CalWORKs grant will change to include the previously excluded children.  In addition, counties must send a mass mailing starting on November 1, 2016 to all CalWORKs recipients informing them of the repeal of the MFG rule.  CDSS encourages counties to display the informing notices in their offices and to discuss the MFG repeal at application and redetermination.

Children previously excluded by the MFG rule will be subject to child support assignment.  Children excluded by the MFG rule were able to keep all child support paid on their behalf.  Child support paid on behalf of these children will be assigned to the state the effective January 1, 2017 and the family will receive the first $50 of child support collected on behalf of the family.  Parents will need to complete the CW 2.1Q Child Support Questionnaire for children previously excluded by the MFG rule if those children are not already identified on an existing CW 2.1Q.  Parents will be required to cooperate with the local child support agency unless they have good cause, including that cooperation will put the family at risk.

Other benefits paid on behalf of children excluded by the MFG rule, such as Social Security dependant’s benefits, will be counted as income for CalWORKs effective January 1, 2017.  In addition, CalFresh benefits will be redetermined based on the new CalWORKs grant.  ACL 16-66 (August 26, 2016).

CalWORKs MAP increase

The CalWORKs Maximum Aid Payment (MAP) will increase by 1.43% effective October 1, 2016.  CDSS has directed counties to notify recipients of the change to their grant no later than September 20, 2016.  CDSS also directed the computer system consortia to automate the grant increase or ensure a workaround to ensure that CalWORKs recipients receive the MAP increase on October 1.

The MAP change may change the Income Reporting Threshold (IRT) for some CalWORKs assistance units.  CDSS directed counties to inform these recipients of their new IRT.

CDSS provided a chart of the new CalWORKs grant levels.  ACL 16-64 (August 16, 2016).

Child support referrals for ARC recipients

The California Department of Social Services has issued instructions about child support referrals for Adult Relative Caregiver (ARC) recipients.  ARC cases can be referred to the local child support agency for child support enforcement and ARC benefits can be recouped from collected child support.

However, an ARC recipient should not be referred for child support enforcement if the parent or guardian of a child on whose behalf ARC benefits are being received is receiving reunification services and child support will pose a barrier to reunification.  Child support can pose a barrier to reunification if child support payment will compromise the parent’s ability to meet the requirements of the reunification plan or the parent’s current or future ability to meet the financial needs of the child.

In addition, the county must determine whether there is good cause for not cooperating with local child support agency under Welfare and Institutions Code Section 11477.04.  This includes risk of harm to either the child or the parent.  ACIN I-48-16 (June 29, 2016).

Posted in ARC

IHSS provider enrollment

The California Department of Social Services has issued information about new regulations implementing IHSS provider enrollment rules and procedures.  These rules and procedures include 90 days to complete the provider enrollment process with a  possible 45 day extension for good cause, attending an in-person orientation, fingerprinting for criminal background check, notice of eligibility or ineligibility to be enrolled as a provider and waiver of disqualifying convictions.  In addition, the county will determine whether a provider has legal authority to work in the United States.

The new regulations also specify that an enrolled provider cannot be required to complete the provider enrollment process when the provider moves from one county to another.  The county that the provider moved from is obligated to give the new county the criminal background check clearance documents and the new county must accept that documentation.  ACL 16-53 (July 7, 2016).

Transitioning from Medi-Cal/MEC to Covered California with SEPs

DHCS is reminding county workers to assist MAGI Medi-Cal beneficiaries to get immediate health coverage when they are being discontinued from Medi-Cal and transitioning into Covered California during a special enrollment period.  Workers must assess individuals for non-MAGI programs first.  If the beneficiary chooses not to be evaluated or selects something else, that beneficiary will get a MAGI termination notice.

Discontinuance of MAGI Medi-Cal is a qualifying life event for a Covered California SEP, after which individuals can enroll into Covered California for up to 60 days.  While most SEPs are subject to the 15th day of the month rule to determine start date of coverage, there are exceptions:

  • Loss of MEC: Can be reported up to 60 days before and after the life event date.  The start date of Covered California coverage can be as early as the first of the month following the month in which MEC is discontinued as long as the beneficiary selects a plan and pays the premium timely.
  • Marriage/domestic partnership: Plan coverage can start on the first day of the next month after plan selection and payment regardless of when the individual makes the plan selection during that month.
  • Birth/adoption/foster care: Plan coverage can start on the date of birth of the child, adoption, or placement of foster care child, or the first of the month following the event.
  • Other less common exceptions as listed in 10 CCR 6504(h)

County workers shall assist beneficiaries with the Covered California enrollment process and advise on the need for timely health plan selection and premium payment to avoid a gap in coverage.  For Medi-Cal beneficiaries, this means selecting a plan in the same month as Medi-Cal discontinuance to have their plan start the following month.  Workers may also direct individuals to certified enrollment counselors if they are unready to select a plan.

Those with Medi-Cal share of cost coverage may qualify for an SEP if they meet their share of cost in one of the past two months and have not received an SOC SEP consideration in the calendar year.  The county must determine whether the beneficiary has met the criteria for any SEP reason, including loss of medically needy coverage.

DHCS ACWDL 16-18 (7/22/16) also includes a service center task guide on SEPs.